Book Review, “A Widow’s Story”

A Widow’s Story is a heart-wrenching memoir by Joyce Carol Oates. Oates usually tends to write novels of fiction, but for the first time in her writing career, readers are able to relate to her through personal experience. She begins this novel by recounting the final weeks of her husband’s life- time mostly spent in the hospital. It is important to know that the death of Ray, her husband of forty seven years, was somewhat unexpected. He become ill very quickly due to an abrasive case of pneumonia. Oates does a wonderful job of conveying her thought process throughout Ray’s illness. There was some level of denial, as no one can ever be truly prepared to lose someone they loved so completely.

Although Oates does explain how her husband passed and the moments leading up to his untimely death, she spends most of the book recalling how she dealt with the aftermath of Ray’s death and how she needed to learn how to cope with the loss of her husband. Oates does not focus on the technicalities of writing in this book, rather she focuses on the heart of human emotion. Sections of this book are broken into chapters of the exact emails between the author and her friends surrounding the time of Ray’s death.

I am fortunate to have never lost someone I was so close to, but I feel the pain and confusion that Oates experienced through her writing. The intended audience for A Widow’s Story is likely to be aimed towards widows and widowers, but I believe any demographic can sympathize or empathize with this story. One of the things that has stuck out the most to me while reading this book is Oates’s impeccable memory. One of my closest friends lost her father a few years ago and she always tells me how she remembers very few things about being in the hospital, as it was all such a blur of many emotions. Oates makes it known that she felt somewhat dazed when dealing with the aftermath of Ray’s death, but she remembers every feeling and even specific people she encountered in the hospital. It is as if nothing has never felt more real, or surreal, to the author.

Oates repeats the phrase “at the wrong time” frequently throughout this memoir. She describes the events leading to her husband’s death as always occurring at the wrong time. Such as a phone call in the middle of the night from the Princeton Medical Center. I think this also reitterates the idea that no one is ever prepared for the death of a loved one, when it comes to losing a spouse nothing will happen at the right time. There could never be a right time for such a thing. She seems to just be going through the motions when planning for the funeral, every movement made and every word uttered was mechanical. It is strange how someone can feel so overwhelmed by emotion while simultaneously feeling so hollow. Cardiopulmonary arrest seems  like common medical jargon, but those words have more of an effect on Oates more so than any other phrase.  “ A widow cannot defend herself against the most extraordinary thoughts. For a widow has learned that the ordinary can so quickly turn extraordinary, and the extraordinary ordinary.” (p. 103)

One of the biggest struggles for the author throughout this story is finding purpose within herself, even in the permanent absence of her husband. It is hard to imagine a life without someone who has always been such a huge part of your own. I have not been alive for even half of the time Oates was with her husband so I should not be able to comprehend the pain of her loss. However, I feel connected and truly touched by the difficult experience she had to endure. The author does an excellent job of conveying her mix of emotions without leaving the reader confused or lost. This must be a daunting task for a writer- to remain clear and understandable when you are feeling anything but.

This memoir was a heavy topic but the last lines provide a sense of hope amidst a time of chaos; “If I have lost the meaning of life, and the love of my life, I might still find small treasured things amid the spilled and pilfered trash.” (p 415)

Oates, Joyce Carol (2011). A Widow’s Story. New York, NY: HarpersCollins Publishers. $14.99. 978-0-06-202050-5

 

The Cost of Dying

The death of one person often affects many people around them. The grief of losing someone close to us is immeasurable. Unfortunately, the  physical cost of dying is measurable and the numbers are staggering. As if losing a loved one was not hard enough, many people are also crippled by the fact that dying is expensive. Medicare beneficiaries have noted that payments for dying patients increase exponentially as they approach the end. Payments during the last month of life make up for roughly 40 percent of payments during the last year of life (Emanuel & Emanuel, 1994). The cost of dying is not inexpensive.

There are various reasons why medical bills increase drastically toward the end of life. For the elderly, it is not uncommon to develop disease or other physiological disabilities. Many older patients end up on life support before they pass. However, more and more Americans are opting out of keeping their loved ones on life support if their disease is irreversible. If this is the case, family members could simultaneously respect the patient’s self autonomy and save billions of dollars in medical costs (Emanuel & Emanuel, 1994). It is sad to know that people feel the need to take someone off of life support because they cannot afford to keep the machines running. However, I do believe it can be best for everyone to stop life support if there is no hope that the patient will get better.

Dying is a very different experience for someone spending their final days in a hospital as opposed to dying in their home. Hospice patients are those who are treated at home. Many hospice patients refuse life-sustaining interventions so, of course, they do not utilize high technology interventions at the end of life (Emanuel & Emanuel, 1994). A series of studies have compared hospice care with traditional care of terminally ill patients, which usually involves multiple hospital visits. It was estimated that hospice care saves between 31 and 64 percent of medical care costs (Emanuel & Emanuel, 1994) .

A controversial issue surrounding the cost of dying is to reduce futile care. Futile care refers to cardiopulmonary resuscitation for patients dying of cancer. Although there is not any solid evidence to prove that patient’s with do-not-resuscitate orders save any more money that those without do-not-resuscitate orders (Emanuel & Emanuel, 1994). The idea is that it costs more money to keep people alive, but futile care is not a clear example of why this is true. Thus, the issue remains controversial.

Unfortunately, there does not appear to be a ‘cheap’ way to let someone go. Medical expenses will always be high when someone is fighting an illness toward the end of their life. Even when patients’ choose to stay at home as opposed to making numerous trips to the hospital, there will significant expenses in order to keep the patient alive. Even though dying will never be convenient or cost effective, we should never stop caring for the people we love by providing them with all the medical needs they may require. Hopefully there will come a time in the future where we are able to grieve over the loss of a loved one without having to consider the economic burden that accompanies death.

 

 

Works Referenced:

 Emanuel, E. (1994). New england journal of medicine. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJM199402243300806

Aging and Positive Psychology

Recently, there has been a lot of research conducted that indicates positive psychology is closely linked with health benefits in our later years. Those who practice positive psychology are more likely to care of their bodies and have the ability regulate emotions. In contrast, negative emotions often lead to negative health behaviors, such as poor nutrition or a sedentary lifestyle. (Ong, Mroczek, & Riffin, 2011)

Aging is closely linked with impairments in health, but also in quality of sleep. I know this is true because, living with my grandmother, I have known her to wake up at dawn- even after going to bed only a few hours beforehand. Since sleep benefits the body in many ways, it is safe to say that regulating sleeping patterns can increase physical and mental well-being. Progressive loss of sleep can have adverse effects on the body, but empirical evidence suggests that positive emotions may be conducive to adaptive sleep patterns. This is especially true among the older population. (Ong Mroczek, & Riffin, 2011; Steptoe, O’Donnell, Marmot, & Wardle, 2008)

As we all know, aging is also associated with a number of physiological issues that can bring on heart disease, diabetes, arthritis, and many more complications. Although the prolonged activation of the immune or cardiovascular pathways can lead to adverse health effects, studies have shown that positive emotions may strengthen these systems. (Ong, Mroczek, & Riffin, 2011) Positive emotion can lower levels of the stress hormone, cortisol. Increased levels of cortisol can speed the aging process up in our bodies. The idea that stress can kill is not that far off from medical fact. Cohen and Williamson (1991) proposed that stress may interact with age to  accelerate the aging of the immune system. In addition to lowering levels of stress, positive emotions are also associated with faster recovery from stress-related arousal, including the lowering of blood pressure. (Ong, Mroczek, & Riffin, 2011)

Another good thing to realize in the study of positive emotion is it’s effect on motivation. People who feel that they have worth or have something contribute to the world are more likely to do so. Motivation is that drive in our bodies that tells us to go out and do something. Especially if that thing is something physical, keeping motivated and active has very positive effects on health and well-being. For older people who are unable to stay particularly active, they are still able to reap the health benefits from positive psychology. This positivity effect can help to emphasize memory and emotion. (Ong, Mroczek, & Riffin, 2011)

It is important to remember that even in our elderly years, we are still able to control how our behaviors affect our psyche as well as our bodies. My grandmother is approaching eighty-six years old and my grandfather celebrated his ninetieth birthday this year. They both are living proof of how positive lifestyles can impact well-being. My grandmother, being one of the most optimistic and spiritual people I have ever met. She does not take any medications other than a daily dose of vitamins with dinner. My grandfather is motivated to play golf or even go for a walk every single day. They are in incredible shape for their age. I know they attribute a lot of their health to surrounding themselves by loved ones and not letting stressful situations get the best of them, which are both major components to positive psychology.

Emotion regulation is a large factor in maintaing one’s positivity. Having the ability to harness positive emotions and overcome negative emotions can greatly impact someone’s outlook on life. Healthy attitudes and behaviors have to potential to lead to longer and happier lives. Just because someone is aging on the outside does not mean they have to age on the inside.

 

Works Cited:

Ong, Mroczek, & Riffin (2011)The Health Significance of Positive Emotions in Adulthood and Later Life. Retrieved from  HYPERLINK “https://sn2prd0202.outlook.com/owa/redir.aspx?C=yLSrxTaFNU2lI-G-W5BwnX0izzwqj88I3ipDiDnPKq0RQRAmD7nflPs5V08sX1mXktiVv264KmQ.&URL=http%3a%2f%2f0-web.ebscohost.com.opac.sfsu.edu%2fehost%2fpdfviewer%2fpdfviewer%3fvid%3d3%26hid%3d106%26sid%3ddfbb9de1-47de-4773-a62a-e8d344407d10%2540sessionmgr111” http://0-web.ebscohost.com.opac.sfsu.edu/ehost/pdfviewer/pdfviewer?vid=3&hid=106&sid=dfbb9de1-47de-4773-a62a-e8d344407d10%40sessionmgr111

Elder Abuse

One of the biggest problems older people are faced with today is the prevalence of elder abuse in assisted living facilities. Far too many people are neglected and must deal with emotional and, at times, physical abuse from there so-called caregivers. Elder abuse can be defined as any act of commission or omission that results in harm to the health or well being of an older adult (Castle, p. 403) Assuming incompetence, people will often harass the elderly by verbal, psychological, physical, or even sexual abuse. It is clearly understood that abuse of this nature has a large negative impact on one’s daily life. Elder abuse is highly associated with poor health consequences, including depression (Castle, p. 403).

Older people are vulnerable to abuse because it is not uncommon for aging individuals to experience cognitive impairment and physical limitations. The high incidences of elder abuse in nursing homes are staggering. “The National Elder Abuse Incidence Study…identified that 50,000 cases of abuse were reported in nursing homes.” (Castle, p. 404) The most common forms of abuse in these cases are neglect, emotional abuse, and physical abuse. These numbers are very unsettling. I am very close with my grandparents, and have lived with them off and on for the past twelve years. I cannot imagine them having to experience the distress that is often caused by mistreatment in nursing homes. My late great-grandmother lived in a few different nursing homes over the course of seven years and she constantly had things stolen from her, presumably by one of the nursing home staff members. This kind of treatment to our elders is absolutely unacceptable. Usually, when one is placed into an assisted living facility, such as a nursing home, their family expects that they will be taken care of and shown respect. Unfortunately, this is not always the case.

There have been alarmingly high rates of elder abuse in nursing homes, and most of these are self report. Many people will not report abuse, meaning that cases of elder abuse are even higher than we could even know. It is not uncommon for older people to believe they are unable to report abuse because they are fearful of the consequences of retaliation and many believe that reporting their abuser(s) will cause even more negative effect to their lives.

Elder abuse has significant implications, as “…there is a growing awareness that causes of death in nursing home residents are often unknown.” (Castle, p. 405) Evidence has suggested that abuse of elderly people has been associated with increased rates of mortality. Individuals who have been abused or neglected are also more likely to develop severe depression, for obvious reasons, as well as dementia and malnutrition. In a large longitudinal study of old people, those who were mistreated were three times more likely to die during a three year period than those who were not (Lachs & Pillemer, p. 1269) If an older person is constantly neglected or ignored in a nursing home, then it is likely that their basic health needs are not being met.

It is important to recognize that aging adults are likely to be mistreated by family members, as well as by staff in assisted living facilities. It is far too common for people to lose patience with the elderly and mistreat them to the point of neglect or abuse. I think there needs to be more done in order to monitor the care of older patients in nursing homes, and those aging in place, to make sure they are not being taken advantage of. Unfortunately, it is not always easy to measure neglect or abuse in these types of settings. If more people are aware of the issues elder patients face, perhaps we can prevent the mistreatment of older people in years to come.

 

 

Works Cited & Referenced

 Lachs, M., & Pillemer, K. (2004, October 2). Elder abuse. Retrieved from http://webspace.psychiatry.wisc.edu/walaszek/geropsych/docs/lachs-lancet-2004.pdf

Castle, N. (2010, November 19). Nurse aides’ reports of residential abuse in nursing homes.

Retrieved from http://0-jag.sagepub.com.opac.sfsu.edu/content/31/3/402.full.pdf html

Quality of Life

American prison systems face a lot of problems today, but one of the main issues is certainly overcrowding. The percentage of prisoners over the age of fifty five rose from 1.5% to 2.2% between the years of 2002 and 2006.(Gaydon & Miller, p. 686) These numbers are only expected to increase as people are living longer. California is especially impacted by the high population of aging inmates because of the Three Strikes Law; this law states that any person who already has two felony convictions must serve twenty five years to life on their third felony conviction. “This law has more than quadrupled California’s prison population since 1980.”(Gaydon & Miller, p. 687) Because of this overcrowding, elderly individuals are often denied the time and care that is required to maintain their health.

The issue of overcrowding also impacts taxpayers. The expenses of incarcerating the elderly are extremely high. It costs roughly 65,000 dollars to house and care for one elderly inmate, whereas it costs about 22,650 to take in a younger prisoner.(Gaydon & Miller, p. 687) These differences are easily explained by the medical bills of the elderly. Medical costs are extremely high for these people because inmates are not eligible for Medicare or Medicaid. (Gaydon & Miller, p. 687)

Those with functional impairment and disease are the ones who require the most care. Unfortunately this applies to a large percentage of the aging population. Older prisoners will often stop alerting guards if they are having medical issues because they either know they will end up dying in prison, or they think their needs will not be met by prison staff. This is a serious problem, because even though these people are behind bars for presumably good reason, it is their human right to receive adequate health care.

There are specific health procedures for older inmates. It is suggested that they be checked for ailments, such as high cholesterol or blood pressure. Elderly inmates need to be closely monitored, as they often have a harder time engaging in the routine activities than their younger counterparts. Crawling into a top bunk, or even walking long distances can prove to be a struggle for some of the older prisoners.

Aside from physical health, many aging inmates suffer from deficiencies in their mental health. According to a 2001 study, the prevalence of depression and various other mental illnesses were observed five times more in the elderly population than that of younger inmates. (Fazel et al.) This could be explained by the length of time behind bars and stress over medical issues, as older people tend to have more health problems. Unfortunately, the mental well being of older inmates is often underdetected and undertreated.

Since the effects of aging can seriously impact physiological and psychological functioning, there are some suggested strategies in American prison systems to address the health care of elderly inmates. For example, prisons should “…modify existing work and education programs to include health care education, preventive medicine, and counseling of the elderly [and] establish special geriatric units for inmates requiring specialized care.” (Reimer, p. 206) If more programs are established to aid in the care of elderly inmates, there is a good chance rates of depression would decrease. I believe better medical care would greatly benefit these prisoners, as aging behind bars is bound to come with mental and physical complications over time.

Works Cited & Referenced:

Beth Gaydon and Monica K. Miller (2007). Elders in the Justice System.

Wiley Interscience Publishing.

Glenda Reimer (2008). The Graying of the U.S. Prisoner Population.

Sage Publications, on behalf of The National Commission on Correctional Health Care.

Seena Fazel, Tony Hope, Ian O’Donnell, and Robin Jacoby (2001). Hidden Psychiatric Morbidity in Elderly Prisoners.

TheBritish Journal of Psychiatry.

Aging On The Inside

The population is constantly increasing in the United States. Although many know about this population growth, a lot of people do not consider how it affects the elderly. We are now seeing more adults over the age of sixty five than we ever have before in American history. The numbers will only continue to increase as the children of the ‘baby boom’ generation approach their sixties as well. As longevity and average age of life span get higher, as will the number of elderly citizens in the United States. “The growth of the elderly population has significant economic implications for our various institutions and the public policymakers who are responsible for carving out a response to this demographic transition.” (Aday, 2003, p. 2) It only makes sense for the elderly population in American prison systems to increase as the elderly population continues to grow outside of these establishments.

When one thinks about social institutions that older people are placed into, nursing homes tend to be the first thing that come to mind. Yes, it is true that there is a very high percentage of the older population that now live in nursing homes or other facilities like them. However, there is not enough attention focused on the percentage of elderly people in our prison systems. Taking into account people who are arrested over the age of fifty and the older prisoners who have been incarcerated since they were a much younger age, the elderly prison population is a very fast-growing age group in American prison systems today. They require much more attention and funding, as many of these prisoners are in poor health and medical services are in a higher demand for them. In 2003, prisoners 45 years and older accounted for 17.8% of sentenced inmates, up from 13% in 1995 (Fields, 2005). Inmates 50 and older are now the fastest-growing portion of the prison population (Associated Press, 2005), increasing at a rate three times faster than the general prison population. (Reimer, p. 204) Keeping this in mind, it does cost more money to keep an older person in prison than younger offenders. This causes a dilemma for policymakers, because it is becoming too costly to care for all the elderly inmates, but their sentences cannot be reduced due to aging and health status.

For the first time in American history, we are faced with the issue of an aging prison population and how to properly care for and house these people. “…The explosion of the general prison population, AIDS among prisoners, and the complications associated with housing a growing number of mentally ill inmates have significantly challenged our correctional system.” (Aday, 2003, p. 7) Specific to the elderly population, issues such as cancer, dementia, Alzheimer’s, and hypertension, can be very taxing to the prison systems. It is important to recognize how difficult it is to care for ill and aging inmates. Even more so, it is important to recognize how aging on the inside affects the mental and physical well being of elderly inmates. Those who do not have the ability to grow old in place, or age among the company of family and friends, are presumably more likely to have mental deficiencies. Aging is already a difficult thing to overcome, without the added stress of having to age in a correctional facility with limited freedom and often inadequate health care.

This blog will focus on aging inmates in America, specifically those over the age of roughly fifty five. I will explore the gender, race, health, and geographic differences among this group of people and how it affects the psyche of those aging on the inside. Both physical and mental health are hugely impacted when growing old inside the prison system.