Reflective Book Review: Still Alice by Lisa Genova

Genova, L. (2009). Still alice. New York, NY: Pocketbooks. $15.00. ISBN:1439102813.

    I cannot remember the last time I read a book from beginning to end, completely hooked the entire time! Still Alice by Lisa Genova really reminded me what that experience was like. Genova’s remarkable novel captures the devastation of early onset Alzheimer’s through the eyes of a Harvard neuropsychologist diagnosed at only 50 years of age. Although Alice is “lucky” enough to catch the disease early, there is no way to completely avoid its progression. Author Lisa Genova has a very natural way of teaching so that the reader doesn’t feel too distracted by the learning process. Actually, I was so emotionally connected with the characters that I almost didn’t realize the density of facts I was simultaneously absorbing. Still Alice is a rarity in literature as it fully captures the personal, subjective experience of Alzheimer’s, while also reassessing essential priorities in life.

    Although Alzheimer’s brings many losses to Alice’s life, the illness may have brought some underlying positive attributes that may be considered in analysis. In one aspect, she bonds closer to her family, and is forced to live for day to day pleasures. Alice says herself later in the novel, “My yesterdays are disappearing and my tomorrows are uncertain, so what do I live for? I live for each day…I will forget today but that doesn’t mean that today didn’t matter.”2 She also grows closer to her free-spirited daughter Lydia, whom she was never able to relate to in the past. Now Alice’s hard set opinions on Lydia’s life become less important as it is the relationship and emotional connection that suffices. Even through the lens of a tragic illness, the story brings a few positive, philosophical themes.

    The viewpoint of this book was very striking. Although it is in third person, it is very subjective to Alice’s experiences. My very first reaction reading the novel was disappointment that we didn’t have the advantage of first person perspective. What I began to notice was how the viewpoint focuses solely on Alice, and tells objectively what she would subjectively observe. The text is then able to present quotes from her internal dialogue without the reader losing sight of what is real and what is not. As you can imagine, this stability within the narration is important to maintain reader clarity as the disease continues to progress. For example, when Alice doesn’t recognize family members, quotations are expressed by “The pretty lady in pajama’s said…”2 when in fact this is Alice’s daughter Anna, an extremely well known character to the reader. There is also an advantage to the third person narration as a major secret to a theme is revealed toward the end of the story. I was very impressed how the author was able to balance the objective and subjective while also being informative throughout.

    Overall, I have no real criticisms for the book or author. The novel has a foundation based upon very accurate information on Alzheimer’s since Lisa Genova is a neuropsychologist herself2. The cognitive experience of the main character seems so spot-on that it is almost unsettling. As it turns out, the author’s grandmother had Alzheimer’s and I can imagine that she spent a great deal of time with her to be able to take on the perspective she does. After reading her short biography, it makes sense how she blended her grandmother’s condition in with her own life to create a deep new perspective for her book. The only conflict I have in my mind comes toward the end, when Alice is faced with a heavy life or death situation. It brings the question, is life worth it once a person has progressed to a certain point in the disease? However I would not want to spoil this major scene since it is what I consider to be the climax of the story.

    Unlike many fiction books, the authors main points are strong and backed by research. One prominent statistic that was significant to Alice, is how a gene for Alzheimer’s has a 50% chance of passing onto a child1 2. Statistically, since Alice has three children, it is likely that at least one of them will be affected by the disease. She already feels so much resentment toward her father who could have passed the gene onto her and does not want this guilt placed onto herself. This infers a valid point that once the gene is detected, an individual may factor this in toward their own family planning. Most of the time, unfortunately, people have no reason to get tested for the gene until they see symptoms of early dementia3. This could mean that by the time these symptoms arise, the gene has passed on already.

    Alice is not alone. There could be as many as 5.1 million people with Alzheimer’s in the United States, though only about 5% of these cases are early onset Alzheimer’s4. This shocking minority is addressed when Alice was unable to find a support group with others who have this rare variation. In addition, there are 10 early signs and symptoms cited by the Alzheimers Research Foundation3. A few of these include disruptive memory changes, and difficulties completing regular, familiar tasks3. These difficulties are what shocks Alice at first, but it wasn’t until the symptom, “confusion with time or space”3, presented itself that she knew it could be something serious2. It makes sense how early onset Alzheimer’s often goes undetected since it can be passed off as a side effect of stress or normal aging. Though still in debate, some sources claim that early onset Alzheimer’s has a faster progression than its late onset counterpart4.

    What can we take from all this research in which the novel relates? Remarkably, there is one major study that caught my attention as inspiration toward our future direction. A long running study regarding approaches toward care taking, suggest that those who incorporate non-medical therapies in addition to medicine alone, on average stay 329 days longer at home (outside of a care facility) than those caretakers who did not1. Non-medical therapies, include three interventions: education about the illness, counseling for the whole family, and improving ties to social support 1. This program acknowledges the holistic complexities of the disease beyond pure science. The details of this study are valuable since this approach provides a better quality of life–both for the individual, and for the family.

    This particular novel, Still Alice, is uniquely similar to the philosophy behind these additional therapeutic components as it looks beyond the one-sided broad medical perspective. It actually takes into account the dynamics of an effected individuals life, family, and emotion. I didn’t realize how much understanding I lacked until I started reading it. I highly recommend this book to everyone!

Video: Lisa Genova discussing Still Alice

1 Alzheimers research on caregiving. (n.d.). Retrieved from http://www.alzinfo.org/ research/alzheimers-research-on-caregiving
2 Genova, L. (2009). Still alice. New York, NY: Pocketbooks. $15.00. ISBN:1439102813.
3 Know the 10 signs: early detection matters. (2009). Retrieved from http://www.alz.org/alzheimers_disease_know_the_10_signs.asp
4 Van der Viles, A., Koedam, E., Pijenberg, Y., & Twisk, K. (2009). Most rapid cognitive decline in apoe epsilon4 negative alzheimer. Psychological Medicine, 39(11), 1907-11. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19335933

Hospice as a Positive Alternative

      Death is usually an uncomfortable topic to think about, let alone plan. Fortunately there are services that can help you receive the most comfortable care possible personalized to your wishes. If you were to find out you only had six months to live, would you prefer taking aggressive drugs hoping for a small chance to live? It may unfortunately be accepted those last few days would be drawn out in the hospital undergoing even more intensive treatments. I know, it’s not necessary to go too far into that scenario. Another option many older folks have chosen is hospice. Unlike a common misconception, hospice is not necessarily a place, but rather a form of care. As laid out by Chang’s article “Development of Hospice and Palliative Care in the United States”, hospice is probably the most sensitive approach, allowing many patients to be taken care of at home, as comfortably as possible3.

      Hospitals focus on curative care, meaning fighting against the cause of sickness in order to come closer toward a cure or remission. The only problem with this approach is that some people may not have a probable cure for their illness. Hospices on the other hand, focus on reducing pain during the inevitable final stage of life1. This is called palliative care, when lessening the pain and preserving independence are the redirected goals toward enjoying your last experiences. This is an alternative to physician care, initially most popular among cancer patients, but now expanding across all different conditions2. As hospice care grows popularity and availability, it is becoming better known for its holistic approach. There are many services available including medical treatment, home health aide visits, spiritual and nutrition counseling, and bereavement support for the family. It not only focuses on the body, but the mind and spirit as well3.

      Unfortunately hospice has a negative connotation for those who are less familiar to the alternative option.The American Hospice website addresses some of these viewpoints. Some people think that hospice is only for the individuals themselves who are dying2. In fact, it is an inclusive healing practice for the loved one’s family. Not only is illness more bearable to manage in the company of friends and family, but friends and family supporting one another as well. There are special grievance support services as part of the care plan 2. Some people may get the impression that hospice is expensive. Actually since this form of care was mainly supported by volunteers in the beginning, many have maintained their non-profit systems. In fact, almost two thirds of hospices are non-profit 2. Additionally, Medicare plans can cover 95% of your fees, and many hospices have been known to decline the 5% copayment 3. Perhaps the philosophy and morale of this service may be a contributing factor to recipient satisfaction.

      Now I am keeping in mind that many of you are still healthy, active, and not so concerned about death at the moment. In fact there will be a few readers who are healthier now in their older years than they have been most of there life! The importance here is considering ahead of time what kind of care you wish to receive should you not be able to make the decision later. With the misconceptions pertaining to hospice, it is possible your family is unaware of this option and It is a never too early to start this dialogue with your family. You would not only be contributing your own wishes, but you can find other family member’s preferences for themselves. I really recommend that you explore the citations I have included.

1 Connor, S. (2009). Development of Hospice and Palliative Care in the United States. In H. Cox (Ed.), Annual Editions: Aging (pp. 86-90). Indiana State University: McGraw Hill.
2 Naierman, N. (2001). Debunking the Myths of Hospice. Retrieved from http://www.americanhospice.org/articles-mainmenu-8/about-hospice-mainmenu-7/36-debunking-the-myths-of-hospice
3 Naierman, N. (2001). The medicare hospice benefit: A good fit with managed care. Retrieved from http://www.americanhospice.org/articles-mainmenu-8/about-hospice-mainmenu-7/42-the-medicare-hospice-benefit-a-good-fit-with-managed-care

The Positive Aspects of Aging

      It arguably seems that within Psychology, we are focusing upon phenomenon that is negative, or otherwise out of the ordinary. You may think of therapy for example, or mental illness…even aging, as subjects which cause concern. It is so focused on identifying people’s downfalls and how to avoid such conditions. In fact, many psychologists would say that there is an innate perspective within us to seek positive attributes within ourselves as well. “Positive Psychology” is a fairly recent term to this concept which was only recently coined in 1998. The APA Division 17 Section on Positive Psychology briefly define the field as “the study of human strengths and wellbeing”. To place this into perspective, you can imagine how there are factors that may cause us to age over time, but there are also powers within ourselves to help defeat the biological clock both mentally and physically.

      Dr. Glenn Ostir, a researcher within the positive psychology field tells BBC News “I believe that there is a connection between mind and body–and that our thoughts and attitudes/emotions affect physical functioning, and over all health, whether through direct mechanisms, such as immune fuction, or indirect mechanisms such as support networks”. This statement may resonate with you personally, maybe as you have found yourself catching illnesses in the most stressful and worst timings throughout your life, as your personal life had affected your immune system. You may have also found that your work across different contexts may have been affected by disputes with friends, or generally having a lack of social connections. As positive psychologists would say, the very opposite of these statements can help you for the best. For example, if you are exercising and becoming more involved in your community, you will find your mental and physical wellbeing to improve exceptionally. Perhaps our answer is to not only focus on factors to avoid, but to seek the most positive actions we can for ourselves.

      Speaking of a predisposition toward negative thoughts, we tend to only think about aging in terms of losses that may occur. You think loss of hair, loss of memory, loss of independence. What is less likely to be imagined first would be strengths such as “wisdom”, satisfaction with having raised a family, and long term goals that were achieved. Unfortunately, it is the losses which are most concrete and obvious to the naked eye. Along with that, they are more easily tested within research. Wisdom on the other hand is an example of an abstract attainment through aging. Wisdom is objectively definied as “rich factual and procedural knowledge, lifespan contextualism, relativism of values and life priorities, and recognition and management of uncertainty,” by Australian Psychologist. As you can see, this is a very situation sensitive, subjective, and individual experience that would be very difficult to test objectively. However, it is partially through wisdom that many older people learn to be more resilient to stress according to Australian Psychologist. Unfortunately, it may be difficult for older folks to look into this as those around them are focusing upon their losses.

      With this insight, where can we go from here? It is apparent that our mind and body seem to be interconnected more than we think. If we can focus on the gains that we achieve while aging, we can upkeep our emotional stamina, and support networks as well. Meanwhile, these positive effects we are fulfilling onto ourselves can ultimately help immune system functioning and ward against physical illnesses. We need to be proactive about our health and not assume that aging is a natural phenomenon that we shall fall victim to. I encourage you to read my other blog entries if you have not already, on ways to get started on this journey toward self improvement.

How You Can Benefit from Volunteering

The laughing handyman.jpg
    Did you know that the number of seniors who are volunteering is rapidly increasing? Believe it or not, based on US Census, the number of volunteers 65 and older are predicted to increase my 50% over the next thirteen years. This is posted in a report by the Corporation for National & Community Service entitled. Furthermore, this statistic is predicted to rise even higher as the youngest baby boomers will not reach age 65 until the year 2029. I’m sure many of you may be skeptical as to the benefits in volunteering. “I’ve worked forty-plus years of my life already, what more do you expect!” some may exclaim. Well actually, a study assessing life satisfaction in older adults found that those who volunteer strongly correlated with this important factor, and showed significantly higher life satisfaction rates than those who continued to work for pay. Now this is neither a suggestion to “quit your day job” nor is it to force yourself back into the work force for free. This is rather a suggestion to take a couple hours out of your week to help others for the sake of their wellbeing (and even your own!)

    Volunteering is a way in which you serve a community or a particular population in need that may not have otherwise been able to find assistance. There are opportunities as short as one time services, or upwards beyond a one year commitment. In the middle range, you may sign up for a program in which you meet once a week on a particular day, or only attend special events when they occur. There is bound to be a commitment that is right for you with these endless possibilities. Next you will want to consider what kinds of communities, populations, or issues would you like to work towards? Maybe kids, seniors, pets, disabled, the environment, education, health access, immigrants, or the homeless? Write down a list of some of your interests, and perhaps some populations in which you have had little exposure. You will probably be surprised with all that you come up with!

    Now looking at your list, you may still be wondering how you would go about starting your community service. Actually, you are probably still wondering why you should go out of your way to even initiate such an endeavor. A news article on Naples News stated several benefits that you may find very appealing. First off, you are likely to engage in a larger social circle than if you didn’t have this connection to other volunteers. I am going to speak from experience here. When I started volunteering myself, I found that those I worked with shared many of the same values that I did. They cared about their education and thinking reflectively, the core values of our service at the Community Involvement Center on campus. Most importantly though, they really just felt like “real” people who actually cared to hear about how you are doing. Think about it. Community service would mainly attract those people who care to do something toward a larger purpose outside of themselves. I find it to be very special to be surrounded around this positive energy.

    Another health benefit that stems from this mindset would be the lower levels of stress anxiety that volunteers encounter. This probably is in part from the social support you would likely build, and the fact that you are getting out of the house to try new things! Activity keeps your body and your mind in its top acuity. Additionally, those who volunteered had a better sense of purpose and accomplishment compared to those who did not. This is pretty self explanatory. It is also noted that there are lower mortality rates in those over 70 who volunteer more than 100 hours annually. This is only two hours a week, and it has such a substantial effect!

    Now, as for where you can go about finding places to volunteer, there are many resources on the internet. You may try Servenet.org or volunteermatch.org. Both of these use precise search techniques to narrow down your options based upon your qualifications and interests. SeniorCorps is another option that assists those 55 and older in finding an ideal volunteer site. There have been over 500,000 seniors who have used SeniorCorps’ services successfully. Another option I want to bring mention to that is very different from others, are volunteer vacations. This is where you travel abroad to a location of your choice to do a combination of sightseeing, relaxing, and helping the community. You can find this at Hands up Holidays among some other “voluntourism” agencies. Of course this option is just as expensive as a vacation on its own, however you additionally receive the healing benefits of volunteering, for yourself.

    It’s easy to get caught in a rut of all the mundane tasks that take up our day, and the subpar ways we hope to entertain ourselves. I dare you to take a step out of your comfort zone to try something new! You will feel better in ways you didn’t realize you would. Many people underestimate the positive affect community service can bring.

Video: Volunteer Keeping Seniors Healthier, Happier

Yoga for Seniors

    Many of us know that yoga is a strength building and rejuvenating exercise for many. There are designated poses (some that even look seemingly impossible) that help promote relaxation, proper blood flow, and improved muscle tone. However, what most of you probably don’t know is that you can participate this exercise no matter what your age may be. Yoga is not just for “young” people anymore. There are many older folks following modified, or even chair positions that help increase mobility and strength at the same time. If you are reading this article, there is probably a modified exercise that could work for you.

    Surprisingly, seniors are becoming increasingly engaged in these exercises as a result of not only improved mobility, but increased energy as well. The ladies in the youtube video linked below are amazed at their own progress, and absolutely love the ways that yoga has helped them. There is another lady in particular who was able to receive assistance doing exercises along with a group in their chairs. The interesting thing about yoga is that you don’t have to do poses in full in order to receive its benefits. What ever is a challenge to the individual is exercise in itself.1 It is about the progress toward improving one’s strength and mobility which is perhaps most important. Remember that in order to improve, you need to exercise to your full-hearted capacity in order to reach beyond your initial limit. If this doesn’t sound appealing just yet, read on…

    Something else to consider is the safety of your mobility, whether now or down the line. As Hatha yoga makes a person strong, limber, and toned, it also improves balance.2 This is especially important as aging progresses, that can help protect against accidental falls in the future. You can say that while yoga does make you more mobile, it can even help you maintain your independence as well. Independence is not just a convenience factor, but a positive emotional mindset to consider.

    Continuing on with this idea, yoga drastically improves mental wellbeing in many ways. In the quiet rejuvenating exercises, many notice improvement in their stress levels. Emotionally, it can ward against depression that may accrue as one ages. Hatha yoga in particular, encourages mental presence, and a clearing of outer distractions. At times, it may not be about avoiding stress, but simply finding time to take care for yourself that really makes a difference. Don’t forget that you need to be taken care of as well.

    Another factor which is interesting in these people’s improvements is that they find it to be a supporting community among other seniors who are looking to become active. It is an unfortunate truth that many seniors don’t have the support system or company around them that may have been stronger in the past. This additional support network can be very beneficial in itself. Additionally, this support can even encourage your persistence in attending the sessions regularly. Just like anything, you only improve by persistent effort.

    In the end, yoga is something to seriously consider for your health and wellbeing. It aids in mobility, strength, safety, emotional wellness, and social connectivity. Don’t let the term “yoga” scare you away. If you are imagining yourself to be too old or too out of shape, there are probably seniors in worse shape than you are. Consider giving it a try for a few sessions and see how you like it. I would be interested in hearing if you have ever tried it, or even if this article inspired you to take on the challenge! For further inspiration, check out the youtube video I have linked below. If you don’t believe me, you can hear it from these inspirational ladies.

Video: Yoga for Senior Citizens

1 http://www.iyengar-yoga.com/yoga/
2 http://www.yoga-teacher-training.org/2011/03/30/yoga-for-women-aging-gracefully/

Growing Population and Us

Singapore New Year 2010 Fireworks

      As we enter the 21st century, the baby boomer population advances in age as well. In fact, with the large mass of baby boomers now approaching senior citizenship, we are expecting there to soon be more 85 year olds than 5 year olds1. Additionally, there are likely to be more females than males in proportion1. Right now, there are 41 males for every 100 females most likely due to health factors. This means that there is bound to be a large number of widowed or single senior women.

      Often, women have had to care for others their whole lives. Many got married at a very young age and had children shortly after. As time moves along, our children, spouse, and other people we care for mature out of our hands’ reach sometimes leaving us without the sense of identity we once had set for ourselves. Not only are children growing up, but we have more women than ever who have chosen to not have children. This makes it even more important to look after oneself, and to rediscover what life has to offer. Taking value in this second half of life also can lead you to enjoy it longer than our parents did. The findings to these studies show that there are going to be a growing number of single older women than there have been in the past. It is up to us to find the emotional support that we need in one another.

      Now, I know you have probably come across many articles discussing how to live a longer life through diet and exercise. With all of the one sided, conflicting arguments, many of us have become so sick of trying to make sense of it all. I want to soon discuss with you different ways you will likely improve your health physically, and also mentally and emotionally. Having there be a growing community of aged single women alongside our growing technology of information and communication, this is a perfect opportunity to come together and support your older years. There are some women who use this time to meet others and do activities they never would have been able to do caring after a husband or family. This can be exhilarating while also beneficial to your health at the same time. The best way to unlock a new healthy life is to get to connect with other women and provide information for one another from valuable sources.

      Emotionally, and mentally, it is important to take time to relax with yourself. Even though you may not be working or raising a family, it is still possible to become stressed. Likewise, it is equally important that you take time for yourself to take a bath or listen to calming music every now and then. Don’t have too high expectations for yourself. This is mainly a quick introduction to my soon to be informational blog, but I really hope you find as much of an interest in optimistic aging as I do. I want to hear your questions and ideas, as I will be posting relevant news articles and psychological studies to help us learn together this phenomenon of aging.

1Cox, H. (2012). Annual editions: aging 11/12. (24 ed., pp. 3-6). New York, NY: McGraw Hill.