Chapter 3
The Looks of Aging

Why is it that the elderly become so inconvenient and
difficult to care for that we no longer want them at home?
Growing up as Virginia did, without many older people
around, she did not have much comprehension of the effects of
aging and the changes she saw in her parents prompted some
questions. What seems to happen to the body and mind as
the years pass? As a younger person, she didn’t even wonder.
Watching her aunt and her parents decline in function she saw
their need for assistance increase. Aunt Rose slowed down
from her tremendous pace and went from traveling the world
to being content to stay in her apartment in Florida. She had
always possessed a remarkable curiosity about everything,
but as her years increased her energy declined diminishing
the level of interest. She did however have a great sense of
humor and it stayed with her until she died. Although Virginia
was close to her aunt, she had never spent extended periods of
time with her and changes in her behavior were not a concern.
When Virginia saw her in her later years, she did notice that
her aunt seemed to tire quickly, spending a lot of time sleeping.
Her mother would comment on it from time to time.

Virginia’s parents kept up their activities but she
couldn’t help noticing a change in their level of interest and
energy. They were always on the go but suddenly, they, like
her aunt, became content to stay at home. One year, they
went on a family vacation to Sedona, Arizona. Alice hadn’t
been to that area in many years but Virginia remembered from
her childhood how her parents loved the southwest. She was
confident they would enjoy the trip. The blooming desert
flowers were exquisite and the contrast between the red rocks
and blue sky was straight out of a travel magazine. The day
after their arrival Alice started asking when they would be
leaving. No amount of scenery, excursions, entertainment or
shopping could distract her from her goal. When were they
going home? On the morning when they were set to leave,
around mid-day, the children were enjoying a last swim in
the hotel pool. Virginia found her mother sitting on the edge
of her bed, dressed for the trip with suitcase packed and
firmly closed. Virginia was disappointed at the outcome
of this vacation and learned a lesson. No more trips. Her
mother seemed to have lost the spirit of adventure that she
had inherited. At the time, she didn’t understand the meaning
of this type of behavior. She was used to both of her parents
being more active, eager to explore and see new things. She
didn’t want a change in the status quo. She easily grew
impatient with them and reacted by leaving to go back to her
own life and, although she still worried, she wasn’t sure what
she was worrying about. As her parents were aging, they were
changing before her eyes.

At the time of the Sedona trip, although her parents
did not have specific physical limitations other than a little
stiffness and moving more slowly, they did not like being
out of their comfort zone. Unfamiliar territory away from
home made them anxious and insecure. What if they got
sick? The doctor was a long way away. Virginia discovered
that environment, especially familiar surroundings, plays a
large part in the sense of well-being. This was even more
obvious with Aunt Rose whose home was important and gave
her confidence. In her eighties, her aunt moved out of her
house and into an apartment in Florida. No one forced her. It
was her choice. The apartment was stuffed with collectible
artifacts and furniture she had acquired from around the world.
She had finally given up traveling except for one visit, when
she was eighty-three, to Singapore, her favorite city and one
she knew well. She knew it would be her last trip so she
stayed for several months. When Virginia went to visit her
parents, Martin would pick up Aunt Rose and bring her down
to stay for a few days. As Aunt Rose grew older, Virginia
noticed that she was a little unsteady on her feet and seemed
a bit confused during these short visits. She would apologize
for walking slowly. The minute she returned to her apartment
she was fine again. She became confident and happy to be
hostess when she was in her own environment, surrounded by
familiar things. She felt secure in her new building: she played
bridge with fellow residents, had a cocktail before dinner,
and was generally happy. The relationship between aging
and environment seems to be a close one. Familiarity breeds
confidence and fosters independence. In Aunt Rose’s case, the
aging process seemed to be gradual and graceful, especially
with a little assistance.43 She remained independent until, at
the age of ninety, she passed away peacefully. That is not the
case with everyone.

Chapter 6
Who Are You, Who Am I?

Working with clients suffering from Alzheimer’s
disease was a challenge for Virginia. She had heard the
disease described on a radio program as a “gluing up” of the
brain. Alzheimer’s disease takes its name from Dr. Alois
Alzheimer, a German neuropathologist, who lived at the turn
of the twentieth century. In 1901, upon examining a fifty-one
year old female patient with dementia symptoms which, at the
time, were associated with extreme old age, Dr. Alzheimer was
perplexed. Why should a middle-aged woman be suffering
from the effects of old age? Her condition continued to
deteriorate while she was at the clinic and ultimately, she
was reduced to what could be called a vegetative state. Four
and a half years later when the woman died, Dr. Alzheimer
was anxious to examine her brain. Looking through a newly
invented microscope at stained slices of her cortex, the doctor
discovered a disturbing phenomenon. Lumps of plaque
and tangled bundles of fibrils had strangled the neurons that
normally operate as message carriers in the brain.105 The
neurons and the neurotransmitters, chemicals that send
messages to cells, are responsible for everything from walking
and talking to memory.106 The neurons were so compromised
by debris that they were unable to operate. This gluing up is
generally thought to begin in the hippocampus (the area of the
brain controlling emotions, learning and short term memory)
and moves on from there until many parts of the brain are
affected.107

This altered condition of the brain reminded Virginia
of a spark plug trying to fire. The poor spark plug sputters
and spurts away, but a lot of built up gunk sadly prevents it
from doing its job. It never produces a good enough spark,
so the engine doesn’t fire. Although lack of maintenance was
probably responsible for the poor performance of the spark
plug, this is where the analogy ends. The cause of the strange
physiological occurrence now named after Dr. Alzheimer
has, as of yet, not been determined. A disturbing statistic
reports, after the age of eighty-five there is a fifty percent
chance of developing Alzheimer’s disease. 108 There is no
cure, but some medications seem to slow down the process.109
However, slowing down the process is only treating the
symptoms.110 A vaccine to stop plaque formation may be in
the works but plaques may not be the only problem. There are
a lot of buts.