Brain Atrophy of Elderly in Nursing Homes: Racism, Social Inappropriateness, Depression, and Problem Gambling

An African American, I have experienced racism my entire life. A child raised in the Jim Crow South, I was reminded every day of my unimportance. Up North in Michigan, I live in one of the most segregated states in America. The continuing documentation of racial-ethnic healthcare disparities in America speaks for itself.

I wasn’t surprised at all when several African American nursing assistants (CNA’s) I spoke to at nursing homes in both Michigan and Massachusetts complained about being targets of racist comments by their elderly white patients. What was interesting in a few instances was that the comments were overheard by the patients’ relatives who said they were shocked after hearing them. Some relatives even apologized to the nursing assistants for the behavior of the patients. According to these relatives, they had never heard the patients make racist statements during all the years they had known them.

These incidents came to mind when I read this research from “Current Directions in Psychological Science” about brain atrophy, which is a gradual shrinking of the brain that includes significant atrophy in the frontal lobes where executive functioning occurs. The study reports that the results of this atrophy include decreased inhibitory ability in late adulthood that can lead to unintended prejudice, social inappropriateness (such as publicly asking personal questions), depression, and problem gambling. University of Queensland psychologist Bill von Hippel explains that older white adults showed greater stereotyping toward African Americans than younger white adults did. Despite being more motivated to control their prejudices, older whites’ attempts to inhibit their prejudices failed.

The study proposes that some of the negative social behaviors attributed to the elderly may be resulting from their loss of inhibition. You can read more about this research on brain atrophy in the elderly at the “Medical News Today” website.

Note: A study from the Buehler Center on Aging at Northwestern University’s Feinberg School of Medicine states that nearly 75 percent of nursing assistants (CNA’s) working in nursing homes experience racism on the job. This research showed that racism is expressed by nursing home residents as well as residents' families and nursing home co-workers.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Spirituality and Elderly, Black, Hurricane Katrina Survivors

Since the publication of my book, "Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes,” I have spoken to a cross-section of groups from healthcare, academic, and general public arenas. Clergy members have often been in attendance. As a hospice volunteer, I am careful not to impose any religious views on my patients, but patients do request counseling from clergy members about religion and spirituality.

I was reminded of this when I read some research about older, black, Katrina survivors. New Orleans is my hometown, and I am particularly concerned about the slow recovery progress, which I witnessed firsthand again during a recent visit there. As I stated in previous posts, elderly residents who have remained in New Orleans or who have evacuated across the country have often experienced difficult adjustments.

The research I read explored coping strategies of these older evacuees living at a retirement apartment complex in Texas. The study states, “Without exception, the findings indicate that this population coped with Katrina and its aftermath through reliance on a Higher Power.” It explains further that the relationship with a Higher Power was not necessarily connected with church membership. This is important because many people who are spiritual are not religious in the church-going sense.

These are the spiritual coping themes that resulted from a series of interviews with these older Katrina survivors:

“1) regular communication with a supernatural power; 2) miracles of faith through this source of guidance and protection; 3) daily reading of the Bible and various spiritual and devotional materials; and 4) helping others as a consequence of faith and devotion to a supreme being.” During traumatic times, spirituality clearly promotes emotional resilience for many.

You can read more about this University of North Texas study at this website.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Perspectives on Dying from Hospice Patients and Healthcare Professionals: (Video 4:28 mins.)

Too often, I talk to adult children who haven't discussed death matters with their elderly parents. Sometimes when they try, parents won’t participate in the discussion. Most people die in institutions, and planning ahead is very important. Advance directives, wills, and other death-related documents should be completed before a crisis occurs and should be readily available.

A research study by the University of Georgia Institute of Gerontology focused on end-of-life preparations and preferences of elders and adult children of elders. Interviews were held with the two groups. The study determined that barriers to discussions about end-of-life preparation and preferences were fear of death, trust in others to make decisions, family dynamics, and uncertainty about preferences. Factors that promoted these discussions were acceptance of the reality of death, prior experience with death, religion or spirituality, and a desire to help the family.

Casually approaching end-of life discussions and creating written records of preparation and preferences were considered successful strategies for expanding communication on this sensitive topic. Knowing good solutions to overcome obstacles and promote these discussions can assist healthcare professionals in encouraging elders and their families in planning ahead.

What are the needs of the dying? How can the end of life be integrated as a natural and sacred human process? This video titled “Solace: Wisdom of the Dying” presents perspectives on dying from hospice patients and healthcare professionals.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Hospice Volunteer Inmates in Louisiana Prison (Video 4:17 mins.)

When you think about prison, what usually comes to mind? You probably imagine depression, fear, violence, and razorwire fences. And you would be right, but not completely. One example of expressed compassion in prison is demonstrated in the caregiving of inmate hospice volunteers who serve terminally ill inmates.

These volunteers provide comfort that may be missing in the lives of some prisoners, especially those who no longer have attentive relationships beyond prison walls. Many serving life sentences, including some volunteers, know they will die in confinement. Nurturing support given by familiar faces of those who have also experienced the prison system can enhance prisoners’ quality of life during the dying process.

This video titled “Will Anybody Cry When I Die?” shows hospice inmates helping a fellow prisoner during his end-of-life journey at the Louisiana State Penitentiary in Angola, Louisiana. Later, they prepare and honor him with a death ritual. Watching this video, you might find yourself feeling distant from negative aspects commonly associated with prison life. You might be feeling the love.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog

Hospice and Nursing Home Story: Patient's Life Review (Video 4:25 mins.)

Something I have enjoyed doing as a writer and hospice volunteer is recording patients’ life reviews. A life review is a legacy that is put in written, audio, or video form for family and friends to treasure after the patient has died. I could not do this with patients who had dementia or those who were too ill physically. Patients who were able to participate in this process enjoyed creating this record that added permanence to their history.

Jackie (pseudonym), a talkative patient with a sharp mind, was glad she could still remember what had happened in her life and eager to tell me her story. During several visits, she answered a series of questions that I recorded on tape and transcribed later. Her story started with descriptions of her parents, their values, and their impact on her life. Later, she included memories of her siblings and incidents that happened to her over eighty years ago.

Speaking with a knowing that only comes with age, she told me about happy times that drenched her with joy, and heartbreaking struggles that drowned her in misery. When she spoke about being hospitalized years ago due to physical abuse by a former husband, I reminded her that others would read the information in her booklet. She responded that her husband’s maltreatment of her was common knowledge. Her family and friends had advised her often to divorce him. “I’m proud now that I finally left with my children and started a better life,” she added smiling. The most important life message she wanted to leave was the truth of her experience.

This video, titled "Hello in There," reminds us that there’s a special story inside each person. Be sure to wait for words accompanying the music.

Frances Shani Parker, Author
"Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes”
Hospice and Nursing Homes Blog