Article Excerpt: The Visit
by Bonnie Lee Camp, BSW
Editor’s Note: The following is an excerpt from an article from the Summer 2010 issue of THE NEW SOCIAL WORKER. Read the full article at:
“You have been coming to see me for a long time haven’t you?” she asks.
“Yes,” I smile, not really thinking that I have been coming all that long in the grand scheme of things. A month and a half perhaps...but it must seem like a long time to someone who sits in a chair or in bed every single day of her life and doesn’t ever get out of her room.
And there is nothing for her to look at. I noticed that on my first visit. She has no pictures on the walls or even a calendar. Once she asked for a calendar, and her son brought her one from a funeral home and hung it on the wall for her. What was he thinking? It didn’t even have nice big, bright pictures on it. But someone has since taken it down, and the walls around her bed are bare once more.
She sits in her bed and glances around the room, too far away from the 8-inch TV screen that sits on the other side of the room to be able to see it. And besides, it belongs to the lady who shares the room with her, and even if it were big enough to see, she wouldn’t be able to hear it. I can’t even hear it.
“When am I going to be able to go home?” she looks at me and asks.
Today she doesn’t understand why she is here or how she got here. She has been diagnosed with end-stage dementia.
“Do you know why I am here?” she inquires. “Do you know when I can go home?”
I see that she is beginning to get agitated because she cannot remember why she is in the nursing home facility. Not wanting to upset her further, I try to explain that she is here because her doctor wants her to rest and make sure that she gets the medicine and medical treatment that she needs.
She seems to be thinking about my answer, and then the attention turns to me.
“Are you getting paid to come here?”
“No,” I reply. “I am a social work intern.”
I am not sure that she understands what I have just said. She continues to look at me, and I wonder if she is questioning why I would come and spend time with someone I don’t know and am not getting paid to provide care for.
“I am going to school to be a social worker, and I have a minor in gerontology,” I begin to explain to her. “I am doing 90 hours in the field this semester as part of my requirement for class. I also volunteer and work with older adults because I feel called to do this type of work. I love being with older adults.”
I think that she is accepting this explanation, until she looks at me and states as a matter of fact, “You have no time for yourself.”
Somewhat surprised to hear that come out of her mouth, I wonder how she knows that. Her insight catches me off guard. Other people I know tell me that all the time. They remind me that I need to learn to say “no” to the many requests that seem to come my way, but that is because they know me too well. I have not told her that I work full time and go to school full time, yet she proclaims it without any hesitation at all. It is like she is looking inside of me and seeing how little time I do keep for myself. This amazes me.
As I sit here looking at her, admiring her inquisitiveness and interest in me (which I have not seen before this particular visit), my mind wanders to the future, and I briefly think about whether there will be someone who will come and visit me when it is my turn to sit in the chair and receive comfort care. Will there be a volunteer like me somewhere out there who will have a heart for older adults and who will want to come and spend time with me just because they feel they have a calling to do so? Are the children in this next generation being raised to be compassionate and caring, like my parents raised me to be? To have a love and respect for other people, especially the vulnerable populations in our society?
Read the rest of this article at:
Additional articles from the Summer 2010 issue of THE NEW SOCIAL WORKER include:
NIH statement on National HIV/AIDS and Aging Awareness Day September 18, 2010
from Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases; Richard J. Hodes, M.D., Director, National Institute on Aging; Jack Whitescarver, Ph.D., Director, NIH Office of AIDS Research
Older HIV-infected adults face unique health challenges stemming from age-related changes to the body accelerated by HIV infection, the side effects of long-term treatment for HIV, the infection itself, and often, treatments for age-associated illnesses. September 18 marks the third annual National HIV/AIDS and Aging Awareness Day, an opportunity to highlight these challenges and the research under way to improve the health and quality of life of older people infected with HIV.
Many HIV-infected individuals are living into their 50s and well beyond as a result of the powerful combinations of antiretroviral drugs that suppress the replication of the virus. In 2006, an estimated 25 percent of people living with HIV in the United States were age 50 years and older.[1
] In those with long-term HIV infection, the persistent activation of immune cells by the virus likely increases the susceptibility of these individuals to inflammation-induced diseases and diminishes their capacity to fight certain diseases. Coupled with the aging process, the extended exposure of these adults to both HIV and antiretroviral drugs appears to increase their risk of illness and death from cardiovascular, bone, kidney, liver, and lung disease, as well as many cancers not associated directly with HIV infection.
In addition, a growing number of adults in their 40s and 50s with long-term HIV infection are experiencing syndromes that resemble premature aging. For instance, these individuals have a greater risk of impaired kidney function and end-stage renal disease than their HIV-uninfected counterparts.[2
] They also are three to four times more likely to develop osteoporosis, increasing their risk for bone fractures.[3
] In addition, 55-year-old HIV-infected men are as likely to be in frail condition as are men ages 65 years or older who do not have HIV.[4
In 2008, an estimated 16 percent of all new HIV diagnoses occurred in people ages 50 years and older in the 37 states with confidential name-based reporting.[5
] HIV disease progresses more quickly in older compared with younger adults, and antiretroviral therapy restores immune system cells less effectively, placing this older group at greater risk for illness and death from HIV infection than younger people who are infected for comparable periods of time. Moreover, the higher rate of pre-existing conditions in people of advanced age often complicates their treatment for HIV infection.
Older people and their health care providers may not consider individuals ages 50 years and older to be at risk for HIV infection, and consequently may not feel compelled to discuss or act on HIV prevention measures. To complicate matters, the signs and symptoms of AIDS in older adults can be mistaken for conditions associated with aging, delaying the diagnosis of HIV infection and the start of appropriate therapy. In the United States, nearly one-fifth of the individuals ages 55 years and older who were living with HIV in 2006 did not know they were infected.[6
] As a consequence of both late HIV diagnosis and greater risk of progressing to AIDS, adults ages 50 years and older are more likely than any other age group to be diagnosed with AIDS within a year of their HIV diagnosis, according to data gathered between 1996 and 2005.[7
To counteract these trends, health care providers should routinely discuss risk factors for HIV infection with older patients, educate them about HIV prevention measures, and offer HIV testing. Because early HIV diagnosis is key to optimal treatment, the Centers for Disease Control and Prevention recommends routine HIV testing for all adults up to age 64 years. CDC also recommends HIV testing for adults ages 64 years and over who have risk factors for HIV infection, such as multiple sexual partners, unprotected sex, or injection drug use. Medicare covers HIV screening once every 12 months for any Medicare participant who asks for the test.
NIH is funding a variety of studies to address the challenges posed by HIV, including aging and the effects of long-term treatment with antiretroviral drugs. Study topics range from HIV-induced decline of immune system function to the increased risk of cardiovascular disease, from the effect of menopause-induced hormonal changes on HIV-infected women to the early detection of kidney disease, and from the decline of memory and cognition in long-term HIV infection to the greater risk of osteoporosis and bone fractures.
Some of these studies are being funded through an ongoing grant program called Medical Management of Older Patients with HIV/AIDS, established by the National Institute of Allergy and Infectious Diseases, the National Institute on Aging, the National Institute of Mental Health and the National Institute of Nursing Research, all part of NIH. This program continues to solicit research proposals to study a range of biomedical issues relevant to older adults with HIV infection. More information is available at:
HIV clearly poses a risk to individuals 50 years and older and presents complex treatment challenges. Therefore, older adults at risk need to get tested for the virus and take steps to protect themselves and their loved ones from becoming infected. In addition, NIH-funded research is under way to help health care providers tackle the often complicated treatment of HIV infection and related illnesses in older individuals, as well as the phenomenon of accelerated aging due to long-term HIV infection.
NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing, and treating these illnesses. NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov
The Office of AIDS Research (OAR), a part of the Office of the Director of NIH, plans and coordinates the scientific, budgetary and policy elements of the NIH AIDS program. Information about the OAR and NIH AIDS research can be found at http://www.oar.nih.gov/
The NIA leads the federal effort supporting and conducting research on aging and the medical, social, and behavioral issues of older people. For more information on research and the aging, go to www.nia.nih.gov
The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. For more information about NIH and its programs, visit www.nih.gov
1. Centers for Disease Control and Prevention (CDC). 2008. HIV prevalence estimates—United States, 2006. MMWR 57(39):1074. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5739a2.htm
2. Eggers PW et al. 2004. Is there an epidemic of HIV infection in the US ESRD program? Journal of the American Society of Nephrology 15(9):2477-2485.
3. Brown TT et al. 2006 Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS 20(17):2165-2174.
4. Desquilbet L et al. 2007 HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. Journal of Gerontology: Biological Sciences 62(11):1279-1286.
5. CDC. 2010. HIV Surveillance Report, 2008. Table 1a. Available at http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/table1a.htm
6. Campsmith ML et al. 2010. Undiagnosed HIV prevalence among adults and adolescents in the United States at the end of 2006. Journal of Acquired Immune Deficiency Syndrome 53(5):621.
7. CDC. 2009. Late HIV testing — 34 states, 1996-2005. MMWR 58(24):664. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a2.htm
Beloit College Releases Mindset List for Class of 2014
Beloit, Wis.—Most students entering college for the first time this fall—the Class of 2014—were born in 1992.
Born when Ross Perot was warning about a giant sucking sound and Bill Clinton was apologizing for pain in his marriage, members of this fall’s entering college class of 2014 have emerged as a post-e-mail generation for whom the digital world is routine and technology is just too slow.
Each August since 1998, Beloit College has released the Beloit College Mindset List. It provides a look at the cultural touchstones that shape the lives of students entering college this fall. The creation of Beloit’s Keefer Professor of the Humanities Tom McBride and former Public Affairs Director Ron Nief, it was originally created as a reminder to faculty to be aware of dated references, and quickly became a catalog of the rapidly changing worldview of each new generation.
The class of 2014 has never found Korean-made cars unusual on the Interstate and five hundred cable channels, of which they will watch a handful, have always been the norm. Since "digital" has always been in the cultural DNA, they've never written in cursive. With cell phones to tell them the time, there is no need for a wrist watch. Dirty Harry (who’s that?) is to them a great Hollywood director. The America they have inherited is one of soaring American trade and budget deficits. Russia has presumably never aimed nukes at the United States, and China has always posed an economic threat.
Nonetheless, they plan to enjoy college. The males among them are likely to be a minority. They will be armed with iPhones and BlackBerries, on which making a phone call will be only one of many, many functions they will perform. They will now be awash with a computerized technology that will not distinguish information and knowledge. So it will be up to their professors to help them. A generation accustomed to instant access will need to acquire the patience of scholarship. They will discover how to research information in books and journals and not just online. Their professors, who might be tempted to think that they are hip enough and therefore ready and relevant to teach the new generation, might remember that Kurt Cobain is now on the classic oldies station. The college class of 2014 reminds us, once again, that a generation comes and goes in the blink of our eyes, which are, like the rest of us, getting older and older.