LEARNING AND MEMORY

 LEARNING AND MEMORY

     Most persons experience a modest increase in memory problems as they get older, particularly with regard to the ability to remember relatively recent experiences.  Decrements are found both in the ability to accumulate new information and in the ability to retrieve existing information from memory storage, although there is little decline in the ability to store new information once it is learned.

     The process of learning new information and encoding it for storage requires more time as individuals get older, because of the reduced efficiency of neural transmission and because of sensory deficits that limit one’s ability to quickly and accurately perceive information to be learned (as discussed above).  In fast-moving day-to-day experiences, this may prevent individual experiences (e.g., the name of someone to whom one is introduced) from receiving the attention needed for complete encoding into secondary memory.  In addition, the extensive life experience of older persons makes it more likely that new information will not adequately be distinguishable from previous learning (e.g., the names of other similar people one has met over the years), making it difficult to establish unique cues and linkages for new experiences.

     Older persons also experience decrements in their ability to retrieve information once it is stored.  In part, this is because of the difficulty identifying just the right piece of information from the vast store of information they have accumulated over a lifetime of experiences.  This can be particularly difficult when the new information resembles previously learned information ( d.g.,when one is trying to recall a phone number from the thousands of phone numbers that have been learned over a lifetime).  Consequently, older persons tend to do considerably worse than younger persons on tests of free recall, where they are asked to retrieve learned information but given only minimal cues.  However, few decrements are found when older adults are given sufficient orienting parameters to limit the scope of the search, or are asked to select the correct answer from among a small number of options (e.g., on a multiple choice test).

     Older persons seem to have a better memory for certain events that occurred in the distant past than for recent experiences.  To a larger extent, this is because the distant events that are remembered are those which either have special personal significance (e.g., the birth of a child, the end of ‘world War II) or are so unique that they are not affected by subsequent experiences, (  e.g., childhood occurrences).  Such experiences are apt to have been rehearsed mentally numerous times throughout one’s life, increasing their familiarity and making them easier to recall than are mundane aspects of one’s day-to-day  life.

     Finally, it is important to note that cognitive processes such as learning, memory, and intellectual functioning are extremely responsive to a person’s physical and psychological state.  Physical illnesses and medications can affect neuronal function and also reduce the energy available for cognitive processes.  Depression and other emotional conditions that involve impaired self-esteem and reduced confidence in one’s own abilities can significantly impair one’s motivation for  learning and remembering new information.  Among depressed older adults, for example, memory complaints can increase and memory performance can decline even in persons who do not have any actual impairment in cognitive functioning or learning ability.  Moreover, older adults who have adopted the popular stereotype that forgetfulness is inevitable in old age may experience increased anxiety and reduced self-confidence when confronted with normal memory tasks resulting in memory problems that would not otherwise have had.

     

                              

     

LEARNING AND MEMORY

 DECISION MAKING BY ELDERS

     

     When making decisions, older persons have been found to sacrifice speed for accuracy, rejecting quick, simplistic solutions to problems and preferring to work slowly, examining issues from a variety of perspectives before selecting a response.  Finally, many of the health problems which are more common in later life (e.g. cardiovascular problems) can significantly affect cognitive functioning as well as test-taking ability.

     Not all cognitive changes later in life are negative, however.  Older persons typically exhibit greater experience-based knowledge, increased accuracy, better judgment, and generally improved ability to handle familiar tasks than younger persons.  Such applied knowledge, or wisdom, may, in fact, be considerably more important to one’s ability to accomplish most tasks of day-to-day life than are the abstract abilities tapped by intelligence tests.

     Even when physical or cognitive competencies are affected by the aging process, older adults often are able to develop strategies for compensating partially or totally.  For example, older typists have been found to type as quickly and accurately as younger typists even though they are unable to move their fingers as fast, because they have developed a better ability to anticipate upcoming words and locate the proper keys on the typewriter.  In general, older adults can perform about as well as younger persons on tasks which provide sufficient opportunity to compensate for slower physical and cognitive functioning.

Chapter 9 continued

     We moved, and it was not much fun.  It just about killed Wayne to work so hard, even though our son-in-law and his crew did most of the heavy moving.  It was still a lot of work emptying and cleaning the two houses.

     Trying to fit two houses into one was a chore in itself, but we managed, although it meant getting rid of all my antiques, and packing up my art supplies and storing them for another time, since our new house didn’t have any place for me to do my artwork.  It was placed on hold and again I adjusted to the situation at hand.  Actually, moving may be a lot of work, but it is wonderful to clean out all the old items that aren’t really needed.  My cupboards had never been so clean.  

     Our portion of the house was split-level and consisted of two bedrooms and an office that was reached by climbing five stairs.  The living room and kitchen were on the main level and Mother was downstairs in the family room, now transformed into her living room.  With the bedroom, laundry room, and bath downstairs, she was perfectly comfortable.  Of course, she had to climb nine stairs to reach our portion of the house, which was almost more than her heart could take.  She loved living with us, so for a while she climbed the stairs.  However, that didn’t last long; her heart bothered her too much.

     We learned that stairs were not appropriate for a heart patient or a person on dialysis.  I knew that, sooner or later, Wayne would have problems with the stairs, and Mother already did, I was right.  Wayne began to have problems after living in the house for three years.  His legs grew weak and he had trouble mounting the stairs to the bathroom and bedrooms.  This was only the beginning of his problems.

     I learned enough from the three family members we had cared for to understand my mom when she moved in with us.  We were honest with each other.  If we were upset, we talked it out.  I tried to take her out of the house at least three times a week.  I encouraged her to invite friends over and to attend church and all its functions.  This kept her happy and in touch with the outside world.  As she became unable to get around much due to angina, I took her places in the wheelchair.  She hated the wheelchair, but he loved to shop and spend money.  I didn’t want to make the same mistakes with her that I had made with my mother-in-law.  Mom was a big help to me in preparing meals.  Even though she couldn’t mount the stairs, I brought her vegetables to clean, salad to make and beans to snap.  She felt a part of the family, even though she wasn’t upstairs with us.  When Wayne was gone, we went out to lunch together or shopping .  And I always took her too the beauty parlor on Saturday to have her hair done, sometimes even a manicure.  We had fun together and it kept her active.  She kept a positive attitude and so did I.

     One of the problems of grown children who care for their parents is underestimating the intelligence of people at an advanced age.  The notion that older people lose mental abilities with the deterioration of the body is simply not true.

     I have to admit I was somewhat condescending at first to my mom and my mother-in-law, the two women I cared for, but I quickly learned to correct that attitude.  Of immense help to me was the Curriculum Module on the Aging Process, a study made possible by funding from the University of California.

     I have excerpted sections of the report prepared by Andrew E. Scharlach and Barrie Robinson and reproduced them here under heading that are mine.  I think you, the reader, will find that your conceptions of aging change as you take in the facts presented.

     

CHAPTER 9

CHAPTER 9

MOM MOVES IN

     During the time my Dad was ill, Wayne’s kidney function dropped to only five percent.  His condition made it necessary for him to begin dialysis.  According to his doctor he had a choice to make; to be on machine dialysis, called hemodialysis, or to use Continuous Ambulatory Peritoneal Dialysis (CAPD).  The CAPD procedure can be done at home every four to six hours, whereas the hemodialysis is done three times a week at a clinic and takes four hours for the process, CAPD allows the patient to lead a normal life and not to be tied down, so Wayne chose that one.  Since he loved to play golf and often attended golf tournaments with is friends, this was a perfect dialysis for him.

     We both took lessons for two weeks learning the procedure, then they surgically implanted a tube in his peritoneal cavity to accept the solution that would cleanse his blood and organs of the impurities and remove the fluid build up from his failing kidneys.

     He also had the option of putting his name on the waiting list of people who needed a donor kidney, but his age and physical condition were against him, or so the doctor said.  He was’t ready for that decision since he believed he could live a long time on the dialysis.  His doctor assure us that he had patients who had successfully been on CAPD for twenty years.  Since Wayne was sixty-five, he decided he could live out his life with CAPD.  Looking back I can see that we were rather naive to think he wouldn’t have any problems along the way.

     Not long after Wayne began dialysis and my father passed away, my mother became afraid to live alone.  This is quite a common reaction for a widow and I thought that eventually she would get used to the idea and settle into a normal routine.  How wrong I was.  She wanted me to sleep over at her house for the first month that she was alone.  I urged her instead to come to our house, but she refused, even though we lived right next door.  I think I agreed to stay with her hoping she wouldn’t need me too long.  It became a problem for me, because I had to get up early in the morning, go home, shower, dress, feed Wayne and get to work by 7:30 a.m.  I don’t know why I gave in to her wishes, because then it was hard to stop..  When I began tapering off on the nights I stayed at her house, I felt guilty when she started crying.  She finally suggested that we add on another room for her, but she didn’t think that would be enough.  She wanted at least three rooms, and that would have cost an arm and leg.  I don’t know why I felt so obligated; she had a nice house and so did I...why couldn’t she leave it at that?  i tried to convince her that she should take in another woman to share her home.  But she had her mind set to live with us.

     My mother and my husband got together and started to look for a new house, one that had plenty of room for all of us.  I finally gave up resisting the move and started looking for a house with five bedrooms all on one floor, with no stairs, because of Mother’s heart condition.

     The realtor looked for this type of house, but there was nothing available.  I was happy about that.  I thought if I could hold them off for a while, maybe Mother would forget about the whole thing.

     She didn’t give up..  We looked and looked until Wayne finally found a house.  It was every that we didn’t want.  Everywhere stairs, stairs and more stairs.  The one redeeming factor about this house was that mother would have a separate apartment downstairs.  It had a large family room with a wet bar that could be transformed into a kitchenette with a refrigerator, microwave and sink.  There was also a bedroom, a bathroom with a walk in shower, and laundry room on that floor.  Even though it was everything we said we didn’t want, Mother and Wayne loved  it.  We sold both our houses and bought it.  It was a nice house, just not what we started out to buy.  I knew that it would cause problems in the future, but I didn’t know how many.  I soon learned.

I BROKE MY CHRISTMAS TREE

     I BROKE MY CHRISTMAS TREE

     The time has come to shop for that perfect Christmas tree.  Some families take a weekend and go to the mountains to find their special tree, others go to a tree farm to cut one, but most people simply buy a tree in town.  Whether you buy it or cut it yourself the crop of trees this year is great.  I’ve spied pines and nobles that would take your breath away, expensive but great.

     Now, me, I opted for an artificial tree again this year.  I have used the same tree for about fifteen years now and I love it.  It’s always perfect and looks lovely with the flocking on all the branches.  However, this year I don’t have room for a tree as wide as the old one, so off I went to buy a new tree, a pre-lit tree this time.  All I should have to do is the fun part, decorating.  I do love to decorate.

     Well, I brought home a 6 1/2 foot tree, pre-lit of course, and started to put it together.

  Now, you would think that a moderately intelligent woman, such as myself, could assemble a tree with no problem, right?  It only had four parts, the stand, the bottom section, middle, and the top.  Okay that’s easy!

     I read the instructions twice, (I’m pretty dense,) and laid out the parts of the tree as they suggested.  The instruction sheet said to remove the extension cord strapped to the bottom section of the tree, which I did.  And then, I was to put the bottom portion in the stand and tighten it, which I also did..nice and tight.

     This is where I ran into trouble.  They must have attached the extension cord to the wrong section of the tree, because when I tried to add the next section I found it was bigger...Oh! Oh!  I put the wrong section in the stand.  Well, no problem, I thought I’d just remove it and place the bottom piece in the stand and start over.  That’s easy enough.  Wrong!

     I rectified my mistake, however, now the middle piece wouldn’t fit.  I figured the pipe must be out of round from putting it in the stand, (I didn’t realize I caused dimples in the metal when I forced it into the stand,)  so I took the hammer and tried to tap it down into the pipe.  It wouldn’t go, now what?  I was compounding the problem, for now the top of the pipe was bent over from hitting it with the hammer.  Smart, really smart!

     There I was sitting in the middle of the floor with pieces of my Christmas tree laying around me, laughing at my own stupidity.  How could I mess up such a simple job?

     
I thought to myself, “Well I can always buy another tree.”

     Now, my daughter bails me out of these little predicaments I get myself into, so I called Casey and through my laughter I said, “Casey, I broke my new Christmas tree.”

     Casey started laughing and promised to come over the next morning and look at it.

     “How did you manage this mother?” she laughingly asked.

     I said, “Believe me darling, it wasn’t easy.”

     We cut off the dimpled and bent parts of the pipe and finally got the tree together.  Although it was slightly shorter, I still enjoyed it.

     It’s funny how a simple job, like putting up a Christmas tree, could cause so much trouble.

     I still contend the instructions were flawed.  That’s my story and I’m sticking to it.

Chapter 7 continued

CHAPTER 7 CONTINUED

     Keep the lines of communications open with the whole family.  This is often hard to do when brothers and sisters ignore their duties to their parents, as the following story from Anne demonstrates.

     My husband is a lot of support most of the time.

     Right now, he’s getting a little tired of sleeping on the sofa bed in the living room so my mom can have our room.  For the first four months we slept on a futon mattress on the floor; the couch is actually a  step up.

     My brother and sisters are unfathomable to me.  My parents were always there for them and me.  How they could turn their backs when my mom needs them is a mystery.

     I believe the season they don’t call is because then they just don’t even think about it and they hope it will eventually a go away.

     The thing that most depresses my husband and me is that this cycle will never end for us.  We know that Mom will never be able to live on her own again.  She will be with us for the rest of our lives.  What worries us most is what will happen when we are no longer here for her.  We don’t want our daughter to feel that she will be responsible for her.

     But the bottom line with all of this is love.  When you love someone, as I do my mother, it’s not what you say that matters in the long run, it’s what you do.

                                                                                       

                                                                                            Anne

CHAPTER 8

MY WONDERFUL FATHER

     Daddy had been feeling ill for some time, but he refused to see a doctor.  He kept saying that he was just getting old and lazy.  Daddy was always that way.  He never wanted to cause anyone any trouble  He was getting on in age, so we didn’t think too much about it.  One night my mother called and said that Dad needed to go to the hospital.  I immediately thought that his heart had given out.  He had many heart attacks during hsi last years, but luckily he sprang back eah time.  When we first arrived at the hospital, no one knew what the problem was.  We admitted him and the staff began to run the ormal test, which showed that he had an aortic aneurysm.  They transferred him to St. Vincent’s hospital in Portland to perform surgery.  This was my first long visit to St. Vincent’s Hospital.

      After more tests, the surgeon talked with me.  He wondered why Dad’s liver was showing problems.  when I told him that I didn’t know, but that daddy was treated for colon cancer sixteen years earlier, he started looking deeper.  Ufortunately, when they opened him up he was riddled with cancer.  The prognosis was terminal.  He had only one to six months to live.  As it turned out, he didn’t even have a month.

     My father was a kind man.  even when he was ill, he didn’t want to bother anhyone with his pain.  he just waited until he could no longer tolerate it and then it was too late.

     We brought him home to care for him.  Of course, we could have placed his wishes.  Besides, we wanted him close to us during his last days.  We installed a hospital bed at my parent’s house and proceeded to take care of him ourselves.

     Hospice was a big help in his care.  As his condition worsened, nurses administered pain medication and we had a list of caregivers that could assist us at night.  Mom was getting worn out taking care of Dad day and night.  I helped her as much as I could.  Fortunately my parents lived right next door to us, so when Mom needed me, I could respond immediately.

     Naturally it is hard to watch someone you love die a little each.  We cried a little at first.  It was such a shock to know that our father was going to die in a short time.  But daddy said that everyone dies when it is their time.  “God will take me when he is ready for me,” he said.

     Every day he would sink a little deeper.  My father was determined that he would live until their sixty-fifth wedding anniversary and his birthday, which were both on the same day.  He didn’t want Mom to remember their anniversary as the day he died.  When September 20 came, he gave Mom a diamond ring that she had wanted.  Then he asked me if I would take care of Mom and I promised I would.  He lapsed into a coma, and never awoke.

     Our family came up from California, but he was already in the coma.  I think that he knew they were there, but he couldn’t respond.  He died on September 26, six days after his anniversary and his birthday, quietly, as he had lived.  With no fuss, no trouble to anyone, he just drifted into that eternal deep, content in the knowledge that I would take good care of his wife.

     That is all my dad ever wanted, to take good care of everyone.  He started young when he quit school in the tenth grade to earn money to help the family.  He sold papers on the street corner, he was so young people thought he was cute and bought his papers, and he always sold out.

     Dad love people and it showed.  he never had an enemy and he would give you anything he had, if you needed it.  He took care of his father and two brothers after his mother died.  In addition he raised four children of his own, while working two jobs and building a big house for everyone to live in.

     My journal entry for September 26, 1992

     Daddy is dead.  He went peacefully at 8:35 A,M.    I didn’t really think it would be so quick.  God was good to him, taking him without a long illness and a lot of pain.  I guess he has been going for the last year or so; we’ve all known it was coming but it speeded up when they tried to do surgery on him.  He might have lasted longer if they hadn’t opened him up.

     I wonder if his spirit was watching us cry for him as we stared at his lifeless body.  He was so still, with hands laying on his stomach.  You would have thought he was sleeping, if he hadn’t been so yellow.

     I really believe there is a crossing-over time, that the spirit is suspended on Earth for a time and can watch the transition of the family.  At least, I hope so!  Goodbye, Daddy.

     After Dad died our family sat around and talked about all the good times we had in our lives together.  We laughed at the dumb things we did, and reminisced about building our house in Michigan.  It was a time for reflection, a time to remember the good times...there were so many.

     When your loved one passes on, you still have memories, memories of better days when you were young and sometimes foolish.  These precious memories are locked in a special place in your heart, waiting to be brought out when you want to be close to him again.

                                           THOUGHT FOR THE DAY

                        The purpose of life is to serve and to show compassion

                        and the will to help others.  Only then have we ourselves

                                        become true human beings.

                     

                                                                                   Albert Schweitzer

CHAPTER 7

IT’S THE LITTLE THINGS THAT MAKE US HAPPY

     You may wrongly believe that taking in one person is inexpensive.  After all, how much can they eat?  You’ll soon learn that they will want special foods---their kind of food, not yours.  They want little things like Kleenex, special toilet tissue, a certain cereal, and many many items that you don’t have in your house.  Accommodating their wishes and making your home as much like their own life style as you can really makes your role a lot easier.  I found this out the hard way!

     When I brought my mother-in-law her lunch one Saturday, she said, “I don’t want this crap again.” (“crap” was one of her favorite words.)  I had warmed some roast from last night’s dinner for her, with potatoes and gravy, vegetables and bread, thinking she would like it.  But she let me know in no uncertain terms that she did not like eating the same meal two times in a row.  We were accustomed to leftovers the day after a roast beef dinner.  You know, hot roast beef sandwiches or cold sandwiches.  We liked leftovers.  She didn’t!

     Thinking I could make her happy by giving her something special, I asked her what she would like, if she could have anything she wanted.  That was a real mistake.  I thought she would request something easy, not a whole meal that was completely foreign to me.

     She answered, “You wouldn’t be able to fix it, even if I told you what I wanted.”

     I said, “Try me.”

     After a long silence while she thought about it, she said, “I’d like to have some friend chicken livers, black-eyed peas and some white hominy, both flavored with bacon grease and bits.”

     Boy, was I sorry I had asked.  This was definitely not the kind of food I keep in my cupboard.  But, I had asked so I thought I would make a stab at fixing it.  It was Saturday; my husband was off playing golf with his friends and I had all day to experiment.  If it made her happy, it would be worth the effort.  I drove to the store and found the chicken livers easily, but the black-eyed peas were a different story.  I went to two different stores before I found them and the hominy.  I hurried home to start my Southern fried dinner for Mother.  Actually I enjoyed the prospect of doing something that might make her happy.  I hoped.

     Mother gave me instructions for cooking this culinary masterpiece, so I breaded the chicken livers and placed them in the hot grease to brown, while I simmered black-eyed peas and the hominy in bacon grease, with a little of the liquid from the can.  I thought it smelled terrible, except for the chicken livers and onions.  When I finished cooking, I laid the meal on a pretty tray, with a flower in a small vase.  There was everything she wanted along with a hot cup of coffee, which she loved.  It really looked pretty darn good.

     I took it to mother and she gazed in amazement at the repast.

     “I didn’t think you would really make it for me,” she said.  She lit up like a Christmas tree and seemed happy for a change.  She took three bites of each item and quit.  that is all she ate of this special meal I worked so hard on, but at least she was happy for a change.  She drifted off to sleep, content.  It was a small thing, but it was important to her.  I’m glad I tried.

     I didn’t bother freezing the leftovers, thinking that she wouldn’t eat them again anyway, since she didn’t like to eat things twice in a row.  but it wasn’t long before she asked for a repeat of this meal.  Since I had thrown it out, I had to start over again.   Oh well, it was easier the second time.  At least I knew where to find the items and I froze all the leftovers, this time

     When I told my husband of the incident, he laughed.  He said that was the kind of food her family had always eaten.  I learned something that day.  It is the little things that make us happy.  I wouldn’t have imagined a heavy Southern meal was to her liking, but I started asking her each Saturday what she would like.  Saturdays were my days off and it was easy for me to find any unusual food items she might want, I was amazed at the difference it made in her attitude, and she began looking forward to Saturdays and her special meals---and so did I.

     It is the little things that make u happy.  They can be expensive, so if you have family to help ease the financial burden, now is the time to ask for help.  Siblings could relieve you once in a while or contribute financially to the patient’s care.  We would like to think that all of the family would take their turn with the care of their parent.

     Some family members have opted to move the parent to each of their houses on a rotation basis.  One or two months are spent with each child.  If the parent agrees and is able to get around, it can work.  It might be difficult if the parent is not ambulatory.  Moving so often can be hard on the parent, but it will be easier on the family when they all take turns caring for the parent.  Of course, the whole family should discuss the parent’s care.  After all, the parent belongs to everyone in the family.  If it is decided that one sibling will be the primary caregiver, while the rest could help monetarily.