In traditional Chinese and other Asian cultures the aged were highly respected and cared for. The Igabo tribesmen of Eastern Nigeria value dependency in their aged and involve them in care of children and the administration of tribal affairs (Shelton, A. in Kalish R. Uni Michigan 1969).
In Eskimo culture the grandmother was pushed out into the ice-flow to die as soon as she became useless.
Western societies today usually resemble to some degree the Eskimo culture, only the "ice-flows" have names such a "Sunset Vista" and the like. Younger generations no longer assign status to the aged and their abandonment
is always in danger of becoming the social norm.
There has been a tendency to remove the aged from their homes and put them in custodial care. To some degree the government provides domiciliary care services to prevent or delay this, but the motivation probably has more
to do with expense than humanity.
In Canada and some parts of the USA old people are being utilised as foster-grandparents in child care agencies.
SOME BASIC DEFINITIONS
What is Aging?
Aging: Aging is a natural phenomenon that refers to changes occurring throughout the life span and result in differences in structure and function between the youthful and elder generation.
Gerontology: Gerontology is the study of aging and includes science, psychology and sociology.
Geriatrics: A relatively new field of medicine specialising in the health problems of advanced age.
Social aging: Refers to the social habits and roles of individuals with respect to their culture and society. As social aging increases individual usually experience a decrease in meaningful social interactions.
Biological aging: Refers to the physical changes in the body systems during the later decades of life. It may begin long before the individual reaches chronological age 65.
Cognitive aging: Refers to decreasing ability to assimilate new information and learn new behaviours and skills.
GENERAL PROBLEMS OF AGING
Eric Erikson (Youth and the life cycle. Children. 7:43-49 Mch/April 1960) developed an "ages and stages" theory of human
development that involved 8 stages after birth each of which involved a basic dichotomy representing best case and worst case outcomes. Below are the dichotomies and their developmental relevance:
Prenatal stage - conception to birth.
1. Infancy. Birth to 2 years - basic trust vs. basic distrust. Hope.
2. Early childhood, 3 to 4 years - autonomy vs. self doubt/shame. Will.
3. Play age, 5 to 8 years - initiative vs. guilt. Purpose.
4. School age, 9to 12 - industry vs. inferiority. Competence.
5. Adolescence, 13 to 19 - identity vs. identity confusion. Fidelity.
6. Young adulthood - intimacy vs. isolation. Love.
7. Adulthood, generativity vs. self absorption. Care.
8. Mature age- Ego Integrity vs. Despair. Wisdom.
This stage of older adulthood, i.e. stage 8, begins about the time of retirement and continues throughout one's life. Achieving ego integrity is a sign of maturity while failing to reach this stage is an indication of poor development in prior stages through the life course.
Ego integrity: This means coming to accept one's whole life and reflecting on it in a positive manner. According to Erikson, achieving
integrity means fully accepting one' self and coming to terms with death. Accepting responsibility for one's life and being able to review
the past with satisfaction is essential. The inability to do this leads to despair and the individual will begin to fear death. If a favourable balance is achieved during this stage, then wisdom is developed.
Psychological and personality aspects:
Aging has psychological implications. Next to dying our recognition that we are aging may be one of the most profound shocks we ever receive. Once we pass the invisible line of 65 our years are bench marked for the remainder of the game of life. We are no longer "mature age" we are instead classified as "old", or "senior citizens". How we cope with the changes we face and stresses of altered status depends on our basic personality. Here are 3 basic personality types that have been identified. It may be a oversimplification but it makes the point about personality effectively:
a. The autonomous - people who seem to have the resources for self-renewal. They may be dedicated to a goal or idea and committed to continuing productivity. This appears to protect them somewhat even against physiological aging.
b.The adjusted - people who are rigid and lacking in adaptability but are supported by their power, prestige or well structured routine. But if their situation changes drastically they become psychiatric casualties.
c.The anomic. These are people who do not have clear inner values or a protective life vision. Such people have been described as prematurely resigned and they may deteriorate rapidly.
Summary of stresses of old age.
a. Retirement and reduced income. Most people rely on work for self worth, identity and social interaction. Forced retirement can be demoralising.
b. Fear of invalidism and death. The increased probability of falling prey to illness from which there is no recovery is a continual
source of anxiety. When one has a heart attack or stroke the stress becomes much worse.
Some persons face death with equanimity, often psychologically supported by a religion or philosophy. Others may welcome death as an end to suffering or insoluble problems and with little concern for life or human existence. Still others face impending death with suffering of great stress against which they have no ego defenses.
c. Isolation and loneliness. Older people face inevitable loss of loved ones, friends and contemporaries. The loss of a spouse whom one has depended on for companionship and moral support is particularly distressing. Children grow up, marry and become preoccupied or move away. Failing memory, visual and aural impairment may all work to make social interaction difficult. And if this
then leads to a souring of outlook and rigidity of attitude then social interaction becomes further lessened and the individual may not even utilise the avenues for social activity that are still available.
d. Reduction in sexual function and physical attractiveness. Kinsey et al, in their Sexual behaviour in the human male,
(Phil., Saunders, 1948) found that there is a gradual decrease in sexual activity with advancing age and that reasonably gratifying patterns of sexual activity can continue into extreme old age. The aging person also has to adapt to loss of sexual attractiveness in a society which puts extreme emphasis on sexual attractiveness. The adjustment in self image and self concept that are required can be very hard to make.
e. Forces tending to self devaluation. Often the experience of the older generation has little perceived relevance to the problems of the young and the older person becomes deprived of participation in decision making both in occupational and family settings. Many parents are seen as unwanted burdens and their children may secretly wish they would die so they can be free of the burden and experience some financial relief or benefit. Senior citizens may be pushed into the role of being an old person with all this implies in terms of self devaluation.
4 Major Categories of Problems or Needs:
Health.
Housing.
Income maintenance.
Interpersonal relations.
BIOLOGICAL CHANGES
Physiological Changes: Catabolism (the breakdown of protoplasm) overtakes anabolism (the build-up of protoplasm). All body systems are affected and repair systems become slowed. The aging process occurs at different rates in different individuals.
Physical appearance and other changes:
Loss of subcutaneous fat and less elastic skin gives rise to wrinkled appearance, sagging and loss of smoothness of body contours. Joints stiffen and become painful and range of joint movement becomes restricted, general
mobility lessened.
Respiratory changes:
Increase of fibrous tissue in chest walls and lungs leads restricts respiratory movement and less oxygen is consumed. Older people more likelyto have lower respiratory infections whereas young people have upper respiratory infections.
Nutritive changes:
Tooth decay and loss of teeth can detract from ease and enjoyment in eating. Atrophy of the taste buds means food is inclined to be tasteless and this should be taken into account by carers. Digestive changes occur from lack of exercise (stimulating intestines) and decrease in digestive juice production. Constipation and indigestion are likely to follow as a result. Financial problems can lead to the elderly eating an excess of cheap carbohydrates rather than the more expensive protein and vegetable foods and this exacerbates the problem, leading to reduced vitamin intake and such problems as anemia and increased susceptibility to infection.
Adaptation to stress:
All of us face stress at all ages. Adaptation to stress requires the consumption of energy. The 3 main phases of stress are:
1. Initial alarm reaction. 2. Resistance. 3. Exhaustion
and if stress continues tissue damage or aging occurs. Older persons have had a lifetime of dealing with stresses. Energy reserves are depleted and the older person succumbs to stress earlier than the younger person. Stress is cumulative over a lifetime. Research results, including experiments with animals suggests that each stress leaves us more vulnerable to the next and that although we might think we've "bounced back" 100% in fact each stress leaves it scar. Further, stress is psycho-biological meaning
the kind of stress is irrelevant. A physical stress may leave one more vulnerable to psychological stress and vice versa. Rest does not completely restore one after a stressor. Care workers need to be mindful of this and cognizant of the kinds of things that can produce stress for aged persons.
COGNITIVE CHANGE Habitual Behaviour:
Sigmund Freud noted that after the age of 50, treatment of neuroses via psychoanalysis was difficult because the opinions and reactions of older people were relatively fixed and hard to shift.
Over-learned behaviour: This is behaviour that has been learned so well and repeated so often that it has become automatic, like for example typing or running down stairs. Over-learned behaviour is hard to change. If one has lived a long time one is likely to have fixed opinions and ritualised behaviour patterns or habits.
Compulsive behaviour: Habits and attitudes that have been learned in the course of finding ways to overcome frustration and difficulty are very hard to break. Tension reducing habits such as nail biting, incessant humming, smoking or drinking alcohol are especially hard to change at any age and particularly hard for persons who have been practising them over a life time.
The psychology of over-learned and compulsive behaviours has severe implications for older persons who find they have to live in what for them is a new and alien environment with new rules and power relations.
Information acquisition:
Older people have a continual background of neural noise making it more difficult for them to sort out and interpret complex sensory
input. In talking to an older person one should turn off the TV, eliminate as many noises and distractions as possible, talk slowly
and relate to one message or idea at a time.
Memories from the distant past are stronger than more recent memories. New memories are the first to fade and last to return.
Time patterns also can get mixed - old and new may get mixed.
Intelligence.
Intelligence reaches a peak and can stay high with little deterioration if there is no neurological damage. People who have unusually high intelligence to begin with seem to suffer the least decline. Education and stimulation also seem to play a role in maintaining intelligence.
Intellectual impairment. Two diseases of old age causing cognitive decline are Alzheimer's syndrome and Pick's syndrome. In Pick's syndrome there is inability to concentrate and learn and also affective responses are impaired.
Degenerative Diseases: Slow progressive physical degeneration of cells in the nervous system. Genetics appear to be an important factor. Usually start after age 40 (but can occur as early as 20s).
ALZHEIMER'S DISEASE Degeneration of all areas of cortex but particularly frontal and temporal lobes. The affected cells actually die. Early symptoms resemble neurotic disorders: Anxiety, depression, restlessness sleep difficulties.
Progressive deterioration of all intellectual faculties (memory deficiency being the most well known and obvious). Total mass of the brain decreases, ventricles become larger. No established treatment.
PICK'S DISEASE Rare degenerative disease. Similar to Alzheimer's in terms of onset, symptomatology and possible genetic
aetiology. However it affects circumscribed areas of the brain, particularly the frontal areas which leads to a loss of normal affect.
PARKINSON'S DISEASE Neuropathology: Loss of neurons in the basal ganglia.
Symptoms: Movement abnormalities: rhythmical alternating tremor of extremities, eyelids and tongue along with rigidity of the muscles and slowness of movement (akinesia).
It was once thought that Parkinson's disease was not associated with intellectual deterioration, but it is now known that there is an association between global intellectual impairment and Parkinson's where it occurs late in life.
The cells lost in Parkinson's are associated with the neuro-chemical Dopamine and the motor symptoms of Parkinson's are associated the dopamine deficiency. Treatment involves administration of dopamine precursor L-dopa which can alleviate symptoms including intellectual impairment. Research suggests it may possibly bring to the fore emotional effects in patients who have had
psychiatric illness at some prior stage in their lives.
AFFECTIVE DOMAIN In old age our self concept gets its final revision. We make a final assessment of the value of our lives and our balance of success and failures.
How well a person adapts to old age may be predicated by how well the person adapted to earlier significant changes. If the person suffered an emotional crisis each time a significant change was needed then adaptation to the exigencies of old age may also be difficult. Factors such as economic security, geographic location and physical health are important to the adaptive process.
Need Fulfilment: For all of us, according to Maslow's Hierarchy of Needs theory, we are not free to pursue the higher needs of self actualisation unless the basic needs are secured. When one considers that many, perhaps most, old people are living in poverty and continually concerned with basic survival needs, they are not likely to be happily satisfying needs related to prestige, achievement and beauty.
Maslow's Hierarchy
Physiological
Safety
Belonging, love, identification
Esteem: Achievement, prestige, success, self respect
Self actualisation: Expressing one's interests and talents to the full.
Note: Old people who have secured their basic needs may be motivated to work on tasks of the highest levels in the hierarchy - activities concerned with aesthetics, creativity and altruistic matters, as compensation for loss of sexual attractiveness and athleticism. Aged care workers fixated on getting old people to focus on social activities may only succeed in frustrating and irritating them if their basic survival concerns are not secured to their satisfaction.
DISENGAGEMENT
Social aging according to Cumming, E. and Henry, W. (Growing old: the aging process of disengagement, NY, Basic 1961) follows a well defined pattern:
1. Change in role. Change in occupation and productivity. Possibly change
in attitude to work.
2. Loss of role, e.g. retirement or death of a husband.
3. Reduced social interaction. With loss of role social interactions are
diminished, eccentric adjustment can further reduce social interaction, damage
to self concept, depression.
4. Awareness of scarcity of remaining time. This produces further curtailment of
activity in interest of saving time.
Havighurst, R. et al (in B. Neugarten (ed.) Middle age and aging, U. of Chicago, 1968) and others have suggested that disengagement is not an inevitable process. They believe the needs of the old are essentially the same as in middle age and the activities of middle age should be extended as long as possible. Havighurst points out the decrease in social interaction of the aged is often largely the
result of society withdrawing from the individual as much as the reverse. To combat this he believes the individual must vigorously resist the limitations of his social world.
DEATH The fear of the dead amongst tribal societies is well established. Persons who had ministered to the dead were taboo and required observe various rituals including seclusion for varying periods of time. In some societies from South America to Australia it is taboo for certain persons to utter the name of the dead. Widows and widowers are expected to observe rituals in respect for the dead.
Widows in the Highlands of New Guinea around Goroka chop of one of their own fingers. The dead continue their existence as spirits and upsetting them can bring dire consequences.
Wahl, C in "The fear of death", 1959 noted that the fear of death occurs as early as the 3rd year of life. When a child loses a pet or grandparent fears reside in the unspoken questions: Did I cause it? Will happen to you (parent) soon? Will this happen to me? The child in such situations needs to re-assure that the departure is not a censure, and that the parent is not likely to depart soon. Love, grief, guilt, anger are a mix of conflicting emotions that are experienced.
CONTEMPORARY ATTITUDES TO DEATH
Our culture places high value on youth, beauty, high status occupations, social class and anticipated future activities and achievement. Aging and dying are denied and avoided in this system. The death of each person reminds us of our own mortality.
The death of the elderly is less disturbing to members of Western society because the aged are not especially valued. Surveys have established that nurses for example attach more importance to saving a young life than an old life. In Western society there is a pattern of avoiding dealing with the aged and dying aged patient.
Stages of dying. Elisabeth Kubler Ross has specialised in working with dying patients and in her "On death and dying", NY, Macmillan, 1969, summarised 5 stages in dying.
1. Denial and isolation. "No, not me".
2. Anger. "I've lived a good life so why me?"
3. Bargaining. Secret deals are struck with God. "If I can live until...I promise to..."
4. Depression. (In general the greatest psychological problem of the aged is depression). Depression results from real and threatened loss.
5. Acceptance of the inevitable.
Kubler Ross's typology as set out above should, I believe be taken with a grain of salt and not slavishly accepted. Celebrated US Journalist David Rieff who was in June '08 a guest of the Sydney writer's festival in relation to his book, "Swimming in a sea of death: a son's memoir" (Melbourne University Press) expressly denied the validity of the Kubler Ross typology in his Late Night Live interview (Australian ABC radio) with Philip Adams June 9th '08. He said something to the effect that his mother had regarded her impending death as murder. My own experience with dying persons suggests that the human ego is extraordinarily resilient. I recall visiting a dying colleague in hospital just days before his death. He said, "I'm dying, I don't like it but there's nothing I can do about it", and then went on to chortle about how senior academics at an Adelaide university had told him they were submitting his name for a the Order of Australia (the new "Knighthood" replacement in Australia). Falling in and out of lucid thought with an oxygen tube in his nostrils he was nevertheless still highly interested in the "vain glories of the world". This observation to me seemed consistent with Rieff's negative assessment of Kubler Ross's theories.
THE AGED IN RELATION TO YOUNGER PEOPLE
The aged share with the young the same needs: However, the aged often have fewer or weaker resources to meet those needs. Their need for social interaction may be ignored by family and care workers.
Family should make time to visit their aged members and invite them to their homes. The aged like to visit children and relate to them through games and stories.
Meaningful relationships can be developed via foster-grandparent programs. Some aged are not aware of their income and health entitlements. Family and friends should take the time to explain these. Some aged are too proud to access their entitlements and this problem should be addressed in a kindly way where it occurs.
It is best that the aged be allowed as much choice as possible in matters related to living arrangements, social life and lifestyle.
Communities serving the aged need to provide for the aged via such things as lower curbing, and ramps.
Carers need to examine their own attitude to aging and dying. Denial in the carer is detected by the aged person and it can inhibit the aged person from expressing negative feelings - fear, anger. If the person can express these feelings to someone then that person is less likely to die with a sense of isolation and bitterness.
A METAPHYSICAL PERSPECTIVE
The following notes are my interpretation of a Dr. Depak Chopra lecture entitled, "The New Physics of Healing" which he presented to the 13th Scientific Conference of the American Holistic Medical Association. Dr. Depak Chopra is an endocrinologist and a former Chief of Staff of New England Hospital, Massachusetts. I am deliberately omitting the detail of his explanations of the more abstract, ephemeral and controversial ideas.
Original material from 735 Walnut Street, Boulder, Colorado 83002,
Phone. +303 449 6229.
In the lecture Dr. Chopra presents a model of the universe and of all organisms as structures of interacting centres of electromagnetic energy linked to each other in such a way that anything affecting one part of a system or structure has ramifications throughout the entire structure. This model becomes an analogue not only for what happens within the structure or organism itself, but between the organism and both its physical and social environments. In other words there is a correlation between psychological
conditions, health and the aging process. Dr. Chopra in his lecture reconciles ancient Vedic (Hindu) philosophy with modern psychology and quantum physics.
Premature Precognitive Commitment: Dr. Chopra invokes experiments that have shown that flies kept for a long time in a jar do not quickly leave the jar when the top is taken off. Instead they accept the jar as the limit of their universe. He also points out that in India baby elephants are often kept tethered to a small twig or sapling. In adulthood when the elephant is capable of pulling over a medium sized tree it can still be successfully tethered to a twig! As another example he points to experiments in which fish are bred on
2 sides of a fish tank containing a divider between the 2 sides. When the divider is removed the fish are slow to learn that they can now swim throughout the whole tank but rather stay in the section that they accept as their universe. Other experiments have demonstrated that kittens brought up in an environment of vertical stripes and structures, when released in adulthood keep bumping into anything aligned horizontally as if they were unable to see anything that is horizontal. Conversely kittens brought up in an environment of horizontal stripes when released bump into vertical structures, apparently unable to see them.
The whole point of the above experiments is that they demonstrate Premature Precognitive Commitment. The lesson to be learned is that our sensory apparatus develops as a result of initial experience and how we've been taught to interpret it.
What is the real look of the world? It doesn't exist. The way the world looks to us is determined by the sensory receptors we have and our interpretation of that look is determined by our premature precognitive commitments. Dr Chopra makes the point that less than a billionth of the available stimuli make it into our nervous systems. Most of it is screened, and what gets through to us is whatever we are
expecting to find on the basis of our precognitive commitments.
Dr. Chopra also discusses the diseases that are actually caused by mainstream medical interventions, but this material gets too far away from my central intention. Dr. Chopra discusses in lay terms the physics of matter, energy and time by way of establishing the wider context of our existence. He makes the point that our bodies including the bodies of plants are mirrors of cosmic rhythms and exhibit changes correlating even with the tides.
Dr. Chopra cites the experiments of Dr. Herbert Spencer of the US National Institute of Health. He injected mice with Poly-IC, an immuno-stimulant while making the mice repeatedly smell camphor. After the effect of the Poly-IC had worn off he again exposed the mice to the camphor smell. The smell of camphor had the effect of causing the mice's immune system to automatically strengthen
as if they had been injected with the stimulant. He then took another batch of mice and injected them with cyclophosphamide which tends to destroy the immune system while exposing them to the smell of camphor. Later after being returned to normal just the smell of camphor was enough to cause destruction of their immune system. Dr. Chopra points out that whether or not camphor enhanced or
destroyed the mice's immune system was entirely determined by an interpretation of the meaning of the smell of camphor. The interpretation is not just in the brain but in each cell of the organism. We are bound to our imagination and our
early experiences.
Chopra cites a study by the Massachusetts Dept of Health Education and Welfare into risk factors for heart disease - family history, cholesterol etc. The 2 most important risk factors were found to be psychological measures - Self Happiness Rating and Job Satisfaction. They found most people died of heart disease on a Monday!
Chopra says that for every feeling there is a molecule. If you are experiencing tranquillity your body will be producing natural valium. Chemical changes in the brain are reflected by changes in other cells including blood cells. The brain produces neuropeptides and brain structures are chemically tuned to these neuropeptide receptors. Neuropeptides (neurotransmitters) are the chemical concommitants of thought. Chopra points out the white blood cells (a part of the immune system) have neuropeptide receptors and are "eavesdropping" on our thinking. Conversely the immune system produces its own neuropeptides which can influence the nervous system. He goes on to say that cells in all parts of the body including heart and kidneys for example also produce neuropeptides and
neuropeptide sensitivity. Chopra assures us that most neurologists would agree that the nervous system and the immune system are parallel systems.
Other studies in physiology: The blood interlukin-2 levels of medical students decreased as exam time neared and their interlukin receptor capacities also lowered. Chopra says if we are having fun to the point of exhilaration our natural interlukin-2 levels become higher. Interlukin-2 is a powerful and very expensive anti-cancer drug. The body is a printout of consciousness. If we could change the way we look at our bodies at a genuine, profound level then our bodies would actually change.
On the subject of "time" Chopra cites Sir Thomas Gall and Steven Hawkins, stating that our description of the universe as having a past, present, and future are constructed entirely out of our interpretation of change. But in
reality linear time doesn't exist.
Chopra explains the work of Alexander Leaf a former Harvard Professor of Preventative Medicine who toured the world investigating societies where people lived beyond 100 years (these included parts of Afghanistan, Soviet Georgia, Southern Andes). He looked at possible factors including climate, genetics, and diet. Leaf concluded the most important factor was the collective perception of aging in these societies.
Amongst the Tama Humara of the Southern Andes there was a collective belief that the older you got the more physically able you got. They had a tradition of running and the older one became then generally the better at running one got. The best runner was aged 60. Lung capacity and other measures actually improved with age. People were healthy until well into their 100s and died in their sleep. Chopra remarks that things have changed since the introduction of Budweiser (beer) and TV.
[DISCUSSION: How might TV be a factor in changing the former ideal state of things?]
Chopra refers to Dr. Ellen Langor a former Harvard Psychology professor's work. Langor advertised for 100 volunteers aged over 70 years. She took them to a Monastery outside Boston to play "Let's Pretend". They were divided into 2 groups each of which resided in a different part of the building. One group, the control group spent several days talking about the 1950s. The other group, the experimental group had to live as if in the year 1959 and talk about it in the present tense. What appeared on their TV screens were the old newscasts and movies. They read old newspapers and magazines of the period. After 3 days everyone was photographed and the photographs judged by independent judges who knew nothing of the nature of the experiment. The experimental group seemed to
have gotten younger in appearance. Langor then arranged for them to be tested for 100 physiological parameters of aging which included of course blood pressure, near point vision and DHEA levels. After 10 days of living as if in 1959 all parameters had reversed by the equivalent of at least 20 years.
Chopra concludes from Langor's experiment: "We are the metabolic end product of our sensory experiences. How we interpret them depends on the collective mindset which influences individual biological entropy and aging."
Can one escape the current collective mindset and reap the benefits in longevity and health? Langor says, society won't let you escape. There are too many reminders of how most people think linear time is and how it expresses itself in entropy and aging - men are naughty at 40 and on social welfare at 55, women reach menopause at 40 etc. We get to see so many other people aging and dying that it sets the pattern that we follow.
Chopra concludes we are the metabolic product of our sensory experience and our interpretation gets structured in our biology itself. Real change comes from change in the collective consciousness - otherwise it cannot occur within the individual.
Readings
Chopra, D. The New Physics of Healing. 735 Walnut Street, Boulder, Colorado 83002,
Phone. +303 449 6229.
Coleman, J. C. Abnormal psychology and modern life. Scott Foresman & Co.
Lugo, J. and Hershey, L. Human development a multidisciplinary approach to the psychology of individual growth, NY, Macmillan.
Dennis. Psychology of human behaviour for nurses. Lond. W. B.Saunders.
