Category Archives: wellness

Hard to Start That Conversation? Try Playing a Game of 32 Questions

You may be asking yourself, “Well, National Healthcare Decisions Day is coming up April 16, so what should I do to celebrate it?”

Okay, maybe you’re not asking yourself that question. Then again, maybe you don’t have to wait another couple of weeks to start having conversations with those closest to you about some serious subjects. Subjects like, what kind of care would be best for me if Ihad a serious illness? How do I feel about treatments and interventions like mechanical ventilation, feeding tubes and CPR?

It’s tough to start these conversations, of course, which is one reason why the majority of adults don’t do it. Or prepare advance care directives. But a Philadelphia-based company called Common Practice has come up with a way to help you with this, that’s clever, effective and fun. It’s a game you can play with two to five  players, called “Hello,” and it’s available on the company’s website for $24.95. And, no, I don’t have any connection or interest in this company.

I  had a chance to speak with Nick Jehlen, a founding partner of the company and lead designer of the game. What piqued my interest was this: underpinning what could be seen on first blush as a lighthearted approach to a weighty subject was in fact the result of a thoughtful and deliberative process of research, design and feedback.

Here’s how the game works. Each player gets a question booklet  with 32 questions (which you keep after you finish playing), and a number of “thank you” chips to give to other players if they say something you find particularly touching, helpful or insightful. You decide how to play: whether to limit the number of questions, or put a time limit on play. There are no wrong answers and really, no winners or losers. As the game designers point out, the most important rule is to listen.

Some sample questions:

In order to provide you with the best care possible, what three nonmedical facts should your doctor know about you?

Who haven’t you talked to in more than six months that you would want to before you died?

            If you needed help going to the bathroom today, who is the first person you’d ask to help you? Who would you never be able to ask?

            What music do you want to be listening to on your last day alive?

            What activities make you lose track of time?

            Write your own epitaph in five words or less.

One of the keys to the game’s effectiveness is that everyone has to answer the questions, so there’s a sense of sharing and no one (such as a person confronting a serious and/or life-limiting illness) is being “singled out” in the conversation.

“We wanted to create a sense of safety,” Jehlen said, noting that he has played the game “hundreds of times and my answers change. [The game] doesn’t force you into a corner. You can play it every year and see how you evolve.” He’s played it with his own parents, too, and said that they found it to be maybe a bit strange at first, but challenging and fun.

How the Game Evolved

Prior to developing the game, Common Practice’s business had revolved around designing tools to help people to communicate better in order to achieve greater workplace productivity and purpose.  When the founders started thinking about what ultimately became “Hello,” they spoke at length with hospice nurses, to learn more about what helps people to be resilient. One insight: families who had actually talked about death and dying were able to care for loved ones better than those who hadn’t.

They entered their game, then known as “My Gift of Grace,” in a design challenge run by the California Healthcare Coalition and were one of the winners. When they realized what an important project it was, and that it was the most meaningful work they had done, they decided to make it the focus of their business, Jehlen told me.

They did a Kickstarter campaign to raise money, and 440 people contributed. In devising the questions that would be part of the game, they queried their contributors for suggestions and reactions to sample questions. They were most interested in questions that generated more than a paragraph to answer. In the end, half of the questions in the game were devised by Common Practice; the other half came from backers.

About a year ago, they changed the name to “Hello,” because some of the feedback was that the name had religious overtones which made some feel left out.

Common Practice also makes “event kits” of the game available to groups of 25 to 50 people in health care settings, including hospitals and hospice agencies. It runs training and workshops for health care staff, aiming to encourage participants to feel more comfortable asking questions of their patients that are more, well, patient-centered.

How effective is this game? One measure: Research conducted at Penn State’s College of Medicine has shown that roughly three-quarters of the number of people who play the game subsequently go on to take some kind of advance care planning action, including creating an advance care directive.

Or, consider the response by health care professionals. After Nick Jehlen made a presentation about the game at the Mayo Clinic’s Transform conference in 2015, he invited attendees to play the game later on that afternoon. 150 people took him up on that offer.

 

 

Telling the Story of Your Life

I recently sat in on a terrific session at the 2016 Hospice Team Conference in NJ. about the importance of narrative in hospice care, presented by Jeremy Lees, LSW , chaplain and bereavement counselor at Holy Name Medical Center’s hospice, where I am a volunteer.

It started me thinking about how important it is that we write or record the story of our life — not only for our loved ones, but also for ourselves. To make sense of the arc of our life, our place in the world, our sense of purpose. And the best time to do this is when we’re healthy and vital!

Here’s my latest blog post from SixtyandMe, with some tips about how to get started.

 

Keep It Moving: A Key to Well-Being

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You know the old cliché: Age is only a number. Well now there’s a study that suggests that it’s true; and that age alone isn’t the best predictor of health. I wanted to share some of the study’s findings because, at a time when we are assaulted daily with horrendous and dispiriting news on all fronts, this should give many of us a reason to smile.

Here’s what a large-scale study by a multi-disciplinary team of researchers at the University of Chicago found: psychological well-being, sensory function, mobility and health behaviors are essential parts of an overall health profile that predicts mortality better than age alone. (Italics mine.)

Rather than focus on medical issues, such as heart disease, cancer, diabetes, high blood pressure and cholesterol levels, these researchers came up with a different model of health that considers psychological, social and physical factors, such as mobility. It paints a different picture of how vulnerable – or not — we might actually be.

Demographer and study co-author Prof. Linda Waite said that “some people with chronic disease are revealed as having many strengths that lead to their reclassification as quite healthy, with low risks of death and incapacity.” On the other hand, though, some people considered healthy might have significant vulnerabilities that could affect their mortality or incapacity within five years.

What contributes to those vulnerabilities? Social isolation, as if we hadn’t guessed this before, undermines people’s health. So does poor mental health, like the depression that can accompany social isolation. Poor mental health is said to affect one in eight older adults. Poor sleep patterns, heavy drinking, having a poor sense of smell and walking slowly also undermine health. By contrast, being socially engaged helps keep us healthy, as does staying physically active. Mobility, in fact, is one of the “best markers of well-being,” according to the study.

And here is a not-so-fun fact: Breaking a bone after age 45 is a “major marker for future health issues,” the study concluded.

Among the more interesting – and counterintuitive – findings:
• Cancer itself is not related to other conditions that undermine health.
• Obesity seems to pose little risk to older adults with excellent physical and mental health.  
• Older men and women have different patterns of health and well-being during aging (and yes, women tend to live longer).

The study, part of the National Social Life, Health, and Aging Project, supported by the National Institute on Aging of the National Institutes of Health, surveys a representative sample of 3,000 people aged 57 to 85, done by the independent research organization NORC at the University of Chicago. You can read “An Empirical Redefinition of Comprehensive Health and Well-being in the Older Adults of the U.S.,” in the Proceedings of the National Academy of Sciences here.

So let’s get together with our friends and family, take a walk (being careful not to trip and break a bone) and raise a toast (though not too many) to our health. Let’s make sure we can smell the roses. Literally. And on a more serious note, let’s pay attention to what our communities are doing to help ease elders’ loneliness and isolation.