September 16, 2010

USA: When Possessions Lead to Paralysis

NEW YORK, NY / The New York Times / Health / September 16, 2010


David J. Ekerdt, who directs the gerontology center at the University of Kansas, has a knack for digging into aspects of aging that most of us register only in passing. I’ve been a fan since I read his work on the “busy ethic,” a phrase he coined to describe our attitudes towards retirement.

So I was delighted to learn that in his new research, underwritten by the National Institute on Aging and undertaken with colleagues from Wayne State University, he’s investigating Stuff.

Dr. Ekerdt can’t document — yet — that Stuff often prevents old people from taking good care of themselves, especially when that involves moving to another location. “It’s entirely unproven,” he acknowledged in a recent conversation.

But the social workers, geriatricians, retirement community administrators and family members he’s been talking to since 2002 universally believe this: The sheer volume of objects in a typical household, the enormous physical and cognitive effort involved in sorting out what’s essential, the psychological toll of parting with what’s disposable — all can lead to a kind of paralysis that keeps seniors in place, even when the place isn’t the best place.

“The premise is that possessions are an obstacle to people living where they can better manage their health and well-being,” Dr. Ekerdt said.

We’re going to have to wait a couple of years while Dr. Ekerdt’s team repeatedly visits and interviews seniors who are moving or have moved, then analyzes the findings and publishes them. But in the meantime, he’s noticed that family members who help with downsizing — he uses the more elegant academic term “household disbandment” — fall into two categories. They assist, or they assert.

If you assist, Dr. Ekerdt explained, “the elder runs things. You say, ‘You’re in charge, Mother. How can we help you?’ ” It’s the approach he favors, when possible, because it preserves the older person’s autonomy. Besides, he pointed out, “family members don’t know as much about these possessions as the elder does, or care as much.”

He’s seen real team efforts to accomplish this disassembly. “Family members will travel across many states multiple times to help an elder move,” he said. “They’ll rent trucks. They’ll help organize the new place.”

“A number of families remember this as a pleasant process,” he added. “Everyone came and helped.”

But acting as an assistant requires that the person in charge have the cognitive ability to make decisions without becoming confused or overwhelmed, even when someone else is supplying the muscle. Which brings us to the more paternalistic, assertive approach.

“Family members take a stronger role and begin to pre-empt the elder’s own decisions — I think out of concern for the elder’s health and safety,” Dr. Ekerdt said. It comes into play when a parent seems unwilling to throw anything away, or even to confront the need to. Or when dementia has robbed him or her of the ability to make rational decisions. Or when a deadline is bearing down — the house is being sold, the rent on an assisted-living apartment begins on the first of the month — and there’s no time for leisurely contemplation of mementos.

Dr. David J. Ekerdt, Ph.D.  has seen adult children discarding Stuff behind a parent’s back, figuring it won’t be needed. He’s also seen seniors retrieve things from the garbage afterward. “There can be exasperation and hurt feelings,” he said. “It can create sour memories.” But in certain situations, it may be necessary.

He thinks most families know themselves well enough to predict how this process will unfold. The way we are at Thanksgiving, the way we behave if we’re trying to plan a family vacation — that’s how we’ll interact as we tackle household disbandment. It’s a matter of concern to me right now, as I attempt to help my father in the next round of downsizing. He thinks it’s time to leave his two-bedroom apartment for assisted living.

We’ll be posting some pragmatic ideas about managing these transitions over the coming weeks. It’s cheering to hear from a leading gerontologist that despite the stress and pressures, people generally feel good, satisfied, when they emerge on the other side.

In the meantime, I hope I can keep in mind Dr. Ekerdt’s caution about treading sensitively: “This isn’t just a move from one residence to another, as it would be earlier in life. This is a step closer to the inevitable world of frail aging, a reminder that time is growing short. People want to hold onto the symbols of their former lives and competence.”

Paula Span is the author of
“When the Time Comes:
Families With Aging Parents Share Their Struggles and Solutions.”

Copyright 2010 The New York Times Company