Twilight strategies; Decisions: Aging couples develop methods for dealing with the inevitable, often painful, changes that come in the latter part of life.

THE BALTIMORE SUN

Cornelious and Alice Pullen, both 70, say they're too busy living to plan for what the future might hold.

Robert and Jean Zoerheide moved to a retirement community long before their children and friends thought they should even be considering such a change.

Santiago and Ida Rain have found themselves in other circumstances. Married 58 years, the couple has been forced to live apart for the past two years -- and likely the rest of their days -- after Ida's failing health made it impossible for her husband to care for her.

Three couples. Three marriages. Three very different decisions about how to face the twilight of their lives together.

Experts say the best way for married couples to face the transitions that come with growing older is to develop a strategy for dealing with potential health problems and other issues while both spouses are still relatively healthy.

But few of us like to think about the bleak realities of aging. So people -- especially senior citizens -- often find themselves reacting to circumstances that alter their lives, rather than seeking to control them beforehand.

"It's human nature not to want to face the end of one's life," says Dr. Samuel C. Durso, medical director of Johns Hopkins geriatrics at the Putty Hill Health Center and an assistant professor at the Johns Hopkins School of Medicine. "And older people perceive these changes as tied to the final stages of one's life."

But according to Durso and others in the geriatric field, not having a strategy for dealing with aging can be even more detrimental. In most cases, aging couples do not make any decisions until one spouse is either incapacitated or dies.

At this crisis point, it's far more difficult to make choices rationally, much less adjust to living with them.

"When you've got each other, you're more likely to be able to make a [new] situation work. As a couple, you get through together. The problems really get more significant when people are alone. You don't have that other person for help, to brainstorm with or even to help out financially," explains Mark Meiners, associate director of the Center on Aging and the geriatric doctorate program at the University of Maryland, College Park.

And while a hefty retirement fund certainly helps, these experts say, it's not as central as some other things. "The most important thing I find are people who have some interested family around, regardless of what kind of means they have. It doesn't always have to be family. It can be friends who have become like family," Durso says.

Cornelious and Alice Pullen say they know they should be looking farther down life's road. Their children have broached the topic. And every once in a while, Alice wonders what they might do if one of them suffered some health calamity.

But after decades of hard work, the Pullens, who live in Arbutus, say it seems silly to weigh down their time together with talk about old age and even death.

The future "is the least thing on my mind," says Cornelious. "It's something I can't help. If I sit down and start planning, then I'll start to worry about it and it'll cross my mind more.

"Now, I just leave it in the hands of the Lord. I'm just living until it's my time to go,"he says with a smile.

Since Cornelious retired in 1992 -- and that was only because his brother became ill and could no longer help run the bus tour company the two men founded -- the Pullens have been savoring retirement.

They like to travel and often get in one of Cornelious' restored classic cars on a whim and drive to visit their daughter in Florida or relatives in North Carolina. Both are active members of New Antioch Baptist Church in Reisterstown, serving in a variety of ministries. And with four children, 13 grandchildren and 10 great-grandchildren -- most of whom live within an hour of their home -- the Pullens have an endless round of family obligations.

Except for flare-ups of a leg injury from a car accident Alice was in 14 years ago, they both remain in basically good health. The couple, who have been married for 51 years, have made their basic final wishes known to their children. They do have an attorney -- though they've yet to write wills.

They also have burial insurance and two plots reserved in the cemetery across the street from their home.

But they can't quite face talking about the years between. The couple expects to stay in their own home "until we can't stay anymore and then we'll make other plans," Alice says.

Facing a move together

Durso say married couples like the Zoerheides are something of an anomaly in retirement communities.

"It's very rare, in my experience, to see a couple [living] together in an assisted living facility or in a nursing home," he says. "It happens, but it's not common."

Robert Zoerheide knew that just by glancing around the dining room at Roland Park Place well before he and his wife, Jean, decided to move there. It was, and remains, overwhelmingly dominated by women.

Robert was pastor of First Unitarian Church on Charles and Franklin streets from 1978 until his retirement in 1985. The Zoerheides, who have been married 62 years, remained on their own in their townhouse in Roland Springs.

Their children, friends and fellow church members were surprised when the Zoerheides told them of their plan to move to Roland Park Place in 1996.

They were in good health and had an active social life. But "we began to realize with age, it was going to be more difficult to keep up our home," Robert explains. "We decided that we wanted to choose where we wanted to live and not move there because it was forced on us by old age."

The Zoerheides -- who have three living children and four grandchildren -- decided their new home must be close to their church as well as Baltimore's cultural life like the symphony, the opera and the theater. The couple visited other church members who had settled at Roland Park Place and liked the setting.

Yet the move itself still proved difficult. Reducing their belongings from a three-story townhouse to a two-bedroom apartment was wrenching.

Geriatric experts say having a strategy for dealing with the later years in life does not always mean those years will be easier.

"Things change -- sometimes suddenly -- in ways that we can never predict," Durso notes. Unexpected health problems, family issues and even a rough adjustment to a new environment can be a big and unwelcome surprise. But for many people, Dr. Durso explains, having made decisions about what these years ideally should be like can make all the difference when it comes to coping with unplanned circumstances.

At 85, Robert suffered his first health setback earlier this year, when he had heart surgery. Jean, 80, remains in good health.

The Zoerheides know their decision is not for everyone. But they highly recommend having some kind of plan in place.

Coping with illness

Santiago Rain, 81, was forced to make a plan when his wife's Alzheimer's disease advanced. Ida, 77, was moved to Levindale Hebrew Geriatric Center and Hospital in March 1997. Shortly after, Santiago moved from the couple's Owings Mills home to an apartment building just a block away so that he and Ida could still spend every day together.

"She is number one," Santiago says, as his wife of 58 years rests her head on his shoulder.

The couple met in their native Argentina and moved with their three children to Baltimore in 1965. Santiago worked as a cabinet maker. Ida, an accomplished seamstress who was fluent in four languages, held a variety of jobs until Santiago talked her into retiring in 1972.

In 1991, they celebrated their 50th wedding anniversary by taking a three-week cross-country driving trip they planned themselves. "We drove 15,000 miles and visited 16 cities," Santiago says, smiling wistfully at the memory.

Ida had her first stroke in 1994. It was sudden and left her partially blind, but Santiago was still able to care for her. In February 1995, Ida suffered another stroke and lost her sight completely. She was later diagnosed with Alzheimer's.

Having Ida attend an adult daycare facility helped for a short while. But the nights at home scared Santiago. He worried endlessly that Ida would somehow hurt herself or leave their house while he was asleep.

Still, Santiago says, it was heart-rending to move his wife to Levindale. The change was the right thing to do -- for both of them, he says. But to this day Santiago has not admitted to Ida that she's in a nursing care facility. Instead -- during her brief moments of clarity -- he tells her she's in a hospital.

Last year, Santiago made pre-funeral arrangements for his wife. It was a difficult step, he says, but he did not want to be caught off guard as he was with the other decisions he faced. Santiago has yet to make similar arrangements for himself, though he plans to donate his body to a local medical school for study.

His sight is failing now -- he can no longer read or write easily. But Santiago continues to put his wife's needs first. He spends his days overseeing her care, making sure she takes her medicine, sitting with her while she eats her meals. Every week he pays to have her nails done. She always has her hands immaculately manicured, he confides.

"This is my life," Santiago says, gently stroking his wife's hand as she dozes on his chest. "The rest of my life is her."

Issues to consider

Dr. Samuel C. Durso, medical director of Johns Hopkins Geriatrics at Putty Hill, and Mark Meiners, associate director of the Center on Aging and the geriatric doctorate program at the University of Maryland, College Park, offer these suggestions for aging couples contemplating a lifestyle change:

* Take stock of your current situation as far as housing, financial needs, health issues and family concerns. Bring family members, friends and professionals like your doctor, accountant and attorney into the discussion and listen to what each one has to say.

* Anticipate increased needs and dependence on others, and make decisions for each stage of the aging process. Analyze all factors. Make plans for all contingencies -- even the ones that don't seem likely.

* Develop a support network of family, friends and others to help care for you. And don't be afraid to ask them for help, Durso says. Meiners points out there are services available for hire to handle transportation, housework, health care and other needs. Have a trusted adviser help if you are afraid of handling the hiring yourself.

* Make the right decision for your individual situation. A retirement community or nursing care facility may not be the right answer for you. Or it may be. But each case is best based on each individual's specific needs, Durso says.

* Do all of these things while you and your spouse are still healthy and able to get around. If you decide to move or alter your lifestyle radically, it's much easier to make new friends and get acclimated while you're still healthy, Meiners says.

-- Joanne Morvay

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