When the extreme elderly slip away

When I woke my nearly 97-year-old mother at noon one day recently, she was delighted with my presence. Leaning in closely so she could see me, despite her macular degeneration, and hear me, despite her near-deafness, we talked about sweet nothings.

Her new normal is confusion. She didn’t know the time or where she was, but she knew me and that was enough. I just let her talk, about anything.

She was once keenly intelligent and aware, well-read and engaged, social and interactive. She has lost much of those capacities to dementia and her disabilities, and what’s left is her generous spirit, sense of gratitude and deep love for family.

Her nine brothers and sisters have all died except one. Yet, in her imagination they are still very much alive. She “speaks” with them regularly, and I don’t disavow her fantasies.

She looked at me intently and said, “John — you look older!”

“Mom! I’m 64!”

Stunned, she asked, “Where did all the years go?”

“You’ve been here all along and haven’t missed a thing. You’ve just forgotten.”

She loves to reminisce about her early life, so I’m now hearing stories (true but confused) that might have taken place 80 or 90 years ago.

In the middle of a sentence, she grimaced, “I feel pain.”

“Where?”

“Here, in my heart — pressure. It hurts.”

I called the nurse. Her blood pressure was elevated. The nurse asked if she should call 911.

“Call my brother first [he’s a doctor], and ask him what he thinks we ought to do.”

Michael and I had decided a year ago that because of our mother’s advanced age, disabilities and dementia we would not send her to the emergency room  unless she had broken a bone, was in intense pain or couldn’t breathe. Otherwise, on-site nurses would treat her.

While the nurse called him, Mom announced to me, “I’m not ready to die, and I don’t want to leave all of you; though I could die now and I look forward to seeing everyone and finding out about them and what they’re thinking.”

Stroking her hair, I was half-certain that this was it. I felt not yet ready to lose her, though so much of who she was has already dissipated into the ether, as she is but a shadow of her former self.

As it turned out, her pain was caused by acid reflux (or heartburn), which Michael diagnosed over the phone, and it passed quickly.

It’s very, very tough to be her age. Roger Angell, a 90-plus essayist and sports commentator, wrote movingly in last month’s New Yorker of the experience of people in their 90s. For all very old people, he said:

Decline and disaster impend. … Living long means enough already. … We geezers carry about a bulging directory of dead husbands or wives, children, parents, lovers, brothers and sisters … all once entirely familiar to us.

Years ago, I read a piece written by a very old woman who complained that no one ever touched her any longer and that she missed dearly that most concrete of human interactions. Ever since, I made it a point to touch, hug or kiss the very old, for their need for human contact never abates. This is certainly true for my mother. She drinks in physical connection and emotional attention like water on the desert floor.

Angell said it well:

Our unceasing need for deep attachment and intimate love [remains]. We oldies yearn daily and hourly for conversation and a renewed domesticity, for company at the movies or while visiting a museum, for someone close by in the car when coming home at night. …Those of us who have lost … the sweet warmth of a hip or a foot or a bare expanse of shoulder within reach … whatever our age, never lose the longing.

He writes of the extreme elderly’s invisibility and how insignificant they feel even at the hands of those who love them most: “Honored, respected, even loved, but not quite worth listening to anymore,” he mourns.

There are so many ways in which we can help our elderly parents and grandparents feel that they still matter and have value. We can ask them to recount their early memories and stories from childhood and young adulthood, their courtships and marriages, their school experiences and work life, their best friends and anything else they recall. 

Recounting memories invigorates and affirms their lives even now. We can ask them, as well, what essential life lessons they have to impart to the next generations in their families, what has really been of value to them, what wisdom they carry.

When we actively engage with the extreme elderly and listen to them without interrupting, interjecting, correcting or adding to their stories, it is empowering to them. That empowerment adds to the dignity of their lives and their sense of self-worth.