OVERVIEW

PRESENTATIONS ARE: APRIL 10, 15, 22 & 24

SYLLABUS

"Only rich guys idly dream that living past 70 is ultimately worthwhile..." Letter to the Editor, the Tallahassee Democrat, November 17, 2007.
 
 

From Annie's Mailbox®, August 26 2008 Dear Annie:  Three months ago, my husband and I accompanied my 71-year-old mother to our home in California. She was released to my care because the authorities in Pennsylvania felt she could no longer manage on her own. She has a history of mental instability (bipolar) and prior to her release had been hospitalized for mental evaluation five times in three months. Our intention in bringing her here was to see how she managed. We planned to ultimately convert our garage into a small apartment so she could be close by but still maintain some independence. What we've observed is someone who does very little for herself and basically goes from the sofa (to watch TV) to the table (for food), to the bathroom and back to the sofa. That's her entire day. My husband and I both work and have to travel a great deal. We tried leaving Mom alone for a few days and it was a disaster. She stopped taking her meds, found some old wine we had forgotten about, got drunk, fell and injured her foot. My husband and I are exhausted from waiting on her, and while she recognizes that we both work very hard, she does nothing to help. We've told Mom she can't manage on her own and have nixed the garage conversion. I have toured several assisted living facilities in our area. Even if we supplement her Social Security income, it's only enough for a shared living arrangement. She doesn't want that. Mom says she is going back to her apartment in Pennsylvania. My husband and I feel it is a very poor decision, but we also know she can't stay here. Should we take her back? — Torn in San Pedro Dear Torn: And do what? Leave her? Mom is incapable of living alone and will resist any attempt to change that, but it has to be done. Call the Eldercare Locator (eldercare.gov) at 1-800-677-1116 and ask what services are available in her area or yours. Look into a home health aide through the Visiting Nurses Associations of America (vnaa.org). Check references for a live-in companion who will watch her for a small fee plus room and board. You sound like a caring daughter. Please don't give up on Mom because she is making it difficult.

NEW: FROM CNN:

SEXUAL ACTIVITY AND STD RATE UP AMONG SENIORS
(actually midlifers and the young old)
"They just don't think it can happen to them..."

If you are seeking a story that ends "and they all lived happily ever after--forever" you won't find it here.

There are many things about old age we don't like: physical problems, the loss of many of those we love, and for each of us when we have made it this far, death at the end.

Erickson called this last life stage "integrity versus despair". With ego integrity, we look back at our lives and how we lived them with a sense of accomplishment. Perhaps we didn't do everything that we wanted and sometimes our life choices were not the best for us, but on balance we feel we did many things that we set out to do in our younger years and accomplished many of our life's goals. With despair, we have the unexamined life; a state of self- and sometimes of other-blame, a feeling that our choices were poor, and that we did not achieve our major goals. Obviously these are subjective evaluations; someone who has achieved a great deal by others' standards may not have met their own internal expectations; an individual with a more modest life itinerary may still feel a sense of grace in how s/he lived their life.

NOTE: I use the term "we" and "us" a great deal in this Guide--that's with the hope that ALL of us make it to senior-dom and thus must face and cope with the strengths and weaknesses of this period.

Following Boyd and Bee, we will divide the senior years into:

The young old, aged 60 to 75 years. For many seniors these are indeed the "golden years". For those still working in a long-term occupation, these years may be the epitome of their career: senior law partner, CEO, named professor, store manager, business owner and so on. For others, it can be the start of a whole new career. Continuing trends I first addressed in midlife, more professional and managerial men around 60, for example, become interested in elementary and secondary school teaching. Many women the same age become interested in entrepreneurship. For others, retirement means travel, hobbies, and exploring the "roads not taken." Individuals in this age group are more likely to make "amenity moves," such as moving to a warmer climate or buying a second home in a warm climate, increasingly including Mexico.

The old old are aged 76 to 85 years. Most of these seniors are, in fact, living on their own, and are moderately active (more on the effects of activity below). However, most of the moves in this age group are called "compensatory migration," typically to move near children or other, younger relatives.

The oldest old are 86 years of age or older. They are sometimes called "the fragile old" or "the frail elderly". As many as one-quarter of this group has moderate to severe dementia. But don't start worrying yet (for one thing, none of us might make it there), this again may be a case of aging versus cohort or generational effects. Furthermore there are many things all of us can do NOW that perhaps can help prevent this mental tragedy. In addition, at least half of this age group is able to undertake their usual daily activities. If you have a grandparent or great grandparent in this age group who is mentally and physically active, congratulations! Genetics is one important factor--although far from the only one--involved with living to a vigorous very old age. Moves at this age tend to be "institutional migration" to various forms of senior living communities.

One consequence of the increase in longevity over the past two centuries is that many more people live into their 70s, 80s and even 90s. Boyd and Bee point out the increase in centenarians (those reaching 100). An individual who retires at 65 may have 10 years or more of life remaining.

Many adults eagerly anticipate retirement: they envision travel, hobbies, volunteer work, perhaps even a college degree or a new career, and more time to spend with family, including grandchildren or even great-grandchildren. At the same time, adults worry about having enough financially to live comfortably and about their health: the specters of Alzheimer's Disease and dementia, osteoporosis and broken bones, arthritis and high blood pressure, loom as scary demons. Physical problems, such as sleep apnea or type 2 diabetes also become more prevalent. 

Things are actually better in many ways than we fear. What's true:

• We often develop cataracts, or clouding of the eye's lens--but the good news is many advances in cataract surgery
• We have almost certainly become presbyopic, or far-sighted (see Guide 7)
• Our hearing begins to fade, especially at the registers for higher pitched sounds--the good news is digital hearing aids
• We begin to lose our sense of smell--which impacts how we taste our food and may be responsible for loss of appetite in some seniors and cravings for sweet things in others
• Our bones do become more brittle and less dense (although this actually began several decades before)
• Our short term and working memory processes slow down, it's a real slowing of neural synapses
• Rates of hypertension ("high blood pressure") rise, and hypertension is implicated in stroke and heart disease--the good news is better medications for high blood pressure
• Rates of Alzheimer's and dementia climb as we move from the "young old" to the "old old"
• Death rates rise, beginning in the late 30s for men and following menopause for women; that means
• More of us live alone than at many earlier points in our lives

Watch out for "pernicious anemia" caused by vitamin B-12 deficiency. By the time we reach middle age, many of us stop secreting a digestive enzyme in our stomach acid that helps metabolize B-12 (and some of us are on acid reducers for a variety of reasons at much earlier ages). Vitamin B-12 deficiency is not just involved with dementia (see below), you can literally die from it. So be sure to check this one out.

Much of what we "reap" in our later years, we "sowed" in our earlier ones. Smoking cigarettes, for example, contributes to osteoporosis in both sexes. Too much alcohol use can contribute to dementia--and it's probably not a good idea to overdo it on the more idiotic TV or radio talk shows (for many reasons)! "Mental exercise," such as card games and puzzles, as well as social interaction literally helps keep our brains in better shape. Unfortunately recent (2010) research suggests that mental exercise can postpone early symptoms of Alzheimer's, but not ultimately the disease itself. However, this does mean the patient can stay active for much longer.
 
 

Regular physical exercise not only makes our muscles and bones stronger, it continues to do so, if we continue to be active, even in our senior years. Physical exercise helps mental acuity too. Eating foods rich in anti-oxidants may also help because some research suggests higher levels of free radicals among dementia patients. Regular use of sunblock in our youth means fewer wrinkles and "liver spots" in old age.

Modern medicine and technology really have worked wonders. Cataract surgery can literally be a 10-15 minute operation. New procedures don't use lasers but ultra-sound to smash the cataract and suck it out through a tiny tube. A plastic lens is then implanted to replace the old, clouded lens: new lenses can be "progressive" (i.e., correct both our distance and our near vision in the same lens). Digital hearing aids are not only tiny but correct the problems (hissing, popping, lack of modulation) that existed in earlier models and are continuously adjustable so that they do not need to be replaced.

We can implant knees, hips and elbows, and take new medications that render arthritis much more livable. My late uncle (who lived into his mid-80s) lived with leukemia under control with medication for nearly 20 years. There are new medications to assist with Alzheimer's (see above) and dementia, and drugs that control HIV or AIDS. Although most of us die in hospitals, hospice care, including at-home care, has proliferated in the past few decades. Medical personnel no longer withhold pain medication from those with a terminal illness and in fact, the patient may have considerable control over its administration. In short, if the money and medical insurance are there, our old age will be much more physically comfortable and livelier than that of prior generations. More about money below.

As you can see, depending on your geographic location and financial situation, physically your senior years can be fairly comfortable and secure...now...how will you use those years? 

Yes, it does take us old dogs somewhat longer to learn new tricks, but once learned, we generally perform as well on most mental tasks as younger persons do. As noted earlier, it's not so much that we lose brain cells (we do but we have so many left), but that synaptic transmission slows down.  In addition, senior adults have more trouble with working memory or more complex tasks than young adults. Learning new strategies takes longer too as does memory retrieval.

NOTE: It is, however, unclear, how much of this slowdown is due to aging, and how much is due to medical conditions associated with aging. For example, seniors, on the average, take more medication and medication often has cognitive and emotional effects. Some researchers have estimated that individuals who undergo general anesthesia for major surgery (more common among the elderly) can take up to TWO YEARS to regain prior cognitive function. Obviously a physical history can be imperative in any intake interview with seniors.

And, yes, older adults do have memory problems, as high as 80% of us. The problems generally lie with less effective short-term memory and moving information from working memory into long-term memory. However, remember that older adults are also probably considerably more likely to notice and worry about memory problems. Events that an individual in their 20s might ignore (in which parking lot did I put the car today? did I check the door was locked before I left?) may disturb an adult in their 60s, who fears dementia may be around the corner.

Because we have slower reaction times and may have balance problems, we need to be careful operating equipment, whether it's electric scissors or a tractor.

We can outwit memory problems by using technical aids (your cell phone, the computer and other programmable devices, and that old favorite: pencil and paper). We can plan out simple routines to achieve our daily goals and memorize those to avoid short term memory lapses.

Do we grow wiser as we grow older? I wish! Unfortunately there's no evidence for it. However, we do seem to increase the number of problem solving strategies that we can bring to bear on a particular issue, which can lead to greater task success.

What about dementia? It is difficult to definitely diagnose dementia or even Alzheimer's in living patients. Rather we are looking at a cluster or syndrome of symptoms, such as extreme memory problems, inability to recognize those one once knew well, failure to competently perform daily activities (turn off the stove, lock the door, eat with fork, etc.), regular sleep disturbances, or lack of orientation to time and place.

NOTE: Some widely used paper and pencil tests for dementia must be treated with extreme caution because they ask about facts that the individual may never have known even at their peak in the first place. Many representative surveys of the general population indicate that we don't know who our elected public officials are, only HALF of us know that the earth goes around the sun and takes a year to do so, we only know our annual income around April 15, and we may be off a day or so on the dates. It's much better to focus on how well the senior adult is able to complete their typical daily routine, whether they recognize (say, recent photos of) their nearest and dearest, if they choose the appropriate utensil for a salad, or can still read basic signs.

Further, a variety of physical and social causes can induce the appearance of dementia in the elderly (or in any of us but dementia is more likely to be diagnosed among the elderly perhaps due to stereotypes). Some examples include:

metabolic disturbances (such as hypothyroidism, more common among the elderly),
reactive, clinical and bipolar depression, and depression is more common among the elderly
vitamin B-12 deficiency,
alcohol abuse,
relatively recent mourning,
heart disease (in unmedicated congestive heart failure, the heart does not beat strongly enough and enough oxygen does not reach the brain)
drug reactions--especially to psychotropics such as "sleeping pills," anti-anxiety medication, or sedatives, but also to medication for epilepsy or hypertension, allergies, or to the cortisones. Benadryl can be risky for adults over 65. Furthermore, physicians may not adjust dosages for age and weight.
After-effects of major surgery and/or general anesthesia.

And let us also remember DISLOCATION. Many seniors literally pull up stakes in their compensatory migration to move closer to their children or even to a new spouse's preference, or even to seek out a warmer climate. They change regions, degree of urban residence, households, and may leave behind their house of workship, familiar neighbors and friends, shops, doctors and dentists, and even pets. A certain amount of confusion is highly likely to occur under such circumstances, so please take that into consideration too and keep watch to see if an elderly person's cognitive state improves with time, stays level or deteriorates.

If you have a loved one who has been diagnosed with dementia, here are some guidelines to follow:

Was there a thorough physical exam to rule out physical causes such as hypothyroidism or heart disease?
How about a physical history, including type of surgery?
Was thorough blood work done (testing for B-12 or vitamin D levels, for example or cortisol levels)?
Does your loved one drink alcohol to excess?
Has your loved one recently "given up" smoking (trust me, that's enough to disorient anyone) or even given up coffee?
What medications is your loved one taking and at which levels? Giving an 85 pound woman (such as my mother) a medication dose calibrated for a 150 pound man in his 50s can create many problems.
Has your loved one been thoroughly evaluated for depression, and if so, for "which kind?" The treatment may be comparable (although the type of medication might differ, e.g., for bipolar illness) but the expected recoveries may differ. Be aware that some symptoms of depression (changes in appetite or sleep patterns, for example) are also associated with "normal" aging.
Has there been any kind of recent social trauma, e.g., death of a loved one or even divorce?
Has there been a significant relocation, even if it is just moving from a metropolitan urban area to a suburb?
 

You may need to become an advocate for your loved one with doctors, lawyers, assisted living facilities and others. Medical personnel may not be familiar with your loved one because they see a new patient and are unfamiliar with his or her medical history (see immediately above). Unfortunately many individuals in elder care also want to sell you expensive services that your loved one may simply not need and which may, in fact, impair your loved one by discouraging their independence and competence. "Full-time companions" are among the most popular services. On the other hand, keep in mind that part-time assistance may enable your loved one to live many more years on their own. Most states and counties have facilities available such as meals on wheels, transportation, or even part-time housekeeping care at reasonable--or even sometimes at no cost. 

Over and over again, several themes in research recur: (1) health factors, (2) a feeling of choice, and (3) social support contribute greatly to senior well-being.

Next to health factors (see earlier section), senior adults with good levels of social support live healthier and more active lives, are more resilient, and may even live longer. [Do recall that seniors with more active social networks may also be those who are healthier to begin with, more engaged with their environment and possibly even more pleasant to be around!] Seniors, like all of us, most often see their relatives (especially children), neighbors and friends.

Older adults don't tend to see retirement as a particular stressor and generally are happier than sadder when the "nest empties." Indeed, marital satisfaction in older adults with no children in the household is generally higher than at any other point except in the very early years of marriage. It appears to be "fledgling return" (remember research by Monica Boyd at the University of Toronto in Guide 7) when adult children "return to the nest" following marital or partnership dissolution often with their own children in tow or following unemployment that can be stressful. Having said that, however, as long as we don't live with them, older adults often see their adult children:

An overwhelming percentage of adults 65 years of age or older see their children several times a month.
Most live within an hour's travel of their children.
It's mutual support: parents and children share financial and other resources
Relationships with siblings and friends become more important as we age: generate feelings of "generational solidarity"
Women tend to have larger social networks than men, stay more in touch with family but social support is important to both sexes

Women, whether married or single, tend to have a more active social life. First, because of custody traditions, women are generally more in touch with their children and grandchildren than men. Second, women tend to be more active as volunteers than men and continue this voluntarism into their elder years.

Rowe and Kahn introduced the idea of "successful aging," the healthy senior who maintains his or her cognitive abilities, who is socially engaged with their community and productive (including volunteerism). Obviously these dimension interrelate--healthier seniors are more likely to be involved with their communities, for example. This approach has been criticized for placing too much pressure on older Americans; however, it is also clear that the better off and active seniors consider ourselves to be, the better shape we are in. Elder adults can subscribe to ageism as much as younger ones (although most of us believe we are better off than other elderly), and our beliefs about how we are negotiating the senior years are critical to our adjustment and perhaps even our survival.
 

A certain amount of disengagement and role shrinkage "comes with the territory." Older adults are more likely to be retired and more often live alone when living independently. Although during the peak years of young adulthood and early middle adulthood, some 89% of men and about 75% of women were employed or seeking work at least part-time (2010 Census figures), by ages 55 to 64, only 70% of men and 60% of women were in the labor force. By age 65 and older, this drops further still to 22% of men and 14% of women (the labor force participation rate of men at all ages has dropped slightly and that for women at all ages has risen since 1980; OPTIONAL: see Statistical Abstract 2012).  .

Baby Boomers expect to stay in the labor force longer than earlier generations but part of that is because Baby Boomers have saved less and feel the financial need. Individuals with low education in low income jobs are more likely to be working at senior ages. But it is also true that Baby Boomers were the first generation to make starting college normative and they also are more likely (at this particular point) to have interesting professional and managerial jobs. Individuals in these lines of work, and well-educated persons, more often intend to stay employed and think about retiring later.

We often underestimate our costs during the later years. Many if not most current seniors own their own homes and cars, and their children are now self-supporting (except for those returning fledglings...) If the individual is retired, their transportation costs and clothing or entertainment costs have also dropped. On the other hand, those who wish to travel may find that's an expensive enterprise. The senior who returns to college faces costs for tuition, books, duplication costs and possibly technology investments. Special college programs for senior citizens often help or ameliorate these expenses (FSU's Pepper Center has a set of these programs) . Depending on age, a substantial minority to a majority of elder citizens are on medication and/or see their physicians more frequently. Out-of-pocket medical or rehabilitation costs may also increase.

Were I writing some 70 years ago I would have noted that those over 60 were the most likely group to fall into poverty. At this point in time senior citizens, depending however on gender, maritial status and ethnicity, are among the least likely to be poor. A great deal of both one's financial and social circumstances during the senior years depend on marital or partnership status. In 2009, median income of households where the main householder was at least 65 was $43,702-about $16,500 less than the median for all households. Asian-American households had the highest incomes followed by White Americans, Hispanic-Americans, and African-Americans. One reason for the ethnic differences is that Asian American families average more earners in the labor force at one time. Married couple families have higher incomes than single males, and finally, than single females, while median income was lowest among Southern U.S. families.

Those at least 65 are the most likely to own interest bearing assets (such as Certificates of Deposit) at financial institutions, are the most likely to own their own homes, and are only slightly less likely than those in middle adulthood to own stocks or bonds These figures drop as we examine the oldest old (over 75 in the U.S. government tables). Adults at least 75 also less often owned their own cars, which has considerable implications for independence and mobility.

The future is hard to predict at this point. The age at which one qualifies for full Social Security keeps rising. Defined pensions supplying a predetermined fixed amount of income are being deemed too expensive now that Baby Boomers face retirement: instead, the future retiree gets to create their "own" plan--i.e., you had better learn about investments, learn quick and keep learning or bite the bullet and pay broker commissions. In the "down market" of late 2008 and early 2009, you can easily see the impact of this change in retirement benefits. Although the U.S. stock market has now generally recovered, it won't bring back lost dollars for those forced to sell stocks in the market downturns of 2008-2010.

Simply put, two people (or more) living together live more comfortably that one individual, particularly a widowed or otherwise single woman. A couple living together not only share expenses but also social security payments and quite possibly retirement pensions and other income. Because women are paid less than men, are in jobs that pay less on the average anyway, and have less continuous employment histories than men, our social security and our pensions also tend to be lower than men's. Single women living alone are more likely to live in poverty and less likely to have health insurance other than medicare (or medicaid). Women are more likely than men to depend upon Social Security as their major source of income. Professionals and managers of either sex are more likely to have pensions or other retirement funds than blue collar workers (except union workers in long-term employment).

Unfortunately, beginning in middle age, there are far more women in any particular older age group than men, and the ratio becomes more lopsided as we age. Thus most senior males are married or cohabiting in a partnership as compared with most women. Older males are more likely to remarry following widowhood or divorce than older females, and, because women currently have greater longevity, are less likely than women to be widowed in the first place.  Incomes of two person households are considerably larger than those of single females. Travelin' the country in an RV or taking cruises is easier to do when there are two incomes in the family. Our cynical Tallahassee Democrat letter writer above sounds dissatisfied with their total income.

On the other hand, libraries and senior centers typically are free to participants. Senior centers offer a host of different classes, action groups (e.g., choirs), hobby groups and social events such as plays or dances. Women are more likely to be involved with either libraries or senior centers as volunteers and are thus more likely to know about these programs. Of course, many restaurants, theaters, clubs and stores offer senior discounts too. In my own research on access and use of the Internet I found that seniors were the fastest growing group using email, presumably to stay in touch with relatives (many cite grandchildren) and friends. Kennedy et al. in a 2008 Pew Internet and American Life study also found that seniors found email and cell phones helpful to stay in touch with family and friends. 

You have probably heard a lot about how Social Security is "in trouble".
Defined pension benefits are also "in trouble" with politicians at all levels and CEO worried about being able to fund them.

There are two major reasons why:

First, Baby Boomers (who reached early and partial benefits retirement age in 2008 when the first "Boomers" turned age 62) married later and had smaller families than their parents did. Although rising slightly until 2008, birth rates are still low. This means that there will be fewer active and employed workers to pay social security taxes for the influx of "Boomers" than there were for earlier generations--and there are lots of Baby Boomers too; this was a huge generation.

Second, the U.S. federal government has been tapping away, "borrowing" from funds earmarked for Social Security for several years. The legality is dubious but the danger as a large generation teeters on the brink of retirement is obvious. There are no painless solutions (lower benefits or increase Social Security taxes are both unpopular and so politicians dither as the Baby Boom ages) and current young adults are wise to be prepared with other sources of retirement funds.

Similar phenomena have occurred with state and local governments and private industry. During the years the Boomers were active in the labor force these retirement funds were also booming with surpluses. (And many stastes and municipalities tapped into those, too.)

Personally I think there is no excuse for the panic. We knew in the late 1960s that Boomers would ultimately retire and begin tapping into retirement funds. Rather than preparing for this onslaught governments and companies happily tapped into these surpluses as though the bill would never come due.

What to do now? My best advice is to wait it out. The boom extended from 1946 to (at its very latest estimate) 1961. The generations following are from cohorts with lower birthrates. The Boom "echo" is now in their productive years and beginning to pay into the system. Corrections now will lead to surpluses within about 10-15 years, followed by another generation tapping in. Hold tight and corrective demographic factors will come into play--and give government and industry a window to truly make corrections to prepare for the next "boom".And for you "echo generation" out there, let's hope government is better prepared then.

RESIDENCE

Contrary to fears that many individuals have of "ending up in a nursing home," only 4% of those at least 65 years of age currently are in any kind of institutional care at any one point in time. Remember, this isn't just "nursing homes." Many seniors are in rehabilitative care from accidents, surgery, or illness too.

"Aging in place" is a term coined to describe the modifications that older adults can make to their homes both physically and socially that enable them to continue living in the same residence. Physical modifications can include adjustments for a wheel chair, grab rails in the bath or shower, and simplifying the home environment to prevent falls. Social modifications can include a "panic button" that can bring trained assistance when pressed, "buddy arrangements" with friends and neighbors, or the use of social services such as Meals on Wheels. Women are more likely to live alone than men (widowed and not remarried) and are more likely to be nursing home residents because of greater longevity and the lopsided sex-ratios noted earlier. Euro-Americans are the least likely ethnic group to live with relatives.

There's a lot to be said for aging in place. Given that memory problems increase as we age, occupying the same residence in the same neighborhood with stable routines makes it easier for seniors to function well (see dislocation above). There is less stress on learning new routes, people or routines. My own personal belief is that aging in place can help us live longer, more productive lives.

But there are several steps between continuing to occupy one's own home and a nursing home! Independent living facilities typically provide at least some daily meals and cleaning services. Resident seniors can continue to drive although transportation to medical facilities or shopping centers may also be provided. Although the senior adult may downsize, they typically keep some of their furniture and other familiar possessions. Both independent and assisted living communities may provide classes or entertainment (although the movies tend to be on the vintage side), and typically a medical person is available on the premises for emergencies. You may be interested to know that it is federal law that independent living or assisted living residents can bring their pets to live with them (within reason, of course and must provide for their care).

In assisted living facilities, the organization typically provides help with some daily tasks, which can include bathing or dressing. Almost certainly there will be medical personnel available around the clock (typically nurses). Finally and most typically for the oldest old, are nursing homes that provide continuous skilled nursing care. As you might guess, each facility becomes progressively more expensive, although nursing home care may be partially subsidized through Medicaid and Medicare (for the first few weeks). "Continuous care retirement communities" often incorporate all three levels of care, beginning with independent living (Westminster Oaks in Tallahassee is one example).

Some research reports that it is not so much the move to senior housing but how the move has occurred. Having a sense of volition or control is important. It is not so much being in a nursing home as being involuntarily moved there. Those who instigated the move themselves tend to be much more content. (Similarly, iIndividuals who felt forcibly retired are unhappier than those who clearly retired voluntarily.)

Religious coping is another theme that recurs in the senior developmental literature. Religious congregations provide an avenue for social as well as spiritual supports and provide opportunities for community engagement and volunteer activities. Religious beliefs can provide a scaffold for individuals to examine their lives and also provide rituals of comfort associated with illness, death, and surviving loss.
 

The younger we are, the less we understand death and (with the exception of adolescents and young adults), the more we tend to fear it.

In nearly Piagetian fashion, those in early childhood have difficulties seeing death as irreversible and universal. Middle childhood youngsters are more likely to realize that death is final and all living organisms ultimately die. Although adolescents and young adults understand the finality and unavoidability of death, they tend to see themselves as invulnerable. The death of a friend or relative has a strong influence on childhood, adolescent and young adult beliefs and emotions about death. Sudden or violent death makes more of an impact on survivors and is harder for survivors to grasp. Beginning in middle age, we tend to think of "the time we have left" and perceive death as loss.

The same variables noted earlier throughout this Guide 8--a sense of optimism and religiosity--partially mitigate our fears about our own death. Optimism also relates to survival and recovery rates for those facing disease or surgery. Ironically the "bad patient" who "fights" her or his doctor, looks up the prognosis and latest treatments on the Internet has a better prognosis for survival.

Kubler-Ross was one of the first clinical researchers to set out "stages of dying", generally for those diagnosed with a terminal illness, and her set of stages is the best known:

In her first, denial stage, the individual denies the diagnosis and refuses to believe it.
Second is anger at the diagnosis and impending death.
Next the individual turns to bargaining (if I give up smoking...if I take all my medication...)
Depression is the fourth stage (and apparently more common among Westerners)
Finally is acceptance and many do not reach this stage

Kubler-Ross based her stages upon clinical observations of patients and her taxonomy became famous. However, wider research does not tend to confirm "stages of dying" among most adults.

Perhaps this is because the United States has become more humane about death. Instead of fiercely fighting it with modern and experimental ["curative"] medicine (although that is still possible), there is a greater focus on physical comfort and living as fully as possible. Opiates are more widely prescribed and hospice care has become more common. Home hospice care is more difficult for family caregivers than hospital or in-place hospice care.

Are there stages of grieving among survivors? Some developmentalists hypothesize we go through a stage of shock or numbness, some form of awareness or even bargaining, a withdrawal or depression stage, and finally a stage in which the survivor reorganizes her or his life. Other researchers find that when the individual had a terminal illness for quite a while, survivors are relieved ("she is at peace" or "he is not suffering any more") rather than angry. Violent or sudden death is harder to assimilate. Depending, some survivors become social activists; the 911 widows and widowers or the parents of slain children provide two examples. In 2012 there was considerable debate about whether the new Diagnostic and Statistical Manual should include "grief" as a "disorder".

Because death is universal, viturally every society has death rituals, both to prepare the decedent and to comfort the bereaved. For the patient, there are religious rituals, farewell rituals, living wills and other legalities. For survivors, there are funerals and mourning rituals such as wakes or "sitting shiva". Middle and upper class widows in Victorian England were mandated to wear black for a year, then graduating to shades of gray and lavender for at least another year. Friends and relatives typically bring food to and after the funeral, both so the bereaved do not need to prepare meals and for the visitors to the household. Families and friends share reminiscences of the deceased and create a collective memory of him or her. The survivor in industrial societies is kept busy for several weeks--or even months--settling finances, completing official forms and legal requirements, distributing the deceased's possessions and selling property. These tasks keep the bereaved busy and engaged with society at a time when they might, in fact, prefer to withdraw, and perhaps, help the living to accept their loss, turn their attention to other survivors (children, spouse, siblings, parents) and continue on with life.
 
 

OVERVIEW

SYLLABUS

Susan Carol Losh
Built with Netscape Composer
March 31 2014

Jeanne McNally, "The Golden Years"