Welcome to those of you who have come to this blog after reading my comment in the nytimes article “Every Older Patient Has a Story” by Paula Span, 10/16/18.
Feel free to look through the various articles about working with older people in a way that they feel listened to, taken seriously and respected.
I am beginning by including an article that Paula Span has written previously about my work with older adults.
Therapy of a Different Sort
In Wendy Wilson’s living room in Massapequa, on Long Island, on a Saturday morning — five in person, one on speakerphone from Florida — were talking about dependence and independence, big issues for people ages 75 to 88.
“Am I lucky to have these kids who are aware of my frailty?” asked one member with Parkinson’s disease, whose children have begun to fill weekly pillboxes for her and her husband. “Yes. Does that make me dependent? No.” She sees herself as “allowing them to be kind to me, as I am kind to them.”
“Emotional maturity is not being independent,” said one of the younger members, offering an axiom she heard years ago. “It’s being interdependent.”
The group liked this notion; nods and murmurs traveled around the circle. “She’s smart, for a kid,” someone said.
Ms. Wilson, the clinical social worker and psychoanalyst who leads this monthly discussion (she recorded the most recent, with members’ permission, so that I could listen in), has never called it a therapy group. She refers to it as a workshop. Its official title is Vibrant Seniors, though participants have dubbed it “the oldies group.” Those from generations reared in a more reticent pre-Oprah culture can be notoriously wary of anything that sounds like mental health treatment.
But whatever its name, “I’m working as a therapist when I’m running the group,” Ms. Wilson acknowledged. “And the results are those you’d see in psychotherapy. People are talking about topics they otherwise never would have.”
She structures each 90-minute gathering around a questionnaire that explores subjects like longevity, friendship, finances, sexuality (the only subject members have trouble talking about), inheritances, family disputes and wisdom. Holding meetings in her home, serving coffee and danish, helps put people at ease, she thinks.
Initially, she invited people she knew to discuss their aging experiences as a way to help her understand the territory (and gather material for a book), so she expected a shorter-term experiment. “But when I asked if people wanted to continue, they all said yes.” In the group’s four-year history, people have grieved for one member (the only man) who died; another is recovering from a fall in Florida — hence, the speakerphone. But the group has endured.
“I have lots of friends to talk to, but not everyone wants to talk about things like this — accepting help, things starting to change,” explained Felicia Cohn, 74. Within the group, “there’s a kind of freedom, a we’re-all-in-the-same-boat feeling.”
Can this model be replicated in assisted living facilities and senior centers and therapists’ offices? Convinced that she’s onto something, Ms. Wilson will be presenting her experience at a conference of the National Association of Social Workers in Washington in July.
The need seems inarguable. “The stereotypes older adults are facing have harmed their self-esteem, their confidence, their mental health,” said Ms. Wilson, who is 70. Yet if they do seek professional help, older patients may find a shortage of those trained to work with people their age. They also often encounter an eagerness to resort to medication.
The efficacy of Ms. Wilson’s approach can’t be ascertained from one small Long Island group. Questions about payment might also arise; Ms. Wilson has led Vibrant Seniors without charge, but to have Medicare cover such services would require a diagnosis, an acknowledgement of the dread T-word.
But according to the annual evaluations that group members write, “people feel more self-confident,” Ms. Wilson said. “They’re happier. They definitely have more control over their lives. It’s hard to quantify, but that’s what I see.”
As one member told the group on a recent Saturday: “I’m realizing what a good time this is. The general consensus is you’re older and you’re slowing down and you don’t have wonderful things happen in your life anymore. But that’s not the case.”
REDEFINING YOUR LIFE
I plan to talk to you about the responses that I have noted from older adults just like you as to the ways that they see themselves as they age, as they retire, as they redefine their lives.
Following that, I would like to hear from you, the experts, on entering and navigating late age, now living it. What has your experience of growing older been like? Not everyone wants to talk about things starting to change, but this is what Joe, a forthright former school administrator told me following his retirement,
“I feel lost to leave something behind. I don’t know where I am. But I also remember how hard it used to be for me. I had to please my boss and to obey the rules. Now it is a relief that it’s gone. I don’t have so many difficulties any more. My successor can have those problems. I’m no longer equipped to do that job.
Will I ever get clear of it? I don’t know how I ever did that job. At the same time, leaving the job is like a death. A voice says to get moving, but I guess it takes as long as it takes to process it. I’m worn down.
I passed on the baton and did my lap in the pool. Now another person will do it. I will miss getting paid. It gave me an identity. But I don’t need the money. It’s matter of security. I used to need to please people so that they admired me. How can you feel angry at a job you hated and you didn’t want anyone else to do that job.
Loss of his job was a personal setback, a comedown. This is a normal reaction. It expresses his feeling of regret for what had been. Even though his challenging job had problems, it served to identify him. It was a place for him to share his determination, to use his skills in doing good work. It represented an attachment that he had to which he had given many years of loyal devotion. Why wouldn’t he mourn the loss? He knows he won’t retrieve the place it served in his life.
He said, “It’s still in me how it used to be for me, my younger self. Those memories won’t leave me alone. You get scared. You want to still be somebody. I am somebody. I am still alive. My life is not finished. I want to show people what I used to be. What am I now, a ‘has-been’.
I still feel young and active. But I have to think of my limitations. There are bursts of excitement. Then I get scared. All these things I think are just my thoughts. I feel crazy. That’s what keeps me from sleeping at night. It’s very strange. You know that life is moving on. How do you let go of your old self when you don’t know what your new self will be like?”
Joe’s self-perception needed to be reconsidered and replaced if he is to realistically move on. Just because he had given up his former full-time job doesn’t mean that he has lost his capacity for regeneration and development. One of the benefits that age bestows is that we become free to reassess our talents. We can learn to discover and affirm who we are, the wisdom we have to offer, and how to make it effective in the world.
As he examined his feelings about aging, Joe then was able to leave these feelings in the past. He moved on to a volunteer position training childcare workers in a local preschool program. They benefited from his previous work experience with children and involvement in classroom management. He felt valued to be able to contribute to the preschool program and to be around children again.
For Joe, this plan was a simple, manageable and appropriate accommodation to change. He looked at the person he had been in the past and the way he lived life at that time. He measured this with the reality of the changed abilities, needs and expectations he currently has. This aided him in accepting a realistic identity he could feel proud of. It redirected his personal strengths and talents toward goals that fit his age and stage of life.
We see the kind of courage it takes to change, especially in late life. Older adults like him are pioneers. They are owed a debt of appreciation and gratitude for showing us how to transition during aging.
We need to visualize new approaches to understanding and experiencing later life, gateways that emphasize development in the face of aging. The more you tell us about what is important to you, the more we authenticate late age. this will become the pathway to redefining old stereotypes. We need to be able to speak about ourselves in a serious way, to be listened to, understood and taken seriously.
A stigma has been attached to talking about serious subjects with others; friends, family, outsiders and professionals alike. This is an unspoken agreement designating the need to appear in a certain manner. Reviewing one’s life, considering what may lie ahead, bearing the complexities of physical aging, and craving personal attention is sacrificed if we are made to feel we can’t discuss these serious concerns.
If we can’t talk about our thoughts and feelings, we can’t normalize and validate our lives. Talking helps us to know and feel the losses and gains that we experience. We can then adapt and compensate for the losses and be proud of our gains.
Part of aging involves handling issues that we hadn’t anticipated and are not used to having. Life in our 60’s, 70’s and 80’s is new territory. We may need to adapt to life differently as we retire, live away from our children, adjust to changed financial circumstances, or manage our health.
We need to know our own thoughts as to what this new phase of life will mean to us psychologically.
You may ask,“What is there to think about? I’ll take it as it comes along. I know the way I want it to be. I plan to enjoy more time with people I love, have more convenience, travel, enjoy a ball game, learn how to use a computer, visit the gym and explore new hobbies and interests. My friends and I walk in the mall, we read the paper in the library, we watch the kids play soccer in the town league”
We are used to living life determined by the needs of bosses, family, finances, friends. How do we handle this new phase in our lives? Will we feel like we don’t fit in when we change the trappings of our work life, our former parent role, or our finances? We may wake up and see we are no longer in charge of anything but ourselves. Questions come up about adjusting to change.
It can be confusing. We might notice that we are seen and treated differently as we age. One woman told me, “I am 71, am loving the last chapter of a very successful life, and would say I have a great deal of self-confidence. Yet, sometimes it’s as if I have suddenly become invisible — a short gray-haired woman of a certain age. They just pass me by. I’m not noticed. I feel kind of temporary about myself.”
–Do you think your stage of life affects the way people react to you?
— Is your self-image affected by this change?
–Does your energy need to be conserved more as you age?
–Do you feel you have to remain the person who you had been in the face of aging?
Updated Thinking in Regard to Aging:
Not many years ago social stereotyping of seniors created barriers to involvement in life. Ageist labeling of older people as being out of the loop is now being debunked and revised by seniors themselves who are working their way out of the those dark ages. We are no longer bound by former expectations of what we should or should not do at a certain age. Instead of being discredited, we are now getting noticed.
Evidence of increased longevity is substantial. Current social and economic advances have enabled us to set our sights higher, raising the bar to choose extended work, elevated status and heightened visibility.This revision along with health care improvements, increasing mobility, vision, hearing etc is providing expansion of opportunities for older adults.
We are the new breed of vibrant seniors. We can help visualize our own original approaches to understanding and experiencing late life. We can live an open and interesting life. We can create our own blueprint to follow as we age. We will do this by defining ourselves in a new way, different from our parents. This will help us to move things foreword for our children and our grandchildren.
We can do this by talking to each other about how to take advantage of these new and open opportunities, not by reading some description of ourselves concocted by younger people.
We need to upend our thinking about what it means to get older. It’s really not about aging. It’s about living. We need to own our age. We want to be defined by who we are, not how old we are.
This happens by being able to embrace our own aging, feeling good about where we are in life. We face different challenges and have different goals from people in their fifties. We are motivated by different things. We see life through a lens shaped by the ups and downs of life and the wisdom gained from those experiences.
Who better to tell us about the older adult life experience than you, the real experts. The more you tell us, the more we can validate your authentic perceptions of what aging is like. I want to hear what you have to say about your thoughts and ideas in regard to your life now. You are living in unique times. It is especially important to have a men’s point of view in regard to retirement and aging. We may have to deal with weak knees, blurred vision, forgetfulness. We may have to deal with lost or changed ambitions. We may have to accept that certain hopes and dreams of ours won’t be realized. By age 65-70-80, our choices have narrowed in regard to what they had been.
A seventy year old adult talks about a dream that she had.
“I see an image of a big open outdoor train station. I want to go someplace on the train, maybe travel back in my life as I previously saw it. My family when everyone was alive and active and connected with each other—what I was familiar with. That was life to me.
In the dream I am trying to figure out how to get to a new unknown place, looking for a train, a cab, asking people. I can’t get back to my family as I knew it or as it is now or will be.
How did this happen to me, this change? I am sitting shiva over the lost life and family. I start thinking of my grandchildren, how they they be in the future, I think of the chain of life being broken, my parents being gone. I will never be the same again after realizing this.”
In the dream she was looking at a change in perspective that she has about her life. She sees that the present and the future will be a change from the past.
What was the past? What has it become? What does it mean for the future? You may have some of these questions. She might grieve for losing what has been, the image she has of herself. She knows that she will never be the same again after realizing this. It illustrates the uncertain attitude that she has about her past and how to view it when planning the road ahead.
Positive attributes acquired as we Age:
We develop emotional maturity and tools of the spirit that are infinitely more potent than the ravages of time. These enable us to deal with life and to adapt to its challenges. We see life from a larger perspective gained from experience. We readjust our attitudes. We reorient our expectations. Things that we used to think were urgent, we realize that we can now live with. We can let some things go, and we come to realize that there are many responses to situations that we can choose from.
You have chosen to live in an over-55 community. You can profit from watching people older than you navigating their elder years, and you can influence those younger than you by your experience.
One perk of living here is the opportunity to attend these educational and informational programs. By coming here today, it shows that you want to participate in life, to meet other people and think about new ideas. You use your time to attend this talk, and you can use what you hear to then talk these issues over with each other.
Here are questions to consider:
-Do you get the same kind of recognition as you had gotten when you were younger?
-When you stopped working, did you miss the recognition you got from your co-workers, your friends, or being paid a salary?
–What did you do to manage the transition from work to retirement?
–What did you do when you were living your life at a time when you felt you wee in control and satisfied?
Can you draw on strengths and coping skills that you relied on earlier in life? Do you still have some of those goals and relationships?
–Do they help you out now?
–What does it take to adapt to the inevitable changes that aging requires of us?
–Do you think you might develop additional personality qualities to promote health as you age, like endurance, resilience, and courage? How would you go about doing that?
–Would you be able to make trade-offs to meet future goals? (exam. Dietary precautions, planning social activities, adapting to health restrictions, making some money?
–Would you be willing to try something new? Will you be able to stick with a new plan?
The process of thinking about these questions involves looking at ourselves. We have to see what we’ve done, why we did it, and what we learned from it in order to think about what we plan for the next five years.
Perhaps the purpose of late life is to recover from the harried pace of earlier times in order to explore and discover new ways to spend our time.
Our first obligation to ourselves is to manage our health. It is inevitable that we have age related conditions. At seventy, health impairment has already made some mark.We can’t enjoy the later years if we are stressed and sick. We can’t have fun unless we are healthy. This involves recognizing health problems or risks involved in aging and taking them seriously. If we ignore the way we feel, we aren’t as able to do something about it.
Vulnerability comes with aging – talking about it acknowledges the reality – yes, it causes sadness, anger, grief – but the more you feel it and tell someone and they tell you, the more tolerance and compassion you develop for yourself and others.
It isn’t shameful to forget, to need to slow down and rest. It’s our bodies’ way to let us know that we need to be cautious, to ask for help if we need it. The feelings that come along with this transition may lead us to feel regret that we can’t be the person we used to be. We may think less of ourselves. We need to adapt to being who we are now. We may get remarks of impatience from others who are more active. That doesn’t have to stop our independent activity but it may limit what we are able to do.
There may come a time when a change has to be made to accommodate to a health problem, it doesn’t mean that the whole of a person has to be altered. But it can feel that way. Adjustments and adaptations, physical and psychological, may be necessary. We may need help, referrals to good doctors, car rides to medical appts.
Many seniors are influenced by the notion that becoming ill when old indicates irrevocable decline. However, because seniors are living longer, healthier lives, new ideas about expecting inevitable serious illness and downward slide are being reconsidered. The conventional view inextricably linking disease with old age must give way to a newer idea that good health characterizes the lives of large numbers of elderly people.Self-reliance becomes less reliable as we age. Health setbacks increase the need for help. This situation escalates fear and anxiety when any change in health is suspected. We feel they must maintain a facade of independence and are likely to see 0urselves as failures when our independence declines. This may diminish interconnectedness with others, increasing isolation. The cycle of giving and receiving help is necessary.
We need to find, in spite of reduced energy and stamina, a way to contribute. It focuses our goals, increases hope for the future and connects them with life. We need to feel appreciated for what we can Making changes requires letting go a former part of ourselves. If an older adult can surrender to the new reality of aging, the wish to be a replica of a previous self is replaced with an expanded and illuminated perspective of life more in line with current age and ability.
Example: Recognition and Adaptation to Change
The plot of Dustin Hoffman’s movie, “Quartet” begins with the entrance to the home of a well-known former opera singer. She realizes that her voice is not what it had been. An invitation to sing in a gala at the home disturbs her because she has long ago decided to give up singing. She speaks about her loss of youthful idealism and energy, “You don’t understand. I was someone once. I can’t insult the memory of who I was.”
Her friend responds with gift has deserted me.”
Her friend says, “It’s deserted us all. It’s called life. Old age is not for sissies. Just let go. What does it matter now what anyone says or thinks? You might even enjoy it. Take part. If you can’t sing at the gala, do conjuring tricks. The only alternative is to be guest of honor at the crematorium.”
“The soprano says sarcastically, “You’re not telling me to smell the roses?” Her friend responds, “Oh, the roses are long gone, but the chrysanthemums are magnificent!” (The Weinstein Co, 2012).
This vignette illustrates the potential available in late age. The soprano felt her life was over because she couldn’t continue singing in opera as she had. However, with help from other performers in the same situation, she agreed to perform again at a reduced level. She didn’t have a worldwide audience at her feet, but she had the comfort and pleasure that came but she had the comfort and pleasure that came from performing for friends as well as the pleasure of continuing to use her talent, although changed.
“The doorway to this new stage of life is not filing for Social Security but thinking differently and continuing to learn. Adulthood is characterized by the wisdom culled from long lives and rich experience, the most acceptable and positive trait associated with longevity, but combines it with energy and commitment in the context of a new freedom from some kinds of day-to-day responsibility, a freedom that challenges expectations and may even be frightening. Together these produce active wisdom that older adults have to offer”. (Bateson)
This is a talk given to a men’s group living in an “over 55” older adult community.