By Marianne Kuzujanakis, MD MPH.
As we in the gifted field – parents, educators, clinicians – work to improve medical professionals’ support and understanding of gifted children, we must be sure not to overlook the needs of our gifted elders.
Gifted children become gifted adults. Gifted adults, in turn, become the gifted elderly. One thing is certain: the gifted do not outgrow their giftedness. But who are the gifted elderly? Earlier this year, the incomparable Annemarie Roeper reflected upon her own life as an octogenarian in “Growing Old Gifted.” You can read other articles on the experiences of gifted adults by Deirdre Lovecky, Stephanie Tolan, Helen Prince, and Mihaly Csikszentmihalyi.
The U.S. population is aging, and the Department of Health and Human Services estimates that currently one in every eight citizens is age 65 and older. In the next decade the number of elderly is projected to increase by almost 40 percent. Today most elderly live independently, and, on average, one-third live alone. With increasing life expectancies through the benefits of lifestyle changes and medical progress, many elders (gifted and otherwise) will remain active and vital all their lives. As family matriarchs and patriarchs, they will dispense valued wisdom and tradition to their families. The influence of family elders is brought prominently to the forefront for many people during this end-of-year holiday season.
Not all elderly enjoy a smooth life journey. Due to a variety of health factors, the elderly comprise upwards of one-third of all hospitalizations. If percentages of gifted are equivalent across the lifespan, three to five percent of these hospitalized elderly are gifted, accounting for close to three-quarters of a million hospital stays for gifted elderly per year. While very reasonably equipped to address the specific issues surrounding medical care of the elderly, physicians do not typically have any body of knowledge that addresses the gifted elderly’s unique needs.
The elderly – as a whole – are frequently far more sensitive to medications, drug interactions, and the risk of hospital complications. With a lessening sense of smell due to aging, many elderly also have reduced appetites and resulting weight loss, placing them at further risk. Hearing and vision impairment may make communication of needs far more difficult. Some elderly are also the primary caregivers for spouses with complex health conditions, and therefore are themselves at high risk for stress-induced health issues. Mental impairment, as a normal result of aging or a progressive condition like dementia, can make a variety of cognitive issues even more challenging. For gifted elders, their giftedness can be a two-edged sword, presenting them with a greater long-view of life and interconnectedness, while also leading for some to increased anxiety and frustration at the changes which come with aging and ill health.
What unique needs and/or strengths can medical professionals in hospitals and skilled nursing facilities look for in the gifted elderly?
· Self-Awareness: The gifted typically have a deep sense of self-awareness and sensitivity that may assist them in the normal process of aging and their journey of life. Gifted elders may fully comprehend and accept the idea of their own mortality, but if not surrounded by loving friends and family, they may be at risk for existential depression. Dr. James T. Webb has written an excellent article about this issue.
· Spirituality: Many gifted individuals have a strong sense of spirituality originating in childhood. This may stem from the sense of being interconnected to all people, and sometimes to all living things, in a timeless universal journey. A wonderful article by Joy Navan addresses this topic. While some gifted individuals remain spiritual their entire lives, others return deeply to the spirituality of their youth only once they are elders or have experienced a significant turning point in their lives.
· Overexcitabilities (OEs): The intensities of gifted children, while sometimes managed to some degree during the adult years, may return again in full force in the elder years as a result of a variety of issues that may affect their mental and emotional states. They may be easily and quickly frustrated. These OEs can lead to strong conflicts in healthcare settings where they are not properly supported or understood. Some gifted elders never fully control their OEs and may have life-long struggles adapting. Try to understand conflicts you yourself may have with your own gifted elders, and ask yourself whether OEs may play a significant role in misunderstandings on both sides.
· Independence: Many of today’s elders lived their formative years during the period of World War II. They grew up in an era when education, careers and job security, and home ownership were common goals. The gifted elders often were persistent and determined in reaching any and all of the goals they set out to achieve. Some of these elders, as a continuation of their childhood desire to be autonomous and in control, may have a particularly difficult time dealing with health issues that require hospitalization and/or skilled nursing home placement. Gifted elderly may insist on independence even when it is medically contraindicated. They may question medical authority, striving to become experts in the knowledge of their health status and prognosis in a desire to maintain control.
· Motivation: This can be a strongly positive and powerful trait, if it encourages a gifted elder to follow recommended medical advice in order to recuperate quickly. However, one can imagine this same trait to be a detriment if the goal the gifted elder sets differs from the medically recommended goal. In situations where there is no quick or easy cure nor even a positive prognosis, the gifted elders may need to look deep within themselves for strength and courage. The Theory of Positive Disintegration (TPD) may play an important role in helping gifted elders to adapt to these life-altering emotionally painful times. Learn more about TPD by reading this article by Sal Mengalio.
· Curiosity: Gifted elders frequently continue learning throughout their lives. In healthcare settings, supporting this hunger for learning may be limited. Gifted elders who lack intellectual peers or are required to stay in a hospital room – sometimes alone for many hours – may experience deep loneliness. Hospitals and nursing homes are beginning to become more aware of the need to encourage brain and emotional health in the elderly through a variety of means, including physical activity and creative outlets. Healthy emotional states can assist in bringing out the child-like, exuberant personalities of many gifted elders, and allow their sophisticated sense of humor to shine.
What can families do to help gifted elders in hospitals and nursing homes?
· Support the gifted elder’s health conditions that may be misunderstood. Alert the medical staff to the non-obvious weaknesses of the hospitalized elder. A gifted elder who can self-advocate can be an enormous benefit. Some of the weaknesses may include hearing and vision deficits that are not always readily recognized, especially in patients who are admitted for a mental disorder such as dementia. Lack of normal patient-staff communication may mistakenly be thought to be a result of dementia, not the failure of the medical staff to properly address the hearing and/or vision deficits.
· Support the gifted elder’s need for mental stimulation. Do not hesitate to bring copies of favorite books and newspapers and DVDs to the hospital or nursing home. Often the choices given to patients are not the stimulating material the elder prefers. Make sure the medical staff is aware of the need for mental stimulation, as well as periodic one-on-one conversations and physical activity whenever possible when family cannot be present. Large-sized crossword puzzles and other mental-stimulating games as well as art supplies are enjoyed and cherished by many elders.
· Support the gifted elder’s unique food and allergy needs. Discuss food and environmental allergies with the medical staff, and ask if food can be brought in from home whenever possible. The gifted population suffers from a higher degree of allergies than the general population, and this may contribute to a greater number of in-hospital drug-related sensitivities as well. When a hospitalized patient becomes agitated or anxious, the tendency is to treat with pharmaceuticals, even though the drug risks may be increased in gifted elders. Treating the source of anxiety and depression may better support these gifted elders before pharmaceuticals are considered. Family has a right to insist that any non-emergency drug changes and additions be discussed with the family before initiating treatment.
· Support the gifted elder’s spiritual needs. If a gifted elder practices a form of spirituality or religion which is not commonly supported in the healthcare setting, request that a practitioner in that realm be able to visit with the gifted elder whenever possible. Meanwhile, be aware that hospitals do offer daily visiting clergy and often have in-hospital chapels.
· Support the gifted elder’s overexcitabilities. Discuss with the hospital healthcare provider the issue of OEs in the gifted elder. Request that lights be turned down or off at night if possible, that soft blankets from home be brought in if acceptable, that night-time checks with complete vital signs be kept to a bare minimum, and that elders be permitted to wear some of their own clothes whenever possible. The effects of hospital-induced psychosis frequently persist even after hospital discharge, so maintaining a light-dark 24-hour cycle is important.
· Support the gifted elder’s cultural background. Seek out hospital volunteers and staff who share specific cultural backgrounds with in-patient elders who are being treated for mental or emotional disorders. Relating to “same” can be enriching to these gifted elders.
· Support the gifted elder’s risk of hypoglycemia – reactive and otherwise. Some gifted elders, in part due to loss of weight and muscle mass, may again experience issues of hypoglycemia. This may lead to falls and mental status changes. Alerting medical professionals to the gifted elder’s need to maintain glucose levels through frequent meals and snacks can make the difference between a stable and an unstable patient. In my own gifted elder father, I have seen remarkable stabilization of dementia symptoms if he consumes high-energy food at a regular schedule. Hospitals serve food at set times, and patients may miss meals or refuse meals at those specific times. Insisting on some flexibility with meal times, and the addition of snacks when medically permissible, can avert any low glucose issues. Furthermore, inadequate food intake can worsen adverse drug reactions. Protein foods may be limited in elders due to diminishing kidney function, so maintaining stable glucose levels to enhance brain functioning can become a challenge.
· Support the gifted elder’s desire to share in the bigger outside world. Many hospitalized gifted elders prefer to hear about the goings on of the world, family, and friends rather than to stay focused on their own ill health. In a hospital setting, one can become too caught up in the issues of illness. The OEs of gifted elders may lead to further introspection and possibly anxiety if all the attention surrounds their own health. Come to the medical facility with stories and experiences to share, apart from their own issues, to help guide these elders back into the outside world.
· Support gifted elders by being there for them. Hospitals are increasingly over-crowded and medical staff over-worked. Being able to play an active role in personally assisting the hospitalized gifted elder does wonders to increase recovery and speed discharge home. Nursing homes are likewise over-crowded, and the staff is not always readily available to assist nursing home residents in appropriate ways. Sometimes there is no option outside of nursing homes, though frequently home health visits can provide more meaningful and supportive care in an environment where the gifted elder feels more in control and productive. If nursing homes are inevitable in the future of a gifted elder, thoroughly interview the facility beforehand to understand how the unique needs of your gifted family member will be supported.
This is the December holiday season. Let this time of year be joyful and let us extend the feelings the entire year round. Share your hearts and time with not just your own gifted elders and family members, but also consider spending time at local nursing homes. Consider donating gifts of books, DVDs, art supplies, and challenging games to the geriatric wards of your local hospitals. If your gifted elders are fortunate to live at home, make a point to spend as much quality time with them as you can. Uncover family history to pass on to future generations. Share traditions of the season. Push aside misunderstandings and conflicts. Come to the realization that we all are deeply interconnected, that time is both a precious commodity and a remarkable gift, and that we all have crucially important roles to help each other through this most mysterious journey that is LIFE.
Happy Holidays to all of you and may your families bring you peace, joy, and a lifetime of happiness.
Additional Readings
1) Life in the Balance: A Physician’s Memoir of Life, Love, and Loss with Parkinson’s Disease and Dementia by Thomas Graboys, M.D. (Union Square Press, 2009)
2) The Last Lecture by Randy Pausch, Ph.D. (Hyperion, 2008)
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SENG Director Marianne Kuzujanakis is a board-certified pediatrician with long-standing interests in parent and clinician education. Her residency training was at the Mid-South’s busy pediatric center in Memphis, TN, including Le Bonheur Children’s Hospital, St. Jude Children’s Research Hospital, and the University of Tennessee Medical Center. Subsequently, Dr. Kuzujanakis served for a time as a hospitalist, and then as the director of the outpatient department of a children’s teaching hospital. The majority of her medical career since then has been in primary care practice in Massachusetts, regularly dedicating a portion of her time as a clinical instructor, both through Harvard Medical School and also as the course director of a local clinician-training program for practicing pediatricians. She is currently focused on being the homeschool educator for her gifted child.