Most of us deny the aging process. As we get older, we sometimes refuse to admit that we don't see or hear as well as when we were young, and even if we admit it, we avoid getting glasses or asking people to speak up unless it is absolutely necessary. But old age comes, perhaps earlier than we expect it. The most rapid decline in the five senses—vision, hearing, taste, touch, and smell—occurs between forty and sixty years of age; however, these deficits are usually associated with people much older. Fortunately, because of the adaptability and the extra abilities possessed by most people, inability to cope and severe disabilities do not occur until seventy-five years of age or later. Yet community and even church programs often separate, stereotype, and stigmatize older people.

        We need to analyze our attitudes about aging and the aged. When you see a person fifty years of age, do you see a person whose life is half over or one who has half his life yet to live? When you look at yourself in the mirror, do you see signs and marks of a life lived and appreciated or do you regret the passage of time? Would you like to return to your younger years?

        Who is old? Is it a ninety-year-old woman who says that she will not participate in a senior citizens center or the Church's Special Interest program because that's where all the old folks are? Is it the sixty-five-year-old who complains about retirement, about his children, about the way society deals with older people? Or is it the woman who is twenty, thirty, or forty years old who complains about what the passage of time has done to her? Many people believe that the only people who are old are those who are older than themselves. Other people consider themselves old if others define and treat them as being old.

        When I was working with elderly Indians in Arizona, a seventy-one-year-old Navajo woman said to me, "I didn't know that I was old until last fall when I was picking an apple off my tree and fell down. As I lay on the ground, I realized that no one had pushed me. I did not trip over a stone. I simply fell down. And, as I looked to the heavens, I said, 'Lord, I must be getting old."' That statement was confirmed when a few days later a worker with a nutrition program for the elderly called at her home. The worker said, "Irene, you qualify as a senior citizen, and we would like to have you come to our nutrition site and enjoy a good meal and socialize with others who are there." Irene had fallen, someone had said she was a senior citizen, so she decided maybe she was old.

        Being old is a perception and an attitude. Some people who are chronologically in their nineties display youthful attitudes, intellect, and enthusiasm, and stay in good physical condition. It is up to each person to decide if he will let others influence the way he perceives his later years.

        On the other hand, being old is also a time in life when people lose loved ones, lose physical agility, and must depend more on others. They often cause families, neighbors, Church members, and the community to face diseases—often deteriorative—and circumstances they have never dealt with before.

        Nevertheless, it is important to understand that there are greater differences among older people than there are similarities. No two people are the same. The freedom we allow and the encouragement we give to people of all ages is critical to building the self-awareness, self-esteem, and independence of older people. We sometimes tend to lump people together, to force all people of certain ages into similar molds. But people are more individualistic and unique when they are older than they were when they were younger. As you are around and work with older people, be sensitive to their uniqueness, for it is impressive, and it is also one of their strengths.

1. Preparing for and adjusting to retirement.

2. Anticipating and adjusting to lower and fixed incomes after retirement.

3. Establishing satisfactory physical living arrangements.

4. Adjusting to new relationships with adult children and their offspring.

5. Learning or continuing to develop leisure time activities to help replace role losses.

6. Anticipating and adjusting to slower physical and intellectual responses.

7. Dealing with the death of parents, spouses, and friends.

        The Young-Old people can be a powerful force in changing laws that will assure that they benefit from an economic system they contributed to for so long. They can also be a great force to be called upon in the Church to help others who are in difficulty; to advise, counsel, and teach the young. Their experiences have given them administrative knowledge, family wisdom, and solutions to many problems. However, time demands on the Young-Old must be offered with the same reverence, prayer, and respect due those of any age group. In addition, a sensitivity to their age limitations, family commitments, and so on is crucial. To assume that a retired couple would be ideal to serve in a nursery or that they should usually tend their grandchildren may be incorrect.

        The other group of people, the Vulnerable-Old, often suffer from loss of hearing or sight. They may have various arthritic or respiratory ailments. Many suffer from some form of cardiac decompensation or from kidney and bladder problems. Diabetes is another common problem of this group. Yet these people continue to survive despite these losses, and are often happy and cheerful.

        People over seventy-five face the following tasks and challenges:

1. Learning to combine their growing dependency on others with their continuing need for independence.

2. Adapting to living alone.

3. Learning to accept and adjust to possible in-home services or institutional living (nursing homes).

4. Establishing an affiliation with their age group.

5. Learning to adjust to heightened vulnerability to physical and emotional stress.

6. Adjusting to losses of spouse, home, and friends.

7. Adjusting to the loss of physical strength, to increased illness, and to the approach of death.

        The Vulnerable-Old have more difficulty than the Young-Old in making friends, maintaining old friendships, and contributing what they would consider their fair share toward church, neighborhood, and community activities. They frequently suffer from isolation—more social isolation than geographic isolation. Their need to be needed is strong and presents a challenge that a counselor can help creatively fill.

        To accurately assess the needs of older people is difficult. But if we focus on their tasks and challenges, understand the personality changes that occur with the passage of time, and then learn about the physical changes of old age, we will have a better chance to deal with problems of the aging more effectively.

        True senile dementia occurs when brain cells die. This condition occurs largely because of cerebral arteriosclerosis, or hardening and narrowing of the arteries. With this hardening, less blood is able to flow into all parts of the brain, and without adequate nourishment, some brain cells die. Senile dementia may also be caused by primary degenerative disease of the brain.

        There is a major problem in making an accurate diagnosis of senility, because other causes may restrict the flow of blood or the amount of oxygen or nutrients in the blood that feed the brain cells, such causes as congestive heart failure, malnutrition, infection, stroke, combination or overdose of drugs, head trauma, alcoholism, anxiety, and depression. All of these causes, however, are treatable and therefore reversible. Only in cases of true senile dementia (approximately 2 percent of older people) is the condition irreversible.

        To assure the family and yourself as a counselor that a diagnosis of senile dementia is accurate, you should select a physician trained in geriatric medicine and consult with a geriatric nurse clinician.

Depression
        Older people who are frequently depressed appear to be suffering from chronic brain syndrome. They seem disoriented, confused, and show memory losses. Because there is a steady rise in depressive conditions with advancing age, depression is a common complaint among the elderly. Social, psychological, and physical changes of old age create difficult problems and make the aged person vulnerable to frustration, failure, grief, disappointment, and apathy. Physical losses and disturbances in the brain may maintain and increase the depressive state.

        Loss of physical health is often depressive, so a counselor should look to prevention and early detection of illness. Depressive states in the elderly often go unnoticed, perhaps because many people assume that older people are by nature somewhat confused and apathetic. This expectation that older people are senile masks the depression.

        Important points to consider about depression in older people include the following:

1. The aged may have difficulty dealing with physical health and social-psychological losses. There is a close link between physical health and mental health. Pay careful attention to the extent of vision and hearing loss, ability to move around, and loss of status. Helping the older person substitute or compensate for such losses will help reduce depression.

2. Anxiety, insomnia, lack of proper nutrition, and energy loss may indicate an underlying depression and, in addition, may contribute to its continuation.

3. Depressions may mimic organic brain syndrome.

4. Apathy is characteristic of depression in the later years.

5. Depressed people are usually not disoriented.

6. Medications can bring about depression.

        Help the older person with depression from loss of status and self-worth to find an activity of genuine interest and to develop relationships with others. Work with the person's family, with his ward members, with his neighbors, and with the community. With more severe depression (because of death of a loved one, serious illness, or other losses), help the person find an "intimate confidant," a person who will be an active listener. The release of grief and anger is liberating, but it is not enough. Listening should be combined with encouragement and reinforcement to help the person establish self-awareness and self-worth.

        Loneliness can be difficult to treat mainly because it is an individual matter and deeply rooted in the self-esteem of a person. Constant effort should be made to bolster the person's self-esteem through frequent contact and acknowledgment on difficult days. Acknowledgment and praise for the smallest gain or positive change in an older person's behavior bolsters his self-image and lets him know that someone cares.

        In relationships with older people, we should be willing to experiment in trying to help those who are lonely. We should be creative in our approaches and encourage interaction of those who are lonely with other people of all ages and in all kinds of activities.

        Despite their many chronic health problems that develop with increasing age, most older people do not consider themselves to be seriously handicapped in pursuing their ordinary daily activities. Though four out of five persons who are sixty-five years of age and over suffer from at least one chronic medical condition, less than one in five report that they are severely handicapped or that they are unable to carry on major daily activities. Generally, most elderly people rate their health as fair, good, or excellent rather than as poor.

        The best way to help people with chronic illnesses is to be supportive and help them manage their disease. We can help with shopping and provide encouragement, companionship, transportation, and help with illnesses or disabilities. We can learn about community support agencies and get help from medical and health professionals in emergencies. Treatment of one disease without knowledge of the other diseases that might accompany it could be disastrous. We should encourage the use of a reputable physician trained in geriatrics and a chemical pharmacist who sees older people regularly and knows their disease and drug histories.

        In-home services include home repairs, shopping assistance, meals on wheels, friendly visitors, volunteer services, telephone reassurance, homemakers, chore services, and home health services. These services are usually inexpensive and can help maintain an older person without placing him in an institution.

        Community services range from social and recreational clubs to community mental health centers. Often the Area Agency on Aging or a community services council maintains a directory listing all the community agencies and the services they deliver. The directories are often free or may be purchased for a nominal fee.

        Community living includes homes and other living arrangements that can provide support and social interaction for an older person. Hospice organizations provide support for a dying person and their families. This support can be delivered as in-home services or as services within a hospice. The professional services allow an older person to die at home or at least outside a hospital.

        Institutional living includes intermediate care facilities, which generally have nursing staffs that are present only during the day, whereas the other types of institutions in this category have nursing and often other health disciplines represented twenty-four hours a day. Only 5 to 6 percent of the population sixty years of age and older are in nursing homes at any one time in the United States, but there is about a 22 percent chance that an older person will spend some time as a patient in a nursing home during his lifetime.

        Conditions that promote institutionalization are usually advanced old age; multiple physical and mental impairments; and lack of economic, family, and social support. The financial resources available to a person from his own private sources, from family, and from federal programs often determine whether he can take advantage of some of the services he needs. In some cases, the most appropriate placement cannot be made because of financial limitations. The eligibility criteria, the range of benefits, and the administrative and admissions arrangements of community agencies and services often control the decision for services.

        The family is interested in the welfare of their older relative but often are unknowledgeable and fearful. It is imperative that others involved in planning help the family work through their feelings. The family is often disheartened, unhappy, frightened, and guilty. Adult children feel that they are rejecting their aged parents. These feelings come even when the only possible solution is institutionalization.

        Some family members find it too painful to watch the deterioration of an older loved one or maintain a distance because of unresolved conflicts. Families may find it difficult to visit long-term care facilities or to watch the degenerative process that changes the personality and appearance of their loved ones.

        If institutions cannot be avoided, it is important that the entire family be encouraged to continue to care for the older person. The counselor should tell the family that there will be difficult times, such as admission day to the institution, and that often on holidays and certain times of the day the person may feel abandoned and forced to be there against his will. Regular visits and planned activities with the older person are crucial to his well-being and happiness.

        The family is the key to adjustment of the elderly. They can draw on great strengths within themselves, their relatives, their neighbors, and the Church to maintain an older person at home.

Suggested Readings

Janet Brigham and Terry Mayer, "When Members Have Long-Term Needs," Ensign 9 (July 1979): 10-13.

Brent D. Cooper, "We adopted Some Grandparents," Ensign 11 (August 1981): 48-49.

William Fox, "Don't Call Me Old What's His Name," Ensign 9 (June 1979): 69.

Ron and Sheri Zirker, "Making Room for Grandpa," Ensign 11 (February 1981): 44-47.

About the Author

Dr. J. Richard Connelly, associate director of the University of Utah gerontology program, received his bachelor's and master's degrees in sociology from Brigham Young University and his Ph.D. from Pennsylvania State University. He has taught courses in human development, aging, child development, and family relations. He has also been involved in the development and administration of gerontology programs at the University of Utah and Oregon State University and screening centers for the elderly. Dr. Connelly is a consultant to state and private agencies and programs relating to retirement and care for adults and older people.

An author and lecturer, Dr. Connelly is a member of several professional and honorary organizations.

In the Church, Dr. Connelly has served in two bishoprics, as a stake Sunday School president, and as a high councilor.

He and his wife, Cheryl Ann, are the parents of eight children.