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For the 'oldest old,' staying independent is hardest job of their lives (w/video)

SOUTH PASADENA

The pain emerged during her morning exercise in the hall of her apartment building. She felt a sharp pinch on her left side, just below her back. It followed Iris Kroener as she rolled her walker up and down the worn azure carpet on the ninth floor, about a mile in all, and it was still there after she rode the bus to the Gulfport Senior Center for lunch and played Rummy 500 and went to her salon and sat quietly in the chair as the stylist teased her hair into frosted strawberry blond curls, all the while prattling on about her son, who had gotten a role in some movie. Around 5 p.m., the hairdresser dropped Iris and her walker home. She rode the elevator up the nine floors to her apartment and put on her pink pajamas and got in bed.

When she got up the next morning, the pain in her backside was so sharp she felt like vomiting. She took Aleve, but it didn't help. She struggled to get out of bed and then she did vomit. Iris called the doctor in St. Petersburg and she called her friends across town and she phoned her son in New York instead of waiting for his daily call and she hoped the pain would go away.

At 95, her existence — solitary, but more or less self-sufficient — depended on the pain going away.

But the pain became unbearable and she could barely walk to the bathroom. The woman who had spent the better part of the past decade battling old age crumpled in her living room chair. So her son booked a flight to Florida and her friend took her to the hospital, where the doctors ordered X-rays and blood tests and MRI scans. And after all that, Iris' doctor told her something she already knew.

Her body was breaking down.

 

//

Along the sun-bleached sidewalks of South Pasadena, population 5,000, those with walkers often outnumber those without. The 1.2-square-mile town, between St. Petersburg and Pinellas County's southern beaches, harbors a mix of strip malls, waterfront homes and 1970s high-rise apartment buildings for seniors.

With 15 percent of its residents 85 and older, South Pasadena has one of the largest concentrations of elderly in the state. In some ways, it is a preview of what the United States will look like in coming decades as the population of the "oldest old" more than triples, from 5.7 million today to 19 million by 2050.

Iris, a widow, lives in a church-subsidized 180-unit building for seniors called Lutheran Residences, a few blocks from a grocery store, a hair salon, a Beall's, a CVS. But all this might as well be miles away when walking to the corner feels like an expedition.

Back when Iris was born, in 1919, most elderly parents moved in with their children. Today, 40 percent of those 85 and older live alone.

Iris' solitary struggle reflects the realities of modern life. Families are separated by miles of highway or airplane rides, so many seniors live in total isolation or in communities with other isolated seniors. "Cross-generational life experiences may not be part of their lives anymore," said Mark H. Waymack, an associate professor of philosophy who specializes in aging and health ethics at Loyola University in Chicago.

Alone, their lives are consumed by errands that get harder and harder to execute. They toil silently to keep going — making the bed, folding towels and sheets, getting dressed, picking up groceries, getting to the doctor. They are afraid of falling so they walk less, use wipes to shower, recede inward, their limbs stiffening and slowing, all the while keeping silent about what terrifies them most: that they will lose their independence and end up in a nursing home or become a burden to their children or grandchildren.

You may not notice them much until you read about the despondent 96-year-old woman who jumped to her death from her 16th-floor apartment in St. Petersburg last month. She lived alone, too, and then her health began to fail and she was more forgetful, and killing herself seemed preferable to losing her independence.

That said, today's elderly are a hardy bunch. They grew up when infectious diseases reigned and smoking was commonplace, when it didn't matter what you ate or whether you exercised. They are here because they survived.

Iris weighed just 2 pounds at birth. She got whooping cough from her mother and spent her first days in a shoebox to stay warm. Later, she contracted measles. At the time, 10 of every 100 babies died within the first year. Life expectancy was 56 years. Growing up an only child in her family's native Germany and later as an immigrant in New York, she didn't know a single person over the age of 90.

"People didn't live that long," she said. "The 80s was rare."

Now Iris is the first of her family to make it into her 90s. Almost 30 years has been added to the average lifespan this century — mostly because of the advent of refrigeration, hand washing and breakthroughs in public medicine.

Iris takes pills to keep her diabetes at bay, to lower her blood pressure, to keep her cholesterol levels in check, plus vitamins filled with fish oil, omega 3, chromium, calcium, vitamin D, garlic, cranberry. The doctor cleaned out a clogged artery in her neck a few years ago and removed a malignant tumor from her arm.

She wants to be alive — as long as she can keep going on her own. But getting through the challenges of another day has become hard work. More work than she has ever done in her life.

 

//

 

In the hospital, the doctors had given Iris something for the pain but her blood pressure was as high as she could remember, so they had admitted her overnight. Her son caught a $600 flight from New York.

A blood technician with a mop of dark hair and a Spanish accent came in and joked that he was "thirsty" for her blood. Iris mustered a faint smile.

"Are you feeling better now?" he asked as he filled a tube from an IV in Iris' arm.

"Not when I get up. I still have the pain," Iris said. "I never had pain like that."

The blood technician nodded, removing one vial and clipping another in place.

"The doctor says it's deger … degener ... disc in the spine and they can't do much about it. They will give me some medication to ease it, but it won't get rid of it. I have to live with it."

It felt like each day brought something else she had to accept.

"Well, at least you're still alive, right?" he said.

"Well, I don't know if that's such a good idea when you are always in pain," Iris said.

He nodded. "Can you still dance?"

"Sure."

"Well, there you go. That's all that matters."

She hadn't danced in years, but she smiled anyway.

 

//

 

A few weeks before she landed in the hospital, Iris guided her red-frame walker out onto the sidewalk in front of her building. Clad in white Dr. Comfort sneakers, she moved swiftly for a 95-year-old. But she had a limp and her back was bent forward and beginning to show the signs of a dowager's hump. She tried to ignore the pains that shot up the back of her legs.

She needed orange juice and yogurt and blueberries. Neighborly Care Network still brought her by bus to the Gulfport Senior Center for lunch every day but it had cut out her bus route to the grocery store. So here she was making her way to the Sweetbay down the street. Sometimes she paid a neighbor $10 to take her, but she had decided she could not afford that. She lived on a moderate fixed income (she did not want to say how much), enough to pay her rent and her bills with maybe $100 to $200 left over to spend.

"Can I pass you up?" asked a woman with white hair, who two-stepped around Iris and continued down the sidewalk.

After about 10 minutes, Iris came to a parking lot behind Sweetbay and a green bench directly in the sun. She lowered herself slowly. Her breath came in rapid puffs.

"It's hard for me," she said.

The sun peeked through the clouds and Iris donned white-framed sunglasses. One minute passed. Two minutes. The trees swayed in the breeze. Cars passed. Two women walked down the sidewalk with walkers.

It surprised her that she had become one of them, but the evidence was starting to pile up like a bad hand in one of her card games. Just the week before, she'd bent down to get a tablecloth out of a drawer and couldn't get back up. She'd had to crawl to her chair.

"I never did anything slowly so it's hard for me to get to that state," she said. Her mind still wanted her body to move like she was 60. She had walked for exercise for 20-odd years, to keep her weight down.

She'd grown up at a time when a girl's prospects in life were determined almost entirely by who fell in love with her. She met Harry Kroener at a formal dinner dance in 1937. She was a typist and he went overseas with the Army. When he returned, he worked at his father's upscale restaurant in Staten Island.

They married, had two kids, welcomed grandchildren, lost their 32-year-old daughter to leukemia, retired, moved to Florida.

For 58 years, Harry fawned over Iris like she was a delicate flower. Iris' life was, for the most part, easy. She took her kids to ballet and fishing, played cards with the neighbors and donned a silver fox coat to go out to dinner with her husband at swanky restaurants and nightclubs. He managed the finances, did just about all of the driving, handled whatever needed to be done around the house. "I hope you die first," he told her, "because you can't take care of yourself."

In 2000, he died of a stroke.

Iris, 82 and in pretty good health, moped around at first. Then she began going to the Gulfport Senior Center, serving lunch to other seniors.

The signs of her advancing age came slowly.

She got a job bagging groceries at Publix. But the groceries were too heavy for her to lift so she had to quit.

She couldn't hear the priest at church; she began to turn the TV up louder.

Right in the middle of talking to someone she'd stop dead. What was that word?

She'd spend an hour changing the sheets on the king-sized bed because she had to rest between each step.

She was 91 when she almost took out a gas pump with her Chevy. It scared her so much she gave up driving.

Then the signs came faster, almost like an avalanche.

When she was 94, she stumbled on the curb outside Beall's one day, landing flat on the ground.

When she was 95, she fell in her hallway, this time bloodying her nose on the wall.

A few months later, walking down the steps of her apartment building, she tripped and face-planted on the pavement. She got five stitches above her eye. Her mottled arms and legs still bore dark red bruises from that fall.

That's when she got the walker. "I knew I was old so why not accept it," she said of the walker.

She used it to lift herself from the green bench and continued on her journey, around the back of the grocery store. A Sweetbay semitrailer truck maneuvered around her and a guy in a silver Toyota threw up his hands when he got caught behind her. Iris was oblivious.

Inside the store, her mind still sharp enough to note differences in price, she pointed out that the reduced-sugar orange juice was 20 cents more at Sweetbay than Publix. She wedged Activia yogurt, blueberries, liverwurst and toilet bowl cleaner in a small basket in her walker. The orange juice was heavy and it nearly slipped out of her hands. Her breathing was rapid, like she had run a couple of miles.

She was looking for furniture polish. Up and down the cleaning products aisle she trudged. There was the Windex and the Palmolive and the Tide. She passed up the Endust four times without seeing it on a top shelf. "There it is," she said after about seven minutes of searching. She reached on her tiptoes for the can.

Once outside, her container of blueberries toppled onto the pavement, but she didn't notice. A boy scooted to the ground and handed them to her. She nodded thanks and collapsed on a bench outside the store.

How would she make this shopping trip in the heat of summer?

 

//

 

Doug Kroener, 60, held his mother's arm as she returned to her apartment building from the hospital and waited for the elevator. Her 80-year-old neighbor, who she often sought out to open jars, asked how she was. Iris nodded that she was okay.

The elevator doors closed, and Iris held her lower back and winced.

"The pain is still there," she said in the crowded elevator. "I can't wait to sit down."

The door creaked to her apartment. She passed her son's suitcase, her black velvet couch, and a glass coffee table full of Hummel figurines and collapsed in her chair.

"I'm exhausted," she said.

A knock on the door. Her 102-year-old friend, Agnes Kinney, wheeled her walker into Iris' one-bedroom apartment. Agnes wore lipstick, foundation, blush, eye shadow, mascara and a hearing aid. Though she was older than anyone in their building, she was more agile than most of them, including Iris.

"What did the doctor say?" Agnes asked.

"They found nothing wrong with me," Iris replied loudly. The doctors had called it stenosis of the spine, a narrowing of the spinal column. "He said, my spine, the bones get smaller and smaller. That's why I'm shrinking."

"You learn to live with it," said her son, Doug, a school district transportation employee.

"Every day it's something else," Iris sighed. "You never know from one minute to the next what happens to you."

She didn't worry about dying as much as she did what led up to it. What if she couldn't walk to the bathroom on her own, or if her son, or worse, a stranger, had to bathe her? She wasn't sure she wanted to live like that. "I wish they had a pill at that point, because what use are you?" she said.

She decided to pull herself together and go to bingo downstairs with Agnes. She had told everyone she would be there. She pulled on a turquoise blouse with matching necklace and pants. Tropical coral lipstick and blush in place, she headed downstairs with her walker, her steps more tentative than a few days before.

 

//

 

Iris' son fussed over her. He brought her groceries, got her money from the bank, spray painted a faded lampshade so it looked bright red again, vacuumed and dusted for her.

Before he left, she pointed out the front hall closet with the long-sleeved ivory lace jacket and matching pleated skirt in which she wanted to be buried. Attached to it was a baggy with her panty hose and the earrings and pearl necklace she wanted to wear. She reminded him how she wanted to be placed in the mausoleum (head-first so her head would be next to her husband's). She wanted irises on her casket, and she'd asked for the interior to be dressed in pink satin so it would give her a "nice glow."

"Even though I'm old, I'm still vain," she said with a chuckle.

"What happens if I need help?" she asked him.

"Mom," Doug replied, "we'll worry about that when it gets to that point."

//

 

A few days later, Iris got up at 3:30 a.m. She sat on the toilet and sipped a glass of water, hoping to go to the bathroom. She flapped her arms seven times. Then she got back in bed and pumped her legs in a bicycle motion 30 times. By the end, she was out of breath so she rested and prayed and read one of her romance novels.

By 6 a.m., she'd dressed in a pink sweat suit and sneakers. She wore a sports bra because she could no longer hook a bra behind her.

Today she would resume her walking routine. She could feel her legs stiffening from the lack of exercise. She didn't feel like resuming the exhausting routine, but she had come to realize it was necessary to keep going. Experts say the elderly of the future will be divided into two groups. A super-fit group who ate right, exercised, avoided smoking and whatever else hacks away at the body. And a super-frail group of people who didn't take care of themselves, perhaps became obese, but were kept alive by medical treatments and medications. Aging experts are focused on figuring out how to maintain quality of life, and though Iris consulted none of them, many said her routine is exactly what is necessary.

At 6 a.m., she headed out the door of her apartment into the hallway on her floor, which was arranged like a figure eight with the elevators at the center. Up and down she went, rather quickly at first. Then slower as she grew tired. After five laps, she returned to her living room chair. She read for 10 minutes, then did five more laps and read for another 10 minutes.

She used a butcher knife to cut cheese doodles into 10 small pieces and set them down on a napkin on her walker. Then out the door again, this time following the figure eight of the hall, eating a tiny cheese doodle every time she did another lap to remind herself of how many she'd done. She was slowing down, her steps getting weaker, her labored breathing the only sound in the quiet hallway.

"I'm dragging my tail," she said, her cheeks quivering. After 10 laps, she fell back into her chair and disappeared into her novel for 10 minutes. She got up again and winced. A new pain, this one in her groin. She pushed through it and created 10 more cheese doodle slivers and resumed her routine. Her arms clutched the walker handles a little heavier and her limp grew more pronounced as she made it through her second round and her third round and her fourth round.

About an hour and 40 minutes after she started, she was done.

"No more excuses," she said, collapsing in her chair. "It's back to work."

Her existence depended on it.

Times researcher Natalie Watson contributed to this report. Leonora LaPeter Anton can be reached at lapeter@tampabay.com or (727) 893-8640.

IF YOU NEED HELP

• Friendship Line at the Institute on Aging (for seniors who just want someone to talk to or are contemplating suicide): toll-free 1-800-971-0016

• National Institute on Aging, Information Center: toll-free 1-800-222-2225

• West Central Florida Area Agency on Aging's Information & Referral Specialists: toll-free 1-800-96-ELDER

did you know?

• Almost half of women age 75 or older live alone.

• Estimated 2012 population over 85 years old in Pinellas County: 35,055. Estimated 2012 population over 85 years old in Hillsborough County: 20,273.

• America's oldest-old — those 85 and older — are expected to triple to 19 million by 2050.

• The median age in Florida is 41. The median age in South Pasadena is 68.

• In South Pasadena, 45.3 percent of those 65 and older live alone. In Tampa, 9 percent of those 65 and older live alone and in St. Petersburg it is 12 percent.

• In 2010, there were 53,364 centenarians in the United States and 34 percent of them lived alone in a household. Their ranks are expected to increase to 601,000 by 2050.

• In 1900, there were 122,362 people in the country over age 85; today there are about 5.7 million.

Sources: American Federation for Aging Research; American Community Survey, U.S. Census Bureau; A Profile of Older Americans: 2011, Administration

on Aging; Journals of Gerontology: Biological Sciences, Centenarians 2010

For the 'oldest old,' staying independent is hardest job of their lives (w/video) 05/01/14 [Last modified: Sunday, May 4, 2014 1:22am]

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