Growing Older With An Eating Disorder.

“I will not eat cakes or cookies or food. I will be thin, thin, pure. I will be pure and empty. Weight dropping off. Ninety-nine... ninety-five... ninety-two... ninety. Just one more to eighty-nine. Where does it go? Where in the universe does it go?”  -- Francesca Lia Block

Left: In Rome. Right: At a Buddhist Wedding.

These pictures of me in my 20s make me feel wistful, but not because I long for my youth. In truth, my sadness comes from remembering my lack of appreciation for myself as a young woman. From the age of fourteen, I struggled with eating disorders that would often manifest during periods of distress. Regrettably, much of my youthful energy was spent exercising and dieting. I was fixated on trying to attain an idealized weight because I thought I could be happy once I was ‘perfect.’  If I could go back in time, I would give my younger self a big hug and unconditional love. I certainly needed it.

Although it’s a difficult topic to discuss, I felt compelled to share my experience after reading a recent article titled, How Eating Disorders Impact Older Women: ‘The Changing Body is a Trigger.’ Often associated with young women, incidents of eating disorders in midlife women have been increasing steadily in recent years. Weight gain and body changes, along with other stressful events such as divorce, death of parents, and financial strains are common eating disorder catalysts. Additionally, the societal emphasis on thinness and youth may evoke feelings of invisibility and contribute to women's fears about aging.  

Some women experience eating disorders in adolescence or young adulthood and may have recurring episodes throughout their lives. Other women may have their first onset in midlife or even later. How eating disorders develop is not entirely clear. Aimee Liu, author of Gaining: The Truth About Life After Eating Disorders, suggests, “Eating disorders are like a gun that’s formed by genetics, loaded by a culture and family ideals, and triggered by unbearable distress.” In looking at my own family environment, I was raised to be a perfectionist, and being ‘good enough’ was not an option. Moreover, I was expected to be cheerful and self-sufficient, even when I felt as if I were falling apart. As a consequence, controlling my weight via starvation diets and vigorous exercise became my way to cope with stress and anxiety. Sadly, these dysfunctional behaviors have been fairly constant throughout my life.

Aside from weight and body shape concerns, eating disorders pose serious health risks. According to AARP, starving, binging and purging have detrimental effects on health and may lead to heart problems, gastrointestinal problems, damaged teeth, and osteoporosis. Older women with eating disorders suffer the greatest harm, as bodies become less resilient with age. Just as alarming as the physical damage is the fact that anorexia nervosa has the highest mortality risk among all mental health issues. According to the National Eating Disorders Association, people with anorexia have a 10 percent mortality rate at 10 years with the disease, and 20 percent mortality at 20 years. 

At 50, I am experiencing bodily changes and finding I no longer fit into much of my wardrobe. Still, I have learned to be much kinder and accepting of myself. Recognizing that eating disorders can be reignited at any time, daily self-care is a priority. For many years, my eating disorder was a dark secret. I rarely, if ever, acknowledged that I even had it. Now I wonder if any women I know might be struggling with similar challenges? For readers who are in midlife and/or going through menopause, how do you feel about changes to your weight and body shape? I would be interested in hearing your thoughts and experiences. Thank you for reading my post.

Bringing Gezellig to Lives of Older Adults

Towards the end of his life, my father was left debilitated by stroke and vascular dementia. To keep his spirits high, I would find activities we could enjoy together, such as listening to music, singing and reminiscing. In looking back, those moments were magical and made us feel happy. 

-- Koko Kawasaki

Very recently, I learned about Gezellig Magazine, a digital publication filled with an array of creative activities for older adults and care partners to enjoy together. The brainchild of Debora Tingley and Patricia Ris, organizers of the Memory Care Café in the San Francisco Bay Area, Gezellig Magazine is visually beautiful and warmly inviting. Browsing through the pages, I was captivated by the contents. Needless to say, I'm delighted to share an interview with Debora and Patricia who discuss their magazine and their inspired ideas.

Patricia Ris and Debora Tingley

What inspired you to create Gezellig Magazine?
We wanted to create an extension of Memory Care Café, as thousands of people in San Francisco are living with memory loss but we could only reach a small, mobile segment of that group. Both of us have wanted to create a magazine as a resource for aging people, so it felt like a natural thing for us to do together. There are very few (if any) similar products available at this time.

What does Gezellig mean?

Gezellig is a very common Dutch word. It evokes a sense of good circumstances and feelings, a kind of coziness, friendliness and homeyness. Gezellig often means being with others, in good company. The atmosphere of a place can be gezellig, and a home can be gezellig. Gezellig Magazine aspires to bring this idea and feeling into day-to-day life. 

Where do you get the ideas for your wonderful activities?
This is one of our favorite things to do! Before we started the magazine, we found it very easy to come up with a year’s worth of topics and were able to outline our six issues in a matter of weeks! That flow likely has to do with our complementary strengths and our aligned passion for supporting care partners.

In terms of topic choice, we’re not so interested in traditional fare, but look for new activities that we’d like to do ourselves, or share with our parents and friends. Seasonal topics are important to bring the outside world in, and to help with awareness of the world around us. Of equal importance are new trends, contemporary approaches and hip topics. Our recent articles include creating personalized emojis and Be Your Own Radio Show Host, about making personal playlists, and these two examples reflect typical interests of our readers.

Nov/Dec 2016 Issue

Are there challenges in creating activities for elders and care partners to share together? If so, could you give some examples?

To appeal to our diverse audience, we created seven categories of activities to highlight different areas of interest. Within these categories, which are listed below, we offer as much variety as possible so that the activities may appeal to people from all walks of life. 

• GO: getting out and moving with a purpose
• WORDS: inspiring thoughts and actions with words
• BY HAND: easy, inventive crafts that inspire the heart and mind
• OUTSIDE: connecting with nature and life around us
• SENSES: treats for the senses
• DIGITAL: fun and simple ways to engage through the Internet
• FOOD: tasty, easy recipes to make together, chosen with current health trends in mind

Each magazine article incorporates various levels of participation. The Day of the Dead Calaveras (Skulls) making in our November/December issue, for example, offers both easy and more complex versions of the recipe. In addition, conversational material is included, in case the “doing” is not possible. In our free issue, we have an article titled Car List Poetry, about creating a poem. This activity can be enjoyed in a question and answer style, but it also lends itself very well to individuals composing their own poetry. 

Mary Beth, a reader from San Francisco, commented: "I loved the line poem about your Deux Chevaux. Lots of memories of hitch-hiking around France in those cars. Glad you put the front-door handle in the right place for the vintage I remember."

The main idea is to help people find what’s appropriate for them and not put them in a box about what they can or cannot do. People experience good days and bad days, and cognitive challenges (especially) vary greatly in one individual from day-to-day. That’s why we create our activities with the highest possible level of participation in mind, along with adaptations for specific needs woven in. The challenge is figuring out how to present options for different levels of ability in a way that is clear without discouraging people from trying something outside their perceived abilities and/or comfort zones.

What are some initial responses to the magazine? 
Here are a handful of testimonials straight from the readers:

"What a wonderful magazine Gezellig is! It looks beautiful, it is very user friendly, full of inspiring articles, ideas, outings and games and I wish we had a similar magazine in the Netherlands. A must read (and must subscribe!) for anyone who is a caregiver or family member or a senior who wants to stay active and enjoy life!" – Nanette R., Amsterdam

"This magazine takes minutes to read but gives you hours of ideas for great conversation, outings and activities…The content is well thought through and presented with purpose. I would recommend it to Elders and care partners alike." – Sean M., Sebastopol, CA

"Gezellig allowed me to engage with my parents through a very entertaining, portable and interesting platform. I felt like we were really doing something together—and not just sitting around the TV! Thank you Gezellig for your creative product!" – June K., Santa Rosa, CA

How can people contribute ideas they may have? 

We welcome contributions from readers and also from professionals. For example, healthy cooking expert Rebecca Katz generously contributed one of her favorite soup recipes, Moroccan Carrot Soup from her most recent Clean Soups cookbook. An article on making this soup is included in our current November/December issue. (Note: A link for the recipe is included at the end).

For readers, we have an invitation at the end of almost every article to share thoughts, send pictures of what they’ve created, or to send us their ideas through our gezellig community webpage. In January 2017, we will have a forum where care partners can share lifestyle ideas with each other--another opportunity for readers to take the helm and create a real, gezellig community to thrive in!

A heartfelt thank you to Patricia and Debora for their commitment to the wellbeing of older adults and for the passion, creativity and joy they bring to Gezellig Magazine. Dear blog readers, it's the perfect time of year to create a gezellig atmosphere with loved ones, so be sure to visit gezelligmagazine.com. Here are two fantastic recipes from the current issue for you to try:
Moroccan Carrot Soup: http://bit.ly/2fHfj1O
Day of the Dead Calaveras: http://bit.ly/2fnY4ihb 

A Death Café in San Francisco

"An awareness and understanding of death raises our state of life. When we are cognizant of the reality and inevitability of death, we begin to seek the eternal and become determined to make the most valuable use of each moment of life." -- Daisaku Ikeda

This year, I've had the unique opportunity to attend the Death Café. Not knowing what to expect, I listened to peoples' views and experiences about death and shared some of my thoughts in a small, informal setting. To my pleasant surprise, the discussions were lively and engaging. As a result, I felt inspired to dedicate a blog post on the Death Café. I contacted Jim Van Buskirk, who co-hosts San Francisco's Death Café each month with Danielle Brandon and Harvey Schwartz. Jim has kindly answered my varied questions about the Death Café and about his interest in death-related matters. 

What is the Death Café?

It is a group of people interested in sharing stories and experiences about a variety of topics related to death and dying. Various conversations have focused on aging parents, one's own mortality, dealing with clutter, wills and advanced care directives, communication with and visitations from the "other side"... People share wonderful stories and there is often, paradoxically, lots of laughter. Our experience shows that people are starving for a safe place to share their beliefs and fears.

Image courtesy of deathcafe.com

How did you become involved with the Death Café?

My friend Harvey, knowing my interest in death, asked me if I had heard about Death Café (DC). We were both surprised that I had not. We attended one together at Chapel of the Chimes where we met Danielle. The three of us San Franciscans decided we would co-host a DC. We looked at the guidelines at deathcafe.com and I knew that the San Francisco Public Library's (SFPL) community meeting room policy would accommodate our use of the Potrero Branch library's room. We divided up the few tasks: I was the contact with SFPL for room reservations, Danielle posted the event on deathcafe.com, and Harvey was the conduit for RSVPs. Our first meeting was a success and we have continued for over a year, with one held at the AIDS Memorial Grove and another at the Fernwood Cemetery in Marin.

Why do you think this subject interests you?

Initially I was interested in subverting the taboo against talking about the inevitable. Over a year later, my interest has deepened into a spiritual calling. I continue to read books, watch documentaries, attend presentations, and talk to people about death and dying. I am continually developing my annotated bibliography on the topic. For example, I am working with the SFPL on an ongoing series entitled, "We're All Terminal: Living with Death & Dying," in which various aspects of a range of topics are addressed by speakers, films, book discussions and/or presentation formats in an effort to offer attendees appropriate resources within their comfort zones.

Jim Van Buskirk

How has your view of death changed as a result of facilitating and taking part in these discussions?
I understand that people move through the world differently and have a wide variety of belief systems and areas of fear/confidence. Although no one knows what happens at the moment of death or thereafter, some are fearful of eternal nothingness, while others eagerly anticipate the next big adventure. The more I learn about the topic, the more fascinated I am, and the more I want to share my discoveries. Some people are eager for the opportunity to discuss the taboo topic, others remain uncomfortable.

Why do you think American society avoids talking about the subject of death? 
I have lots of theories, some related to Ernest Becker's pioneering book "Denial of Death" and the Terror Management Theory, developed by psychologists Jeff Greenberg, Tom Pyszczynski, and Sheldon Solomon, based on Becker's ideas. I also believe there is pervasive magical thinking, that if one doesn't talk about death, write a will, make arrangements, one will somehow avoid the inevitable. We as a society have outsourced so many markers of death. One used to die at home, the body washed and prepared by the same women who birthed babies, and be buried in regularly-visited church graveyards. Now people die in nursing homes and hospitals, mortuaries whisk away the body, and people are urged to "get over" their grieving process. All of this is unhealthy individually and societally. By being removed from the fact that we will all eventually die, we are removed from our humanity.

Any interesting anecdotes from the discussions?

Many, but one participant in particular, stands out. She is a beautiful young woman, a pediatrician who is dealing with her own cancer diagnosis. In her cancer support group, she is not allowed to talk about dying so she regularly comes to DC. As a physician, death is seen as a "failure" so she is not comfortable sharing her feelings in that environment. Her ability to articulate her dual perspective is a welcome addition to the group. Participants have shared death from various cultural perspectives including Italian, Irish, Jewish, Chinese, Buddhist, small town/big city, etc. Some people afterward apologize for not saying much in the group, but express their gratitude for being able to soak up the energy, saying that this is where they needed to be.

Many of us prefer not to think about death, let alone talk about it. Nevertheless, attending a Death Café may help you look at life and death in a whole new way. I highly recommend it! If you have attended a Death Café, I would love to hear about your experiences. A very big thank you to Jim for a thoughtful and thought-provoking interview. For more information on finding a Death Café near you, visit www.deathcafe.com.

On the Topic of Robots at The Legacy Film Festival on Aging

Left: Robot Dog. Right: Alice Cares.

As a graduate student, I conducted a literature review on the subject of robots as caregivers for older adults. A few professors thought this topic was controversial and would not support my paper. Even with the proliferation of robotics technology, the idea of using robots to augment the caregiver shortage is often met with ambivalence. On this subject, two robot-themed films were featured in the 6th Annual Legacy Film Festival on Aging (LFFoA): Robot Dog, directed by Drea Cooper and Zackary Canepari, about an aging (presumably childless) Japanese couple and their beloved robotic dogs, and Alice Cares, directed by Sander Burger, on a Dutch pilot study pairing Alice, a social 'care-bot', with older women who lived alone. In both films, robots provided companionship and helped decrease feelings of loneliness. In addition, Alice encouraged healthy behaviors and inspired social interactions between its users and other people.

After the screening, I co-facilitated a discussion and Q&A with Victor Wang, an MIT-trained roboticist and researcher. The interactions between the subjects and robots in the films were mainly positive, and many LFFoA audience members found the films and discussion interesting and educational. A few, however, expressed concerns, and even disapproval of the idea of robots as caregivers. I was not surprised that some people would find the idea distressing, as I found similar opinions among professors and classmates regarding my literature review topic on robots and caregiving.

Concerns often revolve around fears that reliance on robots would lead to elder neglect, or that robots would gain too much control over people. Robot technology is far from being perfect, but it's fair to say that having human caregivers does not guarantee that older adults would always receive the best care. Geriatrician Dr. Louise Aronson states many caregivers are overworked, and supplementing care with robots may reduce neglect and abuse. From a logistical standpoint, Johan Hoorn, the researcher from the Alice robot study, states that there won't be enough people to provide care for the global aging population. Utilizing robots, therefore, may become a necessity.

Left: Alice Cares. Right: Audience discussion with Victor & Koko. 

Many of our beliefs are shaped by our cultural environments, and until recently, caregiving was provided solely by people. It's no wonder that many older adults are uncomfortable with the idea of receiving assistance from robots. In contrast, the Japanese are enthusiastic towards the use of personal robots. Author Christopher Mims suggests that Japanese share the cultural belief that everything has a soul, which was also mentioned in Robot Dog. This may partially explain why older Japanese do not seem as distressed over the use of caregiving robots. Personally, I see myself utilizing robots in older age and wonder if my attitudes stem from my Japanese heritage and from growing up in a technology-dependent environment? In addition to receiving practical assistance, a robot's cool impartiality appeals to me as I imagine it would not care how old I am, what I look like, or be irritated by my personality quirks. It would not lose patience if I become forgetful due to memory changes, and it would not take things personally if I'm in a foul mood and should utter unkind words.

Quite possibly, robots may help fill the caregiver shortage in the coming years. Nevertheless, it is always critical to include older adults in the entire process of creating robotic products so they can be active participants rather than passive recipients of technology. In looking back at the LFFoA, the films on robots and older adults stimulated honest conversations about ways to support our aging family members and to think of our own needs as we age. As always, I applaud LFFoA for featuring thought-provoking, socially relevant films on aging. I'm grateful for having had the opportunity to be part of this unique event!

Adventures with The Legacy Film Festival on Aging

The Legacy Film Festival on Aging emphasizes that aging can be a great adventure. So come and see for yourselves! -- Sheila Malkind, executive director, LFFoA

What a difference a year makes! Around this time last year, I posted an interview with Legacy Film Festival on Aging's (LFFoA) Sheila Malkind about the 2015 film festival. This year, I've had the pleasure of participating as a board member with the organization. Though I've volunteered with LFFoA in the past, being on the board requires greater commitment. As Sheila mentioned before, it's hard work to put together a film festival! Nonetheless, I have no complaints as it's been a labor of love. 

As a board member, I have been involved with a multitude of tasks and gained greater appreciation for the behind-the-scenes efforts that go into the making of LFFoA. Being a small nonprofit, board members and volunteers pitch in wherever there is a need, ranging from social media postings, sponsorship requests, reviewing films, etc. It was sheer joy to dive right in and to find creative ways to connect with people and organizations to promote the film fest. With less than 2 weeks until the event, we even created a quick iPhone video PSA to be aired on a local public TV station -- my 'directorial debut!' :-)

Left: Scene from the LFFoA PSA with Sheila & Phu. Right: Howard, Phu, Koko & Sheila selfie.

All of this comes at a pivotal time in my life. I recently turned 50 and have determined to focus on projects that are both meaningful and enjoyable. Through the experience of working with LFFoA, I've been able to tap into my creativity and social media skills to contribute to a truly unique film festival. I'm grateful to Sheila and LFFoA for inviting me to participate as it truly has been an 'adventure.' 

The Legacy Film Festival on Aging is around the corner and it's going to be an enjoyable, thought-provoking event. Hope to see you there! Here's the LFFoA PSA VIDEO.

Legacy Film Festival on Aging

September 16-18, 2016

New People Cinema, Japantown

1746 Post Street, San Francisco

www.legacyfilmfestivalonaging.org

Aging & Involuntary Childlessness: Does It Affect Men?

I think it is important that the myth that men don't feel sad is busted. It is so damaging for everyone and society as a whole. - Robin Hadley, PhD

Articles and research on the effects of involuntary childlessness often focus on women. Interestingly, we seldom read or hear about childless older men's experiences and whether they feel sadness in not having children. As a Master's student, Dr. Robin Hadley sought to investigate the experiences of childless men as there was little information available. The research culminated in Dr. Hadley's PhD dissertation, Life Without Fatherhood: A Qualitative Study of Older Involuntarily Childless Men. Recently, I had the opportunity to ask Dr. Hadley some questions in his area of expertise to which he provided insightful responses:

Dr. Robin Hadley (© Paul Tonge)

How did you develop an interest on the subject of involuntary childlessness in older men?
I was looking for a subject for my Masters dissertation in Counseling and in discussion with my supervisor, Liz, I just said, "I was really broody in my 30's". She replied she'd not heard anything about that subject and so that is how it started. I then found there was very little about the male experience of childlessness and that has spurred me on. I think it is important that the myth that men don't feel sad is busted. It is so damaging for everyone and society as a whole.

Do you think there is a stigma around older men without children? 
Yes I believe there is a stigma about older men without children. In fact it is a double taboo as both older people generally are subject to ageism and the childless are seen as 'different' and suspect. The men in my recent study all reported a fear of being seen a paedophile and the view of men as a threat is reported widely in the media.

Are older men without children at a greater disadvantage as they grow older? If so, in what ways? 
It rather depends on their circumstances. However, men tend to have smaller social networks than women and when men exit work, their social network also tends to reduce. If they have a partner, they may come to rely on their partners’ social network. If the men's partner dies, their social network can again reduce. European research shows that there is no difference between the older childless and similar people with children. The difference occurs if something negative happens to the childless person. For example, if they fall ill, formal care is accessed earlier and they are more likely to be taken in to a care facility earlier and for longer compared to people with adult children. Adult children are often advocates in their parents’ dealings with health and care service providers. In the UK, there have been a number of high profile cases of poor care/abuse of older people in health and care facilities. The majority of these cases were highlighted by adult children.   

Was there anything that you found in your research that surprised you?
There are three things that surprised me: firstly, that the men very easily talked about their thoughts and feelings to a complete stranger. Many of them said this was the first time they had spoken about their feelings and thoughts about childlessness. Secondly, the fear that they all expressed about being viewed a paedophile - it is such a shame that all men are portrayed as a threat whatever their age. Thirdly, four of the men I spoke to had a role of 'grandfather'. The benefit they showed in those relationships was a joy to see.

What advice would you give to men who wished to be fathers but are childless and having regrets? 

Do something! Either talk with someone you trust or with a counselor. All the men I have spoken to considered becoming a father as natural. Not achieving it was a loss that was not possible to talk about - as men aren't 'supposed' to care! Therefore, the impact of non-fatherhood is not recognised in society and that loss does need to be acknowledged. Keeping it in and not being able to appreciate your feelings may adversely affect thoughts, feelings and behaviour. I would also consider looking at what connections you have that may give you the chance to have a role as an active uncle, grandfather, mentor or advisor. For example, in the UK many schools encourage older people to become involved in reading to children who would benefit from person-to-person learning.

Prior to learning about Dr. Hadley's studies, I had not considered how involuntary childlessness affects older men and appreciate learning about this issue. An important takeaway from this interview is that men experience sadness and regret as women do in these circumstances. Despite assumptions that men do not like to talk, they are, in fact, open to sharing their experiences. Therefore, it's vital to create opportunities for honest conversations and to truly listen. Thank you for this interview, Dr. Hadley. Additional details on Dr. Hadley's research: www.wantedtobeadad.com

Left: Graduating from Keele University, 2015. Right: Final Thesis