Archive for February 20th, 2011

THE ELDERLY

Sunday, February 20th, 2011

On his show many years ago, Art Linkletter was interviewing children, and they came up with the following answers to a question he posed: “You can’t play with toys anymore…the government pays for everything…you don’t go to work…you wrinkle and shrink.” The question was “What does it mean to grow old?” The responses of the children contain many of the stereotypes our society attributes to the elderly. They also show that this negative picture develops from a very early age. There is a stigma to growing old. The notion is that for the elderly there is no play or fun, no money, no usefulness, and no attractiveness.
It is important to recognize that in considering the elderly, we all really are talking about ourselves. It is inevitable: we will all age; we will all become the elderly. A participant at a recent geriatric conference reported being asked by a friend, “Give me the inside scoop… what can I do to keep from getting older?” The response the person received was simple: “Die now!” There is no other way to avoid aging. So, for those not themselves among the elderly, in thinking about the older person, imagine yourself years in the future, because many of the circumstances will probably be the same.
Of the approximately 240 million people in the United States, 29 million are over age 65. This is the group arbitrarily defined as the elderly, or aged. Each day, 3000 die and 4000 reach their 65th birthday, so there is a net gain of 1000. By the year 1990, it is estimated that over 35 million persons will be over age 65; this will represent a larger percentage of the population than ever before. Consequently, the problems of the elderly, including alcoholism, that will be discussed are going to become a growing concern for our society.
Coping styles. Despite the inevitability of aging and despite the inevitability of physical problems arising as the years pass, there is an important thing to keep in mind. It has been said many times and in many different ways that you are as young as you want to be. This is only possible, however, if the person has some strengths going for him. The best predictor of the future, specifically how someone will handle growing old, is how the individual has handled the previous years. Individuals who have demonstrated flexibility as they have gone through life will adapt best to the inevitable stresses that come with getting older. These are the people who will be able to feel young, regardless of the number of birthdays they have celebrated.
Interestingly, as people get older, they become less similar and more individual. The only thing that remains alike for this group is the problems they face. There is a reason for this. Everyone going through life relies most heavily on the coping styles that seem to have served them well previously. With years and years of living, gradually individuals narrow down their responses. What looks, at first glance, like an egocentricity or eccentricity of old age is more likely a life-long behavior that has become one of the person’s exclusive methods for dealing with stress. An example illustrating this point arose in the case of an elderly surgical patient for whom psychiatric consultation was requested. This man had a constant smile. In response to any question or statement by the nurse or doctors, he smiled, which was often felt to be wholly inappropriate. The treatment staff requested help in comprehending the patient’s behavior. In the process of the psychiatric consultation, it became quite understandable. Friends, neighbors, and family of the man consistently described him as “good ole Joe, who always had a friendly word and a smile for everyone, the nicest man you’d ever want to meet.” Now under the most fearful of situations, with many cognitive processes depleted, he was instinctively using his faithful, basic coping style. Very similarly, the person who goes through life with a pessimistic streak may become angry and sad in old age. People who have been fearful under stress may be timid and withdrawn in old age. On the other hand, people who have been very organized and always reliant on a definite schedule may try to handle everything by making lists in old age. What is true in each case is that the person has settled into a style that was present and successful in earlier life.
Main stresses. In working with the elderly, in order to understand what is evolving in an individual case, it is imperative for helping professionals to consider every possible piece of information. Integration of data from the social, medical, and emotional realm is essential for understanding what makes the elderly person tick in order to make an intelligent treatment plan. Four areas of stress should be considered in dealing with the elderly: stresses that arise from social factors; psychological factors; biological or physical problems; and, unfortunately, iatrogenic stresses due to the helping professions as they serve (or inadequately serve) the elderly.
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