Conscious Aging

— A new paradigm to enhance senior living. Embrace aging as a gift.

By John Ritchie

Conscious Aging: to experience senior aging as more a gift and less a burden, and many burdens as also gifts.

Senior living, with retirement or part-time work, may bring more free time, less work stress and more choices for what you want to do. It can also at times feel lonely, or leave one feeling depressed or anxious because of the loss of work and work community, diminished physical abilities and social contacts, and decreasing accomplishments, recognition, usefulness and felt importance. I see Conscious Aging as a special combination of mutually enhancing experiences and practices uniquely relevant and available to seniors.

Conscious, in this context, means to intentionally be more mindful and present, to enhance our awareness and connections, or open our mind and heart. “Inner Work” is the primary practice and relationships become more important than accomplishments. Through increased exploration, self-reflection and compassion, we can experience a shift in our interests, values and needs, and greater acceptance, appreciation and enjoyment of senior living. Conscious Aging is focused not on what we should believe or externally do, but how to be and experience life.

I am suggesting that our present “successful” aging and “positive” aging models or guidelines for senior living support a paradigm that primarily focuses on external criteria and goals. It is common for seniors to talk about, and identify with, their travels, recreation, fun activities, entertainment interests, past accomplishments and children/grandchildren activities. Focusing on external-based goals, possessions and activities tends to not find fulfillment or happiness beyond short-term pleasure; and avoids directly exploring and finding “positives” from our “negative” senior sufferings, losses and limitations. Successful models were more important and helpful for us when we were young adults and middle age (e.g. finding a good job, spouse and career; and creating a successful family, comfortable home, active social life). These external-based models now tend not to align with our internal senior shifts in interests, values and needs; nor satisfy our increased senior yearnings or utilize natural aging experiences.

I am advocating for what I’m calling “Enhancing Awareness and Connections” as a quality or process of how to focus our attention and effort, to be applied to all components of Conscious Aging. All of senior aging is our curriculum. Conscious Aging has been applied to various components, or “what” to focus our attention and effort on. Some of these components include 1) conscious eldering, 2) bringing closure to life, 3) preparing for dying and death, 4) conscious senior service, 5) Conscious Villages or co-living, and 6) living life’s purpose and meaning.

I. For those of you who are already seniors, see if you resonate with some of the listed common shifts from middle age to senior age in interests, values, needs or roles. These are often due to, or facilitate, “inner work” and increased awareness and connections, that come with senior aging. “Living more from the ‘inside out’ rather than from the ‘outside in’.” “It’s not what happens to us, but our relationship to what happens.”

Doing to Being … Staying Busy to Slowing down … Intensity to Intimacy

Holding On to Letting Go … Past/Future to Present … Seeking Pleasure to Appreciation

Outcomes to Relationships … Competition to Cooperation … Self-Centered to Selflessness

Learning to Understanding … Criticalness to Empathy … Distractions to Presence

Head to Heart … Fairness to Compassion … Accomplishments to Contributions

II. See if you resonate with some of these increased senior “yearnings” as you become more aware of what “pulls” you rather than responding to what has “pushed” you in the past. Yearnings support “inner work” or enhanced understanding and relationships, and Conscious Aging. “We want to know our essential nature or essence, or to go from self to soul to spirit.”—Kathleen Dowling Singh. “The second half of life is about restoring wholeness.”

Find Life’s Meaning … Clarify My Purpose … Understand Spirituality … Know Thy True Self

Become Comfortable With Dying … Want Deeper Relationships … Connect to Everything/Divine

III. See if you resonate with some of these natural senior aging experiences, which support and enhance inner work or greater awareness/understanding and connections/relationships, and thereby Conscious Aging. “Senior aging is not a problem we need to solve, but a stage of life to be fully experienced.”

Slowing Down … Solitude … Silence … Letting Go … Patience … Acceptance

Being in the Present … Calm … Forgiveness … Simplifying … Humility … Vulnerability

Intentional Living … Surrender … Withdrawal … Selflessness … Gratitude … Appreciation

IV. As you will notice, the following intentional “inner work and internal practices” overlap with natural senior aging experiences and what seniors commonly experience as middle-age to senior-age shifts in interests, values, and needs, to further enhance Conscious Aging. “We can’t choose or control the circumstances of our age, but we can choose the quality of awareness we bring to those circumstances.” “Your compassion may or may not change others, but it will certainly change you.” “When life is short, make it broader and deeper.”

Calm, Curious, and Compassionate … Being in the Present … Slowing Down … Silence … Solitude

Inclusion … Receptiveness … Letting Go … Acceptance … Appreciation … Gratitude … Respect

Patience … Selflessness … Seeing Beauty … Vulnerability … Humility … Empathy … Mindfulness

V. We can apply inner work and internal practices to common senior aging negative experiences to access and experience positive thoughts, feelings, and experiences. Our struggles become portals for understanding, growth and healing. “There are some things you can only learn in a storm.” “Until we suffer, we won’t look deeply for something more to learn.”

For example, if you are feeling sad and lonely, frustrated and stuck, or very ill and tired, direct your attention inward and internally slow down in silence to become calm, curious and compassionate. Direct your attention to the present, which will help you let go of future and past attachments or distractions. You will then notice how you can see broader and deeper with greater presence, understanding and loving kindness. This will help you notice what moves you or brings you joy and what you appreciate in the moment or about others and yourself. For example, you’re stuck in bed, and you shift your attention from what you can’t do, to what you can do, enjoy or appreciate, such as sight (notice beauty, watch movie), sound (listen to music, birds outside), or touch (pet your dog, give self a massage). You can shift attention to relationships and initiate or schedule more frequent and closer connections- longer talks, phone calls, Zoom meetings, texting, Facebook, or invitations to visit you. It’s now more about connections, harmony and wholeness, than about individual accomplishments and success.

Complete Article HERE!

What does ‘brain dead’ really mean?

— The battle over how science defines the end of life


The concept of brain death is facing its greatest challenge in the United States in decades.

Ideological differences threaten to muddy the definition of death in the United States — with potentially negative consequences for clinicians and people awaiting organ transplants.

By Max Kozlov

Dead in California but alive in New Jersey: that was the status of 13-year-old Jahi McMath after physicians in Oakland, California, declared her brain dead in 2013, after complications from a tonsillectomy. Unhappy with the care that their daughter received and unwilling to remove life support, McMath’s family moved with her to New Jersey, where the law allowed them to lodge a religious objection to the declaration of brain death and keep McMath connected to life-support systems for another four and a half years.

Prompted by such legal discrepancies and a growing number of lawsuits around the United States, a group of neurologists, physicians, lawyers and bioethicists is attempting to harmonize state laws surrounding the determination of death. They say that imprecise language in existing laws — as well as research done since the laws were passed — threatens to undermine public confidence in how death is defined worldwide.

“It doesn’t really make a lot of sense,” says Ariane Lewis, a neurocritical care clinician at NYU Langone Health in New York City. “Death is something that should be a set, finite thing. It shouldn’t be something that’s left up to interpretation.”

Since 2021, a committee in the Uniform Law Commission (ULC), a non-profit organization in Chicago, Illinois, that drafts model legislation for states to adopt, has been revising its recommendation for the legal determination of death. The drafting committee hopes to clarify the definition of brain death, determine whether consent is required to test for it, specify how to handle family objections and provide guidance on how to incorporate future changes to medical standards. The broader membership of the ULC will offer feedback on the first draft of the revised law at a meeting on 26 July. After members vote on it, the text could be ready for state legislatures to consider by the middle of next year.

But as the ULC revision process has progressed, clinicians who were once eager to address these issues have become increasingly worried.

Fuelling their fears is a rising tide of political polarization and mistrust of scientific expertise. Some clinicians following the ULC discussions say that the idea of brain death itself is facing its greatest challenge since its conception in the 1960s. The outcome could have serious implications for intensive care units (ICUs) across the United States and might affect the availability of vital organs for transplant. And although few expect the ULC’s recommendations to erase the idea of brain death, some observers fear that the doubts and narratives sown throughout the process could have a lasting effect on state laws and on public perception.

“I thought this would be an upgrade, and it’s completely fallen apart from that perspective,” says Robert Truog, a bioethicist and paediatrician at Harvard Medical School in Boston, Massachusetts, who is not a voting member of the ULC committee, but has watched its progress closely. “As soon as we talk about the deeper issues, the profound disagreement of some members of the committee become apparent, and you reach a standstill.”

Redefining death

Current legal definitions around the world generally allow for two types of death: when heart and respiratory function stop irreversibly, or when crucial functions of the brain are lost. Historically, these two have been closely entwined: stop the heart, and the brain is dead in minutes. Stop the entire brain functioning, and the heart stops beating. But medical advances in the 1950s, such as modern ventilators, meant that the two types of death could be separated.

Such technologies, along with improved methods of measuring brain function, prompted the formation of a committee at Harvard University in Cambridge, Massachusetts, in 1968. The members developed a definition of irreversible coma or brain death that was controversial at the time.

In 1981, prompted by a presidential commission on the topic, the ULC codified this form of death into a model law called the Uniform Determination of Death Act (UDDA), stating that a person can be considered dead when there is an irreversible cessation of circulatory and respiratory function or of all functions of the entire brain, including the brainstem. The Harvard committee and the UDDA proved influential: most countries in the world followed suit with their own laws adopting brain death.

People who are in a coma, or who have unresponsive wakefulness syndrome, or locked-in syndrome are not brain dead. Not all functions of their brains have stopped, and some might be able to breathe without the assistance of a ventilator, show signs of wakefulness or have intact reflexes (see ‘A scale of consciousness’).

A SCALE OF CONSCIOUSNESS. Chart shows various diagnoses based in part on levels of cognitive and motor impairment.
Source: J. L. Bernat Annu. Rev. Med. 60, 381–392 (2009)

Today, although brain death makes up just 2% of adult deaths and 5% of childhood deaths in hospitals in the United States, it tends to garner outsized attention from the media and in the law. Erin Paquette, a paediatrician and bioethicist at Northwestern University in Evanston, Illinois, says that’s because the physical appearance of a person who is brain dead often doesn’t line up with people’s concept of death. Hooked up to a ventilator, a person who is brain dead might look like any other individual in an ICU.

This can make it difficult for clinicians to communicate with family members about brain death, especially when the law lags behind scientific understanding. This happened in McMath’s case. Although she never definitively regained consciousness or the ability to breathe on her own, she began puberty and had her first menstrual period — a sign that a small region of her brain called the anterior hypothalamus, which helps to control the body’s hormones, might have been active.

This realization prompted her mother to sue the state of California in a bid to erase the death certificate there because not “all functions of the entire brain” had ceased as the UDDA dictates. Using a strict interpretation of the law, McMath’s mother might have been right, says James Bernat, a neurologist at the Dartmouth Geisel School of Medicine in Hanover, New Hampshire, even though it wasn’t a sign that the girl would recover. The anterior hypothalamus, Bernat says, receives blood through a different supply from the rest of the brain, so some function might be preserved in a small subset of people who have been declared brain dead. (McMath’s heart stopped in June 2018, at which point she was issued a second death certificate; her mother withdrew the lawsuit shortly afterwards.)

Language tweaks

Clinicians have called for changes to the language of the UDDA, hoping to clarify which brain areas are relevant to recovery. Other countries, such as the United Kingdom and India, define brain death much more narrowly than the United States, focusing not on the entire brain, but on the brain stem, which is necessary for essential functions such as breathing, swallowing and maintaining a heartbeat. The United Kingdom goes one step further by not separating the ways that death happens: all deaths happen when brainstem function is lost.

Truog supports this simplified system, which Canada adopted in May. But Bernat says it’s unlikely that the United States will adopt this standard: “If the ULC is going to do anything to the UDDA, they want to just tweak it,” he says. Nevertheless, he hopes that the revised law will address how to interpret residual activity in areas of the brain that are not linked to consciousness or breathing.

A silhouetted Nailah Winkfield wiping tears from her eyes. Behind her is a projected image of her smiling daughter
Nailah Winkfield appears at a news conference in 2018 to discuss the death of her daughter, Jahi McMath.

Other language changes are more subtle. Some clinicians have been calling to amend the law so that it refers to a ‘permanent’ loss of brain and heart function instead of an ‘irreversible’ one. The argument is that current tests for death do not evaluate reversibility, but rather permanence. Irreversibility, clinicians say, is a much higher standard to meet, and would require them to wait for hours to prove that they cannot restart heart or brain function. And even if it were possible to restore some functionality, some have said it might not be wise or even ethical to do so.

The need to address the language about irreversibility has been made more urgent thanks to research by Nenad Sestan, a neuroscientist at Yale University in New Haven, Connecticut. He and his colleagues pumped a blood substitute through the bodies of pigs and restored cellular function in some organs1, including the brain2, hours after the animals were slaughtered. They were careful to note that although cells might be metabolically active, this does not translate to organ function. “We might one day be able to reverse things we used to say were irreversible, and ultimately what we care about is permanence,” says Alex Capron, a medical ethicist and specialist in health policy at the University of Southern California in Los Angeles, who helped to direct national efforts to define death in the 1980s.

These language discrepancies mean that guidelines put out by organizations such as the American Academy of Neurology (AAN), in Minneapolis, Minnesota, outlining what physicians should test for when declaring brain death don’t line up with the UDDA.

Individual hospitals, too, have their own determination-of-death policies and procedures that might differ from those put out by the AAN. Currently, the UDDA states that physicians ought to use “accepted medical guidelines” as the basis of their determination, but that leaves room for them to use different medical organizations’ guidelines, and ones that are outdated.

In 2016, David Greer, a neurologist at Boston Medical Center, and his colleagues were surprised to find substantial differences when they analysed nearly 500 hospitals’ policies to see whether they adhered to the AAN’s guidelines3. They found that most clinics did not require someone with neurology experience to determine brain death, and more than one-quarter didn’t require physicians to test for conditions that can mimic brain death, such as abnormally low blood pressure or hypothermia.

New AAN guidelines are coming later this year, says Greer, who co-authored them. The revision will standardize death determination between adults and children to make the concept easier for people to understand, he says. Greer and others are calling for the UDDA to specify which medical guidelines to rely on and a process by which states can incorporate newer standards into practice.

Added tensions

But some are afraid that the time is not right to update the UDDA. Lainie Ross, a paediatrician and bioethicist at the University of Rochester in New York, says that when she heard this process was opening up, she felt uneasy. “It’s not that I think what we have is perfect,” she says, “but sometimes, perfect is the enemy of the good.”

Ross says her fears have been borne out — and many other medical professionals who spoke to Nature agree that the ULC discussions so far have not been as productive as they would have liked.

One concern is a lack of scientific expertise. The ULC committee that will ultimately decide on the final text of the revised UDDA consists of 15 voting members, all of whom are attorneys, and none of whom has direct experience treating people with severe brain injury.

One of the commissioners is James Bopp Jr, who serves as the general counsel for the anti-abortion organization the National Right to Life Committee in Washington DC. He says that he publicly supported the UDDA in the 1980s, but has changed his mind in the past few years and no longer thinks that brain death constitutes biological death. He now argues that even if a person has no chance of recovery, they still have rights.

So far, Bopp’s efforts to remove brain death from the UDDA have not succeeded. But although the concept of brain death will probably remain in the United States, the ULC might approve bracketed text, which serves as an optional recommendation for state legislatures as they consider revising their laws. This bracketed text could include a clause similar to New Jersey’s current law, allowing people to object to a diagnosis of brain death for reasons such as religious beliefs.

Many agree that it’s important to include language to handle objections and accommodations, but allowing for such opt-out clauses in the UDDA has split researchers. Truog is in favour of them, adding that they are the only sure-fire way to stop the deluge of lawsuits that threatens to undermine public acceptance of brain death. But Ross says that consistency is paramount, so she would prefer that either no states have an opt-out clause, or every state has one — to avoid the situation in which someone is considered alive in one state but dead in another.

To add to the tension, people who are brain dead represent most deceased organ donors in the United States (see ‘Organ-donor dilemma’), meaning that any changes to how death is determined will also have knock-on effects on the organ waiting list — which currently stands at more than 100,000 people. The worry is that with more people refusing to accept a determination of brain death, the waiting list could grow substantially, and ICUs could be filled with people who will never recover.

ORGAN-DONOR DILEMMA. Graphic shows the rise in organs transplanted from US donors who have been declared brain dead.
Source: Organ Procurement and Transplantation Network (OPTN)

Truog says that New Jersey has had its opt-out clause for years, and it has neither massive organ shortages nor ICUs filled with people who are brain dead. But Capron cautions that expanding opt-outs for religious reasons to many states would be venturing into uncharted territory. And signalling that brain death isn’t universally accepted could “have an effect on people who would not have gone into it having any doubts”, he says. The logistics of organ transplantation also become sticky in this scenario: organ-transplant registries have become more national. Higher opt-out rates could pose an obstacle if one state’s population is providing fewer organs to the registry but still requires the same number, Ross says.

Exploring other options

The outcome of the UDDA revision process is still largely unknown. The ULC could recommend leaving the 1981 UDDA intact. In that scenario, individual state legislatures could still vote to revise their laws in any way that they see fit, but it would be without an explicit recommendation from the ULC. If drafting continues as planned, the full ULC will vote on the revised UDDA at its summer 2024 meeting.

Beyond revising the UDDA, there are other, more systemic, ways to build public trust in the concept of brain death, Paquette says. One example is more uniform and robust medical training: because brain-death determinations are relatively infrequent, many neurology residents in the United States finish their training without witnessing a single brain-death examination4. This can result in less uniformity between clinicians and poor communication with the family or carers of a person with a devastating brain injury. Students need more practice in communicating diagnoses and potential outcomes with the family or carers of a person with a devastating brain injury, Paquette says.

“It’s helpful to outline what the death based on neurologic criteria process will look like,” she says. “And it’s important to acknowledge that what someone is seeing might not match up with their notion of death.”

Complete Article HERE!

Have You Prepared Your Advocates?

— Estate planning includes naming advocates in your key health and estate documents. But are your advocates truly prepared to make decisions on your behalf? Our expert shows what you need to do.

By

Going through the process of completing your estate planning documents is not an easy process. Working with an attorney to determine what documents you need, how you want the language written so that your assets are handled and decisions are made the way YOU want them, and choosing the best advocates to carry out those instructions can be very involved. No wonder it is a task that many people put off doing – it can be overwhelming!

Common Documents With Named Advocates

The most common estate planning documents that individuals have drafted (and that will require advocates to be named) are the following:



Most clients are so relieved when their documents have been drafted; it is a huge weight off their shoulders to have so many important decisions made and in place. It feels satisfying to have the binder of documents drafted by the attorney in hand and completed.

Perhaps if you are even more “on the ball,” you follow through and get copies of your documents to your financial advisor and update your asset titling and beneficiaries according to the funding instructions provided by the attorney. If you have done that, you are ahead of the majority of clients, most of whom take the big binder home and file it away in a safe place and consider their estate planning completed! But is it?

Have you taken the final step and communicated to those you have chosen as your advocates that you have named them in your documents?

The Importance of Communicating With Your Advocates

It is not uncommon for people to name others as future advocates for them in their legal documents, but not to communicate to them that they have been named. If you’ve ever been in the shoes of being that named advocate, and getting that “surprise” call that you suddenly need to make a life and death decision about someone’s health treatment when you had no idea you were named as their health care advocate and had not had conversations with them regarding their wishes around end of life treatment, you might think differently about having those proactive conversations.

It is extremely important to take this last step, and not only communicate with your advocates that they have been named in your documents but also give them the key information that they will need to fulfill your wishes.

Here is the key information you need to share:

Patient Advocate/Health Care Advocate:

  • Drug allergies
  • Current medications (or where to find your medications list)
  • Your primary providers, your wishes on Code Status (i.e. DNR or full Code), and where your estate planning documents are located
  • Your past surgical history
  • Whether or not there is metal anywhere on your body
  • What your wishes are for end-of-life care and treatments (i.e. aggressive vs. comfort treatment)
  • Plans for future care and any professional relationships and resources that can be used to assist the advocate in their role (social workers, Geriatric Care Managers, etc.)

Durable Power of Attorney/Successor Trustee:

  • Contact information for your professional advisors and, if possible, an introduction to those professionals.
  • Instructions on where to find an “open me first” document (ex. Personal Financial Record System) that details your financial life (bank accounts, investment accounts, insurance policies, government benefits, employer benefits, etc.)
  • Where to find your estate planning documents and a review of your Trust (especially for your successor Trustee, so they have a heads-up on how they might be managing your assets)
  • An overview/general conversation about your wishes regarding handling your assets for future care and your values around money.

Executor/Advocate:

  • Contact information for your professional advisors and, if possible, an introduction to those professionals.
  • Instructions on where to find an “open me first” document (ex. Personal Financial Record System) that details your financial life (bank accounts, investment accounts, insurance policies, government benefits, employer benefits, etc.)
  • Instructions on where to find your Letter of Last Instruction document outlining your wishes for after death.
  • Where to find your estate planning documents, especially your Last Will & Testament, which will be the guiding document for your Executor.
  • An overview/general conversation about your wishes regarding after-death arrangements, about your Will, and how you would like your assets handled post-death, especially if there is no Trust for assets to flow to.

The more information you can share with your future advocates, the better prepared they will be to make the decisions you would want them to make on your behalf should they ever need to serve. An advocate’s job is to be your fiduciary, which means to make decisions in your best interest; without the benefit of having full information on you and your situation, you make it almost impossible for them to do their job to the best of their ability.

If you have taken the time to draft your estate planning documents, our best advice is to complete the process by fully preparing your advocates to serve in your best interest – they’ll be glad you did!

Complete Article HERE!

The healing power of nature

— Five ways nature can help us through grief

How can nature comfort us while we’re grieving? From refocusing our minds to showing us how to carry on, here are five ways that nature can help.

By Paddy Wilson

There are many ways people try to process and manage their grief, from talking with people close to them, to writing about their loss.

For others, immersing themselves in nature helps. But can taking a walk in a forest, going for a swim or setting out into the wilderness really help people work through their loss?

In a talk for Marie Curie, the Healing Power of Nature in Grief, TV presenter and survival instructor Ray Mears, author Raynor Winn and filmmaker Cat White shared their experiences of how nature provided them with comfort through grief – and how others might find comfort in it too.

1. Refocus and release

Most simply, nature can help people to take their mind off grief. When wild swimming, for example, “the shock to your system of cold water… you’re so cold that there’s nowhere else your brain can be at that moment in time,” says Cat, whose short film, Fifty-Four Days, reflected her real-life experience of daily swimming to process her grief.

And refocusing your attention on nature can also provide a sense of release. “When families go on journeys into wild places, it gives them a sort of release from the normal complexities of life,” says Ray.

“Even families with difficult relationships can be moved by being in a wild place where nature takes a hand in the events of the day. Time out from normal life can be very, very healing.”

2. A comforting sense of smallness

For many, grief can feel insurmountable. But nature’s vastness can provide an antidote. As Ray explains, in nature – particularly in wilder spaces – “you’re constantly reminded you aren’t the dominant force in that landscape.”

“I like to go to a very big wilderness and big forests where you feel absolutely tiny,” says Ray. Getting face-to-face with the scale of the natural world can be comforting because, as Raynor suggests, “nature puts things into perspective.” While this perspective won’t end our grief, it might help us manage it.

3. The importance of specific places

While the vastness of nature can help, finding specific meaningful places in nature can provide comfort too. For Ray, who spent time outdoors with people close to him who’ve died, “to be outdoors is to be forever reminded of them”.

Particular places can conjure specific memories and feelings. Ray suggests caution therefore, and a mindfulness to look after yourself when you’re grieving, because “unless you’re in the right frame of mind, it’s not easy to go there because the feeling is so profound”.

“But at the same time, it’s also warming. Those places and landscapes can be places to visit if you wish to visit those memories.”

4. Sharing in nature and grief

Like grief, nature belongs to everyone but is experienced individually. In the same way we share in nature – treading paths trodden before, swimming in lakes already swam in – sharing with others who are going through similar feelings can be helpful.

As Raynor explains, “Sometimes it’s enough to know that that place and feeling you’re inhabiting right now, you’re not alone because everyone who’s passed over that path has felt some element of what you’re feeling. There’s a sense of community within your isolation.”

As with grief, “anyone who spends time in nature… shares some sort of connection of knowing that they belong to something bigger and that you’re part of something with them”.

5. Nature’s endurance

Ultimately, grief is something we all experience. It’s a fact of life that people close to us will die. But nature’s longevity offers a different feeling: a sense of endurance. “Nature carries on when we think we can’t,” says Raynor. “If you allow yourself to experience that continuity of nature, it allows you to feel that’s possible within yourself.”

Its sense of endurance doesn’t mock our mortality; it helps us understand that we can carry on. As Cat explains, “Dawn will always come again. However overwhelmed we feel, nature has the possibility to remind us there will be another day and a sense of keeping going.”

Proximity, not prescription

Whether trekking through a forest or taking a stroll in a park, getting out in nature is one of the most straightforward strategies to help with bereavement. “It’s so accessible. And you don’t need a prescription,” says Ray, to walk through a park or go for a forest trek.

“You don’t need anything,” adds Cat. “It’s so easy. You need proximity – but that’s all you need.”

There are lots of ways you can get support when someone dies, from embracing nature to talking to someone.

Complete Article HERE!

The Rare Walking Corpse Syndrome

— How Could Someone Feel Dead?

The mind is truly an amazing — and strange — contraption, and few things demonstrate that better than Cotard’s syndrome. Learn about the bizarre condition of walking corpse syndrome.

By Avery Hurt

Cotard’s syndrome, or Cotard’s delusion as it is often called, is a rare neuropsychiatric disorder in which a person believes they are dead, that they do not even exist, or sometimes that the world itself does not exist.

The condition was described in 1880 by Jules Cotard, a French neurologist and psychiatrist. In a presentation to the Société Médico-Psychologique, Cotard ;reported the case of a 43-year-old patient who believed she had “no brain, nerves, chest or entrails, and was just skin and bone.” She claimed to need no food because she was “eternal and would live forever.”

What Is Cotard’s Syndrome?

Not all patients with Cotard’s syndrome expect to live forever in some Zombie-like state. In fact, most believe that they’re already dead or very close to death. Individuals with Cotard’s Syndrome experience a profound distortion of reality and beliefs about their existence.

They may adamantly assert that they do not possess a physical body or have lost their internal organs. This perception of self can lead to extreme apathy, self-neglect and detachment from the world around them.

A 2018 study analyzed the cases of 12 people who had been diagnosed with this disorder and found that eight of the 12 believed they had died. The other four believed they were in the process of dying. Three of the four who claimed to be dying said worms, viruses or bugs were eating their internal organs.

Patients with Cotard’s Syndrome Symptoms

The patient’s belief that they’re dead or dying is often accompanied by other delusions as well. A 44-year-old man diagnosed with Cotard’s also hallucinated spiders in the walls, rats running along the baseboards and people’s faces melting.

A 74-year-old patient reported that he had been stabbed while in his nursing home and referred to his hospital bed as his casket. This man also believed that his wife had been replaced by an imposter, a separate delusion known as Capgras syndrome.

A 35-year-old woman with Cotard’s believed that her brain was rotting and reported that she could feel worms crawling around in her brain. A 50-year-old male who believed he was dying insisted that his arm had been cut off and his fingers were being ground up. None of this, of course, was true.

Nevertheless, the patients were thoroughly convinced and could not be persuaded otherwise, even when the evidence (the arm was still attached to the body; no worms could be detected on brain scans) or logic (how can you talk with me if you have no brain?) seemed convincing to everyone else. The patients often used a logic of their own. When caregivers urged one Cotard’s patient to eat, she asked, “Why do I need to eat when I’m already dead?”

Causes of Cotard Delusion

Though very rare, Cotard delusion can be a symptom of schizophrenia; two of the 12 patients in the 2018 study also had schizophrenia. (Other studies have shown that fewer than one percent of schizophrenia patients also have Cotard’s.) However, the study also found that various neurological and psychiatric disorders were associated with the syndrome.

Three patients had been diagnosed with depression, and four had a history of addiction to opiates and benzodiazepines. Seizures, cluster headaches, evidence of stroke, lesions in the brain and loss of brain volume have also been found in various combinations in Cotard’s patients.

However, whether or not any of these conditions cause Cotard delusion is unknown. It seems that this bizarre constellation of delusions can result when any number of things go wrong in the brain.

Unsurprisingly, there is no specific criteria for a diagnosis, and there is no entry for Cotard’s in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the book psychiatrists and other mental health professionals use to guide them in diagnosing and treating mental illnesses.

How Is Cotard’s Syndrome Treated?

Devastating as these symptoms are, Cotard’s can be treated. Typically by treating any underlying neurological or psychiatric disorders with psychotherapy, pharmaceuticals or a combination of the two approaches. Electroconvulsive therapy (ECT), a treatment that involves electrical stimulation of the brain, has been shown to be effective in some patients as well.

Cotard’s syndrome is one of many neurological conditions that remind us just how little we understand how and why our brains do what they do. While treatment is available, researchers are still working on finding out more about Cotard’s syndrome.

Complete Article HERE!

How To Prepare For The Impending Loss Of A Loved One

— The Waiting Game Can Be Brutal

By Amanda Chatel

One of the few things that can make losing a loved one even harder is anticipatory grief. This is the grief that’s experienced when your loved one is still alive, but the end is near. It’s a waiting game on the inevitable, and the toll it takes can be debilitating. It’s a complicated grief that’s tied up with the fear of losing them, as well as the knowledge that when they do pass, there will be a sense of relief, something that can make people feel guilty.

“Anticipatory grief starts as soon as your loved one’s life is put into question,” bereavement counselor and founder of Grief Specialists, Maria Bailey told Refinery 29. “When you know your loved one is going to die, it’s like death by inches — you start losing little pieces of them, rather than the whole of them at once.”

There’s no easy way to lose someone we love and there’s certainly no right or wrong way to grieve. But setting time aside to deal with grief and taking steps to prepare yourself for the impending loss can help you navigate those emotions that will become all too real once they pass away. Preparation won’t erase the pain, but it will ease a bit of the emotional toll. It’s this easing that will help you get through this process.

Acknowledge your grief

woman sad on her bed

You are grieving. Accept it. Don’t try to ignore it, don’t try to outrun it, don’t try to suppress it. Grief can manifest in many ways. It can result in anger, guilt, sadness, anxiety, confusion, and even joy. These emotions can be felt at any time during your grieving process and you should lean into them and feel them. If you’re angry, let yourself punch a pillow. If you’re sad, cry your eyes out until it feels like you have nothing else. If you feel joy (yes, joy), embrace it as a momentary relief from the more complicated feelings that come with grief.

Grief doesn’t go away. It’s a human experience that must be felt in order to move forward. Putting it on a shelf won’t get rid of it. Instead, you’re just putting off something that is a necessary part of loving and losing. Every loss requires a grieving period. So embrace your emotional vulnerability – let yourself grieve now and let yourself grieve when they’re gone. This is a must for your mental, emotional, and physical health. Acknowledge that you’re grieving and expect the unexpected in regard to how you internally process your grief. That’s really the best thing you can do for yourself during this difficult time in your life.

Surround yourself with support

women showing support

According to a 2020 study published in Omega, people who are experiencing anticipatory grief have an easier time proactively coping and growing from the experience due to social support. That support can come from friends and family, or from the outside, like a therapist or grief counselor. Hanging with your friends and loved ones is good for the soul, and when you’re surrounded by people who validate your feelings and tell you it’s okay to feel as you’re feeling, it can provide a safety net to just feel, feel, feel — and that’s what you need to do.

“What we see in science is, if you have a grief experience and you have support so that you have a little bit of time to learn, and confidence from the people around you, that you will in fact adapt,” clinical psychologist Mary-Frances O’Connor told NPR. Adapting is the key here. You won’t get over the loss, nor are you expected to. What you will end up doing is moving forward and adapting. The hole that a loved one leaves in their passing never goes away and it can’t be filled. You just learn to steer your way around that hole and try not to fall in.

Be kind to yourself

woman on couch thinking

Taking care of yourself can help in overcoming the physical toll of anxiety and depression that can often accompany anticipatory grief. As much as you’re struggling, you need to be kind to yourself. You need to take a break when you feel it, eat when you’re hungry, sleep when you’re tired, and cry when you need to cry. You’re not only doing this for your physical and mental well-being, you’re doing it for your loved one as well.

“You have to put your own [oxygen] mask on first,” licensed psychologist Mekel Harris told The Washington Post. “Anticipating a loss of a family member is exhausting mentally, physically, and spiritually. If you’re exhausted, it makes it difficult to be present for the moments that you do have with your loved one.”

During this challenging time, the last thing you want to do is miss out on these final moments together. You don’t want to run yourself sick when you could be making lasting memories. As much as you’re suffering and trying to juggle complicated emotions like obligation, guilt, fear, and more, take a step back and check in with yourself. Ask yourself how you’re doing — really doing — and where you can make tweaks in your current situation to feel better. It’s important to keep yourself strong and healthy so you can handle not only what’s happening now, but the emotions that will come after your loved one passes away.

Avoid unhealthy coping mechanisms

woman drinking and eating

When faced with an impending loss, some people turn to things that will numb or at least dull the pain. That can be drinking, drugs, spending exorbitant amounts of money, and similar behavior that feels good in the moment but is toxic more than anything else. You can’t wallow in a haze forever. Eventually, you have to come up for air and face the reality of the situation.

“As humans, we often choose the path of least resistance by ignoring the cues designed by our bodies and minds to help us learn from our history and each other,” Paula Pavlova of Pavlova Wellness told Real Simple. “We use substances like drugs, food, and alcohol to drown our worries, pick little fights to avoid feeling our feelings, point out others’ flaws and hold grudges instead of looking closely at ourselves… These tactics are attractive because they’re easy — but they work until they don’t.”

You also run the risk of these coping mechanisms becoming dependencies. When that happens, you’re going to turn to these toxic behaviors every time you suffer a blow that you feel you can’t manage on your own. A glass of wine after an emotional day? Sure. The whole bottle? Put it away; it will be there tomorrow.

Know there’s no right way to grieve

sad woman in bed

Many of us have been taught that there are five stages of grief and that when we go through those stages, we’ll be on the other side of the pain. If only it were that easy. According to a 2018 study published in the Journal de Thérapie Comportementale et Cognitive, these stages don’t exist. The research found that strong yearning was the only emotional state linked to grieving, and the theory that grief stages are experienced in a certain order was untrue. While it would be nice to wrap up things into perfect little boxes, the human condition doesn’t work like that. There is no step-by-step grieving process because there is no one way to grieve.

If you grieve for months, so be it. If you grieve for years, then that’s what you’ll do. When it comes to grief, we’re here without a compass and we just have to go with it. Where it takes us, emotionally and mentally, is anyone’s guess — which is ultimately a good thing. If grief fell into specific stages, we’d all be running around with a checklist, which probably wouldn’t help the situation. So go with Rilke when it comes to grieving: “Let everything happen to you: beauty and terror. Just keep going. No feeling is final.” You will get to the other side eventually. No matter how you get through or how long it takes you, don’t sweat it; that’s your journey.

Complete Article HERE!

Hospice care has a big problem


A terminally ill hospice resident sits with a music therapist in her bed in Lakewood, Colorado.

By JOANNE KENEN

A LITANY OF WRONGS — A number of years ago, when I had a fellowship to write about end of life care across the United States, a geriatrician in California told me, “There are no do-overs in death.”

A group of prominent physicians who specialize in end of life care think it may be a do-over time for hospice. Or at the very least a gut-check. Once a movement, hospice is now an industry dominated by publicly-traded companies and private equity firms, and it’s been the subject of critical government reports and withering exposes, including a New Yorker-ProPublica investigation of the “for profit hustle.” Today, with half of all Americans dying in hospice care, some doctors believe its challenges are in urgent need of fixing.

In a six-page “call to action” recently published in the Journal of Palliative Medicine, 325 prominent doctors in this field wrote that “in recent years, we have observed an increasing prevalence of serious deficiencies in hospice care and high variability in quality of care.”

Instances of “poor care,” they said, are “increasingly common.” The signatories (some of whom are retired) include pioneers in the field, including two-thirds of the living former presidents of the American Academy of Hospice and Palliative Medicine, the professional society for these physicians.

Ira Byock, a long-time hospice and palliative medicine physician who was the lead author, told Nightly that the Academy and the main hospice trade group should do more to set quality standards and promote transparency. That would help government regulators focus on what matters to patients and families, rather than generating a lot more administrative hassles.

The essay in the journal cited a litany of wrongs — not enough physician involvement in patient care, unmanageably large nurse caseloads and inadequate, interdisciplinary care teams. The nurses, doctors, social workers, chaplains and others who are the core of hospice care, which generally takes place in patients’ homes, are overworked or not properly trained. They also said some hospices don’t have the required backups for emergencies, such as intense pain or difficulty breathing that families can’t take care of themselves. That means families dial 911, and patients end up back in the very hospitals that they chose hospice to avoid.

Some issues the essay cites reflect challenges in U.S. health care across the board — like nursing shortages after the pandemic. Others reflect the changing nature of hospice ownership and the Medicare payment system. The authors want the statement to be a roadmap as physicians negotiate with employers so they can provide consistently good care.

Ben Marcantonio, interim CEO of the National Hospice and Palliative Care Organization, the trade group, told Nightly that a small number of hospices that have committed “actually fraudulent behavior” have tarnished how hospice overall is perceived. The industry, he said, has also called for federal resources to educate health providers in the field, which will help with both workforce shortages and quality. And they’re working with the Center for Medicare Services on quality measures “that really do put the focus in the right place.” They also want Medicare to pay hospices more.

Dr. Holly Yang, president of the American Academy of Hospice and Palliative Care and a practicing palliative care physician in San Diego, said she doesn’t think hospice’s challenges revolve so much around nonprofit vs for-profit ownership, but about the Medicare hospice benefit itself. A lot has changed since Congress added hospice to Medicare in 1982 — how we age and die, and where and how families live and work and who is available to stay home and care for a dying relative.

The hospice benefit “has not changed with the times,” said Yang, who also trains upcoming hospice and palliative care doctors. Hospice in its early days was very focused on cancer, which had a more predictable and shorter course than it does with today’s treatments. And more people in hospice have conditions like dementia or congestive heart failure, where the trajectory is uncertain. People can live with serious illness for a long time but need support.

For Byock and his colleagues, calls for legislative change aren’t enough, particularly as advocates have been calling for remedies for several years and Congress isn’t racing to comply. Hospice, they say, needs to do more to protect quality, to protect “vulnerable seriously ill people with their families” on its own. There may be no do-overs in death. But maybe it’s time for a do-over of hospice.

Complete Article HERE!