Clinical Handbook of Mindfulness (117 page)

428

Trudy A. Goodman and Susan Kaiser Greenland

a painful emotion arises. Using this process, children
act
only after taking a

moment to
reflect
on and viscerally sense their inner and outer experience.

Scram
reminds them to do so with kindness or
metta
.

Scram
is most effectively taught through a combination of verbal and non-

verbal methods; with one’s own mindfulness practice as a fundamental pre-

requisite of this work. How long must one practice mindfulness before being

qualified to teach children? This is the subject of vigorous debate in the field

and there is no definitive answer. We know, however, that in order to
embody

or model
scram
one must viscerally understand how the work is rooted in

mindfulness, and that the intention of mindfulness-oriented work with chil-

dren is education, healing and service. In the drawing of the
InnerKids
tree,

with roots deep in awareness practice, service is represented by the trunk

of the tree, which underlies and quietly supports the work with children

in families, schools and clinical or community settings. For the work to be

authentically transmitted, it must remain connected to its trunk and roots –

connected to the intention of service with deep roots in the practice of

mindfulness.

The Sanskrit root of the word
sati
, mindfulness (in Pali), means “to remem-

ber.” In our work we remind children “remember! – Remember to notice, to

pay attention to what’s happening within you and around you, from moment

to moment to moment.” It’s easy to overlook the first moments of mindful

awareness, which can be so fleeting. By teaching children to remember to

notice, we are helping them value and extend moments of pre-verbal atten-

tion that come naturally, but so often are unnoticed or forgotten.

Remembering
to practice mindfulness over and over again can be as

transformative for the mentor as for the child, by giving, the mentor an

opportunity to viscerally understand the child’s experience and the child

an opportunity to feel deeply seen and understood. This nonconceptual

way of knowing has a profound effect on all those who experience it,

Chapter 22 Mindfulness with Children

429

inherent in which is Mindful the potential to change the way that chil-

dren and mentors relate to their emotions, their relationships, and their

world.

We do not have a magic bullet to alleviate the suffering of children faced

with painful emotional experiences, but we’ve seen even the most basic

mindfulness practice have a remarkable impact on the life of a child. As with

many things, this is best summed up by a child:

I learned one thing about mindfulness. I learned that when you don’t feel so

well, maybe you can breathe, In-then-out, that is what I learned.

InnerKids’ Second Grade Student, Lucy

References

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Guilford Press.

Kabat-Zinn, Jon (2005). Guided Mindfulness Meditation Practice CDS Series 3, in con-

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23

Mindfulness-Based Elder Care:

Communicating Mindfulness

to Frail Elders and Their Caregivers

Lucia Mc Bee

“The most important intervention we can offer is ourselves, who we are

in each moment, being present with the other, feeling our connection,

and verbally and non-verbally conveying this felt sense.”

Introduction

Since its inception in 1979, mindfulness-based stress reduction Mindfulness-

Based Stress Reduction (MBSR) has been introduced into many community

and institutional settings with a variety of populations. There is an under-

stood caveat that the participants are able to understand and follow instruc-

tions, have a good attention span, are able to commit to the experience,

and to participate in some form of exercise. In this chapter, I discuss group

and individual interventions offered to populations who often are not able to

meet the above criteria.

While MBSR has prescribed interventions and tools, the core of these inter-

ventions lies in the skillful application and intentions of the teacher. The

“heart of mindfulness” or the basic elements are not the tools, which could

be described as a finger that points to the moon, not to be confused with

the moon itself. The skill of the teacher arises from a personal practice of

mindfulness that allows resourcefulness and flexibility. With a physically or

cognitively frail population, the key is in the adaptation of the skills and the

teacher’s embodiment of mindfulness.

Since 1995, I have been offering mindfulness-based elder care (MBEC)

groups to frail elders and their caregivers, most frequently in the nurs-

ing home setting. I have made moderate to significant adaptations to the

MBSR model while maintaining the core intention of mindfulness. In MBEC

groups, participants learn the techniques of meditation, gentle yoga, and

mindfulness, and discuss ways to integrate these techniques into their day-

to-day lives. MBEC groups and mindfulness practice foster an awareness

of life, moment by moment, allowing them to face illness, pain, and loss

with increased presence and equanimity. My hope is that readers of this

chapter will be encouraged to conduct their own work with frail elders and

their caregivers, and also consider additional adaptations of mindfulness to

younger populations with significant cognitive and physical disabilities.

431

432

Lucia Mc Bee

Rationale

In 2001, Kinsella and Velkoff reported that the world’s population of people

65 and older was growing by almost 800,000 a month. Lower infant mortal-

ity, increased birth rates and declining death rates lead to estimates that this

trend will continue. In addition, the fastest growing segment of the 65-plus

population belongs to people over 80 years old
(Kinsella & Velkoff
,
2001).

Increasing the quantity of our lives may not increase the quality of our lives.

Elders disproportionately suffer from chronic illness and multiple losses. In

the United States, 80% of the over 65 population is living with at least one

chronic condition and 50% have two (Centers for Disease Control and Pre-

vention,
2003).
Cognitive, as well as physical health can have a profound impact on elders’ quality of life. International studies document that dementia affects 1 in 20 people over the age of 65 and 1 in 5 over the age of 80.

Worldwide, there are an estimated 24 million people with dementia. By 2040

the number will have risen to 81 million
(Hebert et al., 2003).

Pain and stress affect the quality of life of older adults
(Ferrell, 1991;
Landi et al.,
2001).
Frail nursing home residents are even more frequently at risk for pain. In a study of one nursing home, 71% of the residents were found

to experience at least one pain complaint, and 34% reported constant pain

(Ferrell, Ferrell, & Osterweil, 1990).
In a review of studies from 14 nursing homes, residents were found to have prevalence of pain from 27 to 83%

(Fox, Raina & Jadad, 1999).
In addition, the multiple losses of friends, family, home, and health can lead to despair and other emotional problems (Cohen-Mansfield & Marx,
1993;
Parmelee, Katz, & Lawton, 1991).
Recent US statistics have found major depression in 1–5% of community dwelling elders, but

over 13.5% in elders who require home health care and 11.5% in elder hos-

pital patients
(Hybels & Blazer, 2003).

The impact of illness and disability on a nation’s finances, health care

services, and caregiving needs are significant. Some predict that “health

expectancy” will become as important a measure as life expectancy is today

(Kinsella & Velkoff
,
2001).
The growth in the aging population also has implications for both formal and informal caregiving. Research increasingly

demonstrates the impact of caregiving on the caregivers’ emotional and phys-

ical well-being
(Schulz & Martire, 2003).
These populations will need multiple tools and interventions to enjoy the quality as well as the quantity of

their lives.

Theoretical Framework

Interventions that focus on curing are not always realistic or appropriate,

especially for elders. Patients are learning that chronic conditions may not

be cured, but may be managed, and lives lived fully despite ailments. Elders

often have complex, multiple, physical and cognitive disabilities, requiring

a multifaceted approach. Pharmacological treatment alone often does not

resolve pain and distress and may have unwanted side effects. For elders

and their caregivers, mindfulness practices can offer holistic relief from the

multiple losses of aging. Elders and caregivers often feel disempowered by

conventional treatment models. Mindfulness practices provide a model for

Chapter 23 Mindfulness-Based Elder Care

433

inclusion and specific skills to promote increased well-being. Older adults are

constantly reminded of their losses and their disability. In mindfulness prac-

tice, they are reminded of their inner strengths and resources. Daily, elders

and their caregivers face the profound spiritual issues of loss, pain and death.

Mindfulness practices can provide a format for reconnecting with individual

spiritual practices and forming new meaning and understanding. Moreover,

mindfulness practice has a demonstrated acceptability with elders and their

caregivers (McBee, 2008;
McBee, 2003; McBee, Westreich, & Likourezos,

2004;
Smith, 2004, 2006).

Caregiving staff for the frail elderly are often at risk for stress and stress-

related problems. Direct caregiving for the confused and, at times, combative

older adult is among the most physically demanding and emotionally taxing

of jobs. Nursing home residents, whether demented or cognitively intact,

easily discern the physical and emotional state of caregiving staff. Further-

more, stressed out staff tend to be less satisfied with their jobs and to have

secondary health problems
(Pekkarinen, Sinervo, Perala, & Elovainio, 2005;

Zimmerman, Williams, Reed, Boustani, Preisser, Heck et al., 2005).
For professionals who are trained to cure, the chronic illness, pain, and disability

associated with aging may lead to feelings of helplessness and frustration.

Families and other informal, unpaid caregivers also experience stress

related to the caregiving role. They may not feel they have the time or skills to

cope with their own distress
(Schultz and Matire, 2004).
Formal and informal caregivers must face their own feelings about aging, illness and death. The

time-limited groups and skill training offered in mindfulness stress reduction

can provide crucial tools for coping with caregiving stress.

Empirical Evidence

MBSR has been studied in multiple settings and with a variety of populations.

Few studies, however, solely target mindfulness training for adults over age

65, or populations with significant communication, cognitive or physical dis-

abilities. In 1978, Garrison reported that a stress-management training includ-

ing relaxation skills, meditation practice and homework was found helpful in