Here’s a thought experiment: What if old age actually meant having enhanced potential for change — but since few realized it, it remained a kind of secret?

Unleashing this secret could go a long way toward liberating souls, if people would realize that change is not only possible, but within reach.

Instead, the great majority of people believe, consciously or unconsciously, that change in old age is not possible.

But that turns out not to be true.

Granted, this claim goes against conventional wisdom, but let me explain how I, as a physician who specializes in adult and geriatric psychiatry, know that aging actually enhances our capacity for change. And, full disclosure, I am 72 years old myself, so you could say I speak from a certain bias.

Also worth knowing is that older adults are the fastest-growing segment of our population, and older individuals are more diverse than any other age group. So beware of attempts (by me or anyone else) to talk about older adults as monolithic.

Too late for therapy?

Meditation, coaching, clergy and family connections are all well-known ways to help facilitate personal growth. Yet, often it’s assumed that past a certain age, there’s no point in trying talk therapy, otherwise known as psychotherapy.

It is still not clear what type of therapy works best for whom. What is clear, though, is that there are some crucial factors common to all therapies. For any therapy to go well, it generally requires a well-motivated patient who has the ability to connect with the therapist, as well as the ability to think about one’s behavior and one’s life. So, three key factors:

• Ability to reflect
• Be motivated
• Form a well-functioning therapeutic relationship

A moment of reflection

It turns out that older adults have a natural tendency to reflect. And reflecting and reminiscing is a normal, healthy developmental aspect of aging.

Robert Butler, the physician who started the field of geriatrics in the U.S., described the natural tendency to reminisce as “life review.” Over the last decades, life review, or reminiscence therapy, has been used to facilitate this process in older adults, leading to rich discussions and realizations about how one has lived life.

Erik Erikson, the pioneering psychologist who described the psychological development of a person’s sense of identity over the life cycle, identified the stage in late life when the individual, by virtue of life review, comes to terms with their life, and clarifies the themes, meaning and purpose of that life.

Feeling motivated

It makes sense intuitively, and is borne out in practice, that therapy works best when the patient is motivated. Older adults tend to be motivated because they are keenly aware they’re not going to live forever, and have a sense that it’s now or never.

At the same time, people are living longer than they ever have, and there is a lot of life left to live when you’re, say, 65 or 70 years old. People who are in unhappy marriages, for example, are more likely these days to get divorced in order to make the most of their remaining years. In fact, they’re driving a so-called “gray divorce” demographic trend.

The realization that time is marching on and that there is usually still enough time to make it worthwhile to change makes the motivation to change doubly strong in older people.

There’s even a theory, called the socioemotional selectivity theory (developed by Stanford psychologist Laura L. Carstensen), that posits that older adults become increasingly selective about how they spend their time and other resources as they age. And what they tend to focus on are emotionally meaningful goals and activities.

Building relationships

Talk therapy is one way to identify and pursue emotionally important goals. Therapy works via a relationship, the so-called therapeutic relationship. Exploring a therapeutic relationship often provides rich insight into yourself that might otherwise be difficult to achieve.

Most therapies benefit from a relationship, so the patient’s capacity to relate to others is extremely important.

Once again, older adults, having honed their relationship skills over a lifetime and tending to value relationships over material objects, are generally good at forming a relationship that then facilitates change. As the long-term Harvard Study of Adult Development found, the most important characteristic associated with successful aging is not intelligence or money, it’s the quality of relationships.

Memory serves

Memory, and other cognitive processes — such as how we think, how we process information, and how we make decisions — are important to consider when thinking about a person’s capacity for growth and change.

As usual in our society, we associate age with loss: Age is associated with a slowing of processes, whether it’s running the 100-yard dash or solving math problems. It’s also common for older adults to have difficulty recalling names, words and even recent events.

The truth is, while this short-term memory impairment is frustrating, it’s usually not a significant problem. And long-term memory is usually well preserved, even in individuals who have some type of diagnosable memory impairment.

In therapy, especially the type of therapy that involves reflecting on one’s life and connecting the dots from one’s earliest memories, long-term memory is key. There’s even a “reminiscence bump” in which older adults recall early life events especially well. So short-term memory impairment, though frustrating, is not necessarily a non-starter for therapy.

While older adults may have slower processing speed, they’re usually better than younger adults at organizing and synthesizing information. An important type of intelligence, called “crystallized intelligence,” emerges in midlife and grows. It’s based on experience, and helps older adults to identify and prioritize what’s important, and to make good judgments and good decisions.

It’s involved in what is called wisdom, which is the ability to use knowledge and experience to achieve a deeper understanding of human nature, inner lives, and what makes people tick. It also helps the wise person to understand what motivates people, to have what is called a “theory of mind” about humans.

Some of the intangibles that enhance the ability to change include wisdom, perspective, being more comfortable with who we are, and less afraid of saying what’s really on our minds.

Older adults also seem to be better at what’s called emotional regulation, which is the ability to respond to situations with a range of emotions, and to not over-respond or respond too quickly. It involves conscious as well as unconscious thinking, and is considered an important part of well-being and mental health. Psychotherapy is one good way to improve one’s emotional regulation, which improves one’s quality of life.

Research on personality has shown that older adults can still change. Biological research has identified “neuroplasticity” in older adults, meaning the older brain is still capable of change. (Remember the line from the film “The Graduate” about plastics? “There’s a great future in plastics. Think about it. Will you think about it?” That guy knew something.)

The barrier: Ageism

For more than a century, case reports and scholarly overviews have reported positive experiences for older adults in talk therapy, showing them as good candidates.

So, with all the things going for us, why don’t older adults utilize therapy to change and improve the quality of our lives? The answer: We are brainwashed into thinking we can’t do it.

It’s called ageism. The term was coined by the same Robert Butler who started the field of geriatrics in the U.S. and who identified life review as a normal part of aging.

Almost all of us who were raised in typical Western culture, myself included, are bombarded with the message that old people are stuck in their ways, and too cognitively impaired to partake of change-making. The general message is that old equals bad, and it’s so much a part of our zeitgeist that we rarely question it.

For example, almost everyone is pleased to hear that they look young for their age. What if someone said to an older adult: “You look great, so old!” I’ve tried it, and I can attest to the fact that it doesn’t go over very well!

Ageism can be relatively subtle, such as the patronizing appreciation of “cuteness” in old people, or giving dumb-downed explanations to older adults, as if the older adult were a child. Most of us have felt what it’s like to be invisible in a grocery or retail store. Even sympathetic authors encourage older adults to think of themselves as “elders” and not elderly or old. An entire anti-aging industry is built around “turning back the clock.”

More pernicious are the effects of having lowered expectations for older adults. Remember when President George W. Bush talked about the “soft bigotry of low expectations” in the context of racism? That same dynamic can easily be applied to older adults, and perpetuates a kind of self-fulfilling prophecy in which people don’t reach for things they feel incapable of achieving. If you don’t think you can do something, you are less likely to even try.

So it’s no surprise that older adults are less likely to seek or obtain mental health services compared to other age groups. With ageism in mind, it is easy to see how this comes about. Looking at the Covid pandemic, with its emphasis on the isolation experienced by younger populations, and some smoldering attitudes about prioritizing younger adults over older ones, provides fresh evidence.

Win for losing

By owning our own feelings, we reclaim important parts of ourselves, and actually liberate ourselves to pursue our better selves. Instead of spending psychic energy on self-criticism, we can think about more realistic alternatives, and make sure we are doing the best we can, which is usually comforting.

Getting back to the emphasis on loss, it has been observed by many therapists, poets, writers, musicians and philosophers that loss is associated with personal growth. Seen from this vantage point, old age presents a wealth of growth opportunities.

Losses come in many forms: there are relationship losses such as the loss of a spouse, medical losses such as loss of energy or even loss of a limb due to a stroke, and losses of independence. The latter is especially important in our country, with its emphasis on being “strong” and independent. Shameful feelings about dependency often connect directly to one’s own upbringing, past relationships, and cultural context.

One of my patients, whom I’ll call G.D., is a retired, successful businessman in his 80s. He immigrated to the U.S. at a young age, lived the American dream, and has a close-knit family of kids, grandkids and great-grandkids. He came to therapy for help with depression and burnout caused by caring for his wife with dementia. We identified and acknowledged his losses: the loss of his wife as he knew her, and also the loss of a part of himself that is confident, able to master difficult challenges, able to experience joy with a sense of humor.

He realized that he was responding to his stressful situation by trying to control and manage the care for his wife, similar to what he had done all his life. It left him feeling sad, guilty and frustrated. In therapy, he was able to see how his coping mechanisms that had served him well in his life now brought him despair. In therapy, he was able to let go of some of his heroic efforts, to accept his circumstances, and to know that he was doing the best he could. This left him feeling “sadder but wiser” (per the song from “Music Man”), and considerably more at peace with himself.

Another patient, S.U., a woman in her 70s, struggled with guilt, anger and sadness connected to the on-and-off relationship with her adopted daughter. In therapy, she was able to add a level of understanding and acceptance that was previously not possible. Her usual attitude was a harsh, blaming one, related to her feelings of regret and remorse over what she had done, and not done, with her daughter.

In therapy, she was able to develop newer, softer and more nuanced attitudes that take into account her own background and upbringing. She came to understand and appreciate the complex psychological contributions behind her actions, leaving her with more compassion and comforting thoughts about herself.

Importantly, she realized that she could not excise the old harsh attitude, but she could relegate it to a less influential place in her psyche, with the more mature and adaptive parts of herself assuming a more prominent place.

How to find help

Perhaps older adults are “designed” to be adaptable because so much happens to them!

While I hope this leads to greater opportunities for older adults, I realize that the supply of experienced therapists who have advanced training in working with older adults is woefully inadequate. I hope those few of us who have the expertise will inspire and train a new generation of therapists.

Meanwhile, the best plan is to ask your primary care physician to make a referral. Many psychotherapists work well with older adults, even if they don’t have formal training in geriatrics.

Also, most (general adult) psychotherapists have older adults in their practices. And since older adults make up the largest percent of most primary care physician practices, the physician will likely have faced this challenge before, and will be able to make a good referral.

Daniel A. Plotkin is a physician who specializes in adult and geriatric psychiatry.

Today, Canellias is known as the “Salsa Diva” to legions of latin dance aficionados. Students take part in her classes at Santa Monica College, where she’s been teaching for more than 20 years, and at By Your Side’s dance studios in Culver City and Marina del Rey.

She still teaches ballroom classes, and some bachata as well, but salsa remains her favorite. “I feel it in every fiber of my being,” says Canellias.

No matter your jam, dancing has loads of wellness benefits. There are, of course, the general benefits of cardiovascular exercise, like keeping blood pressure and blood sugar in check. Depending on the style of dance you choose, though, you might focus on improving your balance and flexibility or strengthening core and leg muscles.

Beyond any fitness goals you may or may not have, though, there’s a sense of satisfaction that comes with taking on a new challenge.

“It’s very rewarding to me as an instructor to see people learning to dance, learning something new,” says Canellias. “A lot of people have desk jobs. It’s important to use that other part of your brain where you learn to do something physical and you learn to do it with other people.”

Finding connection

Dancing with people in the same physical space also lends itself to finding a sense of community that you might not get through other forms of exercise. To do this, though, you need to find the style of dance and type of class that resonates best with your interests and lifestyle.

“We yearn for a sense of community and interaction with other people. Human beings need that,” says Canellias. “We’re social animals and we have to find a way to come together, and salsa is a great way to do that.”

Canellias regularly sees that sense of community in salsa. “You make friends. You recognize the same people that go out to the clubs,” she says.

Sometimes, people find their future partners on the dance floor. Canellias has seen multiple couples who met through salsa and ultimately married.

If you’re interested in salsa, you could dance at a club. But if you’re new to it, you might get more out of a class at a studio, where students who are of the same skill level practice together.

“Know that when you go into a class, especially a beginner class, everybody is a beginner,” says Canellias. “Very few times is there a more advanced dancer in there, unless they’re helping out.”

With salsa, like other dances that involve partners, you may be paired up with someone you don’t know.

“Initially, for someone who has never danced before, there’s a certain amount of anxiety,” says Canellias. “They get a little nervous about dancing with a stranger, but that’s how we make friends.”

‘Spiritual’ dimension

For those who are interested in larger group dances, hula might be the right option.

“Hula goes beyond dance. It’s spiritual. It’s emotional,” says Chase Keoki Wang. “It teaches them about life, no matter what age you are.”

In 2010, Wang opened Hula Hālau Nā Mamo O Pane’ewa, the Glendale school that his grandmother passed down to him. There, he teaches all levels, with some participants as young as 5 and others older than 80.

“Not only is it a physical dance, it’s also a spiritual journey for some,” he says. “Especially those who are from Hawaii, they find a connection, or what we call a pilina, with their ancestors through hula, through the discovery, through the old chants and things like that.”

As for the dance itself, hula can be quite challenging.

“Hula dancing is very physical. People don’t realize it,” says Wang.

Additionally, there’s a good amount of memorization involved, from the choreography to the chants. All of that has plenty of health benefits. Studies conducted in connection with the National Institute of Minority Health and Health Disparities showed that, for Native Hawaiians and other Pacific Islanders, hula has a number of benefits for heart health — not just for the exercise, but also because people strengthened cultural and community ties.

At this school, Wang has seen some of the benefits that go beyond physical fitness.

“For some, it’s that connection and the camaraderie with what we call their hula sisters and hula brothers in each group, or their hula ohana or hula family,” he says. “The support that they give each other, whether it’s getting ready for a performance or competition, the gatherings that we have, the sense of community that we have is very important for many people, especially those from Hawaii.”

Do it for self-expression

If you simply want to move without the stress of getting the choreography right, a cardio dance or dance aerobics class might be your best option.

“Back in the day, I couldn’t find a dance class where I would let myself really try, because I was scared. I felt afraid,” says Emilia Richeson-Valiente, who founded the popular dance aerobics class Pony Sweat back in 2014. “What I try to do with Pony Sweat is make a space where you might feel less afraid.”

Richeson-Valiente, who teaches at Stomping Ground in El Sereno and Athletic Garage in Pasadena, has cultivated a “fiercely noncompetitive” atmosphere in her classes that has attracted a following far beyond Los Angeles, thanks to livestreams and video releases.

Music selection is key to the classes. Richeson-Valiente, who started by choreographing routines to songs from The Cure and Smashing Pumpkins, makes playlists that mimic old-school mix tapes.

“I try to have an emotional arc to it, like we did when we were in the practice of making mix tapes regularly,” she says. (For the music buffs, Richeson-Valiente also teaches a class called Exercising and Listening to Records, where participants bring their vinyl picks to class.)

Perfect isn’t the point

Beyond the mix of tunes, though, Richeson-Valiente’s “anti-perfectionism” outlook keeps Ponies coming back to class. “Because there’s so much emphasis on that, folks come back because they feel free, they feel secure to maybe not know how to do something and trying it anyway,” she says.

Ponies have told her that the classes help them honor their bodies. “That makes them feel closer to themselves and acknowledge parts of themselves that they might otherwise try to hide,” she says.

Richeson-Valiente adds, “I’ve witnessed that in the people that come regularly. There’s an expansiveness. People’s lives become changed when they find a way to be in their bodies.”

The community that forms inside the classes helps foster those kinds of changes. People are asked to read Pony Sweat’s core values and community agreements, posted on the class’s website, before attending. “The reason why this space feels supportive is because of the energy everyone puts into it,” says Richeson-Valiente.

The positive energy of dance class isn’t necessarily unique to Pony Sweat, though.

“Pony Sweat can be pretty cathartic in a lot of ways, like a lot of group dance experiences are,” she explains. “You’ll feel different when you leave the class than when you came in. That’s just the power of group dance, what happens when we dance together.”

And while the specific cancer that killed him, Merkel cell carcinoma, is quite rare, skin cancer in general is the most common of cancers, with the basal and squamous types affecting about 3.3 million Americans a year, according to the American Cancer Society.

Thankfully, skin cancer is usually treatable when caught early, but lately, one of the most popular ways to protect yourself — sunscreen — has come under fire. Which is not good news if you live in perpetually sunny Southern California.

Safety issues

Specifically, the product under fire is chemical sunscreen, the lotion (or spray) you apply to your skin and let absorb before going outside. This is opposed to mineral sunscreen, which does not absorb, but sits on top, in some cases making the wearer look like they’re wearing a mask.

In 2021, the Food and Drug Administration flagged 12 active ingredients, including oxybenzone and octinoxate, commonly used in chemical sunscreens, after studies showed that they get into the bloodstream, with sometimes high levels found in a variety of bodily fluids, including breast milk and semen.

Whether these compounds truly harm your health is still not clear. However, the concern is that they may disrupt the endocrine system, the network of glands in our bodies that produce the hormones that regulate our vital functions.

A year earlier, a study by researchers at UC Irvine looked at 29 smaller studies on the subject, and found that none could confirm that these ingredients caused harm. Still, the UCI researchers concluded it would be wise to do a larger and more comprehensive study.

Your various glands, however, are not the only worry. Several environmental studies, including one in 2008, and another in 2016, showed that oxybenzone and octinoxate hurt marine life, particularly by bleaching coral, leading the state of Hawaii and Key West in Florida to ban chemical sunscreens with those ingredients.

Yet other environmental researchers have said those studies may not be correct. In a rebuttal in The Conversation, an online magazine, Australian coral reef researcher Terry Hughes points out that the coral in the studies were exposed to far more of these compounds than it would be in a natural environment. More damning, he says, is that the coral in the Great Barrier Reef continued to bleach in 2020 when tourism shut down completely due to COVID-19.

If that’s the case, why bother banning sunscreen?

“It’s banned by governments that want to appear to be doing ‘something’ about coral bleaching. Despite the evidence that bleaching is caused by anthropogenic heating,” Hughes responded via X (formerly Twitter).

As for the FDA imposing its own nationwide ban on chemical sunscreen, that is not what’s happening here.

“It is important to emphasize that the FDA is not saying don’t use them,” says Dr. Kerry Hanson, a research chemist and sunscreen expert with the Bardeen Research Group at UC Riverside. “They are asking for more data, so consumers have the best information to make informed decisions.”

Hanson, like the UCI researchers, agrees further study is a good idea.

The question, though, is what do you, the consumer, do while all of this is being sorted out? Stay inside? Resign yourself to using products that make you uncomfortable?

Or, should you just take the advice of social media influencers across the political spectrum, who maintain that sunscreen is terrible overall and encourage its non-use — and, in some cases, even advise that everyone tan areas that, ahem, you usually wouldn’t show to the sun?

Taking health advice from Instagram or TikTok, said Dr. Caroline Opene, a dermatologist and director of UCLA Health’s Skin of Color Clinic, may not be the best idea.

“Essentially, the general population needs to check credentials,” she said. “Who is giving the advice?”

Opene’s advice, which echoes that of the vast majority of credentialed experts, is to do what you can to protect your skin, and not just from a painful sunburn.

“There is no such thing as a healthy tan,” she says.

The ‘healthy tan’ myth

This may come as a surprise to generations who grew up in a sun-worshiping culture where it wasn’t uncommon to slather oneself in baby oil, then spend the summer baking on the beach or near a pool.

Then there were the tanning salons — which started appearing in the early 1980s and were available year-round — that advertised tans without that pesky sunburn.

Western culture’s sunbathing craze started in the 1920s. Some say it should be blamed on French fashion designer Coco Chanel, who, after spending a vacation cruising the Mediterranean, impressed her friends and fans upon her return with her sun-kissed glow. Soon, the wealthy and the famous (and all those who aspired to be) were soaking up the sun.

This was quite the contrast to previous generations, which considered having a tan to be the mark of a lower class (not to mention the issues of entrenched racism and colorism).

Unfortunately, all that sun soaking came with a price: leathery skin, wrinkles and, even worse, skin cancer. Then, tanning salons were found to be not all that safe, given the alarming uptick in cancers among users in the ’90s and early aughts. (Still, they continue to be popular, even as doctors and scientists scold.)

The culprit in all of this? Ultraviolet light.

Blind to the light

Human beings can’t see ultraviolet light, which is why scientists may be forgiven for not knowing it even existed until German scientist Johann Wilhelm Ritter discovered it in 1801. It would take another 88 years for Swede Erik M.P. Widmark to prove it was UV light that causes burns and aging.

There are, in fact, several kinds of UV light — all affecting the skin differently, Hanson explains.

“UVB is higher in energy, and causes sunburn. Think ‘b’ for burning,” she says. “UVA is lower in energy and causes many of the visible signs of aging, like wrinkles and age spots. Think ‘a’ for aging.”

Although human eyes can’t see either UVA or UVB, the skin can sense it. The reason there is no such thing as a healthy tan is that it’s actually the skin’s stress response when subjected to too much radiation.

Raise the melanin umbrellas!

Tanning happens in the top layer of skin, known as the epidermis, which is composed of four types of skin cells:

• Merkel cells (responsible for being able to sense touch);
• Langerhans cells (part of the immune system, they tackle bacteria and other invaders);
• melanocytes (they dictate skin color, as well as eye and hair color); and
• keratinocytes (containing a protein called keratin, also the building block for your hair and nails).

Keratinocytes are the most abundant skin cells, constantly reproducing and shedding, which means that the average human grows a whole new epidermis about every month.

When exposed to too much UV, the keratinocytes send an SOS to the melanocytes, which produce melanin. Melanin, or specifically, eumelanin, is a dark brown pigment that is quite effective at blocking radiation. (Redheads can thank pheomelanin for their coloring.)

The melanocytes transfer pigment packets, called melanosomes, to the keratinocytes. The keratinocytes arrange their new melanosomes over their nuclei (which is where cells keep their precious DNA) into a little melanin umbrella.

So, when you look at your freshly tanned arm, what you’re really seeing is millions of tiny melanin umbrellas.

Sunscreen, revisited

Why worry, then, about wearing sunscreen, when the human body effectively produces its own with eumelanin?

It’s all about the sun protection factor, or SPF.

“The SPF value represents how long a person can stay in the sun without getting sunburned,” Hanson explains, adding that SPF only applies to UVB radiation.

“So, for example, if you burn within 10 minutes of UVB exposure, then an SPF 15 should protect you for 15 times 10 minutes, or 150 minutes, before you get burned. Melanin can provide an SPF of up to about 13 depending on your level of melanin in your cells.”

There’s the catch: Melanin is useless against UVA radiation.

“Melanin blocks UVB, but does not block UVA,” Hanson said. “People who have more melanin may not burn as quickly as those with less melanin, but sunburn occurs in people with all skin types.”

This is why Opene, at her UCLA clinic, advises patients with darker skin to always use sun protection, preferably a broad-spectrum UVA and UVB product with an SPF of at least 30.

“In general, people dramatically overestimate the amount of protection that melanin offers,” she says. “People with the darkest skin tones have an SPF that is less than 15. So, while they may rarely or never burn, they can still accumulate DNA damage in their skin cells when they tan. Over time, this leads to the very common findings of white freckling on the arms and legs, brown spots, and a leathery texture of the arms and legs.”

But how, exactly, does that recommended sunscreen work?

Again, the mineral kind sits on top of the skin, much like a mask. The chemical kind, though, contains chemicals that form an internal mask. That mask, though, acts less like a shield and more like a raft of little sponges, each absorbing either UVA and UVB radiation, then breaking it down, then releasing it, usually as heat.

Neutralizing UV radiation, however, quickly destroys the sponges, which is why consumers are encouraged to reapply sunscreen every two hours (more often if they swim or sweat a lot).

Both Hanson and Opene say neither of those types of sunscreen will help if not applied properly. Since mineral sunscreen is easier to see, make sure you coat your skin evenly and thoroughly.

Chemical sunscreen can be trickier. Experts recommend a shot glass worth, but it really depends on your size. Hanson recommends applying chemical sunscreen after you’ve done your skin routine, including makeup, so that the protective layer is on top. When you apply also makes a difference. It’s best if you apply about 10 minutes before you go into the sun, Hanson said, and make sure it dries into a nice film.

Finally, check the expiration dates. No sunscreen lasts forever. If your favorite lotion has separated or clumped, throw it out.

Smart sun protection, without shame

There are ways to enjoy the sun without slathering on sunscreen. Here are some tips from the experts:

• Get a parasol, a nice big hat with a wide brim, long sleeves, and long pants or skirts. All help, but just make sure the material is tightly woven. Darker colors are also better, even if they tend to absorb the heat. That doesn’t mean, though, that you can escape the need for sunscreen entirely. You should still apply it to exposed skin. More clothes just mean less need for creams.
• Check the daily UV index (a feature available on most weather widgets these days). If it’s high, don’t stay out too long, and if you can, avoid going out between 10 a.m. and 4 p.m.
• If you are older, and take certain medications, you may be more sun-sensitive, Hanson said, and burn even while taking precautions. Statins and anti-inflammatories, for example, are on the FDA’s list of drugs that make you photo-sensitive.
• Ditch the guilt over the bad old days. Opene reports many of her older patients are ashamed about past sunbathing habits. It’s never too late to be careful. Remember, sun damage builds up over time. Just do your best to avoid more!
• Get very familiar with your skin. Not everyone has access to a dermatologist, so keeping track of changes, like a mole growing or changing colors, patches that keep peeling, or injuries that won’t heal, is crucial. And that means ALL skin, Opene stressed. That includes palms and soles, between fingers and toes, eyelids, ears — even the inside of your mouth and your genitals. It may feel terrifying at first, but it pays to catch problems early.

Why did my husband and son constantly complain that I cranked the sound too loud on the television? Couldn’t they tell there was something wrong with the speakers?

When did the tea kettle whistle become so faint?

And why were people looking at me funny when I replied “Fine, how are you?” to the question they just asked? At least that’s what I thought they asked.

Clearly, the world had a problem.

I couldn’t be the one with the problem, right? I was a healthy woman in my early 50s — I didn’t need any medication for anything, was an enthusiastic equestrian, had a successful career, and enjoyed a fulfilling family life. I traveled, I was a public speaker. With so many things going on, maybe I was merely distracted and overwhelmed by bings and dings and buzzing, the cacophony of modern life.

This is what I thought right up until that moment in the staff meeting.

I had gathered everyone to review pages for an edition of the magazine before it shipped to the printer. I was inspecting one of the layouts when suddenly I realized the room was very, very quiet. Too quiet.

I looked up to see everyone staring at me expectantly, except for Tobin, who seemed upset.

“Uh, OK you guys, what’s going on?” I asked.

My art director Karen let out an exasperated sigh and said with her usual blunt candor, “Sam, didn’t you hear Tobin talking to you? Or were you planning to ignore him? You really need to get your hearing checked!”

To say I was embarrassed is an understatement — more like mortified. I apologized to Tobin and asked him to please repeat what he’d said. As soon as we wrapped up the page review, I went into my office and closed the door. And shut the blinds.

After all, if you’re going to cry at work, you need some privacy.

A club I didn’t want to join

An audiologist confirmed what everyone else had already figured out: I had moderate hearing loss.

Despite all the evidence around me, I was still surprised to see the irrefutable results of my hearing test, an objective graph of hills and valleys that created a picture of the sounds escaping me.

Another surprise was that this loss wasn’t primarily caused by all those rock concerts I’ve enjoyed throughout my life, although they didn’t help — being around loud noise does have a long-term impact on hearing, audiologists will tell you. I thought of a time in the late ’80s when I had interviewed Alex Van Halen, drummer for the iconic rock band Van Halen. He kept saying, “What?” and “I’m sorry, can you say that again?” during our conversation, until he finally laughed and told me, “I’ve been playing drums so long I can’t hear anything.”

But no, my audiologist explained that my particular situation is caused primarily by genetically inherited damage to nerve fibers in the inner ear, a progressive condition called sensorineural hearing loss.

A light bulb went off in my head. My mother had worn hearing aids from her mid-forties on, and so had my grandfather and various cousins. Suddenly, I understood that being hard of hearing didn’t run in my family, it practically galloped.

My family, it turns out, isn’t unique. In fact, we joined a club with many members: Hearing loss is one of the most prevalent health conditions across the world, according to the World Health Organization. In California alone, about 3 million residents are deaf or hard of hearing, or so say statistics from the Orange County Deaf Equal Access Foundation website.

And here’s another truth, according to information from the Mayo Clinic: More than half the people in the United States older than 75 have some degree of age-related hearing loss.

Aging? Who, me?

If I’m honest, that “age-related” part is what kept me from acknowledging all the evidence of my hearing issue. I still wanted to think of myself as a vibrant, capable, dynamic person. I wanted to think of myself as an attractive woman who could still be appealing to my husband. Facing the fact of my hearing impairment meant facing all the stereotypes I had bought into about aging — and beneath those stereotypes, my deep-seated fear that getting older would equal a loss of personal power, of value, of meaning.

Those old-age stereotypes are so deeply entrenched that it’s hard to know where to begin ripping them up.

Worry created anxiety, which created insomnia, which created a pressing need for me to Google “hearing loss effects” late into the night. And what I found didn’t ease my worry: Unaddressed hearing loss is linked to an increased risk of dementia, and of falls that can lead to serious health consequences. What’s more, once your original hearing is lost, it’s lost. There’s no getting it back.

Reader, here’s where I tell you that I started to feel scared, and very sorry for myself.

What pulled me out of it was the wise words of a friend of mine, Jen Pastiloff. Aside from being a social media phenomenon and sought-after workshop leader, Jen is the author of “On Being Human: A Memoir of Waking Up, Living Real, and Listening Hard.” She also lives with a profound hearing loss, and is nearly deaf. In one of her essays, “Losing My Hearing,” she wrote:

“It’s exhausting, straining to make out what people are saying. I read lips, but that’s also sleep-inducing. Staring so hard at mouths making their O shapes or their various forms of joy or disgust, it can wear a person out. Sometimes I simply stare into space, because really, what else is there to do when you can’t hear and you’re tired of pretending?”

That made me realize that not facing my hearing loss had already constricted my life. My denial was what was making me “old.” I thought of the restaurants I avoided because of how difficult it is to make out what people are saying above the din. I thought of the times I had stayed silent and not engaged in conversation, rather than risk the possibility of misunderstanding what was being said back to me. I saw the ways I was making my life smaller and duller — my fear of not being a vibrant, vital person had become a kind of self-fulfilling prophecy.

Jen’s words rang in my head. I too was tired of pretending.

Now hear this

I wish I could just write, “And then she lived happily ever after,” but we all know no story ever really ends that way.

Once I got over my denial and decided to deal with the fact of my hearing loss, I had to tackle the somewhat daunting process of actually getting hearing aids. I say “daunting” not because there aren’t viable, plentiful options for hearing aids — there are. Many feature technological advancements that employ Bluetooth so you can magically adjust the devices to your needs in any given situation, and come in sleek, discrete designs.

No, the daunting part was all about money. Despite the prevalence of hearing loss and the well-studied detriments it can have on your health, most health insurance policies don’t cover hearing aid devices or the cost of examinations for fitting them. Period. Does this make any sense at all? Nope. Nada. Zip.

The devices recommended to me came with a (gulp) $5,000 price tag — although there was an even more refined option, if I wanted to spend $7,000. Uh, no.

After I picked myself up off the floor — not really, but I swear I did feel faint at the prospect of shelling all those thousands out of pocket — I started to look for solutions.

Hearing loss assistance exists, but it’s an uneven patchwork of local and state agencies, with nonprofits stepping up, like the Kiwanis and Lions Club. Yet this doesn’t address all the need. Many hearing aid manufacturers offer financing plans, which is something, I guess. Over-the-counter hearing aids are some help in a pinch, but they just amplify nearby sounds and aren’t tailored to the nuances of individual hearing loss. Good old Costco offers the best option for many, offering hearing tests and good devices fit by an audiologist for around $1,500.

For my particular type of hearing loss, coupled with the demands of my career, the best option ended up being the most expensive. Those hearing aids would have been out of reach for me financially, however, if a group of friends hadn’t gotten together and created a GoFundMe to help make up my budget shortfall. Accepting help from friends and family humbled me, and also made me part of another club — about a third of all GoFundMe campaigns are reported to be for medical expenses.

I know how lucky I am to have had this support. Every time I’m in a crowded room and can actually follow a conversation thanks to my hearing aids, a wave of gratitude still washes over me.

Learning to really pay attention

As helpful as hearing aids are, they’re still not able to give you the experience of life like when your hearing was intact.

What I’ve had to learn is a new way of being in the world, a way that was never possible when I was still pretending my hearing hadn’t lessened. Facing the truth means that I’ve had to become more present to what’s going on around me, to really stop to observe my world, to not just hear but to listen deeply.

People call that friend of mine mentioned above, Jen Pastiloff, the one with the profound hearing loss, a “fierce listener.” I have yet to achieve it, but I keep it as a goal.

This way of being also demands that I be frank about what I didn’t get, to not pretend, to not be too proud to admit something is hard for me. To face the world with an almost child-like honesty, learning and relearning as I go.

The migratory monarch butterfly population is estimated to have declined by 99 percent in California. I have only ever seen one tattered-winged monarch in my yard in Banning. That butterfly, which I reported in 2019, was the only sighting in Banning on the Western Monarch Milkweed Mapper.

All the same, the milkweed grew and by June, through some sort of butterfly sorcery, the monarchs had found them. I saw five and then spotted females laying eggs in August. By September, I had 12 fat caterpillars feasting on my offerings. I never raised monarchs in elementary school. So, I may as well have been a 12-year-old.

I watched the caterpillars slough off their skin to become a chrysalis. I tracked the chrysalises as they turned from opaque jade to a thin membrane barely obscuring the black and orange pattern of a monarch’s wings. Then I watched six butterflies plump, dry and test their wings before making a lazy exit to join the migration.

As I watched the last of my butterflies spiral upwards on its way to join the waning migration, I felt a powerful rush of awe. I had added six souls to this inexplicable journey to winter in Coastal California and Mexico. I was a part of something I could barely understand, but knew took place every year long before I started my short time on earth. I hoped it would continue long after I was gone.

As I mulled over my small contribution, I also considered my role as co-executive director at Rivers & Lands Conservancy. If a tiny patch of milkweed could make me a positive contributor to something so amazing, then what was the impact of the 3,000 acres of wild open space we steward in perpetuity? I felt small, but I felt connected to something so huge I could barely fathom it. More than this, I wanted others to have this feeling as well and I wanted to do more. This, at its core, is the power of awe.

Seeking awe in nature

Nature is one of the easiest places to experience the emotion of awe. While philosophers and poets have delved into the meaning and power of awe for thousands of years, it has only been in the last two decades that science has studied this emotion.

Today, psychologists describe awe as a moment of experiencing vastness, or feeling that we are a part of something much larger than ourselves. This is followed by a need for cognitive accommodation or a change in perspective.

When we think of experiencing awe in nature, our thoughts go to standing beneath a giant sequoia, watching a meteor shower in the Mojave Desert or maybe the vast patchwork of a wildflower super bloom. Yet, awe can be sought and found in much smaller patches of nature. All it takes is to give nature our full attention.

In their 2023 book “The Power of Awe,” authors Jake Eagle and Michael Amster encourage readers to hone their ability to experience awe in everyday life. The book is based on the authors’ research at Northbay Hospital and UC Berkeley. Working with more than 300 patients and 200 hospital staff and frontline workers during the height of the COVID-19 pandemic, they discovered that “micro-dosing” awe was a fast and powerful method to improve overall well-being.

Their clinically proven A.W.E. Method takes 20 seconds; those practicing this method three times a day experienced reduced anxiety, chronic pain and burnout. The research also showed improved clarity and purpose.

By pausing to give our full attention to something as common as a sycamore leaf, examining its network of veins and considering how it nourishes a tree, we expand our awareness and realize we are a part of something vast. We are not alone but connected. We feel smaller, but we also feel more inclined to connect with others, participate in our communities and do what is best for everyone, not just ourselves.

Eagle and Amster speculate that when we feel awe, our body releases oxytocin, the “love hormone,” and everyone struggling with loneliness could use more of that. While oxytocin is primarily released during positive physical contact with others, awe can be experienced alone. You do not need another person to feel that rush, but you can definitely share it with someone you love.

Further benefits of nature

A study published in 2021 found that people who spent time in nature reduced their odds of being lonely by 28 percent. Spending time with family and friends in nature can certainly boost our mood. Yet, even when people spend solitary time in nature they are more likely to feel spiritually connected and less likely to be lonely.

Science is not yet clear on the optimum amount of time spent in nature to reap the most benefits. Some studies have demonstrated a decreased level of the stress hormone cortisol with just 20-30 minutes walking or sitting in nature. Other studies have found that people who spend two hours in nature over the course of a week were more likely to report better health and well-being.

However, all the research agrees that any amount of time in nature is better than staying inside. In addition to a sense of connection and lowered stress, time in nature has been proven to decrease anxiety, increase cognitive abilities, lower blood pressure and boost creativity.

Fortunately, California’s weather invites outside activities nearly year-round. As the most biodiverse state in the nation, there is also a wealth of ecosystems to explore no matter where you live. While this is a great reason to visit our state and national parks, you do not have to travel far or seek isolated wilderness to find benefits in nature. You can get the same results by visiting nearby city parks or nature preserves, walking on local trails and working in the garden.

If you bring curiosity and a desire for discovery to your nature dates, you can increase the impact even further. Getting to know the plants, wildlife and seasons of nearby nature havens inspires awe and creates a sense of place and a connection to it.

Get to know the birds

Birds make us happy, and scientists have done research to prove it. A study out of Cal Poly San Luis Obispo found that hikers who heard birdsong while hiking felt more joy and overall had a more positive experience.

Another study, by the German Center for Integrative Biodiversity Research, looked at the life satisfaction of 26,000 people in 26 European countries and compared it to the level of bird diversity where they lived. The study found that people who lived near natural areas with a greater number of bird species were much happier. When the researchers factored in the socio-economic data of the people surveyed, they found that seeing 10 percent more bird species increased their happiness as much as a 10 percent increase in income.

Planting bird gardens and putting up bird feeders can attract more bird diversity to your yard, encourage you to step away from your screen and provide more opportunities to experience the benefits of nature. Finding and identifying birds by appearance or by song requires focus and attention to detail, opening you up to more impactful nature experiences and feelings of awe.

Using Cornell University’s free Merlin Bird ID app on your smartphone can help you discover species you have never noticed or perhaps did not even know existed. In addition to providing a list of regional birds with photos and natural history, the app can identify birds by sound. Just turn on the sound ID in a quiet space outside and let it run while it lists all the birds it hears.

Even if you can’t get a raise, you can at least benefit from discovering the diversity of birds that surround you.

Invite nature to your garden

California native plant gardens also offer a deeper connection to nature by providing habitat and food for a greater diversity of local wildlife. Native plants can attract new birds and pollinators to your yard, inviting new experiences in nature and moments of awe.

But you don’t have to convert your entire yard to native plants. The addition of just a few plants can attract new birds and pollinators.

There are many great resources to discover the best native plants for your landscape. California Native Plant Society (CNPS) is one of the best places to start. CNPS’s Calscape website provides all the resources you need to find plants native to your area, their growing needs, the wildlife they support and what local nurseries carry them.

If you are looking for inspiration on a design for a native plant garden, CNPS’s Bloom California website provides a selection of possibilities. There are even suggestions for container gardens for those working with a small space.

Volunteering for nature

Perhaps the most effective way to immerse yourself in the benefits of nature is to volunteer for nonprofit organizations that are working to beautify and restore the environment. There are numerous opportunities throughout Southern California to participate in beach clean-ups, tend community gardens, plant trees and restore habitat.

Land trusts, nature preserves, parks and grassroots organizations all offer opportunities to get outside and volunteer your time in meaningful ways.

Beyond getting an emotional boost from making a difference in a significant way, volunteering makes us feel connected to our communities while also feeling that we have something important to contribute.

There is always the possibility of making new friends when you connect over common values. Volunteering also empowers us, proving that each of us can create change and make the places we live better. This alone can greatly improve our mental well-being.

As our population becomes increasingly concentrated in urban areas, our contact with nature continues to decrease. Scientists have suggested that the loss of human-nature interactions is creating a “extinction of experience” leading to generations who no longer understand the deep and lasting benefits that nature provides.

In a place as rich in natural beauty as California, a generational disconnect would be a tragedy. There are so many benefits to spending time communing with green spaces and wilderness. Nature is easily accessible and free.

More than this, the future of conservation depends on our youth discovering the benefits and making their own connection to wild creatures and wild spaces. We need nature and nature needs us.

I doubt I will ever find the metamorphosis of a monarch butterfly anything less than awe-inspiring. Just in case, though, I will be planting two toyon bushes in my front yard this fall. A few winters from now, with any luck, the native toyon will be heavy with deep red berries. Then, perhaps a flock of cedar waxwings will descend to fill their bellies close enough that I’ll be able to see the red waxy tips of their wing feathers. That would be awesome.

How to use the A.W.E. method

A.W.E. is an acronym for attention, wait and exhale and expand.

First, you give something you value, appreciate or find amazing your full attention. It can be a memory, an object, or even a pet, but you must examine it closely and notice everything about it. If it is your dog, notice the feel of her fur beneath your hand, the feel of her heartbeat, the color of her eyes.

Second, you wait, slowing down or pausing while you continue your appreciation to take a deep breath.

Lastly, you exhale and expand, making a slightly deeper exhalation than normal. Allow your feelings to grow and fill you. If you smile, relax, feel a warmth in your belly or an upwelling of emotions, you have experienced awe.

Tips for getting the most out of your time in nature

• Choose a place you feel safe exploring.
• Block out the time for nature in your calendar so you don’t have to rush.
• Be present when you spend time in nature. Turn off your phone and put away your earbuds.
• Take deep breaths. Deep breathing signals your body to relax and slows down your thoughts.
• Focus on the details around you. Invite moments of awe.

If you’re worried about what happens as you age, or when you’re no longer able to handle your own affairs, or even when you’re no longer around, it’s easier than you think to put everything in order. Whether your concern is your own health care, finances, family, assets, or all of those things, there are solutions that don’t cost a fortune. And you’ll likely breathe a sigh of relief when you get it done.

The State Bar of California and my liability insurance require me to tell you that what I’m about to share isn’t legal advice and it’s not meant to substitute for legal advice. If you are not sure whether you need an attorney, ask one. Many estate planning attorneys will give you a limited consultation free of charge. And the hacks below may help you help yourself, especially if your assets are limited.

What you need while you’re still around

HEALTH CARE DIRECTIVE – Everyone, no matter how old or how healthy, should fill out this form. What happens, for example, if you get in a car accident and you want your significant other (to whom you’re not married) to be able to guide your care while you’re in the hospital?

This directive allows someone you choose, which can be a family member or not, to make medical decisions on your behalf when you are not able to do so. [See “Who will speak for you when you can’t speak for yourself?” on page XX for more on this.] It’s temporary, and only in effect while you are unable. Most hospitals will ask for this document when they admit you and it will help those closest to you make sure you get the care you need. Here’s the free form: bit.ly/AHCDirectivePDF

POWER OF ATTORNEY – A Power of Attorney allows someone you designate to handle your financial affairs for you when you are no longer able to do it yourself. It’s only in effect while you are alive. And yes, it’s another free form: Power of Attorney.

After you’re gone

Do you need to name who’s going to look after your child? Want to make sure your spouse inherits (or doesn’t)?  You need a LAST WILL AND TESTAMENT. California has a statutory will, which is (you guessed it) a free form.

BUT, and this is a big BUT: If you only have a last will but not a trust, your estate will go through a court process known as probate. Many people believe that having a will means their estate won’t go to probate, but that’s not true in California. Probate can take years and is something to be avoided unless you don’t really have family or much in the way of possessions, or don’t care how long it takes for your will to be carried out.

Here’s what probate costs: 4% on the first $100,000, 3% on the next $100,000, 2% on the next $800,000, 1% on the next $9 million, and .5% on the next $15 million. If your estate (including your home) is worth, say, $1.5 million, you’ll pay $28,000 (lawyer) + $28,000 (executor) = $56,000 total in fees. Or you could avoid probate for less than $5,000, which is what it typically costs to have an attorney create a revocable trust and estate plan.

That’s right: $5,000 now or $56,000 later. Your call.

Your stuff — do you need a trust?

The first thing to figure out is the size of your estate: How much do you have? Your estate is the dollar value of everything you own, including your home, regardless of money that may be owed.

SMALL ESTATE

If everything you own totals less than $184,500, then you are exempt from probate, yay! Your heir (the person who has a legal right to inherit your stuff without a will, such as your son or daughter) will simply need to file a Small Estate Affidavit (that’s right, another free form).

SMALL-MEDIUM ESTATE

Let’s say your estate is worth more than $184,500, but less than $1.5 million, there are only a few items that you want to leave to certain people, and you don’t mind if it takes a few years for it to go through probate. If this sounds like your situation, then you may be okay with just a will. But make sure you have that will (see above) done, and tell someone where the original is kept.

MEDIUM-PLUS, LARGE-ISH OR LARGE ESTATE

If your estate is worth substantially more than $184,500, you need to avoid probate. The best way for most people to do that is a revocable trust. That does require an attorney, but many attorneys create revocable trust estate planning packages for a flat fee of less than $5,000.

The great thing about revocable trusts is that you can revise them as often as you want, or even revoke them and start over. They are also fully customizable for almost any situation and allow you to provide guidance to the folks you leave behind.

For example, maybe you want to pay for any of your grandchildren to get a college degree. Or perhaps you’d rather that your beneficiary didn’t get her or his inheritance all at once, but at certain specific ages or milestones. Or maybe you want to make sure your furry family members can continue living in the style to which they’ve become accustomed — then you include a pet trust. Or, let’s say you want to leave whatever is left over to your favorite charity.

There are infinite ways in which a revocable trust can be customized, and this is the E-ticket option for most people.

Jan D. Breslauer-Dowdall is an estate planning attorney in Orange County.

On a rare night off, I was invited to a writer friend’s house; she was a superb hostess with a cranky, charismatic hubby who retired from the industry. He had a career as a producer whose claim to fame included the hockey fan favorite, “Slap Shot,” starring Paul Newman.

That night, I tried to get his take on a film I had just seen.

“The movies?! Anne, I don’t have TIME to go to the movies!” It wasn’t an angry response, he just seemed puzzled that I didn’t understand. I chalked it up to his long list of eccentric interests: he loved screwcap wines, knives, guns and cigars; he had inherited Alfred Hitchcock’s collection of stogies.

No time for a flick? What was he up to? Now I know.

Decades after that dinner, I’m almost two years retired myself. I had enjoyed my fast-paced job as a features writer/editor for local publications including The Orange County Register, Los Angeles Times and Orange Coast magazine. But as I began to age, it was taking a bigger and bigger chunk out of me.

I hung in as long as I could, trying to keep up the relentless pace. Then I started having health issues: I was trying to do my long run after skipping it for weeks and I threw my back out. I struggled on for a few years without taking a month for it to heal as I had in the past. Now that pain was chronic and I was in my 60s. Retirement loomed.

Still, the thought frightened me. What would I do with myself when I was off deadline once and for all? It’s been an interesting journey, but with time for self reflection I’ve learned seven important lessons on what makes for a happy retirement.

Finances first

Setting our finances straight was Lesson No. 1: Less can be more if it leads to delight. 

The biggest money issue was real estate. I love Southern California and had vowed I would never move back to Texas. But how could I afford to retire here?

My husband also is a writer, and even before the pandemic we considered downsizing. We continually feared that the mortgage on our big comfy house eight blocks from the Huntington Beach Pier would crush us if I lost my job.

We wanted to Marie Kondo our lives, play it safe. The pandemic hit and we called our realtor to ask if we should wait. She didn’t mince words: “If you can get out quickly, I can stage it and sell it fast.”

We had an estate sale. Listed and sold within about six weeks.

We’d gotten our price but the problem in this luxury market is that we would have to spend it all to buy another place. Unless — and it was a big unless — we could live in an affordable 55+ community.

We decided to try it on for size. We found a charming rental in Laguna Woods that reminded us of our beach house. The tree-filled neighborhood with green lawns was elysian. There will never be another community built just like it because land is worth too much now in Southern California.

Joining the village people

We liked Laguna Woods so much we decided to buy. It turned out to be a huge relief. So much pressure was off our shoulders.

So, there we were in our new neighborhood, or should I say village? Modest condos. Wrinkled residents with tiny dogs. Some of my newspaper pals were collapsing with laughter. “Anne, why are you living in old lady land?”

Even my sister asked a couple of times. How do you feel living among all these oldsters? I answered with a question: Who wouldn’t want to be in a community where all around you were seniors enjoying their longevity? It was an inspiration that my neighbors were living independently, aging with grace, strength and dignity.

Honestly, some of them had a lot more mobility than I did. The longer I lived there the more I understood. There were five pools. I had more time to go swimming and luxuriate in a huge hot tub. Hospitals and doctors were all around us. I could see my nearby physical therapist weekly, so there was less pain and more nights of restful sleep.

I started to get more health conscious and dumped calorie counting for the Dash Diet. Pounds were shaving off, verrrrry slowly. Feeling physically better was the ultimate mood booster, and that was Lesson No. 2: Keep your spirits up and your body will follow. 

I watch what I eat, but my diet isn’t draconian. When I interviewed celebrity chef Ina Garten, she told me a healthy diet is not the only key to longevity.

In one of her books, she wrote that she and her husband know a physician, a geriatrics specialist, who spoke to them about life expectancy. “Loneliness is an epidemic in this country, and may be a more important predictor of longevity than diet and exercise,” she wrote.

Creative fulfillment

It took about a year for the back to begin feeling better. During that time, I was doing a lot of thinking about returning to all the pursuits I loved, especially writing and music. Throughout my career I had thought about penning a book, played around with a few nonfiction ideas and also took courses in fiction writing, but nothing had ever taken off.

As I got closer to leaving my job, I started reading more. I bought a copy of “The Middle Passage” by James Hollis and the biggest takeaway was that my happiness was up to me; that was Lesson No. 3.

Hollis explains that we break from counting on our parents to make us happy and look to our soulmate to provide that joy; but that isn’t the path toward true contentment.

“It is a cruel self-deception to believe in the magical other,” Hollis writes. “When one has the courage to turn within, one has the opportunity to open to those neglected parts of one’s own personality. If one lifts off of the partner the imperative for incarnating life’s meaning, then one is called to the activation of one’s own potential.”

Would I have the courage to return to my favorite forms of fulfillment and face them like an adult? We had bought a dazzling new grand piano with some of the money we made from the sale of our house. But realistically, I gave up my dream of becoming a concert pianist many years ago, and now, with my back problems, I couldn’t practice six hours a day like I did in undergrad.

Still, I started playing again and my technique returned almost fully. Playing solos gave me an incredible sense of power as I was reminded how hard I had worked for years to produce a rich, bravura sound and how much I loved music. Who needs Spotify when you can channel Bach, Bartók, Mozart and Chopin with your own two hands?

Facing myself as a writer was a lot harder. Six months went by without missing writing at all. When I started to think about tapping out a book idea or a story, I would look at my desk and feel rage directed at my chair. That’s what caused all my pain: long hours of sitting. For a year, I was stuck. I had horrific anxiety, convinced that anything I wrote would be awful and that any time spent sitting would trigger intense back pain. There were tears. Nightmares. Psychic agony.

But one afternoon I remembered a dream I had shortly after my father died. He was a true Renaissance man: a math teacher, realtor, mechanic, a ball turret gunner who fought in World War II. As a teen, he was a laborer and one of the strongest men I’d ever known. In the dream, I saw his powerful hands — he boxed and had won a Golden Gloves award — and his palms were turned up, like the logo in the Allstate insurance ad. His voice simply said, “Begin it.”

Encouraged by the spirit of my dad, I decided to take baby steps.

Project chocolate

I thought of Anne Lamott, the patron saint of procrastinators, author of “Bird by Bird.” She always advises that if you feel stuck, start moving. “Don’t look at your feet to see if you are doing it right. Just dance,” she writes.

I riffed off her wisdom with Lesson No. 4: If you want to stop procrastinating, start putting yourself out there.

At first that lesson was pretty tough. I found myself avoiding some of my younger friends who weren’t retired because next to them I suddenly felt irrelevant. But as I made even a minuscule amount of progress, my courage grew. I started to plan more social activities and I took that lesson headfirst into my book project.

My big idea? A directory of chocolatiers in California. Would I have the nerve to meet with one of the field’s leading authors in the industry? While I was dragging my feet, I got a phone call from a former colleague who told me our friend’s daughter, in her early 20s, had died in her sleep.

The tragedy shot through our circle of girlfriends like a lightning bolt. We gathered around her and did everything we could to help her pull together a memorial. Meanwhile, the drumbeat of another life lesson has resonated in the background ever since: death can come to any of us at any hour.

Lesson No. 5: Don’t waste time second guessing yourself or thinking you’re too old to do something. Do what you want now or forever have regrets. I stopped saying I wasn’t ready to meet with the chocolate guru.

I was going to be in Vancouver, Canada, where she lived, so I reached out with an email to arrange a meeting. She responded! We spoke for hours in person and she set me on a fascinating path. She told me not to put anyone in the book unless their product was the best.

Since chocolate isn’t rated like wine or coffee, we agreed; I’d have to do all the tasting myself. Poor me!  She recommended books on flavor. I’m studying vigorously and I’m certain loads of family and friends will volunteer to help with my “research.”

Bucket list anxiety

As for my old line of work, I don’t have the strength or interest to go back into the daily grind. I am freelancing, just to keep my hand in and to make sure the writing skills stay sharp. I’ve also begun my best hobby novel ever. It might never be published, but at this point, success to me is never fearing the blank page.

Yet, with all these Wonder Woman-sized missions of self-fulfillment on the go, there’s still more to do. For the first time I’ve got a little family around me. My niece and her sister have moved to Orange County. They fell in love with this place as kids, during summer vacations at my beach house. I like spending time with them and my great nephew, usually at my house because I love to cook and entertain.

My friends keep asking me if I’m traveling. “Do it before you’re 70!” they say. Up until now I didn’t think that I would be well enough, but I’m getting more fit and I’m hopeful. What better way to work on those European languages I studied but never mastered in grad school?

There are so many bucket list challenges it threatens to create its own anxiety, but for now I’m keeping that on the back burner: Lesson No. 6: You’ve stopped working, so be done with stress.

Other little lessons still creep up. Like the words of a former therapist who always said, “Give yourself permission to suck at something!” It’s a witty way of describing Lesson No. 7: Try new activities to see if they spark joy. Like a ukulele class I took at a resort while vacationing in Carlsbad.

So, each day is its own little adventure. Or not, because I can always sleep late and spend all day at the beach. There’s no schedule and no guilt when you’re off the clock. But if I stick to my retirement life lessons, I find it a lot easier to know what to do with myself each day.

I’m happy leaving work behind and finding the world so full of wonderful things. My neighbors keep reminding me that I could join one of the 200 clubs offered in Laguna Woods. Clubs?! Whuuuut? I don’t have TIME for that right now.

The global pandemic intensified what was already classified as an epidemic of loneliness in America.

A 2021 study commissioned by Cigna concluded that more than half of adults in the U.S. (58 percent) are considered lonely. The many health consequences of loneliness — increases in conditions such as heart disease, stroke, diabetes, dementia, depression, anxiety, addiction and suicide — prompted U.S. Surgeon General Dr. Vivek H. Murty to issue an advisory in April 2023 warning that lack of social connection increases the risk of premature death as much as daily cigarette smoking.

Because social connection is such a significant predictor of longevity, Murty made increasing it a priority for public health, creating a national plan for how to foster these essential connections. A key recommendation is to actively participate in social and community groups — in other words, adults need more play.

“When we talk about and think of play, we often imagine children running around a playground or teenagers playing sports or video games with their friends. The face of play, if you will, rarely is the face of adults, even though play in adulthood is just as important as it is in childhood,” says Dr. Elizabeth A. Laugeson, a clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at UCLA’s Semel Institute for Neuroscience and Human Behavior. “Play is simply engaging in recreational activities that are enjoyable.”

Not just kid stuff

Play — for adults, not just kids — reduces social isolation and improves mental and physical health.

“A lot of it has to do with the fact that play provides opportunities for us to socialize with friends and family. Having even one or two close friends buffers the impact of stressful life events and is actually closely related to things like quality of life. Those one or two close friends make it less likely that we’re going to be depressed or anxious. Play can provide an important vehicle to fuel those friendships,” says Laugeson, founder and director of the UCLA PEERS Clinic, an outpatient program that provides evidence-based social skills training for individuals from preschool to adulthood (she also wrote the book “The Science of Making Friends”).

To find ways to play — and foster social connection — Laugeson likes the social platform Meetup as a resource to find those groups, which offers a diverse array of opportunities, from cosplay and improv comedy to sports teams and tattoo design.

“While just showing up to a Meetup group based on your interest is not a guarantee of a friendship or a social connection with someone, the fact that you are all at this group means that you all want to be social and you all have this common interest so you’re already off to a good start,” she says.

Her life hack for finding friends or fostering a sense of social connection? Find something you like to do and a place where other people with the same interests are — which certainly works to promote play. Instead of languishing at home, get out and find someone to play with. Some ideas:

Archery

Why not take a stab at something new? Historically used for combat and hunting, the practice of shooting an arrow with a bow is now mostly reserved for target shooting as a sport or recreation.

Similar to martial arts, horseback riding and racquet sports, there’s both a physical and a mental component to archery that demands both focus and agility. Plus, as a sport it’s often played in teams, so there’s a social dimension.

A number of nonprofit clubs offer lessons for beginners, including the Pasadena Roving Archers, who provide the equipment and a lesson for first-timers on certain Saturday mornings in the Lower Arroyo public park, and the South Bay Archery Club in Palos Verdes.

Art classes

Art therapy has long been used to improve physical, mental and emotional well-being, and studies show that even a passive engagement with art affects the prefrontal cortex of the brain — the part that regulates emotions, thoughts and behaviors.

Trying out some mode of visual art — drawing, painting, printmaking, crafts, ceramics — offers an opportunity for self-expression and socialization through taking a class. Municipal organizations offer a host of affordable options for all ages, as do art museums, or join a community group that’s working in a particular medium.

The Southern California Plein Air Painters Association hosts “paint outs” in parks, nature preserves and even at the San Clemente Pier, where people get together to paint outdoors (they also host Zoom gatherings). POT, a community ceramics studio with locations in LA’s Echo Park and Mid City, offers ongoing pottery classes in English and Spanish — and, for those who just want to drop-in, a range of fun, one-time workshops.

Book clubs and writing workshops

Word play counts as play — there doesn’t have to be a physical dimension to reap the benefits of play — plus, having the same reading material serve as a center for discussion means there’s no struggling to find commonalities for conversation.

Public libraries and independent bookstores host open book groups that serve a range of interests and genres. For example, the Newport Beach Public Library Foundation offers a free book discussion group. Skylight Books, located in the Los Feliz neighborhood of Los Angeles, offers 15 different affiliated clubs, plus two more book clubs run by the store.

The Southern California News Group offers Bookish, a free monthly virtual author interview program with a lively online discussion. Also subscribe to the free weekly newsletter The Book Pages, which frequently includes information on ways to connect with the literary community.

Want to be a writer yourself? Check out some of the free writing workshops at the Venice-based nonprofit Beyond Baroque, or explore the offerings of Riverside’s Inlandia Institute. Independent Writers of Southern California is another avenue for writerly connections.

Community gardening

Gardening is outdoor exercise that benefits physical health, and studies show it also boosts moods and helps with anxiety.

Community gardens offer the opportunity to reap these benefits while also meeting neighbors, who share plant knowledge and food with each other. Find one through organizations like the Los Angeles Community Garden Council, the Long Beach Community Garden Association, or UC’s Master Gardner’s Association.

Or, look for volunteer opportunities and workshops at nearby public gardens. Pasadena’s Arlington Gardens welcomes novice green thumbs on Tuesdays and on weekends to work on projects, and the Los Angeles Neighborhood Land Trust operates programming with classes and learning opportunities at community gardens across Los Angeles.

And, if an at-home option works better for you, another free virtual program by the Southern California News Group, Garden Party, might help you connect while offering lots to learn. Past shows are available, with a new series launching in January with columnist Laura Simpson.

Game nights

From classic board games and giant Jenga to trivia nights and Dungeons & Dragons, venues across the Southland host theme nights dedicated to getting patrons to play. Look to local bars, breweries, boba and tea cafes, coffee shops, restaurants, museums, recreation centers and parks for free events. It can be as casual as chess in West Hollywood’s Plummer Park or family game night in neighborhood parks in the city of Lakewood, to a special “Flower Hour,” game night at Claremont’s California Botanic Garden.

Geocaching

For those not familiar, geocaching is a worldwide, continuous scavenger hunt that uses GPS equipment (mostly smartphones) to track down and find “caches” hidden in public spaces. An app tells seekers how many caches are nearby, and the treasure hunt begins. Once found, the seekers sign a log IRL that stays with the cache (or online), but be sure to put it back so other explorers can continue to play. Sometimes the cache has tiny treasures inside that players can take or trade for, leaving their own gifts inside.

Provided the rules are followed correctly — the California Department of Parks and Recreation website has guidelines for how to geocache without damaging ecosystems — this fun activity promotes both physical movement, puzzle-solving skills, and connecting with strangers. And, it can be done alongside other geocachers as well.

Hiking clubs

Outdoor exercise plus community and time in nature? All of these make for good play, so joining one of the many groups dedicated to exploring some of Southern California’s stunning hiking trails is a great way to get connected to people and places.

From an urban trek to the Hollywood sign in Griffith Park to traversing more strenuous routes in the San Gabriel Mountains, there’s a wealth of options for all abilities. Many groups inspire greater diversity and inclusion such as Black Girls Trekkin’, Latino Outdoors and Women Who Hike. Many land and environmental conservation organizations, including the California State Parks and the Sierra Club, offer resources to help find guided hikes.

Jam sessions/group music lessons

Music brings people together — and it’s not just Beyoncé and Taylor Swift who prove it.

Research studies in neuroscience show that performing music together triggers endorphin release in the brain, which plays a role in forming social bonds and connection. And, while singing together inside can be a concern due to the transmission of respiratory viruses, playing music together outdoors is one way to forge new connections and reap the brain benefits of play and music.

Look for outdoor community concerts, and even join in — some long-standing drum circles meet weekly, including ones on Sundays in L.A.’s Leimert Park and Griffith Park.

Lawn and racquet sports

Pickleball is the fastest-growing sport in America for good reason: it’s an outdoor exercise that is accessible (there’s a low barrier to entry in terms of cost and skills) and allows socializing at the same time (the close net play allows participants to talk throughout the game). The stereotype of it being a sport only for seniors is wrong — recent data shows the average age of a pickleball player is 34 and the fastest-growing segment of players are under 24.

With all the buzz, it’s time to raise the profile of the similarly accessible sports of badminton, bocce, lawn bowling and ping-pong — all of which can be played with minimal equipment in parks. Some public parks already have the facilities (just bring paddles, racquets, balls or shuttlecocks), and there are many community clubs for enthusiasts.

Museum docents

Training as a docent for a local cultural organization or museum provides preparation to talk to new people — there are outlines and scripts from educators to guide the presentations and conversations, so it’s an opportunity to learn more about a subject of interest and a way to meet other folks interested in the same subject.

For history buffs, there’s training to lead tours of historic sites with organizations including Hollywood Heritage, Los Angeles Conservancy, Riverside’s Mission Inn Museum, or LA’s Central Library, which offers a docent program for volunteers interested in the library’s art and architecture.

Similarly, museums of all kinds offer extensive training courses, including Santa Ana’s Bowers Museum of Cultural Art, the Getty, Orange County Museum of Art and USC’s Pacific Asia Museum in Pasadena.

Volunteering

From fostering pets and helping at animal shelters to stocking food banks and participating in community clean-ups, community service helps build social connection, and (as numerous studies have concluded) also improves physical and mental health for the person volunteering.

Not only does volunteer work offer a chance to meet new neighbors and expand social networks, it also encourages people to engage with individuals who have different experiences than their own.

Wordle

Here’s one that doesn’t require leaving home and is endorsed by Dr. Laugeson: do the daily Wordle. “I’m obsessed with Wordle, and I even looked this up: 14% of Americans play Wordle on a regular basis. That’s a lot of people … and it’s a form of play,” she says.

While doing the daily Wordle might seem solitary, posting the results on social media spurs online conversation. Laugeson, like many players, also shares the results of her Wordle with people in her social circle. “I mean, I’m guaranteed to hear from my mother daily through our Wordle. If I didn’t hear from her, I would be concerned.”

That’s how performer/writer Chris Wells describes the experience of moving with his husband from New York back to his childhood home in Lancaster, Calif. What was intended to be a short-term visit to help settle his mother into a retirement community has been extended and complicated by her frailty, and the challenges of untangling a complex web of social and medical services.

And then there’s Elizabeth Aquino in Los Angeles, who has accumulated more than a quarter-century of lived experience as a full-time caregiver since her daughter was diagnosed with a seizure disorder. Aquino has become well-versed in the ins-and-outs of accessibility and disability rights. She has successfully advocated for everything from changing tables in high school restrooms to the use of medical marijuana for seizure treatment, but, even after all this time, much feels beyond her ken.

“People say they couldn’t do what I’m doing,” she says, “I can’t do it either. I am not amazing. I’m just winging it. I’m alert all night long. It’s so scary.”

Caregiving is common

According to CDC estimates, during any given month, nearly one-quarter of all adults over the age of 45 in the United States will have given care or assistance to a loved one in need of help. Additionally, an estimated 5.4 million children and teenagers aged 18 or younger provide significant assistance or care to a family member with a chronic illness, disability, mental health condition, or frailty due to aging.

Caregivers may be tenth graders studying for midterms, or young adults just starting a career. They are spouses, partners, friends and relatives. Those in the so-called “sandwich generation” are simultaneously caring for a loved one, while also tending to young children. Some, like Aquino, are in it for the long haul, while others, such as Dr. Feylin Lewis, assistant dean of Student Affairs at Vanderbilt University School of Nursing, have emerged from a difficult period, but are irrevocably changed.

Just 11 years old when she assumed care for her own mother, Lewis has spent her adult life researching and advocating for young caregivers. “We tend to gravitate toward our lived experience,” she says, “and want to help others.”

Losing yourself in caring

I was 30 when my 57-year-old father received a diagnosis of early onset Alzheimer’s disease. I left my friends and a budding writing career in California, and returned to New Mexico to partner in caring with my stepmother, a process I often described as “being only hands for doing and feet for running.” My own self-identity had begun to blur long before Dad forgot my name.

As I sat down to consider how we might “care for the caregiver,” it was this feeling of disappearing that came back to me. It’s a given that caregivers always need more time. Of course, more money would help. Improved, accessible, affordable medical and social services would be transformative.

But what can you do today? Right now? Get to know them. Understand what they’ve set aside, given up, and postponed. It’s likely that, one day, you also will be a caregiver.

“I had to accept that my work-in-progress was going to be in progress for many more years,” says writer Bruce Bauman. Since 1995, Bauman’s wife, artist Suzan Woodruff, has undergone dozens of surgeries for chronic oral cancer.

During the last five years, he has been a near full-time caretaker. “There was a long period where Suzan said she didn’t know if she’d paint again, that she had no inspiration. I felt like both of us were dying inside when she said that.”

Bauman made it a priority to write a little each day or “at the least sit with my book and ponder.”

Kate Washington, author of “Already Toast: Caregiving and Burnout in America,” who was mother to two elementary school-aged children, as well as primary caregiver to her husband during his bout with cancer, might refer to this practice as “keeping one’s flame alive.” It’s an important strategy for holding on to your own individuality. For Kate, the one thing that made her feel like herself was red lipstick.

While a writing notebook or a tube of Ruby Rose might link back to the before time, “claiming the role and the title of caregiver can be relieving for some people,” Washington says. “Oh, this is why things feel so hard. Because I have a 24-hour-a-day job that is unpaid and largely unacknowledged.”

Recognize that it’s a heavy load

Acknowledging the mental and physical load of the caregiver is helpful for those taking on this primary role, but it’s also important for those hoping to support the caregiver.

Perhaps you’ve never considered that the caregiver often functions as a giant household hard drive, responsible for remembering all appointments, medications, bills, repairs and meal planning.

“Providing emotional support to a distressed partner while not dumping your own distress is caregiving,” says Washington. “Researching this rare disease is caregiving.”

She points out that advocacy and financial support are caregiving, as is the “kin work” of maintaining connections with extended family and other social relationships.

“I feel like we barely talk about this moment,” says Chris Wells, “I think it’s because it culturally falls under the umbrella of women’s work and so it’s not discussed as, like, this huge deal that is going to come along, and you’re not going to be ready, and it’s going to rock your life in a real profound way.”

Having an awareness of this often unseen work is a good first step for family members and friends who wish to be of use.

‘I am a caregiver’

Defining the job of caregiver can be a personal and revelatory process and might offer ways to take a little more care of yourself.

“You have to step back and make a decision,” says Patti Davis, whose experience caring for her father, Ronald Reagan, informed her book, “Floating in the Deep End: How Caregivers Can See Beyond Alzheimer’s.” “I’m in this, too. I’m important, too. Things can fall into place as a result of that decision. It doesn’t mean you will be freed of your responsibilities, but once you decide you’re in the game, too, you can begin to let go.”

Letting go means giving up control; giving up the idea that “no one can do it as well as I will.” Letting go might be leaving the dishes in the sink, might be relying on frozen pizza, it might be opening up to the possibility of more help. It might mean letting go of feelings of shame or guilt.

“When I’m away from her, I sometimes catch myself enjoying life and I think my poor mother is suffering right now,” says Elsa Florez. “Her spine is literally collapsing and so her body is being crushed every day.”

Florez, who has been caring for her mother for two years, recently stepped down from her job as assistant to Father Albert Bahhuth at Holy Family Church in South Pasadena.

“I try to stay busy,” she says, “but you still have that nagging thing. How long is mom going to last? Should I be with her? What am I going to miss? Am I going to regret anything?”

Stuck in the in-between

Absence may spawn feelings of guilt, but so, too, may the sense of being too present. You may be struck by the disconnect of parenting a parent or have what might feel like an insensitive reaction. “There were some things I could not unsee and still cannot,” says Kate Washington. “A therapist told me once that disgust is a core emotion and it’s not something you can reason yourself out of.”

At moments such as this, it’s important to find a way toward self-compassion. Doctor Pooja Lakshmin, in her book, “Real Self-Care,” suggests cultivating “dialectical thinking,” which means acknowledging that two opposites can be true at the same time. You love your mother, but realize you cannot care for her alone.

“Real self-care is still work,” Lakshmin writes, “But it’s less about adding something to your list and more about seeing your place in the world, your family, and your relationships differently.”

Opportunity for emotional healing

The response “yes, and…” is a technique used in dialectical thinking, but also in improv theater games. It’s a phrase that honors the simultaneous existence of a multitude of conflicting ideas, and one that recognizes the value of each player in a scene. “Yes, and…” opens to possibility.

“There’s this tension,” says Chris Wells. “I don’t want to be here. I don’t want to be with my mother. It took Herculean effort to get out of here, to be a working artist. And now, my husband and I are sleeping in the bedroom where my brother and I slept in bunk beds, and I’m just aware of those contradictions. And the other thing is, it’s also incredibly healing.”

The work of caregiving may open exploration of hardwired behavior and unexplored or unresolved hurt, but it can also offer unexpected shifts of perception.

“Mom was always busy with the next baby and the next baby,” explains Elsa Florez, one of 10 siblings, “Now, we see she’s cold and we put her socks on — she’s our baby now. Even though I didn’t feel that nurturing from her — at least not that I can remember — I want to give that to her.”

Getting help for the helper

Acknowledging the emotional complexity of the role of caregiver is important, but so, too, is understanding the very physical day-to-day tasks related to direct care and household upkeep.

“There is no road map, no play book,” says Paolina Milana, community engagement and program specialist at USC’s Family Caregiver Support Center. The center, associated with the USC Leonard Davis School of Gerontology, provides services for family caregivers, including information and referral, support groups, and educational workshops for those in Los Angeles County. Caregiver California offers similar services for those living throughout the Golden State.

“You don’t realize all the legal and medical stuff you need to have in place,” Milana says. “Our consultants can look at your situation and help create a plan.”

You may be entitled to paid respite care or an hourly wage as a family caregiver. Learning about the benefits available to you through insurance or other services is a first step to framing a supportive scaffolding for the days ahead.

Further support is available through the medical community. “Find a doctor who is compassionate and a good communicator,” Bruce Bauman advises. “Ask as many questions as you can think of.”

“As soon as possible,” he recommends, “find a therapist for you and the patient. I could not have given my wife the emotional and physical support that was needed without guidance from my mental health team. Family and friends can only do so much.”

Of course, family and friends can do a lot, but they will need guidance. It’s important to set expectations and boundaries. A family meeting with a brief agenda can be a place to set goals and make plans. Set a clear objective and take notes to ensure clarity. People want to help, but they are often unsure how to begin. A caregiver may designate one friend or family member to be in charge of meal trains or task lists. Those in the support circle are encouraged to volunteer to coordinate aspects of care.

Kate Washington remembers friends who texted offers to pick up groceries or other necessities and specified that, if required, the goods would be dropped on the porch by day’s end. “The magic words,” she says, “were no need to respond.”

For those wishing to help a caregiver, the need to respond is sometimes hard to resist. We might jump in with advice or preface all our conversations with “have you tried…” As well-meaning as this behavior may be, it might not be the best way to nurture your friend or family member.

“Be open, sit in that space with your friend,” says Dr. Feylyn Lewis. “You don’t have to be an expert. You just have to be someone who cares and listens and doesn’t hog the space.”

“How do you do it?” It’s a well-meaning question, but there is no real answer.

“I don’t know,” Patti Davis says. This phrase became her mantra. “We don’t know what’s going to happen in life and we don’t know how we are going to feel about it when it does happen.”

Elizabeth Aquino credits the support of her fellow caregivers and her “absurdist streak” for getting her through the darkest times. “It’s radical acceptance,” she says.

For Elsa Florez, recognizing the similarities and differences between herself and her mother are key. “I don’t need a massage, a pedicure, a manicure,” she says. “I need to be, in my mind and my heart, at peace. And I think the way I do that is I embrace who I am.”

Where can you find support?

Information about becoming a paid caregiver (through Medicaid) for a family member.

Organizations

AARP: General resources, fact sheets, and a vast trove of information pertaining to almost any care situation.

Alzheimer’s Los Angeles: For those in Los Angeles County, caring for loved ones with Alzheimer’s or other dementia. You’ll find a variety of programs, support groups and educational resources as well as advocacy opportunities.

Alzheimer’s Association Orange County

American Association of Caregiving Youth: Information and resources for young caregivers.

California Department of Social Services: Information about local programs including home care, respite, and in-home care.

Caregiver Action Network: Advocacy, information and caregiver support from caregivers.

Caregiver California: Searchable, statewide support group and service locator.

Caring Across Generations: Get involved with advocacy work on behalf of caregivers and learn about legislative priorities.

Family Caregiver Support Center at USC: Serving Los Angeles County, the center offers referrals, resources, respite, support groups and help with legal, medical and financial planning.

HFC (Formerly Hilarity for Charity): Founded by Laurel Miller Rogen and Seth Rogen, this organization provides grants for respite care, educational resources, support, information and a few laughs to support brain health and those caring for loved ones with Alzheimer’s disease and other dementias. Also, excellent advocacy and engagement opportunities for young caregivers, and high school and college students.

National Alliance of Caregivers: An extensive collection of resource lists, research results, information, advocacy opportunities, as well as a library of downloadable guides.

Have you decided who will make tough choices for you, if you can’t make them for yourself?

According to a 2020 survey from the National Poll on Health Aging, more than half of older adults haven’t made arrangements to assign a healthcare proxy, the person who makes medical decisions on behalf of the patient.

The survey showed that 46 percent of adults ages 50-80 have completed at least one advance care planning document — legal documents such as a living will that outlines preferred medical treatment should they become unable to communicate their wishes. These documents often include the designation of a “durable healthcare power of attorney,” aka a healthcare proxy. This role is an essential part of advanced care planning, but that’s the part many haven’t filled out.

“I want my patients to get the best possible care, and having the right healthcare proxy is part of that care,” notes Dr. Christopher J. Pietras, director of Palliative Care at the UCLA Department of Medicine.

States have different requirements for who the healthcare proxy can be (most require an adult age 18 and older) and also how to best document that choice: A living will is one of many options, but there also are advanced care documents online including Five Wishes and free forms from Stanford Medicine and the State of California’s Department of Justice.

“There’s a number of documents to help guide these discussions so that patients are not having these conversations without materials to help prompt important questions and discussions,” says Dr. Alisha Beth Benner, a palliative medicine specialist at the Duke Cancer Center in Durham, North Carolina. She suggests asking your regular physician for forms and guidance to begin the process.

Getting the right form is step one, but there’s still a difficult decision to make: who is the best person for the job?

“A healthcare proxy should be someone that a patient feels would honor their wishes in the way that they have shared — someone that is able to set aside their own personal wishes for the patient and honor those of the patient,” says Benner. “They do not need to be related to the person — it doesn’t have to be a blood relative. It can be a best friend, a trusted mentor, someone who is willing to take on the role and be present when called upon.”

Discussions with family members about end-of-life care can be emotional already, so letting a partner or loved one know that they may not be right as a healthcare proxy might best be done with mindfulness.

“I would come at it from an empathetic relief kind of standpoint,” says Benner, “that you are not burdening them with that responsibility.”

No matter who the designated person is, it’s important to physicians like Dr. Benner that patients update their choices for care, and perhaps even who they want as a proxy, as their healthcare issues change. Human bodies and health concerns aren’t stagnant, nor should these decisions remain static.

Any time there’s a change in health status, advance directives should be reviewed so that the proxy remains the person best equipped to look after the patient’s medical wishes.