Managing Sibling Relationships In Adult Life

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Managing Sibling Relationships In Adult Life

After our previous main feature on estrangement, a subscriber wrote to say:

❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞

And, this is indeed critical for many of us, if we have siblings!

Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.

Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.

A foundation of support

Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.

This is for reasons of mutual support, and an “always there” social presence.

Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.

Growing warmer or colder

Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.

Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.

However, two things can throw a wrench into the works:

  1. Long-term rivalries or jealousies (e.g., “who has done better in life”)
  2. Perceptions of unequal contribution to the family

These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:

  • Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
  • Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”

It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).

It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.

And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.

So, all that seems quite bleak, but it doesn’t have to be like that.

Practical advice

As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.

Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.

So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.

Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:

  • Make sure outright needs are met first
  • Try to address wants next, where possible

Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:

“In order to be able to do that, I would need… [description of support]; can you help with that?”

(it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)

Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.

The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:

Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:

❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞

Our previous main feature about good communication can help a lot:

Save Time With Better Communication

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  • Beet “Kvass” With Ginger

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    Kvass is a popular drink throughout Eastern Europe, with several countries claiming it, but the truth is, kvass is older than nations (as in: nations, in general, any of them; nation states are a newer concept than is often realized), and its first recorded appearance was in the city state of Kyiv.

    This one is definitely not a traditional recipe, as kvass is usually made from rye, but keeping true to its Eastern European roots with (regionally popular) beetroot, it’s nevertheless a great fermented drink, full of probiotic benefits, and this time, with antioxidants too.

    It’s a little saltier than most things we give recipes for here, so enjoy it on hot sunny days as a great way to replenish electrolytes!

    You will need (for 1 quart / 1 liter)

    • 2¾ cups filtered or spring water
    • 2 beets, roughly chopped
    • 1 tbsp chopped fresh ginger
    • 2 tsp salt (do not omit or substitute)

    Method

    (we suggest you read everything at least once before doing anything)

    1) Sterilize a 1-quart jar with boiling water (carefully please)

    2) Put all the ingredients in the jar and stir until the salt dissolves

    3) Close the lid tightly and store in a cool dark place to ferment for 2 weeks

    4) Strain the beets and ginger (they are now pickled and can be enjoyed in a salad or as a kimchi-like snack), pouring the liquid into a clean jar/bottle. This can be kept in the fridge for up to a month. Next time you make it, if you use ¼ cup of this as a “starter” to replace an equal volume of water in the original recipe, the fermentation will take days instead of weeks.

    5) Serve! Best served chilled, but without ice, on a hot sunny day.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • He Thinks His Wife Died in an Understaffed Hospital. Now He’s Trying to Change the Industry.

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    For the past year, police Detective Tim Lillard has spent most of his waking hours unofficially investigating his wife’s death.

    The question has never been exactly how Ann Picha-Lillard died on Nov. 19, 2022: She succumbed to respiratory failure after an infection put too much strain on her weakened lungs. She was 65.

    For Tim Lillard, the question has been why.

    Lillard had been in the hospital with his wife every day for a month. Nurses in the intensive care unit had told him they were short-staffed, and were constantly rushing from one patient to the next.

    Lillard tried to pitch in where he could: brushing Ann’s shoulder-length blonde hair or flagging down help when her tracheostomy tube gurgled — a sign of possible respiratory distress.

    So the day he walked into the ICU and saw staff members huddled in Ann’s room, he knew it was serious. He called the couple’s adult children: “It’s Mom,” he told them. “Come now.”

    All he could do then was sit on Ann’s bed and hold her hand, watching as staff members performed chest compressions, desperately trying to save her life.

    A minute ticked by. Then another. Lillard’s not sure how long the CPR continued — long enough for the couple’s son to arrive and take a seat on the other side of Ann’s bed, holding her other hand.

    Finally, the intensive care doctor called it and the team stopped CPR. Time of death: 12:37 p.m.

    Lillard didn’t know what to do in a world without Ann. They had been married almost 25 years. “We were best friends,” he said.

    Just days before her death, nurses had told Lillard that Ann could be discharged to a rehabilitation center as soon as the end of the week. Then, suddenly, she was gone. Lillard didn’t understand what had happened.

    Lillard said he now believes that overwhelmed, understaffed nurses hadn’t been able to respond in time as Ann’s condition deteriorated. And he has made it his mission to fight for change, joining some nursing unions in a push for mandatory ratios that would limit the number of patients in a nurse’s care. “I without a doubt believe 100% Ann would still be here today if they had staffing levels, mandatory staffing levels, especially in ICU,” Lillard said.

    Last year, Oregon became the second state after California to pass hospital-wide nurse ratios that limit the number of patients in a nurse’s care. Michigan, Maine, and Pennsylvania are now weighing similar legislation.

    But supporters of mandatory ratios are going up against a powerful hospital industry spending millions of dollars to kill those efforts. And hospitals and health systems say any staffing ratio regulations, however well-intentioned, would only put patients in greater danger.

    Putting Patients at Risk

    By next year, the United States could have as many as 450,000 fewer nurses than it needs, according to one estimate. The hospital industry blames covid-19 burnout, an aging workforce, a large patient population, and an insufficient pipeline of new nurses entering the field.

    But nursing unions say that’s not the full story. There are now 4.7 million registered nurses in the country, more than ever before.

    The problem, the unions say, is a hospital industry that’s been intentionally understaffing their units for years in order to cut costs and bolster profits. The unions say there isn’t a shortage of nurses but a shortage of nurses willing to work in those conditions.

    The nurse staffing crisis is now affecting patient care. The number of Michigan nurses who say they know of a patient who has died because of understaffing has nearly doubled in recent years, according to a Michigan Nurses Association survey last year.

    Just months before Ann Picha-Lillard’s death, nurses and doctors at the health system where she died had asked the Michigan attorney general to investigate staffing cuts they believed were leading to dangerous conditions, including patient deaths, according to The Detroit News.

    But Lillard didn’t know any of that when he drove his wife to the hospital in October 2022. She had been feeling short of breath for a few weeks after she and Lillard had mild covid infections. They were both vaccinated, but Ann was immunocompromised. She suffered from rheumatoid arthritis, a condition that had also caused scarring in her lungs.

    To be safe, doctors at DMC Huron Valley-Sinai Hospital wanted to keep Ann for observation. After a few days in the facility, she developed pneumonia. Doctors told the couple that Ann needed to be intubated. Ann was terrified but Lillard begged her to listen to the doctors. Tearfully, she agreed.

    With Ann on a ventilator in the ICU, it seemed clear to Lillard that nurses were understaffed and overwhelmed. One nurse told him they had been especially short-staffed lately, Lillard said.

    “The alarms would go off for the medications, they’d come into the room, shut off the alarm when they get low, run to the medication room, come back, set them down, go to the next room, shut off alarms,” Lillard recalled. “And that was going on all the time.”

    Lillard felt bad for the nurses, he said. “But obviously, also for my wife. That’s why I tried doing as much as I could when I was there. I would comb her hair, clean her, just keep an eye on things. But I had no idea what was really going on.”

    Finally, Ann’s health seemed to be stabilizing. A nurse told Lillard they’d be able to discharge Ann, possibly by the end of that week.

    By Nov. 17, Ann was no longer sedated and she cried when she saw Lillard and her daughter. Still unable to speak, she tried to mouth words to her husband “but we couldn’t understand what she was saying,” Lillard said.

    The next day, Lillard went home feeling hopeful, counting down the days until Ann could leave the hospital.

    Less than 24 hours later, Ann died.

    Lillard couldn’t wrap his head around how things went downhill so fast. Ann’s underlying lung condition, the infection, and her weakened state could have proved fatal in the best of circumstances. But Lillard wanted to understand how Ann had gone from nearly discharged to dying, seemingly overnight.

    He turned his dining room table into a makeshift office and started with what he knew. The day Ann died, he remembered her medical team telling him that her heart rate had spiked and she had developed another infection the night before. Lillard said he interviewed two DMC Huron Valley-Sinai nurse administrators, and had his own doctor look through Ann’s charts and test results from the hospital. “Everybody kept telling me: sepsis, sepsis, sepsis,” he said.

    Sepsis is when an infection triggers an extreme reaction in the body that can cause rapid organ failure. It’s one of the leading causes of death in U.S. hospitals. Some experts say up to 80% of sepsis deaths are preventable, while others say the percentage is far lower.

    Lives can be saved when sepsis is caught and treated fast, which requires careful attention to small changes in vital signs. One study found that for every additional patient a nurse had to care for, the mortality rate from sepsis increased by 12%.

    Lillard became convinced that had there been more nurses working in the ICU, someone could have caught what was happening to Ann.

    “They just didn’t have the time,” he said.

    DMC Huron Valley-Sinai’s director of communications and media relations, Brian Taylor, declined a request for comment about the 2022 staffing complaint to the Michigan attorney general.

    Following the Money

    When Lillard asked the hospital for copies of Ann’s medical records, DMC Huron Valley-Sinai told him he’d have to request them from its parent company in Texas.

    Like so many hospitals in recent years, the Lillards’ local health system had been absorbed by a series of other corporations. In 2011, the Detroit Medical Center health system was bought for $1.5 billion by Vanguard Health Systems, which was backed by the private equity company Blackstone Group.

    Two years after that, in 2013, Vanguard itself was acquired by Tenet Healthcare, a for-profit company based in Dallas that, according to its website, operates 480 ambulatory surgery centers and surgical hospitals, 52 hospitals, and approximately 160 additional outpatient centers.

    As health care executives face increasing pressure from investors, nursing unions say hospitals have been intentionally understaffing nurses to reduce labor costs and increase revenue. Also, insurance reimbursements incentivize keeping nurse staffing levels low. “Hospitals are not directly reimbursed for nursing services in the same way that a physician bills for their services,” said Karen Lasater, an associate professor of nursing in the Center for Health Outcomes and Policy Research at the University of Pennsylvania. “And because hospitals don’t perceive nursing as a service line, but rather a cost center, they think about nursing as: How can we reduce this to the lowest denominator possible?” she said.

    Lasater is a proponent of mandatory nurse ratios. “The nursing shortage is not a pipeline problem, but a leaky bucket problem,” she said. “And the solutions to this crisis need to address the root cause of the issue, which is why nurses are saying they’re leaving employment. And it’s rooted in unsafe staffing. It’s not safe for the patients, but it’s also not safe for nurses.”

    A Battle Between Hospitals and Unions

    In November, almost one year after Ann’s death, Lillard told a room of lawmakers at the Michigan State Capitol that he believes the Safe Patient Care Act could save lives. The health policy committee in the Michigan House was holding a hearing on the proposed act, which would limit the amount of mandatory overtime a nurse can be forced to work, and require hospitals to make their staffing levels available to the public.

    Most significantly, the bills would require hospitals to have mandatory, minimum nurse-to-patient ratios. For example: one nurse for every patient in the ICU; one for every three patients in the emergency room; a nurse for triage; and one nurse for every four postpartum birthing patients and well-baby care.

    Efforts to pass mandatory ratio laws failed in Washington and Minnesota last year after facing opposition from the hospital industry. In Minnesota, the Minnesota Nurses Association accused the Mayo Clinic of using “blackmail tactics”: Mayo had told lawmakers it would pull billions of dollars in investment from the state if mandatory ratio legislation passed. Soon afterward, lawmakers removed nurse ratios from the legislation.

    While Lillard waited for his turn to speak to Michigan lawmakers about the Safe Patient Care Act in November, members of the Michigan Nurses Association, which says it represents some 13,000 nurses, told lawmakers that its units were dangerously understaffed. They said critical care nurses were sometimes caring for up to 11 patients at a time.

    “Last year I coded someone in an ICU for 10 minutes, all alone, because there was no one to help me,” said the nurses association president and registered nurse Jamie Brown, reading from another nurse’s letter.

    “I have been left as the only specially trained nurse to take care of eight babies on the unit: eight fragile newborns,” said Carolyn Clemens, a registered nurse from the Grand Blanc area of Michigan.

    Nikia Parker said she has left full-time emergency room nursing, a job she believes is her calling. After her friend died in the hospital where she worked, she was left wondering whether understaffing may have contributed to his death.

    “If the Safe Patient Care Act passed, and we have ratios, I’m one of those nurses who would return to the bedside full time,” Parker told lawmakers. “And so many of my co-workers who have left would join me.”

    But not all nurses agree that mandatory ratios are a good idea. 

    While the American Nurses Association supports enforceable ratios as an “essential approach,” that organization’s Michigan chapter does not, saying there may not be enough nurses in the state to satisfy the requirements of the Safe Patient Care Act.

    For some lawmakers, the risk of collateral damage seems too high. State Rep. Graham Filler said he worries that mandating ratios could backfire.

    “We’re going to severely hamper health care in the state of Michigan. I’m talking closed wards because you can’t meet the ratio in a bill. The inability for a hospital to treat an emergent patient. So it feels kind of to me like a gamble we’re taking,” said Filler, a Republican.

    Michigan hospitals are already struggling to fill some 8,400 open positions, according to the Michigan Health & Hospital Association. That association says that complying with the Safe Patient Care Act would require hiring 13,000 nurses.

    Every major health system in the state signed a letter opposing mandatory ratios, saying it would force them to close as many as 5,100 beds.

    Lillard watched the debate play out in the hearing. “That’s a scare tactic, in my opinion, where the hospitals say we’re going to have to start closing stuff down,” he said.

    He doesn’t think legislation on mandatory ratios — which are still awaiting a vote in the Michigan House’s health policy committee — are a “magic bullet” for such a complex, national problem. But he believes they could help.

    “The only way these hospitals and the administrations are gonna make any changes, and even start moving towards making it better, is if they’re forced to,” Lillard said.

    Seated in the center of the hearing room in Lansing, next to a framed photo of Ann, Lillard’s hands shook as he recounted those final minutes in the ICU.

    “Please take action so that no other person or other family endures this loss,” he said. “You can make a difference in saving lives.”

    Grief is one thing, Lillard said, but it’s another thing to be haunted by doubts, to worry that your loved one’s care was compromised before they ever walked through the hospital doors. What he wants most, he said, is to prevent any other family from having to wonder, “What if?”

    This article is from a partnership that includes Michigan Public, NPR, and KFF Health News.

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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    Subscribe to KFF Health News’ free Morning Briefing.

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  • Swordfish vs Tuna – Which is Healthier?

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    Our Verdict

    When comparing swordfish to tuna, we picked the tuna.

    Why?

    Today in “that which is more expensive is not necessarily the healthier”…

    Considering the macros first, swordfish has more than 8x more total fat, about 9x more saturated fat, and yes, more cholesterol. On the other hand, tuna has more protein. An easy win for tuna.

    In terms of vitamins, swordfish has more of vitamins A, B5, D, and E, while tuna has more of vitamins B1, B2, B3, B6, and B12. A marginal win for tuna, unless you want to weight the other vitamins more heavily, in which case, more likely a tie, or maybe even an argument for swordfish if you have a particular vitamin deficiency on that side.

    When it comes to minerals, swordfish has more calcium and zinc, while tuna has more iron, magnesium, manganese, phosphorus, potassium, and selenium. A clear win for tuna.

    One other thing: they’re both very rich in mercury, and while tuna is bad for that, swordfish has nearly 3x as much.

    In short, both have a good spread of vitamins and minerals, and both are quite tainted with mercury, but in relative terms, there’s a clear winner even before considering the very different macros, and the winner is tuna.

    Want to learn more?

    You might like to read:

    Farmed Fish vs Wild Caught: Important Differences

    Take care!

    Share This Post

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  • One More Resource Against Osteoporosis!

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Your Bones Were Made For Moving Too!

    We know that to look after bone health, resistance training is generally what’s indicated. Indeed, we mentioned it yesterday, and we’ve talked about it before:

    Resistance Is Useful! (Especially As We Get Older)

    We also know that if you have osteoporosis already, some exercises are a better or worse idea than others:

    Osteoporosis & Exercises: Which To Do (And Which To Avoid)

    However! New research suggests that also getting in your recommended 150 minutes per week of moderate exercise slows bone density loss.

    The study by Dr. Tiina Savikangas et al. looked at 299 people in their 70s (just over half being women) and found that, over the course of a year, bone mineral density loss was inversely correlated with moderate exercise as recorded by an accelerometer (as found in most fitness-tracking wearables and smartphones).

    In other words: those who got more minutes of exercise, kept more bone mineral density.

    As well as monitoring bone mineral density, the study also looked at cross-sectional area, but that remained stable throughout.

    As for how much is needed:

    ❝Even short bursts of activity can be significant for the skeleton, so we also looked at movement in terms of the number and intensity of individual impacts. For example, walking and running cause impacts of different intensities.

    We found that impacts that were comparable to at least brisk walking were associated with better preservation of bone mineral density.❞

    ~ Dr. Tiina Savikangas

    Read more: Impacts during everyday physical activity can slow bone loss ← pop-science source, interviewing the lead researcher

    On which note, we’ve a small bone to pick…

    As a small correction, the pop-science source says that the subjects’ ages ranged from 70 to 85 years; the paper, meanwhile, clearly shows that the age-range was 74.4±3.9 years (shown in the “Results” table), rounded to 74.4 ± 4 years, in the abstract. So, certainly no participant was older than 78 years and four months.

    Why this matters: the age range itself may be critical or it might not, but what is important is that this highlights how we shouldn’t just believe figures cited in pop-science articles, and it’s always good to click through to the source!

    Read the study: Changes in femoral neck bone mineral density and structural strength during a 12-month multicomponent exercise intervention among older adults – Does accelerometer-measured physical activity matter?

    This paper is a particularly fascinating read if you have time, because—unlike a lot of studies—they really took great care to note what exactly can and cannot be inferred from the data, and how and why.

    Especially noteworthy was the diligence with which they either controlled for, or recognized that they could not control for, far more variables than most studies even bother to mention.

    This kind of transparency is critical for good science, and we’d love to see more of it!

    Want to apply this to your life?

    Tracking minutes-of-movement is one of the things that fitness trackers are best at, so connect your favourite app (one of these days we’ll do a fitness tracker comparison article) and get moving!

    And as for the other things that fitness trackers do? As it turns out, they do have their strengths and weaknesses, which are good to bear in mind:

    Thinking of using an activity tracker to achieve your exercise goals? Here’s where it can help—and where it probably won’t

    Take care!

    Don’t Forget…

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    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Healthy Kids, Happy Kids – by Dr. Elisa Song

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    If you have young children or perhaps grandchildren, you probably care deeply about those children and their wellbeing, but there can often be a lot more guesswork than would be ideal, when it comes to ensuring they be and remain healthy.

    Nevertheless, a lot of common treatments for children are based (whether parents know it or not—and often they dont) on what is most convenient for the parent, not necessarily what is best for the child. Dr. Song looks to correct that.

    Rather than dosing kids with acetaminophen or even antibiotics, assuming eczema can be best fixed with a topical cream (treating the symptom rather than the cause, much?), and that some things like asthma “just are”, and “that’s unfortunate”, Dr. Song takes us on a tour of pediatric health, centered around the gut.

    Why the gut? Well, it’s pretty central to us as adults, and it’s the same for kids, except one difference: their gut microbiome is changing even more quickly than ours (along with the rest of their body), and as such, is even more susceptible to little nudges for better or for worse, having a big impact in either direction. So, might as well make it a good one!

    After an explanatory overview, most of the book is given over to recognizing and correcting what things can go wrong, including the top 25 acute childhood conditions, and the most critical chronic ones, and how to keep things on-track as a team (the child is part of the team! An important part!).

    The style of the book is very direct and instructional; easy to understand throughout. It’s a lot like being in a room with a very competent pediatrician who knows her stuff and explains it well, thus neither patronizing nor mystifying.

    Bottom line: if there are kids in your life, be they yours or your grandkids or someone else, this is a fine book for giving them the best foundational health.

    Click here to check out Healthy Kids, Happy Kids, and take care of yours!

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  • Food for Thought – by Lorraine Perretta

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    What are “brain foods”? If you think for a moment, you can probably list a few. What this book does is better.

    As well as providing the promised 50 recipes (which themselves are varied, good, and easy), Perretta explains the science of very many brain-healthy ingredients. Not just that, but also the science of a lot of brain-unhealthy ingredients. In the latter case, probably things you already knew to stay away from, but still, it’s a good reminder of one more reason why.

    Nor does she merely sort things into brain-healthy (or brain-unhealthy, or brain-neutral), but rather she gives lists of “this for memory” and “this against depression” and “this for cognition” and “this against stress” and so forth.

    Perhaps the greatest value of this book is in that; her clear explanations with science that’s simplified but not dumbed down. The recipes are definitely great too, though!

    Bottom line: if you’d like to eat more for brain health, this book will give you many ways of doing so

    Click here to check out Food for Thought, and upgrade your recipes!

    Don’t Forget…

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    Learn to Age Gracefully

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