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Sunday, August 10, 2008
Simulating Age 85, With Lessons on Offering Care
What does it feel like to be old in America? At the Westminster Thurber Retirement Community here, Heather Ramirez summed it up in two words. “Painful,” she said. “Frustrating.”
Mrs. Ramirez is only 33, but on a recent morning she was taking part in a three-hour training program called Xtreme Aging, designed to simulate the diminished abilities associated with old age.
Along with 15 colleagues and a reporter, Mrs. Ramirez, a social worker at the facility, put on distorting glasses to blur her vision; stuffed cotton balls in her ears to reduce her hearing, and in her nose to dampen her sense of smell; and put on latex gloves with adhesive bands around the knuckles to impede her manual dexterity. Everyone put kernels of corn in their shoes to approximate the aches that come from losing fatty tissue.
They had become, in other words, virtual members of the 5.3 million Americans age 85 and older, the nation’s fastest-growing age group — the people the staff at the facility work with every day.
What a drag it is getting old, even if it’s just make-believe.
As the population in the developing world ages, simulation programs like Xtreme Aging have become a regular part of many nursing or medical school curriculums, and have crept into the corporate world, where knowing what it is like to be elderly increasingly means better understanding one’s customers or even employees — how to design signs or instrument panels, how to make devices more usable.
With the baby boomers edging into their 60s, engineers at Ford and other car companies have designed elaborate “age suits” that restrict movement and blur vision to approximate the effects of aging.
“I must say, you look lovely,” said Vicki Rosebrook, executive director of the Macklin Intergenerational Institute in Findlay, Ohio, which developed Xtreme Aging as a sensitivity training program for schools, churches, workplaces and other groups that have contact with the elderly.
Then Dr. Rosebrook put the group through a series of routine tasks, including buttoning a shirt, finding a number in a telephone book, dialing a cellphone and folding and unfolding a map. The result was a domestic obstacle course.
Some tasks were difficult, some impossible. The type in the telephone book appeared microscopic, the buttons on the cellphone even smaller.
And forget about refolding a map or handling coins from a zippered wallet.
Dr. Rosebrook told the group an anecdote about being in a department store behind a slow-moving older woman, when an impatient customer behind her called the woman a “Q-Tip head.”
“The next time you’re in line at the grocery store and you’re thinking, ‘You old geezer, hurry up,’ just think about how this felt,” she said.
Dr. Rosebrook, 55, said she started Xtreme Aging three years ago after a teenage clerk at a hotel joked about her husband being a member of AARP. “We all started sharing experiences and realizing things that we perceived as discrimination,” she said.
She said she hoped to provide more training in the corporate world: at hotels or theme parks, at department stores or customer service centers. “But there’s a lot of denial out there,” Dr. Rosebrook said. “They don’t see a need. We can’t even get AARP.”
The Macklin institute and Westminster Thurber both subscribe to a model of care for older people called the Eden Alternative, designed to reduce the isolation, boredom, loneliness and helplessness that plague old age. At Macklin, older residents spend days with children; at Westminster Thurber, administrators are experimenting with a small communal house for people with dementia.
Xtreme Aging is meant to foster sensitivity both inside and outside facilities, Dr. Rosebrook said. “You people already get it,” she told the group, adding that her most memorable training sessions had been with children or factory workers. “They related to it emotionally,” she said. “They said, ‘That could be my mother,’ or ‘That could be my grandma.’ ”
To approximate the state of people entering a nursing home, she asked each participant to write down five favorite possessions, five cherished freedoms and three loved ones on Post-it notes. Then one-by-one she asked members of the group to part with a possession, a freedom or a person: a car here, a husband there, freedom of travel next — until all that anyone had left were two possessions.
“You guys just aged to the point of going into a nursing home,” she said, as participants made the last hard choice, invariably giving up contact with their children. “What did you give up? All your loved ones. All your privileges. And at most nursing homes you only get to bring two possessions.”
She asked, “How did that make you feel?”
Hands went up.
“Like I want to die.”
“Like I failed.”
“Now,” Dr. Rosebrook said, “how many of you look forward to living in a typical nursing home?” No hands went up. “But this is what we do to people. If we’ve taken everything away, what have we done to the elders in society?”
Kim Hansen, 46, who works in the facility’s rehabilitation unit, said the hardest part of the exercise was giving up the people in her life. “I gave up my parents first,” she said. “Then it was between my husband and my kids. I gave up my husband. I got very emotional with that.”
Westminster Thurber runs its own aging simulations once a month. Michele Engelbach, the facility’s administrator, said she brought in the Xtreme Aging program, at a cost of $60 per participant, because “it’s really important to have as much sensitivity training as possible. We don’t know what it’s like to lose our faculties. The better we can understand, the more effective we can be with our residents.”
The simulation is not quite like the aging process. As people get older, they lose their abilities slowly, and compensate by adjusting their behavior. But Robin Eggers, the director of nursing at Westminster Thurber, said the simulation would help staff members see that the hardships of aging could be overcome.
“You can have this pain and disability at any stage; it’s not just limited to the elderly,” Ms. Eggers said. “But things don’t have to just shut down.”
Among the most difficult tasks, Dr. Rosebrook asked the participants to hold a pencil in their nondominant hand and rotate their off foot counterclockwise, then write their name, address and telephone number using their nondominant hand. “Come on, come on,” she said, “we don’t have all day.”
Groans went up. Pencils traced erratic scribbles. No one finished in the few minutes allowed.
“That could be what it feels like to experience a stroke,” Dr. Rosebrook said. “Your dominant side doesn’t work, you’re fearful, there’s a lot of anxiety.”
Mrs. Hansen looked at the scribble in front of her. “So is this what it’s going to look like when I get up there?” she asked.
At the end of the simulation, the effects of aging receded as quickly as they came on.
Mrs. Hansen said the program gave her a cautionary view of her future. She added that it made her feel good about working with older people.
“This gives me the satisfaction of knowing that I’m doing the right thing for the elderly,” she said. “It’s the right thing to do.”
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