Monday, July 26, 2010

Early to Dine, Early to Die?

My mom is navigating her first year as a widow.  She hates that word, and who wouldn't, so don't tell her I used it in the same sentence as "my mom".  

One of the hardest parts of this new life, is the loneliness at the end of the day.  Preparing a nice dinner had long been a big part of Mom's identity.  Now with no one to feed but herself, she is grateful whenever she has evening plans.  Her friends have been wonderful about frequently including her but once in a while the weekend looms with nothing on the calendar, and those are the days that I most regret  living nearly 2000 miles away.

So when Mom told me she'd been invited to dinner last Friday at her friend's retirement home, I was thrilled.  Then she told me what time she was invited to come for a drink beforehand.  

4:15 p.m.

Well if you're going to have a drink before dinner, and you're required to be at the dining room by 5:15 , then 4:15 makes sense. Except for the fact that it's absurd. This premature dinner bell for the elder crowd floors me as much as the 7:00 a.m. school bell start for a majority of  high schools. These times are clearly for the convenience of everyone but the ones who matter most. 

First of all, what do you think your evening would be like if you began cocktailing at 4:15? (Mind you this group that I grew up with have always had cocktail hour before dinner, and that's not likely to change until their only sustenance is through an I.V.) And even if they were willing to wait until dinner to have a drink, they couldn't, because most senior homes won't serve alcohol.  So, just like underage college kids, they pre-game in their rooms, apartments or cottages.

The next question is what do you do at 6:15 when dinner is over, the help is shooing you out of the dining hall, and it's not even going to be dark for another two hours? Well, one guess is that you continue drinking (or go to bed at 8).  Either way, it sounds pretty damn depressing.  No wonder 80,000 of the 8 million alcoholics in this country are senior citizens.  I'd be one too if that's what the second half of every day looked like. 

I've learned that alcohol withdrawal syndrome (AWS) is often the trigger for organ failure in general hospital patients. Before my dad's hernia surgery last fall, he was advised not to drink for the 24 hours leading up to the surgery.  Now my dad relished his scotch and soda, but he was also the type of guy who would never disobey a doctor's orders.  So he didn't have a drink that Sunday.  Which only meant that the DTs hit him a day earlier than they would have if he had.  Alcohol withdrawal is a process; a long process  While there have been attempts (by the Mayo Clinic no less!) to develop a protocol around detection and management of AWS in general hospital patients, the failure of medical personnel to fully analyze a patient's odds for experiencing "delirium tremens" is certainly a factor in the mortality rate of elderly surgery patients.
In fact, there are doctors and researchers who suggest that it be safer to give
patients a drink so that they don't go into what is often a fatal withdrawal syndrome.

Now I'm not saying that my dad would be alive today if the senior living spots weren't serving dinner so early. (In fact, the fancy community where my parents moved was developed by a number of their peers who figured cocktail hour into their planning, and there the dinner hour can start as late as 7:30, and can be accompanied by alcohol-at least they aren't drinking  empty stomachs).  But nevertheless, this is a trend that should be examined.  Why treat our seniors like children?  For god's sake, even my ten year-old doesn't want to eat dinner at 5:00. 

Imagine how patronizing it must feel to have your meal time dictated every single day.  In fact there is plenty of evidence that feeling a lack of control over circumstances in your life has a direct connection to depression. Estimates of depression in seniors range from 1-5% of that population; in geriatric hospital patients it is over 11%, and in seniors requiring in-home healthcare it hovers over 13%. Rates of suicide may be higher in senior centers according to an alarming recent study which notes that specific risk factors for older people living in a residential home include being widowed or divorced, having a pessimistic outlook, sleeping more than nine hours a day and drinking more than three alcoholic beverages a day.  

Whether from suicide, DTs, or a slow degeneration from depression, this is no way for our senior citizens to die. There must be at least a few relatively simple solutions; lets give them back a little dignity via control of their mealtimes.  First step, move the supper hour.  When I call my mom at 6:30 I should be catching her before she leaves for dinner, not as she's returning. 

And while we're at it, I say ditto for the school bell.  For one year, lets try giving teenagers a solid seven or eight hours of sleep and then see how many kids are still "left behind".


  1. I always thought it was odd that the "senior discounts" at restaurants seem to start at 4:00! You make some good points, and I didn't realize that such a large percentage of seniors were alcoholics.

    There was one year my son started high school at 7:05 and it was horrible! Now it's 8:00 (they changed it) but somehow that still seems a bit early. I think it's the teachers who don't really want to teach later into the day!

  2. I run into seniors with alcohol problems a lot in ICU.

    I'm older, and I absolutely dread having to be in a place where my life is the least bit regimented. Suicide is a viable alternative as far as I'm concerned. There aren't too many choices when a senior becomes unable to manage by herself; and none of the choices are best. Home health is really ok except no one in the government wants to pay for someone to go into a senior's home two or three times a week, even if in the long run it will keep the senior out of the hospital, which costs a hell of a lot more!