Most of us who do not contract dementia will still experience growing old. This presents its own set of issues. I wrote this article several years ago for a group of seniors that met regularly.
Understanding old age is one thing; accepting old age so that we can adapt and cope well is quite another.
When we were younger, we challenged the future with optimism. We believed that it was not enough to just be. We wanted to be happy, fulfilled, and successful. That meant having expectations, setting goals, taking the initiative, competing, and making things happen. These were driving forces throughout our parenting and career years. We were positive, assertive, and confident.
We never really thought about old age. Old age is what happened to other people. We had empathy for and respected elders, but aging wasn’t something we prepared for. Then, after a lifetime of challenges, we started to realize that things that had always been easy to do were more difficult. Our sense of urgency declined. There were times when we tired faster than before, our minds wandered, we had to search for words, memories eluded us, or we experienced moments of confusion. Ready or not, old age had arrived.
After living many years, we seniors have gathered a wealth of experience that has altered our mindsets. In his research on Gerotranscendence, social scientist Lars Thornstam found that a large percentage of elders are less socially oriented and more grounded than they were years earlier. They take themselves less seriously, are less concerned about material things, are more selective in their choice of company, are less interested in superficial social contacts, and find more satisfaction in their inner worlds. This change in perspective is the result of a natural maturing process, and it produces increased feelings of contentment.
The outlook for the elderly, however, puts this contentment at risk. We need only to look at the lives of the very old to get a glimpse of life with few positives, as recorded in my discussion a few years ago with Anne Ophelia Dowden, then ninety-five:
“I really try not to think about it, but I’m afraid I don’t have a very positive attitude now. I did for most of my life. But now I have a resigned attitude. It’s accepting. It seems to me that all I do is accept one frustration after another. Everything seems to be going downhill. Physically. The eyes. Hearing. Walking to the telephone. Just staying alive. Everything takes six times as long. Every household chore that used to be mechanical now takes planning. It takes time and it takes push. Actually, a day with nothing to do is a real pleasure.”
Other aging seniors share Anne Ophelia’s concerns. In Being Mortal, Dr. Atul Gwande explained,“It is not death that the very old tell me they fear. It is what happens short of death—losing their hearing, their memory, their best friends, their way of life…. Old age is a continuous series of losses.”
Naturally, all seniors hope to grow on gracefully. Our best chance of achieving life satisfaction and contentment starts with being honest with ourselves and adapting our behavior. What follows is a summary of suggestions from respected professionals about: (1) social awareness and perspective, (2) making a difference, and (3) life-changing decisions.
Social Awareness and Perspective
Psychologist Erik Erikson believed that individuals pass through eight stages of personality development over the course of their lives. In the last stage, we assess our lives and determine whether we are pleased or displeased with our lifetime accomplishments. If we are displeased, we feel regret, despair and sense that our lives have been wasted, in which case our prospects for life satisfaction are poor. If pleased, we are blessed with satisfaction, contentment and freedom from major regrets. This allows us to put our lives in perspective and approach the future with a sense of wisdom and peace. The favorable resolution of this conflict is an essential first step toward life satisfaction and contentment in our elder years.
The Dalai Lama, spiritual leader of the Tibetan people for more than sixty years, encourages people “to prepare ahead of time by familiarizing yourself with the kinds of suffering you might encounter. You might consider things like old age and death as negative, unwanted, and simply try to forget about them. But eventually these things will come anyway. And if you’ve avoided thinking about these things, when the day comes that they occur, it will come as a shock causing an unbearable mental uneasiness. However, if you spend some time thinking about age, death, and these other unfortunate things, your mind will be much more stable when these things happen, as you have already anticipated that they will occur.”
“How you perceive life as a whole plays a role in your attitude about suffering. If your basic outlook is that suffering is negative and must be avoided at all costs, this will add a distinct psychological component of anxiety and intolerance when you encounter difficult circumstances, a feeling of being overwhelmed. On the other hand, if your basic outlook accepts that suffering is a natural part of your existence, this will undoubtedly make you more tolerant towards the adversities of life.”
During most of our lives, we lived with positive expectations and the drive to pursue them. Facing inevitable diminishments in old age suggests that we adopt a different approach. In fact, there is a distinct advantage to eliminating expectations altogether. As the Dalai Lama observed, “Desires can become unreasonable. That usually leads to trouble. Instead, you can enhance life satisfaction by simply shifting perspective and contemplating how things could be worse. Be grateful for what you have. If you maintain a calm, peaceful state of mind, you can be a very happy person even if you have poor health.”
Robert Atchley’s views are compatible with the Dalai Lama’s. Atchley is a former director of the Scripps Gerontology Center at Miami University in Ohio, a past president of the American Society on Aging, and the author of two particularly relevant books, Continuity and Adaptation in Aging and Spirituality and Aging. “Aging does not invariably bring spiritual development, but it does alter the conditions of life in ways that can heighten awareness of spiritual needs.” “There is a fundamental truth in the saying, ‘Know yourself and the truth will set you free.’” “The elders who are happiest and most fulfilled have self-knowledge and self-acceptance. They are the people who have done their homework on themselves.”
Knowing yourself includes clarifying your religious and spiritual beliefs through praying, thinking, introspection, and meditation. “In meditation and prayer, learning to dwell in silence can play an important part in creating an inner-opening for spiritual experience.” Spiritual development “is about developing a perspective about life that transcends the purely self-centered.” It is common for seniors to shift their orientation from self-esteem based on feedback from others to self-esteem based on integrity, that is: adherence to moral and ethical principles. When people see these values at work in their lives their perspective widens and self-respect can be maintained.
As important as self-knowledge is, Atchley feels, “self-acceptance is the key to the door of personal freedom.” “It is really important to come to terms with all of the stuff you have done in your life that you wish you hadn’t. We must acknowledge and accept the totality of what we are, including those aspects of ourselves that we are not very fond of.” Self-acceptance in old age also includes accepting all of the consequences of being old. “Older people who have a sense of fulfillment possess a serenity born out of acceptance of the transitory nature of life…. Self-acceptance allows the acceptance of others, and both lead to inner peace. Fulfillment is the freedom to be without expectation or fear.” Letting go of personal expectations—accepting the realities that life brings us—allows us to reduce suffering and increase life satisfaction. People who know and accept themselves have a greater capacity to fend off the problems they face.
Thornstam’s Theory of Gerotranscendence holds that when we shift from a materialistic, role-oriented life philosophy to a more transcendent, spiritual perspective, we see ourselves in a different light. We become part of a larger context in which the flow of life surpasses the significance of the individual, and this results in greater compassion for those less fortunate than ourselves. Geotranscendence is the result of a natural process towards maturation and wisdom that leads to increased satisfaction with life.
These observations from Gwande, Erikson, the Dalai Lama, Atchley, and Thornstam suggest that developing social awareness and perspective can increase life satisfaction and contentment in old age. We also benefit when we make a difference in the lives of the people we care about.
Making A Difference
Joseph Schumpeter observed, “One does not make a difference unless it is a difference in other people’s lives.” When we had young families and careers, our daily activities provided constant feedback that we were making positive contributions to the people who relied upon us. During old age, when our families have grown up and our jobs are behind us, that automatic feedback loop has weakened, and feelings of self-worth can be adversely affected. Five ways in which we can continue to make a difference are: role modeling and mentoring, giving back, embracing optimism, living up to values we respect, and completing unfinished business.
Role Modeling and Mentoring
Role modeling and mentoring are powerful vehicles for passing on knowledge, skills, and values. We have been role models for our family and others throughout our lives. And the way we behave during old age shapes how the youngest of our family members will remember us.
As Atchley observed, “The issue isn’t so much about role modeling your lifestyle or personal style, it is to model your values and attitude—somebody who listens, who cares about other people, and who allows other people to be themselves…. The role of mentors is not to clone themselves. It’s about listening to the other person’s dreams and helping them get where they want to go.” One of the strongest proponents of mentoring was Rabbi Zalman Schachter-Shalomi, who viewed it as a veritable obligation. “If you don’t save your life experience through mentoring and leaving legacies, the wisdom that you have synthesized through decades of learning will disappear.” When we communicate the lessons we have learned, we feel good about the contributions we are making.
As seniors, we also have the opportunity to role model how to age well: demonstrate inner strength, accept setbacks, and avoid dwelling on negative thoughts, unnecessary lectures, and dispiriting health issues. These are good reminders for us—and valuable lessons for other family members.
Giving Back
Giving back is a duty and an honor. Atchley again: “If you feel you have been blessed, you feel motivated to share that blessing by giving your time or your money or your nurturing. The older population does a lot of giving. It comes in different forms—childcare, financial support, encouragement, volunteering. None of these forms of giving has any moral superiority over any other. People should give whatever they can, but time and attention are especially rewarding because of the personal satisfaction that you feel. In the field of service, the act of doing the work itself is the reward.”
If we live our lives selfishly, we will never be happy. If we live our lives giving, we will have meaning and purpose. Death becomes less of a threat because we know that we have made a difference.
Embracing Optimism
Since optimism is a self-fulfilling prophesy, we benefit when we have a positive attitude. As Pastor Charles R. Swindoll said, “The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failure, than successes, than what other people think or say or do. It is more important than appearance, giftedness or skill. It will make or break a company… a church… a home. The remarkable thing is we have a choice every day regarding the attitude we will embrace for that day. We cannot change our past… we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude. I am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you. We are in charge of our attitudes.”
But there is an additional benefit! When we adopt positive attitudes, the feeling is contagious. We each have a choice of living with a weight on our shoulders or a twinkle in our eyes. When we choose to be positive, we affect those around us. This is a way to make a difference daily.
Living Up to Values We Respect
Self-esteem is priceless, and nothing can be more important than knowing that we live by standards that we—and others—honor. It’s hard to imagine having self-esteem or life satisfaction without this foundation.
Completing Unfinished Business
On several occasions after my parents were gone, I regretted that I had not learned more and asked certain questions. Unfortunately, I had been too wrapped up in my immediate family and my work, and then it was too late. The answers to my questions are gone forever. I suspect other people have experienced the same sense of loss.
Our kids are no different. We can perform a real service to them by taking time to foresee their future wants, needs and questions—and responding accordingly. This goes beyond the traditional estate planning documents to stories about family history and family heirlooms, lessons we learned from personal successes and disappointments, secrets we have never revealed, family medical histories, financial advice, the importance of core values, and any other things our kids may want to know about us and our lives. There is no guarantee that our kids and grandkids will appreciate our efforts, but we will feel good that we have done the best we can.
Life-Changing Decisions
Success in our younger years was about creating opportunities and making things
happen. Success in old age is about adapting to limitations and making good decisions. Dr. Gwande’s book, Being Mortal, provides an excellent discussion of the realities of life and death in our later years. Among the subjects covered, he observes that independent living can become problematic, and there may be a time when it is wise to consider alternative living arrangements. “Most of us will spend significant periods of our lives too reduced and debilitated to live independently. We don’t like to think about this eventuality. As a result, most of us are unprepared for it. We rarely pay more than glancing attention to how we will live when we need help until it’s too late.” As we proceed through old age, it is important to be informed and make wise decisions. Being Mortal is an invaluable resource to help us do both.
We come now to our most difficult subject: dealing with death. We have spent our lives avoiding thinking and talking about it. As a result, it is shrouded in mystery, darkness, and finality—and we are notoriously unprepared to deal with it. But because death is inevitable and because it is so often mismanaged, death warrants a closer look.
Of all the things I learned in researching old age, the most startling is that there is a fallacy in our view of death. We all seek healthy lives and longevity. But striving to live longer is not always wise. As Gwande observed, “For most people, death comes only after a long medical struggle with an incurable condition—advanced cancer, progressive organ failure (usually the heart, kidney, or liver), or the multiple debilities of very old age. In all such cases, death is certain, but the timing isn’t. So, everyone struggles with this uncertainty—with how, and when, to accept that the battle is lost.
“Our reverence for living leaves no account of the reality of what happens in life: sooner or later independence will become impossible. Serious illness or infirmity will strike. It is as inevitable as sunsets. And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained?“
Since we hate death, we fight to avoid it. But when death finally arrives, it is often a relief. A friend of ours died recently, after surgery and several months of pain and anguish. Shortly afterward, another friend wrote, “No one should have to go through what he did. His passing was a true blessing to him and his family.” Think about that. As much as we hate death, when it comes it is often a “blessing,” because sustaining a declining life can cause prolonged pain for everyone.
Shortly before my mother died of congestive heart failure, she announced with conviction, “Pete, I am going to die today.” She made this mental leap because deteriorating health had taken its toll, and death was a better option than the pain, indignity, and drudgery of ongoing life. I expect that when my time comes, I will fight it off while I can. But I no longer think of death as a defeat. It’s the inevitable culmination of life on this planet and for many of us is the beginning of a new life in another form.
Gwande recognizes that patients’ attitudes often change with their condition, “People with serious illnesses have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.”
“We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable wellbeing. And wellbeing is about the reasons one wishes to be alive.” To correct for this, Gwande feels the medical profession should be more willing to ask, “When should we try to fix and when should we not?” This is difficult for doctors when patients are desperately seeking hope. “You worry far more about being overly pessimistic than you do about being overly optimistic. And talking about dying is enormously fraught…. The last thing you want to do is grapple with the truth.”
In many cases, Hospice is a preferable option. “The difference between standard medical care and Hospice is not the difference between treating and doing nothing…. The difference is in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.”
The benefits of Hospice can be remarkable. “I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But multiple studies find otherwise…. For some conditions, hospice care seemed to extend survival. Those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer.”
In a Massachusetts General Hospital study: “those who saw a palliative care specialist stopped chemotherapy sooner, entered Hospice far earlier, experienced less suffering at the end of their lives—and they lived 25% longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.”
How each of us will deal with this issue is highly personal, but Gwande has made it clear that we have options to consider when the time comes. No generation before ours has had comparable information or technical capabilities. We have been blessed. There has never been a better time to accept old age and make informed decisions.