I did my senior interview on a man who is approaching his sixty-seventh birthday in June of this year. The gentleman’s name I interviews was Elmer. Elmer is the youngest of two sisters and one brother, who all grew up in a small town in New Jersey. Both of Elmer’s parents died before his twenty ninth birthday, his mother dying of a young age after suffering from tuberculosis, which caused her to live her last years of life quarantined to a sanatorium. When I asked Elmer about his thoughts on aging, he answered by stating that aging is “a natural progression laid out by God. I am not scared to die and instead, I look at each day as a gift. I don’t see aging as a positive or a negative, but just a normal, natural process.” Elmer concluded by adding that, of course, dreaded aches and pains do in fact come with age, but so does increased wisdom and the opportunity to continue to learn about oneself. . As the conversation between Elmer and I continued on however, I noticed that he did have concerns about aging, which became more apparent in his references to financial issues as well as the poor job he indicated he has done at living a healthy lifestyle.
When asked if Elmer if his thoughts have changed about aging in the past twenty years, he mentioned that “financially, he blew it. Twenty years ago I was in a great financial position, and now I have nothing. I can barely make the rent for my apartment, have no retirement and I’m scared for that reason.” Elmer was married and divorced two times, and commented that the second divorce, coupled with his own “detrimental behaviors and bad decisions” led to the state he is in today.
Without prompting, Elmer went right into a conversation about how unhappy he is with his lack of effort to take proper care of himself. Elmer explained that currently he works twelve hour days, smokes heavily, drinks alcohol in excess and follows a “bad diet” filled with fast, easy foods that are usually high in fat and little nutritional value. In addition, he has had a heart attack and suffers from diverticulosis, irritable bowel syndrome, is overweight, and has high blood pressure and high stress in his life. In addition, Elmer mentioned that he has had changes in his oral health and over the past few years has had three teeth removed. Finally, Elmer had a recent scare when he contracted a nosocomial infection, MRSA, after an operation on an infected wound site located on his foot, which kept him out of work for weeks.
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At this point, based on Elmer’s honest answers to my questions, I asked him what he thought nurses and other health care professionals can do to assist people like him at reaching their goals of a healthy lifestyle. Elmer responded by stating “well, you can’t blame the doctors. There is plenty of information out there and in our society people sue left and right and blame others constantly, but it is ultimately up to the individual to take responsibility for his [or her] own wellness.” In addition, John stated that there is every opportunity to be healthy but that “one huge important thing is that [health care providers] need to care. People should not be made to feel that they are being rushed from nurse to doctor on an assembly line without having the chance to ask questions or engage in conversation.” Elmer provided details of the doctor that he sees on a regular basis who, “does not overload his schedule with patients, and actually has patience” and concluded that a little more quality time spent with patients could go a long way in terms of patient outcomes. He also emphasized the importance of promoting independence and autonomy in older adults because he feels that as “soon as someone ends up in a nursing-home and is told when and where to do things, loneliness and loss of self-concept contribute to a rapid decline in health.”
While interviewing Elmer, it seemed that to identify at least two strategies that he has used to promote healthy aging and wellness was going to prove difficult, as most of our conversation was focused on his feelings of failure at promoting his own wellness. At one point, I even asked John this very question: what strategies have you used to promote yourself knowing your getting older? His response was that he is a “terrible example” and is very disappointed in what he has done with his health—that he has done the “opposite of healthy in every way possible.” At this point, I acknowledged Elmer’s disappointment with himself and then turned his attention to the fact that he had mentioned tennis and bike riding earlier in the interview.
When I asked if he would consider exercise a strategy that could promote healthy aging, Elmer agreed that it does help to promote healthy aging and described to me that despite being a smoker, and at times overweight, he had engaged in moderate to vigorous exercise on a regular basis for most of his life. The few times in Elmer’s life that he gave up drinking alcohol, he was actively participating in a rehab program and mentioned that “I lost weight, and I felt great. I would play basketball every day and no one could believe that an old geezer like me could beat them, but I did!” I believe that if Elmer had guidance and encouragement to get involved in a social network, or organization, centered around physical and mental activity, he would find it much easier to make some healthy changes to his lifestyle. Although John admitted that he currently does not exercise, he said if anything about his current lifestyle changes, it will be that he will mix more activity into his daily routine.
Another strength that I believe has helped Elmer significantly with him aging is his continued faith in his religion. With everything that Elmer has gone through in his life he has always had the utmost faith in God. During the interview, Elmer stated on several occasions that his unhappiness with the way he has treated his body stems from beliefs that God gives each of us a body that we should cherish and treat with greatest respect. Elmer also commented that “without faith I am not sure I would still be alive today” while talking about some of the more difficult times he has been through with alcoholism, drugs and depression. As previously mentioned, Elmer is concerned about the potential for loneliness if he should require assistance with living. I believe that his faith in God and aging as a natural process will help him to continue to be an active member of a religious community and to deal constructively with any worries about aging. Elmer currently belongs to a church community and uses this membership as a means for support, guidance and friendship.
Elmer commented that “if there’s only so much money to go around, the nonproductive are not going to get any. For example, they’ll just look at me as a smoker my whole life and say that I shouldn’t get any assistance, pretty much, I’m going to be nothing when I retire and need assistance.” These emotional statements are at the heart of many older adults’ concerns and unfortunately there does not seem to be a clear or optimistic view for the future since increasing numbers of elders will require assistance and therefore additional resources.
Another major thing that came about in this interview relates to the anxiety that some older adults begin to feel when they think about the possibility of requiring nursing-home care. Elmer made several comments about the fact that he is divorced, single and that his children do not live near him while explaining that this has created a fear of being lonely in his older years. Not only is Elmer’s concerned with potential loneliness, however he expressed his beliefs that once a person enters a nursing-home, their mental health deteriorates much more rapidly than their physical health. When John was discussing his recommendation that nurses and other health care professionals should instill more caring and “less dictating” in their practice, he expressed concerns about the loss of autonomy that one experiences when living in a nursing-home.
Elmer’s view on nursing-home care is that people are told what to do and when they can do it with little regard for each person’s individual preferences and choices. He stated that an assisted living facility that promotes mental, social and physical engagement opportunities while supporting individual lifestyles and decision-making would be an ideal living situation for someone in their later years of life. I believe that this is exactly what Elmer was discussing however, an increased demand for resources, a growing number of elderly people requiring assistance and less than ideal numbers of nurses available in the workforce creates time constraints and daily challenges for nurses to create the ideal living environment for each individual.
As previously mentioned, Elmer has already had three teeth removed, struggles financially and therefore eats cheap, unhealthy foods, works long hours and often times skips meals and binges later, drinks alcohol in excess, does not exercise and is a smoker. While many of these behaviors could potentially be modified, it does not change the fact that Elmer is still at risk for, and most likely already suffering from, poor nutritional health going into his late sixties. The Nutrition Screening Initiative Checklist found in Gerontological Nursing, which is used to evaluate the health status of individuals, states that one in five adults skip meals daily while only thirteen percent eat the minimum requirement of fruits and vegetables. Elmer is aware of how his habits and circumstances are affecting his health, however he mentioned that he just no longer has the “grit to try to be reasonably healthy.” I believe this is an important concept in gerontological nursing because it is a reality that many patients will come from similar backgrounds that John has, and therefore nurses need to make an effort to understand that they may have endured various struggles before reaching retirement age in an effort to avoid making assumptions or judgments about how they have cared, or not cared, for their health.
An important realization that came out if my interview with John was an understanding of how often we stereotype certain behaviors or ailments as being part of the natural process of aging, when in fact these might be the results of how an individual has taken care of his or her self and do not necessarily apply to all older adults. In the case of Elmer , his lifestyle habits will play a large role in his quality of life as an older adult, and he is the first to admit that his situation could be drastically different had he chosen to live his life a certain way. Older adults such as Elmer are at risk for poor nutrition, adjustment disorders and loneliness, but this is not true for every older adult. It is important to remember that not all older adults are unhappy or unhealthy and many individuals may have lived their lives in a manner that promoted optimal wellness that has carried over into their later years of life.
I think the most important insight that I obtained from doing this interview is the importance of good communication skills when dealing with patients. Elmer’s interview was at times difficult while he was discussing disappointment with himself and how he has treated his body. I also observed the fear in his voice and concerned facial expressions as he discussed concepts of loneliness, financial struggles and listed the various ailments that already affect his quality of life at sixty six years of age.
Throughout this process, I found it was imperative that I maintained an understanding, empathetic and realistic outlook on the things he was telling me in order to provide a level of comfort and reassurance for Elmer. At the close of the interview, Elmer commented that after discussing his views on aging with me, he felt a certain obligation to address the concerns about his health and stated that “this conversation makes me sit back and think, when am I going to make changes? Time keeps going on and next week will turn into next week unless I do something now.” I believe that many elderly will be more inclined to be honest with themselves as well as the health care professional. This, in turn, will ideally lead to more moments like the one I experienced at the end Elmer’s interview where a self-awareness and inclination to make positive changes occurred. It would then be up to the families, friends and doctors to provide the proper resources, education and support to help the patient act on the motivation gained from the encounter.
Based on the fact that nurses come from various educational and training programs, I believe that an important systems change that could be implemented into health care facilities is some sort of program that teaches nurses different communication styles and emphasizes the most important aspects of communicating effectively with any individual. Continuing-education is an important aspect of any career that is focused on continued growth and learning. To facilitate this change, I would design a curriculum that focuses on teaching nurses both basic and advanced concepts and techniques to aid in good communication.
This curriculum would be taught through a series of mandatory learning sessions for all nurses working in the given facility. As nurses learn new medications and innovative technology, the fundamental basis of nursing—how to communicate effectively—should continually be taught. Effective communication skills can be taught and improved upon with proper training and practice and therefore while evaluating systems in health-care facilities it is important to consider this as a means of helping to improve quality patient care and outcomes. Having worked in a nursing-home as an Licensed Practical NurseI, I witnessed several occasions where effective communication could have had drastically changed the outcomes of situations and therefore believe that this needs to be considered as one focus of systems change. Nurses, as professionals, need to be the ones who understand how to communicate properly and obtain the information we need from patients while also understanding what they require of us. We cannot expect the patient to be the expert in communication.
In summary, this interview with an older adult confirmed my belief that people may have unresolved emotions about the process of aging and what retirement age will be like for them. Many of the concerns that stemmed from Elmer’s comments were focused around nutritional health, a fear of loss of autonomy, loneliness and potential financial hardship. In order to address these concerns and other concerns that older adults have about the process of aging, nurses must be well-trained communicators and have the knowledge and skills to provide insight, educational tools and resources for these individuals in order to facilitate a better transition into retirement and the changes that occur with the aging process. This interview also helped bring to light the importance of taking a reasonably adequate amount of time with each patient in order to, as Elmer put it, care, thus providing him, or her, the opportunity to ask any questions that may arise and to share information that comes to mind as the nurse-patient relationship is being formed. Despite Elmer’s decisions to partake in unhealthy lifestyle habits, he will need support from health-care professionals as he continues to age and the best thing that we can do as nurses is to be educated on how to best support him in happy and fulfilling aging process.
