We need meaningful engagement.

My sister often complains that Mom loves to sleep and that she sleeps too much. When we ask her to get up, she responds, “What is there to do?” She thinks she has nothing to do, and it doesn’t matter if she sleeps in.

My students and I visited a nursing home for nuns in Macau. It was 4 p.m. when our visit was almost done. We said goodbye to some of the nuns who were in bed and, before we left, asked one of them if she would like to get up. She said no; she had nothing to do. It was fine for her to lie quietly in bed.

My mother spends a lot of time in bed out of her own choice. I don’t know if it is the same for the nun we met. Although their daily lives are structured–they get up, groom, eat, rest, and go to bed—it it likely that they do so without engaging in activities that are meaningful to them. At least, that is the way I see it.

When kids explore their world by bumping around, we think they are normal; that they are healthy, active kids. When people grow old, we think it is OK for them to lie in bed not doing anything. Why is that OK?

Would my sister and I feel better if my mother got up, sat around and did nothing? Would it make visitors to the nursing home for nuns feel better if Sister got out of bed and sat in a wheelchair, but with nothing to do? By doing so, they would maintain the appearance of being “normal.” So I could happily attend to my own business?

As a gero nurse, I did not fully appreciate the importance of being engaged in life until I encountered these situations. People of all ages need to be engaged in meaningful activities. When they can no longer do this because of cognitive or physical impairment, it is up to us to create a structured world for them that is meaningful. They need to get up, engage in small tasks, talk to people, do things for themselves, or do little things for others. Only with meaningful engagement will our time in this world be worth living.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Do you respect older people?

Do you respect older people? Why? Do you respect older people because of their age? Or for other reasons? If it is because of their age, why so?

Chinese societies are very much into respecting elderly people, with few explanations as to why this should be. I used to wonder why such “wisdom” is passed through generations without being challenged. I have to say that I don’t respect seniors just because of their age. Respect has to be earned.

Just as I don’t disrespect children because of their age, I don’t respect seniors because of their age. Age per se is not a good argument for me. To me, we should respect life, respect people as individuals, having a rightful place on this planet. Seniors don’t get extra respect for the mere reason of being older. There are some young people who put me in awe, and many more who deserve my admiration and respect. And there are a lot of older people whom I don’t respect.
But, of course, there are other qualities that come with age that I appreciate–the ability to withstand adversity, worldly wisdom gained out of a lifetime of experience, and so on. But age is never a good enough argument for me.

As a gero nurse, I advocate for the well-being and health of seniors, not because they are a respectable group because of their advanced age, not because of their growing numbers and looming “grey power.” As a gero nurse, I am cognizant of the right of every member of our society to receive the same respect, irrespective of power, wealth and class. Only when groups live in harmony and recognize each other as having equal rights can we start to build a better world.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Development of people-friendly cities: Observations of a gero nurse

Hong Kong is probably not on the list of the top 10 most habitable cities in the world. Although my view is coloured by having been born and brought up here, my bias is not unfounded when I say that it is a reasonably good city to live in—apart probably from the air, sound and light pollution problems we have. (We can do something about the air pollution, but won’t be able to solve the problem entirely because of all the factory smoke that is blown from across the border.)

There are certain prerequisites required to survive in Hong Kong. One, of course, is having strong nerves to tolerate sharing 1,095 square kilometers (423 square miles) with seven million others. This means that one should have the ability to withstand crowdedness, noise, a very fast pace of life and a sense of urgency in everything we do.

Although a “developed” city, Hong Kong is not as “civilized” as cities in Japan. But civility comes with a price—a very high cost of living—because its habitants are paying a lot for the basic infrastructure. As a developed city, we share many ills and strange phenomena with others. Our city may be advanced, but it is not quite a senior-friendly city. With the present trend toward cool structures and minimalism in design, there are just too many glassy reflective surfaces, mirrors and glistening facades of massive buildings and shopping malls around us.

These are not good for aging eyes when glare becomes a problem. The many mirrors and glass structures are traps for seniors who have less-efficient depth perception to differentiate subtle changes in tone between surfaces; without such perception you cannot know whether it is a passage or a mirrored wall. Marble floors, a symbol of luxury, pave most new and recently renovated shopping malls. Even though designers claim that these floors are non-slippery, try walking on them on a rainy day. They are essentially traps for seniors in a modern city.

I have not yet mentioned the problem of finding your way. These modern, massive structures are not simple. You need to learn the language and have a different set of orientation skills than what you learnt a couple of decades ago. First of all, you need to learn how to perform a methodical 3D scan of a large space—I mean 360 degrees front to back, and from the tall ceiling to the ground you are walking on. Often, the signage is hanging high up in the air. (Try to recall a large airport you have visited).

What is more, special signs and utilities are designed to be artistic and blend into the physical space surrounding us. The philosophy of modern design is to make transition of space inconspicuous, blending man’s architecture with natural scenes. Thus, you will need to learn to decode the signs or symbols, making sure you are heading toward your destination.

And finally, you need the energy and ability to cover that long distance to find the bathroom or information counter. It is not always a breeze getting into a building and quickly identifying how to get where you want to go. It is a whole new language that the older generation needs to embrace and understand.

There is still a long way to go before Hong Kong can become a people-friendly city.

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For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.