The National Instuties of Health (NIH) announced a new update to an important resource for senior health information. The redesigned NIH Senior Health features nearly 50 health topics, more than 150 health videos, plenty of frequently asked questions (FAQs), easy quizzes and more, the new NIHSeniorHealth should be a first stop for anyone seeking fast, reliable, up-to-date information about older adults and health.
To see the site, please visit http://nihseniorhealth.gov/.
The following article is reprinted by permission of the author, Alicia Ahlvers, and the Reference and User Services Association (RUSA), publishers of Reference and User Services Quarterly. The article originally appeared in Reference & User Services Quarterly, Volume 45 No. 4, pp 305-12, Summer 2006.
Libraries across the country are experiencing an increase in use of their facilities and services by senior citizens. A search of the literature turns up numerous articles and books on working with seniors in the library. From computer classes to film series to programs on health, finance, and long-term care, libraries are looking at ways to reach out to an older population and provide them with the information and resources that they need.
The demand for services and resources for seniors is also being felt in the readers' advisory world. In this issue, Alicia Ahlvers examines some of the generational trends of which readers' advisors should be aware when working with seniors. She then explores ways that readers' advisors can shape encounters with senior readers based on this knowledge. Ahlvers considers some of the challenges of working with seniors--in particular, challenges associated with physical limitations of the reader. She then discusses opportunities for librarians to overcome these barriers, and to provide seniors with a satisfying readers' advisory encounter that will keep them coming back to the library for further suggestions.
Ahlvers serves as the senior services librarian for the Kansas City (Mo.) Public Library. She coordinates the delivery of services and programs to older adults. These include delivery of materials to homebound patrons, providing materials in large print and audio format, providing adaptive technology for users with disabilities, and, of course, providing readers' advisory services.—Editor
Working with older adults can be one of the most rewarding customer interactions in the library. Apart from the preschool crowd, no other group is as openly appreciative when they receive the help they need. The elder group also is most likely to form long-term attachments to a favorite librarian or staff person. Throughout the years, working both in branch settings and with the homebound population, I have received everything from home-baked cookies to hand-knit scarves to express their fondness and gratitude. They are also quite likely to point out how young I am on a satisfyingly regular basis. This is in direct contrast to my years as a children's librarian, when I was often asked on school visits how old I was. When I would tell the students that I was the advanced age of thirty-five, I would often hear something along the lines of "Wow, you are even older than my mom."
One reason older adults are often so appreciative when receiving good or excellent customer service is that in today's fast-paced world, service staff often can be impatient with anyone who needs extra attention. Because seniors frequently need extra attention as a result of physical problems, this can be particularly disheartening for bright, aware older adults already mourning the loss of vision or hearing. It is important for librarians working with seniors to remember that becoming an older adult can be a challenging and stressful time. We all know people who embrace the changes that come with aging, but for many the loss of mobility and independence can be a frightening experience. Pipher notes that:
Many old people are living in a world designed for young people. They can't drive, walk through shopping malls or airports, or deal with rushed doctors in managed care systems. Many can't handle stairs, small-print books or menus in darkened restaurants. ... Some people live to be more than a hundred, but they often outlive their support systems, neighborhoods, and bank accounts. 
Older adults are also often cut off from their support systems. One of my customers is ninety-five, and all of her friends in town have passed away. Her daughter lives halfway across the country, and her granddaughter is in Africa. Her daughter calls once a week, but apart from health-care visits, she has very little contact with other people. The volunteer who delivers her library books to her each month is one of the few nonmedical visitors she sees. Try to keep in mind that some older adults crave human contact and may only get this contact from their library encounters. Look at this as a customer need and understand that you may have to spend more time working with older adults in order to help them find library materials. My position allows me to work with a customer for long periods of time on a fairly regular basis, and I have more time allotted to spend with each customer. This does allow for a depth of interaction that isn't always possible when working in a busy branch. However, a few extra minutes with a librarian may enrich a customer's life, not only by gathering information to provide well-thought-out readers' advisory, but also by giving the gift of time. After all, studies show that older adults thrive if they have at least three regular contacts with which to converse.
When working with older adults, it can be useful to know something about the different generations. The three distinct categories used to refer to older adults include the G.I. Generation, the Silent Generation, and the Baby Boomers, who are just now starting to retire (table 1).
The G.I. Generation
The G.I. Generation (GI) is older than the age of 85. This generation tends toward civic duty and fiscal responsibility, and they are big believers in agreement and conformity. As a group they believe in working together to achieve the best for everyone. They stay busy in retirement or don't retire at all and dislike people they perceive to be wimps or slackers. Because this group believes that the harder they work, the more they are rewarded, they often have a strong sense of entitlement.
These traits mean that a person from this generation is not afraid to speak his or her mind. This group will let you know in great detail if your book recommendation is on target. They often have strong feelings early on about a novel, and they are willing to tell you when a book has missed the mark. Luckily, they often have a strong gallant streak to temper their criticisms, and usually are willing to give you several chances to get it right. The GIs are particularly fond of sentimental stories and novels with characters from their generation. In addition, they often are guided by bestseller lists, newspaper recommendations, or any other books "everybody is reading" or should have read. Classic novels that they "should" read and recommendations by loved ones also fall into this category. Remember, conformity is a characteristic of this group.
The GIs have a rather black-and-white outlook, a strong patriotic viewpoint, and a deep interest in politics. If a novel reflects this world outlook, they usually like it. A strong dislike for profanity in novels is also an important consideration. One customer threatened to throw any books with profanity "straight into the trash." Either I have chosen well, or she hasn't made good on her threat because so far everything I have sent her has made it back in one piece. Christian mystery, romance, and fiction and cozy mystery large-print imprints are very useful when selecting for this type of customer--even when they are not interested in the Christian theme.
The most frequently requested authors for GIs at the Kansas City Public Library (KCPL) are:
1. Maeve Binchy
2. Belva Plain
3. Rosamunde Pilcher
4. LaVyrle Spencer
5. Louis L'Amour
6. Zane Grey
7. Jan Karon
8. Jimmy Carter
9. Margaret Truman
10. Phyllis Whitney 
The Silent Generation
The Silent Generation covers seniors aged approximately sixty-four to eighty-four. This generation believes in working hard and paying your dues. They like security and stability, dislike debt, believe in clean living, and are often quite reserved. The Silent Generation has a strong stoic streak and doesn't want to be a bother. This attitude can present problems when attempting to provide readers' advisory assistance. I repeatedly have to tell this group to let me know if they don't like a book I recommend. I like to point out that I didn't write it, and so my feelings won't be hurt if it isn't to their taste. I also have to repeatedly reassure the customers that bringing extra books isn't a bother, and they are not intruding on my time whenever they call.
In terms of readers' advisory, the Silent Generation is very willing to accept the advice and recommendations of experts. They will try books recommended by celebrities, newspapers, educators, and librarians, and they have a great deal of faith in the experts. For example, this group tends to trust their doctor to know best, and they usually will not ask for information about medical problems or try to research the topic on their own. This group also remains interested in connecting with the younger generations, and will be willing to stay open-minded to exploring work by new hot authors. On the other hand, they also like novels that show empowered older adults leading full and interesting lives. Authors Haywood Smith, Joan Medlicott, and Alexander McCall Smith are popular for this reason. Some individuals from this generation develop an interest in inspirational and spiritual matters, and will ask for authors that explore these issues in a broader context. Carolyn Myss, John Edward, and Sylvia Browne are current favorites.
The most frequently requested authors for the Silent Generation at KCPL are:
1. Barbara Taylor Bradford
2. Tim LaHaye
3. Robert B. Parker
4. Fern Michaels
5. James Patterson
7. Sandra Brown
8. Patricia Cornwell
9. Catherine Coulter
10. Walter Mosley 
When the Baby Boomers start to retire, watch out. All of the traditional ideas about older adults will go out the window. The motto of this group could be "if you've got it, flaunt it," and the key characteristics may include a tendency to be talkative, bossy, inquisitive, and competitive. Boomers also see themselves as trend makers instead of trend followers. In contrast to the preceding generations, they do not take the idea of aging philosophically, and are more likely to resent intensely being referred to as senior citizens or elderly. This group is not afraid of debt and likes to spend money, so count on them having all of the latest gadgets and toys. Those who become homebound are more likely to be willing and able to use the online catalog to reserve or download books. Another reason that they will appreciate this technology is that they are used to having immediate service. They expect to have the book in their hand as soon as they ask for it. Downloadable books and audio-books likely will be very popular with this group.
The GIs and Silent Generations tend to prefer the mystery and romance genres, and few in these age groups will express interest in other genres. Boomers will use all of the traditional sources for obtaining book suggestions, with online book sites as popular selection tools. Fans of certain genres will seek out romance, mystery, or science fiction electronic discussion groups and will expect to walk into the library and find the newest titles waiting on the shelf. The Boomers will accept more sex, violence, and profanity, so interest in true crime and horror stories will increase. They will be much more particular about getting just the right book. They look for riveting tell-all books, fast-paced thrillers, and conspiracy mysteries--which helps explain why The Da Vinci Code by Dan Brown became such a huge hit. While the Silent Generation will be likely 'to be patient with the trial-and-error process of readers' advisory, the Boomers will be much less willing to spend months working with you to fine-tune your recommendations. You will have only a few chances to get it right and then they will move on. On the other hand, they will be willing to try less well-known authors and "sell" them to their family and friends if they like them. And once you have sold them on the new library conveniences and earned their trust, they will become loyal library users.
The most frequently requested authors for Boomers at KCPL are:
1. Stephen King
2. Anne Rice
3. Nora Roberts
4. Dean Koontz
5. Suzanne Brockmann
6. Janet Evanovich
7. Terry McMillan
8. Jonathan Kellerman
9. David Baldacci
10. Richard North Patterson 
The following authors are extremely popular with all generations:
* Mary Higgins Clark
* Lilian Jackson Braun
* John Grisham
* Sue Grafton 
Pipher also talks about two additional categories that can have a profound effect on the different generations. She refers to these as the young-old and the old-old. The major difference between the two groups is that the young-old are healthy and the old-old are not. The young-old are energetic, vibrant, and active. The old-old suffer loss of mobility, are often in pain, suffer increased hearing and vision loss, and do not have opportunities to interact with others, especially those outside of their age group. This group craves interaction with children and younger generations and values social interaction a great deal.
Another essential element to providing good readers' advisory service is awareness of the reading trends among senior readers. Not surprisingly, these tend to match up with the generational characteristics mentioned above. Bestsellers are popular with almost every generation. Books by John Grisham, Sue Grafton, Nora Roberts, and Jan Karon are requested daily, and customers are always checking to see if the latest is out and if their name has been added to the waiting list. Older adult customers still tend to request no profanity, nice characters, and lack of gory description as elements that appeal to them.
For this reason, cozy mysteries are in high demand. Authors such as Lilian Jackson Braun, Mary Higgins Clark, and Alexander McCall Smith are current favorites. In addition, the cozy animal mystery trend that started with Jackson Braun is still popular, although this seems to be on the downswing. For the same reasons that cozy mysteries are popular, Christian mysteries and romance are also in high demand. Customers report that these books are comforting reads, and they are reassured that there will not be any unpleasant or unwanted surprises while reading these novels. Romantic suspense and contemporary romance are on the upswing with the older adult crowd. These sub-genres are popular because as a result of their exciting plot lines. Some of these have some of the same elements as the cozy mysteries, but many can be quite explicit, so with this category it pays to know your authors. For example, Nora Roberts, the queen of romantic suspense, can be a little racy for some customers while others love her. Luckily, she writes enough to keep her fans well-supplied with new titles.
The lack of useful subject headings for romance and, to a lesser extent, mysteries, can make these genres difficult to search. Books aren't often assigned sensuality ratings or subgenre notes and these elements can be of vital importance to many readers. The readers' advisor can keep up in these areas by reading extensively in the romance and mystery genres, using reviews, participating in fan electronic discussion lists, and keeping an eye on the genre Web sites in order to assess the profanity level and sex scenes. A useful Web site for romance, www.likesbooks.com, includes "heat level" ratings from "kisses" to "burning." When not familiar with an author, it is useful to check the reviews in order to see how their books are typically ranked.
The Readers' Advisory Interview
Because customers usually sign up for the Home Bound Book program at the Kansas City Public Library by mailing in a questionnaire, my first step is to note their reading preferences. The customer then receives a follow-up phone call to obtain more detailed information. The same process applies to the face-to-face interview: The first step is to ask customers what types of materials they prefer.
If they are primarily interested in nonfiction, especially if they have specialized interests, the level of subject detail in the MARC records makes titles fairly easy to locate. There are also customers who already have lists of authors and titles of books that they are interested in, who will come to the library and request them as needed. Encourage these customers to reserve books ahead of time to ensure that the requested volumes are available when they come to the library to visit, especially if browsing the shelves is difficult for them. If they have Internet access from their home, teach them how to reserve titles using your online catalog. If they don't have access to the Internet, another option is to send them home with vendor catalogs. Please make sure it is a company your library actually uses to order materials. The customer can browse the catalog, call in an order and have it ready to go when they get to the branch. If print size in the catalog is an issue, see if your state library or other agencies in your community have small magnifying glasses available that they give away as promotional material.
My most challenging customers are the ones who would like me to select their ten large-print mysteries or twenty spoken-word romances a month. This is also my favorite type of interaction because it gives me a chance to practice my readers' advisory skills. Of course, my first question is, "What kinds of books do you like to read?" Some have detailed information about types of books, specific authors, and favorite titles or subjects. Others have not given this question much thought and can only hint at broad outlines of their preferences. In these cases, I will often ask what type of television programs they prefer, what hobbies they have, and what current events have they found interesting lately. With these questions, the customer and I can come up with one or two genres or a couple of subjects. Since those of us in the readers' advisory game know how many different subgenres exist, this information can serve as a jumping-off point to gather information in the readers' advisory interview. Keep in mind that sometimes these genre requests are deceptive. One customer routinely asked for paperback romance set in the South or West. After working with her for a while, it became clear that what she really wanted was Westerns.
Try to keep the trends and characteristics of each generation in the back of your mind, but always remember to treat every older adult as an individual. When asked what she liked to read about, ninety-three year-old Sadie stated that she wanted to read about "sex, sex, sex," to the surprise and delight of a colleague. While it is important to be aware of the generational trends discussed above, it is equally important to remember that each individual has a type of book that speaks to them in a personal way. Books about ladies living in small towns may be a current trend, but don't jump in with a suggestion too quickly. Wait until you have conducted the full readers' advisory interview before suggesting titles.
Another challenge to working with older readers may occur when a middle-aged adult comes in to pick out books for their parent. A daughter may have an image of what she thinks her sweet, eighty-year-old mother should be reading, but at the same time have no idea of what books actually bring her mother joy. In these situations, it may be useful to call the parent or have them call you to give more information about their reading tastes. This could be a problem if there are hearing problems, in which case a questionnaire can be sent home asking for more detailed information.
It is important in readers' advisory interactions with older customers to note a hearing or vision disability because recommending a list of books and then not being able to find them in the necessary format is frustrating for both you and your customer. After taking a reader's personal information, an important question to ask is their preferred reading format. I also have customers rank their format choices. Luckily, in today's world there are a variety of format options from which to choose. Many publishers often offer simultaneous releases of bestsellers in all formats as a selling point.
Multiple formats suited to older adults or anyone with a physical disability are available in today's library market. These include large-print books (sixteen-point print is the standard) in hardcover and paperback, books on tape, books on compact discs, MP3s on compact discs, downloadable books, and spoken-word books. Tomorrow there will options we haven't even dreamed of yet.
Many older adults can still read regular print but to others it can become a difficult process. Large-print books are a great option for anyone experiencing loss of vision. Imagine trying to read an entire novel with very small type. It would be frustrating and tiring and would become a task rather than a pleasure.
There are several mainstream publishers that deal with large print and each has its own specialty and mission. Thorndike Press, a Gale subsidiary, boasts that it is the world's leading publisher of large-print books. Thorndike has purchased many other large print imprints, such as Wheeler, which was known for its Westerns. Thorndike uses current trends to offer a wide variety of standing order plans of interest to the older adult. Both HarperCollins and Random House have large print lines and primarily publish bestsellers in fiction and non-fiction. The HarperCollins Web site mentions that their target market is the one in six Americans older than the age of forty-five who have difficulty reading small type. Ulverscroft, Isis, and Magna have been publishing large-print books since the 1960s. They publish primarily British authors and have extensive Western lines. They also publish a line of smaller, paperback large-print books.
Another relatively new publisher, The Large Print Company (www.largeprintbookco.com), is currently concentrating on growing their line of perennial classic titles in softcover large print editions. According to its Web site, they also select additional titles using library review journals and fan media, including Web site and fan reviews posted on the Internet. The goal of Center Point Premier, another large print company, is to target the Baby Boomer with books that will "thrill as well as enchant the senior patrons."
Downloadable books are predicted to become the wave of the future for those needing large print but we aren't there yet. Access in the downloadable spoken word books may cause problems. Many older adults live on fixed incomes and may not be able to afford the latest technology, while others may be unwilling to learn or fearful about technology. However, older adults are beginning to jump on the technology bandwagon as they discover the joy of e-mailing their grandchildren. Limited selection, lack of superior quality readers at an affordable price, and technology fear make this format difficult to recommend at the present time but look out once the baby boomers start to retire.
Spoken-word cassettes and CDs present a similar problem with availability although this format is also striving for improvement with regard to title selection and simultaneous release dates. In addition to availability issues, spoken-word books have other issues that are frequently mentioned by listeners with hearing loss, such as the narrator reading too fast, the narrator's accent making hearing each word difficult, and higher-pitched or softer-spoken voices being hard to hear. It is worth your time if you have a large population of older adults visiting your library to research the different narrators to find those who have slow, clear diction. Of course, they must also be lively and interesting narrators. Audible.com has ReadAudio samples that you can use to get an idea of the different narrator styles. Barbara Rosenblatt and Jim Dale are two current customer favorites.
Another option for small libraries with very limited selection or for customers who are not particularly mobile is to refer them to your state library Talking Books program. Although the quality of the recordings is not comparable to those produced by publishing houses, this program features more variety. In addition, the special player, the four-track cassettes, and the postage are free to eligible candidates. These programs are available to anyone who is visually impaired or physically unable to hold and read a book. Applications can be obtained through your state library and kept on hand for customers.
In addition to vision problems, another consideration with older readers is the customer with arthritis or loss of physical strength. This customer may have trouble holding or carrying hardback and other heavy books. Some older customers have difficulty holding books for long periods of time and you may have to look to the very limited supply of paperback versions of large print title. In a best-case scenario, they will not have vision problems and can be supplied with an endless supply of paperbacks. In more extreme cases it may be necessary to try to help them adapt to using the spoken-word format.
Once genre preferences have been established, ask your customers to talk about a recent book they have read. This step can give a lot of information about the style of book that a customer wants, although you may find that some customers have difficulty verbalizing or even describing the book. If this is the case, ask them if they like fast-paced books with lots of plot twists or a descriptive story about relationships. This will usually give them a starting place to use to describe the book in more detail. Sometimes you may have to read or skim the book being described to figure out what different references mean. One customer loves John Grisham's books and during an initial interview said how much she loves the level of detail in his books. After further discussion it became clear that she didn't mean that she likes lots of descriptive scenes with plenty of detail, but that she likes the same amount of detail that John Grisham uses in his novels. Going back and rereading one of her favorites while paying particular attention to Grisham's descriptive details helped me recommend other authors to her.
Once enough information has been gathered, recommendations can be made, but this is not the end of the interaction. It is important to stress to your customer that this is just a starting point and that having her provide honest feedback will help you make even better recommendations in the future. This is particularly important with the Silent Generation, who will not want to criticize your recommendations or take up your time. Also, if you find that your interactions with a customer are frequently rushed or interrupted, it can be helpful to let customers know times when they can call or find you at the service desk, or when the library is less busy. In this way, readers' advisory interviews can be unhurried and productive and customers won't feel pressured or guilty at taking up your time.
Physical disabilities, lack of reliable transportation, and different world views or perspectives can all create barriers to a successful readers' advisory interview. Librarians need to be particularly sensitive to any customer who has a hearing or vision loss. Because older adults often have these problems, it is important to look for warning signs. When suggesting titles, ask how often they are able to come to the library. Also ask how many books will last them until their next library visit. Sometimes older adults won't get a desired number of books because they can't carry the books to their car or other transportation. This may also be a reason for them to stick with tried-and-true authors so that they can count on having something to read before the next library visit. If you have the time or another staff person is available, you may want to offer to carry their books to the car.
If your senior readers are depending on rides from family members, friends, or senior care providers, they may also be anxious about incurring overdue charges or having their library card taken away. Let them know about library policies on telephone renewal options and overdue fines. Also, point out any special services you offer, such as home delivery service or books-by-mail. If your library does not currently offer these services, you may wish to consider adding them. If these are not options, you may be able to offer extended checkout or to create special library cards that have extended checkout or a no-fine feature. Vision problems may make it difficult to know when the books are due. Be sure to offer to use large print to stamp the book or print out their receipt and have large-print versions of booklists or other promotional material on hand.
If you are interested in adding a books-by-mail program to your service plan, your library can create a fairly simple and inexpensive program. A Friends group is a good resource for providing funding to purchase canvas mailers to use. There are also grant opportunities available to fund these types of programs and getting durable mailers can be obtained for very little money. If that is not an option, manila envelopes are a low cost alternative, although they are not as sturdy as the canvas mailers. Postage is usually the biggest expense to think about when establishing a books-by-mail program. Under the U.S. Code, title 39, sections 3403-3405, libraries may be able to mail items to qualifying recipients free of charge. There are very clear rules and regulations as to what customers may be eligible, how mailing labels should be worded, and the type of materials that can be included. This option can be used when mailing large-print or spoken-word materials to visually impaired persons of any age. In addition, most libraries also use an application for the service (with a doctor's signature) to weed out those not qualified and to keep on file to verify that a customer is visually disabled in case questions arise. For more information, see the appendix.
All of these suggestions are designed to make the readers' advisory experience more pleasurable for you and the older reader. Every community is unique and has its own set of challenges, so take a look at your older adult users and see how close they match up to generational characteristics. Then tailor these ideas to fit your community. Above all, enjoy your older adults. They will reward you with their enthusiasm, loyalty, and gratitude. Who knows, you may even make a new friend with stories to tell and knowledge to share.
My supervisor often jokes that she wants me to have the programs possible for older adults since someday she will need to have this help from the library. It is up to all of us to look for ways to make our libraries places where all of our generations can feel welcome and will find the help they need to entertain, educate, and inform them. After all, as Pipher so aptly puts it:
In a few decades, our solutions to the dilemmas of caring for our elders will be applied to our own lives. The kindness, the indifference, the ignorance, and the wisdom will be passed on. The more we love and respect our elders, the more we teach our children to love and respect us.
Table 1 Generational Profiles
Generation Other Names Approximate Characteristics
G.I. Builders, Hero Gen 1900-22 Gallantry
Silent -- 1923-42 Reserved, stoic, clean-living, gentlemanly
Boomers Baby Boomers 1943-63 Talkative, bossy, inquisitive, stylish,
Xers 13ers, Busters, 1963-82 Pragmatic, individualistic, arrogant, risk-taking
Millennial NetGen, Gen Y, 1983-2000 Tolerant, caring, honest, balanced, independent, optimistic, cleancut
Gen Z 2000-(?)2020 Undetermined
Adapted from TomorrowToday, The Generations Model: The Theory Explained, "Generational Profiles." Accessed January 4, 2006, www.tmtd.biz/articles/generations/training-the-generations.
References and Notes
1. Mary Pipher, Another Country (New York: Riverhead Books 1999), 5.
2. This information is taken from the Home Bound Book customer database histories at the Kansas City Public Library, as of May 4, 2005.
3. This information is taken from the Home Bound Book customer database histories at the Kansas City Public Library, as of May 4, 2005.
4. This information is taken from the Home Bound Book customer database histories at the Kansas City Public Library, as of May 4, 2005.
5. This information is taken from the Home Bound Book customer database histories at the Kansas City Public Library, as of May 4, 2005.
6. Pipher, Another Country.
7. Center Point 2005 Fall Catalog. Accessed Jan. 5, 2006, www.centerpointlargeprint.com.
8. Adapted from the Domestic Mail Manual, United States Postal Service, "Free Matter for Blind and Other Physically Handicapped Persons." Accessed January 5, 2006, http://pe.usps.gov/cplm/ftp/manuals/dmm_old/E040.pdf.
9. Pipher, Another Country, 17.
Relevant sections of the code for free matter for the visually impaired are included below. To see the code in its entirety go to http://pe.usps.gov/cpim/ftp/manuals/dmmrrold/E040.pdf
TITLE 39 -- POSTAL SERVICE
PART IV -- MAIL MATTER
CHAPTER 34 -- ARMED FORCES AND FREE POSTAGE
Sec. 3403. Matter for blind and other handicapped persons
(a) The matter described in subsection (b) of this section (other than matter mailed under section 3404 of this title) may be mailed free of postage, if --
(1) the matter is for the use of the blind or other persons who cannot use or read conventionally printed material because of a physical impairment and who are certified by competent authority as unable to read normal reading material in accordance with the provisions of sections 135a and 135b of title 2;
(2) no charge, or rental, subscription, or other fee, is required for such matter or a charge, or rental, subscription, or other fee is required for such matter not in excess of the cost thereof;
(3) the matter may be opened by the Postal Service for inspection; and
(4) the matter contains no advertising.
(b) The free mailing privilege provided by subsection (a) of this section is extended to --
(1) reading matter and musical scores;
(2) sound reproductions;
(3) paper, records, tapes, and other material for the production of reading matter, musical scores, or sound reproductions;
(4) reproducers or parts thereof, for sound reproductions; and
(5) braille writers, typewriters, educational or other materials or devices, or parts thereof, used for writing by, or specifically designed or adapted for use of, a blind person or a person having a physical impairment as described in subsection (a)(1) of this section.
(c) Other physically handicapped persons certified by competent authority as meeting one or more of the following conditions:
(1) Having a visual disability, with correction and regardless of optical measurement, that prevents the reading of standard printed material.
(2) Being unable to read or unable to use standard printed material as a result of physical limitations.
(3) Having a reading disability resulting from organic dysfunction and of sufficient severity to prevent their reading printed material in a normal manner.
(4) Meeting the requirements of eligibility resulting from a degenerative, variable disease that renders them unable to read or use conventional printed material because of impaired eyesight or other physical factors. These persons are eligible during the time in which they are certified by a competent authority as unable to read or use conventional materials.
SOURCE- (Pub. L. 91-375, Aug. 12, 1970, 84 Stat. 757.)
1.4 Certifying Authority
For purposes of this standard:
a. The postmaster may extend the free matter privilege to an individual recipient based on personal knowledge of the individual's eligibility.
b. In cases of blindness, visual impairment, or physical limitations, "competent authority" is defined to include doctors of medicine; doctors of osteopathy; ophthalmologists; optometrists; registered nurses; therapists; and professional staff of hospitals, institutions, and public or private welfare agencies (e.g., social workers, caseworkers, counselors, rehabilitation teachers, and superintendents). In the absence of any of these, certification may be made by professional librarians or by any person whose competence under specific circumstances is acceptable to the Library of Congress (see 36 CFR 701.10(b)(2)(i)).
Early to bed, and early to rise, makes a man healthy, wealthy and wise…So does going to the public library.
Submitted by: Kathleen Mayo, OLOS Subcommittee on Older Adults
Last fall I attended a service learning/volunteer workshop at Florida Gulf Coast University (FGCU), my local state university. I was hoping to interest one of the professors in working with me on an intergenerational project. As luck would have it, I met Maria Roca, a professor in the Communications Dept., and she thought this sounded like a great partnership. We would train students to work with older adults living in assisted living facilities as well as those attending adult daycare and congregate meal programs. They would make connections with individuals and small groups through intellectually stimulating activities that would encourage thoughtful discussion.
I was looking for three – five students who would like to pilot test this idea for me since I was writing a grant proposal that would involve training a volunteer corps to do the actual project. Dr. Roca had a different idea. She wanted her two classes of senior Communications majors to take this on as a class project with each student contributing at least 20 service learning hours in addition to the training. We now had 50 students who would contribute a total of 1,000 hours!
At the time, I was the Outreach Services Manager for the Lee County Library System (LCLS) in Fort Myers, Florida. The library had a long track record of serving older adults through its Books-by-Mail, Talking Books, and Senior Outreach services. It also had a great collection of programming resources that included two sets of each BiFolkal kit and large collections of music CDs and large print titles.
Dr. Roca divided the classes into 10 teams of five students. Each team would work together to develop programs and plan activities for the site that they would be visiting. Their first visit would be a meet and greet where they got to meet the Activity Director and start to know the older adults they’d be working with. Each team was assigned to a facility or program; one large facility had two teams. The teams would then make four to six visits to a facility over the next two months. One member of each team was a memory keeper who recorded important insights from the group discussions.
Since all of this would be happening during one semester (January through April 2010), we started our training in week two. I enlisted the help of two experienced activity coordinators for the first session. We introduced the students to the aging process, the life experiences and interests of people in this age group, and the realities of life for the seniors we would be meeting. We also explained the role of the activity coordinators in these sites. The students shared their perceptions of aging, described the oldest people they knew, and shared some of their concerns.
At our second training I focused on a few programming ideas for them to use. We discussed reminiscence-based programming ideas and practiced with BiFolkal kits. The kits have excellent program manuals and the students enjoyed thinking of ways to personalize them for their own groups. I introduced them to reader’s theater and the steps involved in picking topics, finding pieces to read, and using props. We also discussed the process of creating thematic programs using library resources. We picked some possible topics and discussed the music, poetry, short stories, and coffee table books they might use to develop the program.
At least one person from each team also received training in the People and Stories program. Roberta Reiss, a local People and Stories trainer, presented the all day workshop on a Saturday and introduced the students and Dr. Roca to this program model. It uses short stories to elicit thoughtful discussion in a group setting. In the process the group explored the methodology of group interaction and facilitation.
As Communications majors - often with a broadcast focus – most of the students had outgoing personalities and a natural ability to socialize well. Adding this to Dr. Roca’s enthusiasm we had a strong group who were highly motivated. In fact, I explained to them that they could not fail. Just being young and friendly would help them to do no wrong in the eyes of the seniors they would encounter.
After their training the teams started setting up meetings with the Activity Coordinators at their facilities and planning their meet and greets with the elders. Most Coordinators plan their activities at least a month in advance so the teams had to fit into those schedules.
The student/senior encounters proved to be successful on many fronts. I was especially proud of how flexible the students were in adapting to the environments they faced and the varied needs of their seniors. Here are some of their experiences:
- One team of white, middle class students visited African American seniors at a facility with a congregate meal site. These low income seniors had little education but they had amazing life experiences to share with the students. The students were eager to hear their stories and developed friendships in spite of their age and cultural differences.
- At a few assisted living facilities many of the residents had memory problems and the students had to adapt to their short attention span. They discovered the value of music and used songs as part of all their programs. Dancing was another popular activity, even for people using wheelchairs who liked to be pushed.
- Some of the groups found that one-on-one relationships worked best with their elders. This was especially true where people had memory issues.
- At one meal site the seniors attended to play rubby cube and didn’t want to stop for other activities. The students, instead, joined in their games and got to have some good discussions with the seniors.
- The BiFolkal kits were a hit with several sites, especially where the Activity Directors got involved and helped them tailor the kits to the seniors’ interests. Because of their age difference, the students had to approach these programs as a chance for the seniors to teach them something about the past.
- One facility had a number of younger residents with disabilities who were living in assisted living instead of at home because the state didn’t pay for a personal care aide. This was one of the sites where People and Stories was most effective and the residents took special interest in the student visits.
- People enjoyed listening to stories and this led to good conversations. Since so many of the seniors have hearing loss this was not always easy to handle.
The students’ reactions were telling:
- They all expressed that they had gone into the project with some definite stereotypes about elders, many of them negative. These changed when they had the opportunity to talk to people face-to-face and see them as complicated individuals with interesting lives.
- They were concerned that so few people in assisted living situations seemed to have visitors. A number of their seniors were looking forward to seeing family members at Easter and no one came. This really upset the students and made them think about connections to their own family members.
- Several students planned to go back to visit some of the people in their groups. They had made friendships that they wanted to continue. One team was going back to attend a “senior prom” event.
- A couple of students started talking about possible careers working with seniors. This project had opened up a whole new career path for them.
- Many found that morning was the best time to visit. They also learned that people love to talk about themselves.
Dr. Roca is continuing the Senior-to-Senior project with her fall 2010 class of 30 seniors and we will be making a number of changes based on the spring experience.
- We’ll have the teams spend more time with their seniors getting to know them and their interests while they plan any activities as a group.
- We’ll have the Activity Coordinators take on a more active role. Although the Activity Coordinators had received calls and written information from me, some of them did not take their role seriously enough and missed out on mentoring opportunities for the students. In the future we’ll devote more time to establishing these relationships since that seemed to make a big difference in the success of the project.
- In the training I need to stress the importance of making and keeping appointments. A couple of teams could not stick to their schedules and this was a problem for the facilities where people were waiting for them.
- We’ll put more emphasis on personalizing reminiscence-based activities and introduce them to the StoryCorps project with its oral history elements. Dave Isay has edited two books on the StoryCorps experiences (Listening is an Act of Love and Mom, a Celebration of Mothers from StoryCorps) that will be good discussion starters.
Other good news is that the grant project was funded and will start in October. I’ll be recruiting for volunteers among people of all ages, including a few university students. Lee County is home to a huge number of older adults so there is plenty of need for activities that promote intellectual stimulation and thoughtful discussion. I’m retired now and will be heading this up for a year as a volunteer myself.
By Barbara Adrianopoli, Director of Extension Services & Branches
Schaumburg Twp. (IL) District Library
I have learned over my thirty years in outreach that this job will prevent you from ever acquiring a big head. This is especially true when you are dealing with our senior population either giving a book talk or coordinating a book discussion group. How many times over the years have I heard, “Now, why did you think we would like this book?” or “I stopped reading the book after the first ten pages because I hated it!” My first reaction is to say, “I don’t know. I just stayed up until 4:00 a.m. reading the book because I knew you would hate it and I wanted to know why?” Just kidding.
I have gone to other libraries’ web sites and noted their book choices, plus I have read Reading Group Choices and browsed best seller lists. Sometimes the book I choose is a winner and sometimes the same book others have found to be great turns out to be a dismal failure. Have you had the same experience?
Reading Groups vary not only in interests but also in ages. One group may consist of seniors who meet the minimum age requirement of AARP and others have lived long and struggled so the book chosen often needs to be on the more leisure side and less thought provoking. There are seniors who have physical problems holding a book or reading too long of a book. Some find too many characters or too many themes to follow. To select a book means you must know your audience. Since our library purchases the books in large print and rotates them among the various groups, and since the group is not charged for the book, I try to have few selections for just one group. Otherwise, it depletes the budget too quickly.
Some of the bits of wisdom I have learned are to make sure you have read the book before selecting it – even though others have found the book to be a perfect choice, it is might not be for your groups. It helps also that the book can be downloaded or on a compact disc so those with disabilities are not left out. I have one senior who loves her Kindle and another two who like me to download the book on their MP3 players. Don’t select all of your books at the beginning of the year, as getting to know your group takes several selections. Make sure you have a discussion sheet and some reviews included for your selection. Often, the already printed discussion questions don’t fit your group or there are too many. You need to fit discussion questions to your group. It makes for good discussion and wonderful interaction. So many times I am rewarded with discussions on the most personal level which have never been shared before but the person feels comfortable enough to discuss. Books such as Breakfast at Sally’s and The Glass Castle brought forth people discussing their own homeless growing up or having parents or family members who suffered from mental illness. Another thought provoking book for each of my groups was The Leisure Seeker, a novel by Michael Zakoorian.
This book can be a winner or people find the ending does not coincide with their value systems. Many times I heard, “I liked it until the end.” But in the end, it is the seniors making a choice which may or may not be what the children want. I won’t give away the ending. For this book I also added information regarding laws in our several of our states as well as customs from other countries. Old standby authors such as Garrison Keilor’s novels and Jennifer Chiaverini’s quilt books have always received good reviews.
Sometimes even the hardest group does not mind learning about the countries in the news. Three Cups of Tea allowed the seniors to learn about another tradition as well as giving a different slant to their news hour. I will see how I Am Nujood, Age 10 and Divorced is received. Since the news has been focusing on Yemen the seniors will have a chance to learned about this country from the words of a young child bride in Yemen.
I will end with a quote from Francis Bacon:
"Some books are to be tasted, others to be swallowed, and some few to be
chewed and digested: that is, some books are to be read only in parts,
others to be read, but not curiously, and some few to be read wholly,
and with diligence and attention."
~ Francis Bacon ~
Life After Cancer
Life After Cancer is a publication from NIHSeniorHealth's Web site, which features basic health and wellness information for older adults from the National Institutes of Health.
Click here to visit the Life After Cancer Web site.
Who is a Cancer Survivor?
Follow-up care after cancer treatment ends is very important because it helps to identify changes in your health. Your follow-up care depends on the type of cancer and the type of treatment you had, as well as your overall health.
The effects of cancer treatment vary among patients. Some side effects continue after treatment is over, while some can develop after treatment has ended. Many older adults have other health conditions such as diabetes, heart disease, and osteoporosis. Sometimes it is hard to tell if physical changes are the effects of cancer or its treatment, or are caused by other health conditions or simply the result of getting older.
Some of the most common problems that older cancer survivors report are
- memory and concentration problems
- pain and nervous system problems
- mouth or teeth problems
- weight gain or loss
- bladder and bowel problems
Physical Changes - Fatigue
Fatigue, or feeling extremely tired, is the most common complaint during the first year after cancer treatment ends. Cancer-related fatigue is different from everyday fatigue. Rest or sleep does not help it. For some survivors, fatigue is mild and temporary, but for others it can last for months after treatment and makes going about daily activities difficult.
Doctors do not know the exact cause of treatment-related fatigue, but many factors may contribute. The causes seem to be different for people who are undergoing treatment than for those who have finished treatment.
Fatigue during treatment can be caused by cancer therapy. Chemotherapy, radiation therapy, and other therapies may cause fatigue. Other problems such as anemia (having too few red blood cells), stress, poor nutrition, lack of exercise, and depression may be linked to this type of fatigue. Researchers are still learning about what may cause fatigue to linger after treatment ends.
What can you do about fatigue? The best thing you can do for fatigue is talk to your doctor or health care professionals about it so you can get the help you need to deal with it. Ask them about the medications you are taking and if they could affect your energy level. Talk to them about how to manage any pain, nausea, or depression you may have. They may also be able to suggest medications or nutritional supplements that may help lessen your fatigue.
Here are some other ways you can manage or cope with your fatigue.
Plan your day so that you balance rest and activity. Be active at the time of day when you feel most alert and energetic. Take short breaks or naps throughout the day, rather than one long rest period. Too much rest can decrease your energy level.
Save your energy. For example, change the way you do things. Sit on a stool while you cook or do dishes. Take rest breaks between activities. Decide which activities are more important and which ones aren't. Try to let go of things that don't matter as much now.
Let others help you. Don't be afraid to ask your family or friends to help with the things you find tiring or hard to do. This may be a task such as preparing meals, doing housework, or running errands.
Think about joining a support group. Talking about your feelings with others who have had the same problem may help you find new ways to cope.
Physical Changes - Memory, Pain, and Nervous System Problems
After cancer treatment, some people find that they can't pay attention or remember things the way they used to, have pain that remains, or have problems with damage to their nervous system. These changes may be side effects of treatment.
Some survivors notice that they can't focus on the job at hand or they have trouble remembering details like names and dates. Sometimes it takes them longer to finish tasks, because their thinking and processing seems to be slower. For older adults, it can be hard to tell whether changes in memory and concentration are because they are getting older or are the result of treatment.
These changes, sometimes called "chemobrain", can begin during cancer treatment or they can occur much later. The exact causes are unknown, but people who have had chemotherapy or who have had radiation to the head seem to be more likely to experience these problems.
The best thing you can do about memory and concentration problems is to talk with your doctor. Discuss whether medications you are taking, depression, problems sleeping, or anxiety could be contributing to your problems. If these problems last for a long time, your doctor may suggest that you see a specialist who can help you.
Here are some ideas that can help with your memory and concentration.
- Jot it down. Write down your appointments, important dates, and phone numbers. Make lists and write down plans for your day
- Put small signs around the house to remind you of things to do, such as locking the doors.
- When doing a task with several steps, such as cooking, whisper each step to yourself.
- Repeat what you want to remember. Saying it a couple of times can help your mind hold on to the information.
Some people have a lot of pain after cancer treatment, while others have less. Some types of pain associated with cancer include pain from surgery and pain or numbness in the hands or feet caused by nerve injury following some treatments.
Another type of pain is called phantom pain. If you have had a limb or breast removed, you may still feel pain or unusual feelings that seem to be coming from the absent (phantom) body part.
Many older adults are reluctant to ask for help to relieve their pain. Some may believe that pain is just part of having cancer and of aging, or fear that taking pain medications will cause drug addiction. Some think that mentioning pain or discomfort makes them a problem for caregivers. Others are afraid that their doctor won't focus on curing the cancer if they spend their time treating pain.
But you don't have to be in pain. Controlling your pain is a way to help you feel better and stay active. And newer medications made available in this past decade have helped control pain due to cancer better than ever before.
Talk to your doctor. Describe your pain as clearly as possible and point out where it hurts. Describe how it feels -- sharp, throbbing, etc. Explain how often it occurs, how long it lasts, and what seems to trigger it, make it worse, or lessen the pain. Explain how the pain affects your daily life.
It may be useful to keep a "pain diary" or record of your pain that includes
- the time of day you experienced the pain
- how much pain you had -- usually based on a scale of 0-10, where "0" is no pain and "10" is the worst pain imaginable
- the activity you were doing when you felt the pain
- how well medications worked to relieve your pain.
Based on the severity of your pain and what seems to be causing it, your doctor may recommend pain-relief or other types of medications, physical therapy, or other things that may help control your pain such as relaxation techniques, acupuncture, or meditation.
Nervous system problems
Sometimes cancer treatment can cause damage to your nervous system or problems with nerve functions. This is called neuropathy and the severity and symptoms vary widely from person to person.
Neuropathy can occur at any age, but it is more common in older adults. It can also be caused or made worse by other conditions that are a concern for older adults, including diabetes, kidney failure, and malnutrition.
Most people first notice symptoms, such as tingling or numbness, in their hands or feet. Other common symptoms include sudden or sharp pain sensations, loss of sensation of touch, loss of balance or difficulty walking, trouble picking up objects or buttoning clothes, and being more -- or less -- sensitive to heat and cold.
Symptoms can start during or after treatment. Symptoms can improve over time, but it may take up to a year or more. If you start to notice these types of symptoms, talk to your doctor or health care professionals right away. They may suggest medications or pain patches to help alleviate symptoms, or other approaches such as physical therapy.
Here are some steps you can take to help manage nervous system changes.
- Pay attention when handling knives, scissors, or sharp objects. Neuropathy can reduce pain sensation, so you could get a wound and not feel it.
- Avoid falls. Pay attention when you walk and if necessary, use a cane to help steady yourself. Remove objects that you could trip over.
- Wear shoes with rubber soles.
- Avoid extreme heat or cold. Wear gloves and hats when needed.
Physical Changes - Other Changes
Some survivors experience other side effects related to their treatment that may include swelling, problems with their mouth and teeth, changes in their weight, and bladder and bowel problems.
Swelling, called lymphedema, occurs when lymph fluids build up just under the skin. It can occur after radiation or surgery to treat any type of cancer. It is most often associated with treatment of breast cancer, melanoma, prostate cancer, lymphoma, and cancers of the female or male reproductive organs.
Lymphedema most often occurs in the arms and legs, but it can happen in other parts of the body including the face, neck, abdomen, and genitals. Other conditions, such as heart disease, also can cause these symptoms.
Symptoms of lymphedema include swelling or a heavy feeling in an area like your arm, leg, or abdomen; a tight feeling in the skin; or an itching or burning feeling in the legs. If you experience any of these symptoms, tell your doctor. The chance of improving lymphedema is better if treatment begins early.
Here are some things that might help prevent or relieve lymphedema.
- Watch for signs of swelling or infection (redness, pain, heat, and fever). Tell your doctor if your arm or leg is painful or swollen.
- Avoid getting cuts, insect bites, or sunburn in the affected area.
- Keep your skin clean and use lotion to keep it moist.
- Wear loose-fitting clothing on your arms and legs.
The goal of lymphedema treatment is to control the swelling and to keep other problems from developing or getting worse. Your doctor may suggest keeping your arm or leg raised above your chest for periods of time, wearing compression bandages, or special types of massages. Under a doctor's guidance, some forms of exercise may also help control lymphedema.
Mouth and Teeth Problems
Many cancer survivors develop problems with their mouth or teeth. Radiation or surgery to the head and neck can cause problems with your teeth and gums, the lining of your mouth, and glands that make saliva. Certain types of chemotherapy can cause the same problems as well as dry mouth, cavities, and a change in the sense of taste.
The advice to help prevent and relieve mouth and teeth problems is the same for cancer survivors as for people who have not had cancer. Brush your teeth and gums after every meal and at bedtime, and floss your teeth daily. If you have dentures, clean them after every meal and have them checked to make sure they fit well.
Another tip is to avoid foods that may irritate your mouth. For example, sharp or crunchy foods such as chips could scrape or cut your mouth. Foods that are spicy or high in acid, such as citrus fruits and juices, tobacco products, and alcoholic drinks also can bother your mouth.
Weight Loss or Gain
Many cancer patients experience changes in their weight during treatment. Among survivors, weight gain is a more common issue than weight loss. Certain kinds of chemotherapy and medicines contribute to this problem.
Sometimes the added pounds stay on even when treatment ends. Breast cancer survivors who received certain types of chemotherapy gain weight in a different way -- they may even lose muscle and gain fat tissue. Unfortunately, the usual ways people try to lose weight may not work for them.
If you are having trouble losing weight after treatment ends, ask your doctor about talking with a nutritionist who can help you plan a healthy diet. Your doctor may suggest exercises that can help you regain muscle tone. Stay positive and focus on the fact that treatment is over and you are trying to get stronger.
Some cancer survivors have no desire to eat and they lose weight. To improve your appetite, focus on making foods more appealing to eat. Try the foods you liked before treatment and add some fruit or flavorings to improve the taste. Several small meals throughout the day may be easier to manage than three larger ones.
Bladder and Bowel Problems
Bladder and bowel problems are among the most upsetting issues people face after cancer treatment. People often feel ashamed or fearful to go out in public because they worry about having an "accident." This loss of control can happen after treatment for bladder, prostate, colon, rectal, ovarian, or other gynecologic or abdominal cancers.
Some surgeries to treat cancer may leave a patient with little or no bladder or bowel control. The opposite problem can happen with some medicines that cause constipation. For some people the problems improve over time, but others may experience long-term issues.
It is very important to tell your doctor about any changes in your bladder or bowel habits. Several things may help, such as medications, changes in diet or fluid intake, and exercises. Joining a support group also may be helpful, especially for survivors who have an ostomy (an opening in the body to pass waste material).
Physical Changes - Effects on Intimacy
For many older adults, intimacy remains an important need. Cancer and cancer treatment can have a major impact on intimacy and sexual function. For example, more than 60 percent of prostate cancer survivors are 65 years of age and older. Research has indicated that sexual impairment may affect 60 to 80 percent of these men, depending on the type of therapy they received.
For both men and women, some side effects of cancer treatment may inhibit intimacy. Problems are often caused by physical changes, such as erectile dysfunction or incontinence which can occur after prostate surgery. Other problems are due to emotional issues like changes in body image because of scarring or the loss of a breast.
Other emotional issues including depression, anxiety, and stress between you and your partner can play a role. Factors associated with other medical conditions such as pain or certain medications also may contribute.
Often, sexual problems will not get better on their own, so it is important to talk with your doctor. He or she can suggest a treatment depending on the type of problem and its cause. A variety of things may help, including medications, devices, surgery, exercises to strengthen genital muscles, or counseling. Talking to your partner about your fears and needs, and listening to his or her concerns, can be an important first step to recovering a sense of intimacy.
Changes in Emotions and Relationships
Just as cancer affects your physical health, it can affect the way you feel and act. It can affect the way you relate to your loved ones and coworkers and how they react to you. Surviving cancer also involves taking care of your emotions and relationships.
Changes in Emotions and Relationships - Emotions
Each person's experience with cancer is different, and the feelings and fears that you have are unique. Some typical emotions experienced by cancer survivors are fear, depression, stress, and loneliness.
Worrying that the cancer may come back is one of the most common fears among cancer survivors. As time goes by, this fear may lessen.
Long-term survivors are usually considered those who have had no signs of cancer five years after their initial diagnosis, when cancer recurrence becomes less likely. However, years after treatment, some events such as follow-up doctor's visits, symptoms similar to the ones you had before, or the illness of a family member can trigger concerns.
Finding ways to cope with the fear of your cancer recurring can help you feel better. It is important to stay positive and focus on what you can do now to stay as healthy as possible. Learning about your cancer and what you can do to take care of your body can give you a sense of control.
Acknowledging your feelings of fear, anger, or sadness can help you sort them out and may help you let them go. Talk about your concerns with family, friends, other cancer survivors, or a counselor. You can also sort out your feelings by thinking about them or writing them down.
Being as active as possible can help you focus on other things and take your mind off cancer and the worries it brings. Get out of the house and participate in activities that you enjoy. Take a walk or get some other type of exercise. Many other health benefits also have been attributed to exercise.
After treatment is over, feelings of anger and sadness may linger. For many survivors, these feelings lessen over time, but for others these feelings worsen and can interfere with their daily life. They may develop a condition called depression.
Although depression can affect anyone and is common among cancer survivors, older survivors are at a greater risk of developing depression than those who are younger. Some older adults lack social support often because they do not live near family members or have experienced loss of family or friends.
It is important for you to talk to your doctor about your feelings. If you are depressed, your doctor may prescribe medication or refer you to a therapist who is an expert in depression.
These are some signs that may indicate you need professional help for depression.
- feelings of worry, sadness, or hopelessness that don't go away
- feeling overwhelmed or out of control for long periods of time
- crying for a long time or many times a day
- thinking about hurting or killing yourself
- loss of interest in usual activities
There are also physical signs of depression, which include unintended weight gain or loss not due to treatment, sleep problems, and fatigue that doesn't get better.
Some cancer survivors feel stressed when they try to get their life back to normal after treatment ends. When you were diagnosed, you may have focused on getting better and put concerns such as those about family and finances aside. Now that treatment is over, you may feel pressured and overwhelmed as these issues begin to resurface.
Finding ways to reduce or control the stress in your life can make you feel better. Many survivors have found exercise, meditation, and relaxation techniques helpful. Taking time for yourself and devoting time to doing activities that you enjoy, such as reading, gardening, or listening to music, can also relieve stress.
Many cancer survivors feel as if others can't understand what they've been through, which makes it hard to relate to other people and can lead to loneliness. Friends and family might be unsure of how to help, and others may feel uncomfortable around you because they are afraid of cancer.
Joining a cancer support group could help you cope with the emotions that you have after cancer. By talking with other cancer survivors and listening to their experiences, you may learn new ways to deal with the problems that you are facing. Being in a group may also help you feel less alone.
There are many types of support groups for cancer survivors. Some focus on one type of cancer, while others are open to those with any cancer. Some groups include both cancer survivors and family members. Support groups may be led by health professionals or by other cancer survivors. You might need to visit one or two different support groups to find the right one for you.
Changes in Emotions and Relationships - Relationships
Cancer involves not only the patient, but also family, friends, and coworkers. This is as true after treatment as it is when treatment is going on. It's normal to notice changes in the relationships you have with the people in your life.
When treatment is over, your loved ones may expect you to be enthusiastic about getting on with your life. They may not understand that recovery takes time. Some may give you too much attention, while others may avoid you or hide their feelings because they think you have had enough to deal with.
Your loved ones also have been through a difficult time and may feel the need to resume a normal life. For example, if you did the gardening before cancer, your spouse may expect you to begin again. If you don't feel up to it, tell them and don't feel pressured to do more than you can handle.
At other times, you may expect more from your loved ones than you receive. For instance, you may still need your family's support and may expect your children or grandchildren to be as attentive as they were during your treatment, but they may not call as often as you think they should. It is important to keep the lines of communication open and give yourself time to adjust to changes. If you need more support, call your friends or family instead of waiting for them to call you.
Sometimes it's necessary to seek outside help. Ask your doctor to refer you to a counselor who can help you communicate with your loved ones. Join a support group if you feel that talking with other survivors who have gone through similar experiences would be helpful. Support groups are also available for loved ones of cancer survivors.
Many survivors age 60 and older are still working. Some may need to work, while others enjoy being around people and staying busy. Returning to work after cancer treatment is over can help you feel that your life is getting back to normal.
Just like your loved ones, friends at work may respond to you in different ways. Some may be very supportive, while others may be uncomfortable and try to avoid you. Think about the best approach for you to deal with their reactions.
Many survivors find it helpful to plan what they will say about their cancer. Some are open about discussing it, but others don't want to focus on it. You should choose what is right for you.
Frequently Asked Questions
Submitted by Brigid Cahalan, Older Adult and Disability Services Specialist
The New York Public Library, firstname.lastname@example.org
The New York Public Library has recently had the pleasure of hosting eleven programs featuring author/computer teacher Abby Stokes speaking on the topic of Demystifying Computers. A former puppeteer and actor, Ms. Stokes knows how to masterfully connect with an audience: she specializes in enlightening the uninitiated and emboldening the cyberphobe. Since public libraries have become the place to use computers for free—and learn to use them if necessary—we librarians can all use advice on teaching older adults, and computer neophytes of any age, with sensitivity and respect. I’ve asked Abby if she would put together a list of tips, so take a look:
TEN TIPS FOR TEACHING COMPUTER SKILLS TO OLDER ADULTS
By Abby Stokes
There are unique obstacles to teaching technology to a generation that not only wasn’t born with a computer mouse in their hand, but clearly remembers when telephones were rotary dial. As a “younger” baby boomer, the transition to computers came a lot easier for me than it did for my mother. But, if she is any example, anyone can learn to use a computer with gentle, patient, and creative guidance.
There are three motivating factors that inspire most silver surfers to take on the challenge of the computer – the Internet, e-mail, and a desire to not be left behind. Keeping those three objectives in mind, here are my 10 tips on how to successfully bring the computer fearful onboard and, hopefully, enjoy the experience the computer and Internet have to offer:
1) Watch Your Language. You probably shouldn’t cuss at the computer or your student, but that’s not what I mean. Be aware of the words you chose. You’ll lose someone in the first 5 minutes if you speak computer jargon. They don’t need to know computer terms in order to use the computer, so avoid tech talk unless absolutely necessary.
2) What Turns Them On? Before sitting down in front of the computer ask your student what interests them. You want to be able to dazzle them what the Internet has to offer specific to their needs and interests. What questions would they like answered? What are their hobbies? What is their family into that they would like to know more about?
3) Slow And Steady Wins The Race. Most seniors are not in a rush - you shouldn’t be either. Assume that you are always going too fast. Take your cues not from the agenda you’ve set for the lesson, but instead the look in the eyes of your student. Eyebrows raised in surprise are good. A furrowed brow and a glazed look are bad. When you see the latter, you need to back up and figure out where you lost your student and start again from there.
4) Shake It Up. Before you even turn on the computer have your student put both hands on the monitor and shake it a little. Take the mouse in your hand and swing it by its tail. It reassures the fearful to know that the computer is just a big plastic box and nothing more. A little levity, with the intimidated, goes a long way.
5) Play Wingman. Your student should start in the driver’s seat from the get go. They do all the hands-on controlling of the experience starting with turning the computer on. Think basic, basic, basic and assume they don’t know anything, but can learn everything.
6) Conquer The Mouse. Any activity on the computer can be broken down into step-by-step instructions to be practiced until the steps become habitual. But, until the mouse is conquered, a newbie can’t practice the steps. Your first teaching session may just be about hand position, single-clicking, double-clicking, and clicking and dragging. The best way to practice all of these skills is by playing Solitaire. (I kid you not.) Be patient, reassuring, and sing their praises when they get it right.
7) Take A Break. There’s a limit to how much anyone can absorb. No matter how far you’ve gotten, stop after 45 minutes. Use a 15 minute break to talk about the importance of good posture while on the computer, what websites you find fun, or chat about the weather. You’ll know you can return to the lesson as you see your student relax.
8) A 3-Step Method. Repetition helps us remember. Do everything three times. The first time they do it is hands on. The second time they do it is to take notes. The third time they do it is to follow their notes to be sure the notes are clear without you guiding them. Example: To access the Internet and visit a new website: With their hand on the mouse you instruct them to 1) double click on the icon to access the Internet. Next have them 2) single click in the website address box to highlight and 3) type in a website address. Lastly they should 4) depress and release the Enter/Return key. Four simple steps. Do it, write it, and do it again.
9) It’s Not Their Fault. When the time comes, and it will, that a website is hard to navigate, place blame where it belongs. Shame on web designers and computer manufacturers. This could all be much easier if those who designed the computer and the Internet took into consideration user issues. Relieve your student from feeling inadequate by pointing out the flaws in design and usability.
10) Give homework. Inspire your student to get on the computer for just 15 minutes a day to practice what you’ve worked on together. It is through short, daily visits to the computer that they will be able to conquer the beast.
Abby Stokes is the author “Is This Thing On?” A Computer Handbook for Late Bloomers, Technophobes, and the Kicking & Screaming www.abbyandme.com.
By Gene D. Cohen, MD, PhD
Something that really annoys me is when a narrow world view is considered accurate, especially when the particular world in question is aging, a realm I have studied for more than three decades. A classic example is the misinformed idea held by the general public and scientists alike for most of the 20th century—that we have all our brain cells by the age of 3, with no capacity to produce new ones thereafter.
From this misinformation, it was concluded that the stage for a gradual downward course was set early in the life cycle. We now know that this is false; we continue to have the capacity to produce new brain cells right to the end of life, a process known as neurogenesis. Moreover, brain scientists have found that neurogenesis in aging is associated with novelty and ingenuity.
Consider, too, the concept of the “senior moment.” When an older person experiences a “tip-of-the-tongue” phenomenon— having trouble finding the right word—too many shoot from the hip that he or she is having a senior moment, as if that handily captures the essence of aging. But what moment do adolescents have when arriving at the supermarket and realizing they forgot the shopping list their mother stressed that they remember to bring? Does the so-called senior moment really reflect the defining moment for a senior any more than forgetfulness should brand an absent-minded teenager?
In contrast, my research and clinical work with more than 3,500 individuals in the second half of life has identified not a characteristic moment that defines aging but a considerable interval of time where remarkable psychological growth and development occur. This sets the stage for what may be called the new senior moment, a time of life which many older individuals experience as their “moment,” a new period in their life where they shine or come into their own.
I describe it as the liberation phase. During this phase, positive events happen not despite aging but because of it. Along with the experience of years come agile thought forms, reflecting a mature psychological development prominent among those in their late 50s, 60s, and 70s. With age can come a feeling of inner freedom, self-confidence, and liberation from social constraints that allows for novel or bold behavior, and this lays the inner foundation for the new senior moment.
I’ve identified four psychological growth phases in the second half of life. They overlap one another, phasing in as we transition from one to the other. For example, in our mid-50s, we enter the liberation phase, which continues to be prominent throughout our 60s and as we move into our 70s. It is, in effect, characterized by friendly metaphorical inner voices saying to us, “If not now, when? Why not? What can they do to me?” These voices give us a new level of comfort, confidence, and courage to try different approaches in exploring new areas of endeavor, problem solving, and tapping into our limitless inventive potential. The liberation phase underlies what many researchers have called the growth of practical intelligence and pragmatic creativity with aging.
Consider the following real-life story:
My in-laws, Howard and Gisele Miller, both in their 70s, were stuck. They had just emerged from the Washington, DC, subway system into a driving snowstorm. They were coming to our house for dinner and needed a cab since it was too far to walk. But it was rush hour, and no cabs stopped. Howard tried calling us, but both my wife, Wendy, and I were tied up in traffic and weren’t home yet—this was the pre-cell phone era. As his fingers began to turn numb, Howard noticed a pizza shop across the street. He and Gisele walked through the slush to it and ordered a large pizza for home delivery.
When the cashier asked where to deliver it, Howard gave him our address, and added, “Oh, there’s one more thing.”
“What’s that?” the cashier asked.
“We want you to deliver us with it,” Howard said.
And that’s how they arrived, pizza in hand, for dinner that night. This favorite family story perfectly illustrates the sort of agile creativity that can accompany the aging mind. Would a younger person have thought of this solution? Possibly. But in my experience, this kind of out-of-the-box thinking is a learned trait that improves with age. Age allows our brains to accumulate a repertoire of strategies developed from a lifetime of experience, part of what other researchers have termed crystallized intelligence. Obviously, Howard hadn’t used that pizza routine before, but the accumulated experience of other successful strategies helped stimulate the thinking that produced his creative resolution. This was one of his new senior moments, occurring, again, not as a failing of aging, but a benefit of it.
— Gene D. Cohen, MD, PhD, is the founding director of the Center on
Aging, Health & Humanities at George Washington University. He’s a past
president of the Gerontological Society of America and, during his
20-year career at the National Institutes of Health, was appointed the
first chief of the Center on Aging at the National Institute of Mental Health
and served as acting director of the National Institute on Aging. In 2000,
he published The Creative Age, a book on creativity and aging, and in 2006,
published The Mature Mind: The Positive Power of the Aging Brain.
By Joyce Voss, Community Services Manager, Arlington Heights Memorial Library
Every year since 1995 a memoir writing class has been offered at the Arlington Heights (Illinois) Senior Center. It is part of the library’s outreach programming.
For many seniors, reflecting back on their lives, reliving special moments, and coming to terms with other aspects of life, are exercises that excite them. They tell their stories, and their families keep urging them to write about their life experiences. Providing them with a structure in which to do that writing, is a winning program idea.
How it is done is not as hard as it first appears. There is a never ending supply of how to books and websites to give you ideas. Here is a sample of what has been done by library staff at the local senior center.
The class meets once a week for eight weeks. Weekly assignments are shared with others in the class and comments are solicited. There are in-class exercises that sharpen the memory “cells.” By the end of the program, each person will write at least eight remembrances. These eight articles, coming from different parts of life, will be like quilting blocks or puzzle pieces. Along with the writing, a discussion will occur about a life outline into which the individual writings can be coded.
As the weeks pass, there is the joyful discovery that many people, places or events are shared by two or more participants. Everyone is amazed at the discovered common ground.
At the first class, it is determined what is meant by “memoir.” It is personal memory. The memories, many will discover, are not the way a sister or brother remembers an incident. Lots of laughter is shared as class members relate how their siblings have disagreed with what they remember. Making it clear that each participant has ownership of his/her memories is very important. It is the personal memory that is to be explored Memories to Memoirs.
To loosen things up at the initial meeting, an icebreaker is used. A favorite is the one to two minute presentation by each member, using a topic drawn from a bag. Some of the topics are: What was your first job? Who was your first best friend and how did you meet? Tell us about your first and/or middle name? Tell one vivid memory of the WWII years. After all have spoken, a list of all the questions used is distributed. Selection of one of the questions to be answered in writing becomes the assignment for the next class.
A printed set of guidelines which include listening, confidentiality, not being judgmental, willingness to share, etc. is distributed and discussed at the first meeting.
In the course of the eight weeks it can be referred to when needed as a document to which all had agreed.
In the second class, a routine is begun that continues through the course. That is each person in turn reads what s/he has been written for that day. The willingness to share is a requirement of the class.
The readings take up the first half (or more) of the class, and then a new topic is tackled, like the importance of place. Place is like a picture frame in which a remembered event comes to life. During class a floor plan of the house one grew up in is drawn. A discussion ensues covering first thoughts on remembering the home where early years were spent. For an assignment each is asked to write about a remembrance generated by the discussion and the drawing of that house.
On another day, an in-class assignment is a list of phrases referring to life events before each person was ten years old. A sample list done by the facilitator is provided to help get the assignment started. Some of the list items read: my father’s singing, climbing trees, chicken coop and the rabbits, the garden, the bread man and milk delivery. After each has her/his own list, the assignment is to enlarge on one of the phrases.
In succeeding weeks, topics could include kitchen memories, fragrances, dangerous topics, money, and important people. In any given year, some of the topics remain and others are replaced. This keeps up the interest of those members repeating the class and that of the facilitator. More than one remembrance can be written on many of the topics. So, even if a person is repeating the class, s/he will be writing something new.
By week six attention now turns to thinking about how the pieces can be woven into a larger story. A master plan for that larger story, in the form of an outline, is worked on during class time and beyond. A sample plan developed by the facilitator is shared. Most opt to do a chronological outline, but that is a personal choice. Once the outline is laid out, always with the notion that it can be tweaked, a writer’s individual pieces can be coded to fit into that outline. Some participants pursue the longer memoir in the months beyond the class meetings. Incorporating genealogy information and pictures with the writing is a choice some make. Several have their efforts put into book form. Others are just as happy to collect the pieces and share them with their families as they write them.
Writings are not collected and corrected by the facilitator. That would be too time-consuming for staff. After sharing a piece of writing, comments are made by the group on what worked, what seemed confusing and/or suggesting an addition.
To provide a sense of “when” in the writing is encouraged. This helps the reader more fully appreciate the story. Ways to accomplish this is by stating the writer’s age at the time of the recollection, mentioning the year, or referring to some famous event that happened. During several of the classes books of decades, Reminisce Magazine, and other articles are shared. Music, fashions, modes of transportation, cost of consumer goods of different time periods are but a few of the topics investigated. Sharing these resources is a big help to the writers as they look for ways to place their stories.
For some this writing class is only a starting point. Others have already been jotting down their remembrances, but Memories to Memoirs gives a structure which is helpful. Several of the writers have taken this class two and three times because they say it gives them motivation to put pen to paper. In these past fourteen years, two Memoirs Alumni groups have formed and regularly meet to listen and to encourage. Several new members are added each year. Occasionally this facilitator visits but these two groups operate independently.
A number of library staff across the country will confirm that memoirs or remembrance programs are a big hit with the over 55 clientele. It can take many forms, so give it a try.
--Joyce Voss is the Community Services Manager at Arlington Heights Memorial Library.
By Carolyn Caywood, Bayside & Special Services Librarian at City of Virginia Beach
Because of its military bases, the Virginia Beach population has been younger than average, but the leading edge of the Baby Boom will nearly double the number of residents over 55. That's why three years ago I was given the job of writing a Senior Services Plan for the Virginia Beach Public Library. The charge: “Create a service plan for seniors to address the special needs of this group” left the process wide open. Some of what we did worked well while I caution against other choices. I am sharing both in the hope that more libraries will begin planning for the “silver tsunami” and learn from our experience.
I asked six people to become a team to outline the plan. Members were demographically diverse and each had an interest in library service to older adults. They were both professionals and paraprofessionals and one was an outside expert from SeniorNavigator. However, no member was older than a Baby Boomer, which was a definite mistake. While we were working, a City Council member launched a citizen planning group of older adults that was very effective in setting up a rural Senior Center.
The team met for a full day with a facilitator who helped us create a context map and brainstorm actions. Unfortunately, we had to change rooms twice, and we learned that being in a small space can inhibit creativity by keeping ideas small too. We had some difficulty defining the target population and settled for definitions that focused more on life events than on age.
Another choice I would change in retrospect is that we did our brainstorming before doing research. We were ignorant of our ignorance! As a result, we approached the idea of senior services as rescuers on the needs that seniors have that we should meet. We failed to think of seniors as people with immense capacities that can contribute to the good of the community.
We clumped our brainstormed ideas into these areas: programs, outreach, marketing, facilities, partnerships, collections, engagement in the community, advocacy, and technology interfaces. We prioritized them in the order I've listed them. Each team member then wrote up actions for an area.
Since one member was not a city employee, she could not access the online folders that the city provides for teams, so we used Pbwiki to share documents. You can see our work at https://vbplseniors.pbwiki.com – use “lssp” as the key for access. Unfortunately, the team never really got the hang of editing wiki-style and I was the only one to post documents. I remain convinced that a wiki is a great team tool, but don't underestimate the training needed to use it effectively.
As I pulled the plan together, I kept discovering more research and opportunities to learn. It was hard to stop adding to the plan. There is a bibliography on the wiki, but I want to highlight a few exceptional resources. Gene Cohen's books and his Center on Aging, Health & Humanities at George Washington University, http://www.gwumc.edu/cahh/ brought a much-needed positive focus to our plan. I was fortunate to participate in the free online conference Creating Aging Friendly Communities and the Libraries for the Future Lifelong Access Libraries Institute, both of which have ceased. If you encounter such an opportunity, don't let it get away!
The most helpful library service resource I found was “Older Adults and Reader Advisory” by Alicia Ahlvers in Reference and User Services Quarterly, Vol. 45, #4, Summer, 06, p. 305-312. Ahlvers explores the differences between generations and how that impacts library use. Helpful background reading for understanding these differences is Generations by William Strauss and Neil Howe (Morrow, 1990)
We learned, in the course of writing the plan, to keep watch on the 45 to 54 age cohort because they will become the newest older adults and unless we plan for them, we'll always be behind. Life after 55 will not be the same as in the past. Boomers are better educated, more diverse, and more likely to live through their 70s than any previous generation of older adults. Life for older adults can be a time of creativity, wisdom, and community-building, and libraries are uniquely qualified to facilitate these positive aspects of aging. But Boomers will not read or use libraries in the same patterns that their parents did.
Experts predict that most Boomers will choose to age in place rather than move away to a community of retirees. This means they will drive public policy decisions about land use, transportation, and tax revenues. We must engage them in support of government services rather than in competition with other service needs. Another prediction is that Boomers will continue to work in some capacity in their retirement years. We will need to adapt our expectations of volunteering and part time jobs to take advantage of this. The alternative is that tax revenues will drop as Boomers retire while demands on government services will rise, leaving little money for libraries. And many Boomers will live in or near poverty.
What we have learned led us to this vision: The Virginia Beach Public Library is a transformational part of the lives of older adults as they balance time and money to pursue a healthy, secure and meaningful life, engage in purposeful and challenging activities, and serve as a source of wisdom and perspective for the community.
Our goals for the plan are:
- To retain and increase library usage as Boomers transition into their senior years by adapting library services to their changing needs, resulting in more visits.
- To employ skilled and educated retirement-age workers who are interested in contributing to the library.
- To cultivate supporters and advocates for library services among older adults, resulting in more voter support.
- To assist City government to address the public policy issues of aging in an informed, organized and efficient manner.
The actions we have proposed require time, attention and commitment more than expenditures. We are now using an advisory group of older adults as a sounding-board to evaluate proposed programs. We now have a specialist position at my branch where we are the pilot for new services. In time, all this will feed into a revised plan that will be more grounded in experience.
--Carolyn Caywood is the Librarian at Bayside & Special Services Library, a combined public branch and subregional library for the blind.