May 23, 2009
True Grit: Growing Old in AmericaBy Judith Acosta
I was sitting near a fountain in Old Town and an older man approached the penny-filled catch pond with an expression so earnest I might in other circumstances have easily confused it with reverence. He closed his eyes and held a coin in his fingers like a rosary. His lips moved but I heard nothing. After what seemed like a very long moment, he tossed his coin into the water, slowly crossed the small brick plaza and sat near me.
I had been taught to never ask a person what he wished for. But he offered.
"Know what I wished for?"
"No. I guess most people wish for money."
"They overestimate the power of it. No. I wished for this."
"To sit and talk to a pretty girl."
"I think I stopped being a girl a long while ago," I said and we both smiled. We talked for almost an hour. I found out where he had been born (Pennsylvania), what he did for a living (machinist), what happened to his wife (died of lung cancer five years before), how many kids he had (three, all of them in Pittsburgh), and that I could call him Mr. Garry (name changed). He spoke mostly of his boredom and his isolation, especially in comparison to the busy life he led when he was married, working, and raising a family. "You know why I like this place? Tourists like to talk."
When I finally had to leave, he rose and shook my hand in both of his. I could feel the bones in his palms. "Thank you," he said, nodding his head as if tipping a hat, and walked back across the plaza.
It has been said that the quickest way to disappear in western culture is to get old.
Nothing averts the gaze of the passerby quite as quickly as accidentally locking eyes with an octogenarian or so suddenly diminishes the invitations to social gatherings as wrinkles that will no longer be lifted. Ours is one of the few civilizations in recorded history that not only ignores the aged but devalues them. The way we have placed such emphatic priority on youthful sexuality, incessant and needless entertainment, and endless consumerism has in effect put the accrued wisdom of the elderly at philosophical and spiritual odds with everything the modern American marketplace stands for. We are a nation of Peter Pans and we believe that somehow we can avoid growing up if we just pretend that aging, like death, is for someone else, not us. And like very young children we cover our eyes and make believe the aged are not there.
They are our parents, our friends, our aunts, our uncles, and our neighbors. Why have we cut them out like this? We are presumably more civilized, more technologically advanced, more compassionate and more capable of caring for others than any civilization before us. Yet, if our media is any indication, they barely exist. Among the many-and I believe, primarily spiritual-reasons for this negation of aging, there is a purely pragmatic one that has been so inextricably folded into our culture as to be barely noticeable: To be valued, one must be marketable. And to be marketable, one must be sexy. To be sexy, one must be young (the younger, the better). Even the race for the president of the United States is subtly spinning on this unflagged but insidious current. It is not new. It is one of the ways John Kennedy won almost 60 years ago.
This is no small problem for America, because the truth of the matter is that as a country we are aging. And rapidly.
The number of Americans aged 55 and older will almost double between now and 2030 - from 60 million today (21 percent of the total US population) to 107.6 million (31 percent of the population) - as the Baby Boomers reach retirement age. During that same period of time, the number of Americans over 65 will more than double, from 34.8 million (12 percent) to 70.3 million (20 percent) by 2030. And the aged amongst us are living longer than ever before, even when they are seriously ill. ("Chronic" illness is a relatively new phenomenon. Before the last century, if you got sick you either died or got better in a fairly short amount of time.)
At the same time, continuing a steady 12-year decline, the U.S. birth rate has dropped to the lowest level since national data have been available (CDC). So from a purely statistical standpoint as the baby-boomers reach seniority, the number of young people available to support and care for them is dramatically decreasing.
The irony is that while the increasing number of elderly in America may need more care and companionship than ever before, many, like my friend, Mr. Garry, will in fact be more alone. With less family living nearby, fewer social invitations, and little or no value in a world that places material success on par with spiritual salvation, they are often stuck at home, unable to care for themselves well or at all, and dependent upon government services instead of family. For many Americans, particularly those who live in front of the television, the aged and infirm are all but invisible.
Most Americans avoid spending time in hospitals with the sick and dying as assiduously as they avoid paying taxes. But there are people who not only take an interest but dedicate their professional and sometimes personal lives to it.
"I am one of the few people to really see them," one social worker who works with the aged and infirm said. "I listen to them. Their experience doesn't scare me. I see my role as that of a sacred witness. Often, I am the only one that does...stand by them with eyes wide open."
The lack of attention to the elderly stands in very sharp contrast to the native experience of many immigrants. Fernando Delgado, a well-known artist and photographer in New Mexico, came to the United States at 12 years of age with his parents and younger brother from Cuba. A sister and her husband had arrived before to prepare the way. As he recounts it, it was nearly unheard of to bring an aged relative to an institution. "It's very different in the United States when it comes to caring for the elderly.
"In this country, we make the time to take care of a newborn baby. With the elderly, it's the total opposite. Old people become like babies, but no one wants to take care of them. I was brought up to believe that we take care of our elderly the way we take care of babies. Our families are extended to include aunts, uncles, cousins. It's not limited to parents. Even people who were mentally ill were kept at home in Cuba. It was a family issue, not a government or system issue.
"My mother died at home when she was 65. She'd suffered from cardiovascular disease for many years, had multiple strokes, and was in and out of hospitals and doctors' offices until they said there was nothing else they could do. So we brought her home. We took turns, my brother and I, while she was sick and when she became critical I took a year off from school to care for her."
The manner in which the elderly were encouraged to socialize was also different.
"The family is a major source of support, but so is the community. People, no matter how old, are included. Children, young adults, the aged-everybody goes everywhere together."
"Who Will Want Me? I'm Old."
Sara M., an older woman who had lost her husband after a long battle with congestive heart failure went to a therapist in New York City. She was attractive, even at 71 years of age, bright, and still active. Because her husband had been gone for almost five years, the question was eventually raised, "Had you considered remarrying or having a companion?" Her response was sharp, unedited: "Who'll want me? I'm old." She kept calling herself depressed, but in reality she was lonely and she seemed bound to stay that way because she believed that her age made her unlovable.
According to a growing number of mental health experts, loneliness is the greatest contributing factor to all manner of illness in our culture. University of Chicago psychologist John Cacioppo and writer William Patrick in their book Loneliness (WW Norton, 2008) state that loneliness is so serious a condition that it puts people at risk for heart disease, cancer and respiratory and gastrointestinal ailments. Citing three decades of research, they point out that loneliness can disturb our levels of stress hormones, immune function, and even gene expression, while positive human interaction increases levels of oxytocin, a bonding hormone that reduces blood pressure and cortisol levels. In this sense, loneliness is transformed from a purely "emotional" state to a measurable biochemical one.
"Western societies have demoted human gregariousness from a necessity to an incidental," the authors write and point to the fact that an overwhelming number of people (27 million) in the United States now live alone. They claim that "the results can be devastating, not only for the individual, but for societies as well."
In no segment of society is this more poignant or disturbing than in the elderly. In 1987, 8.5 million elderly lived alone; by 2020, 13.3 million elderly will live alone. More than 6.5 million, or 77%, of all elderly living alone are women. Among those over 85, 52% of women live alone compared to 29% for men, with widowhood being the predominant contributing factor. Sara's situation is far too common. And so is her misinterpretation of her own needs, branding her sadness and loneliness "pathological" rather than seeing it as a normal human need, albeit a thwarted or frustrated one.
Patch Adams, the doctor made famous by the movie of the same name, had been known to say that anti-depressants are really anti-loneliness pills. Both his personal experience at being hospitalized for depression and later his professional experience as a medical doctor in a clinic, led Dr. Adams to believe that loneliness was the culprit behind innumerable disease states. As more current research indicates, he was right.
In 2007, a study reviewed on WebMD Health News and reported in Current Directions in Psychological Science concluded that the unhealthy effects of loneliness accumulate with time and may contribute to the wear and tear of stress and aging on the body. In the study, researchers Louise Hawkley and John Cacioppo of the University of Chicago compared stress levels among college students (avg. age 19) with middle-aged and older people (avg. age 57). They found that although those who described themselves as lonely reported the same number of major life events as others, they were significantly more likely to report an increased number of chronic stressors and unhappy childhood events.
In the older group, the lonely adults had higher blood pressure and presented urine samples with higher levels of the stress hormone epinephrine than adults who were not lonely. The results also showed that not only did lonely people perceive their past in a more negative light, but they were also more likely to feel helpless and threatened in their current situations and, ironically, less likely to seek help when they were stressed out.
Samuel Quiles, LISW, a social worker currently employed with the University of New Mexico Hospital, worked for many years as a case worker with a home care agency in southern New Mexico, where he made personal and regular visits to the elderly in his area. When asked to comment on the mental health needs of the elderly in the state, he became impassioned: "The topic is so important when you provide health care in New Mexico. There are so many retirees here. To find a lower cost of living, they have to pick up and leave everything and everyone they know and come to places like Elephant Butte or Truth or Consequences, where I used to live. Eventually, it catches up. Health care is inadequate in smaller communities and there is limited preventive care. Most of the time they have lousy insurance, if they have any at all. When they finally get sick they are in the unenviable position of having no other family with them. So it is one person, if they are lucky enough to have a spouse or partner with them, who is faced with the task of caring for them and managing their finances, their health care, and all their domestic needs. It is very lonely."
When Courage is Not Enough: Depression.
One man described aging in America in an unusual and poignant manner. "Everything changes when you're alone. When you were little and you were learning to ride a bike, you probably had someone's hand holding the back of your seat until you got steady. I did. Even after my dad pulled his hand away, it still felt like it was there and I could see him near me. If I fell, I knew it wouldn't be such a big deal. When you get old in America, a lot of the time you're alone. And when you're alone, failure is bigger and meaner. Everything changes."
As a result of their rapidly changing physical and social conditions, the mental health issues facing the elderly are numerous and potentially critical. According to mental health experts, there are several particularly important challenges that a man like Mr. Garry and a woman like Sara face in America which specifically contribute to their marked tendency towards loneliness and depression.
Reduced activity and productivity in a capitalist culture
According to a 2002 survey conducted for Civic Ventures, 59 percent of older Americans see retirement as "a time to be active and involved, to start new activities, and to set new goals." Just 24 percent see retirement as "a time to enjoy leisure activities and take a much deserved rest." Those who plan to work through their retirement years cite the desire to continue belonging and participating in life, rather than economic necessity, as the primary reason. More than half of the respondents (56 percent) say civic engagement will be at least a fairly important part of retirement. (Peter D. Hart Research Associates, "The New Face of Retirement: An Ongoing Survey of American Attitudes on Aging," San Francisco: Civic Ventures, 2002).
Not all of those who retire, however, are able to do all the wonderfully productive, socially conscious things they set out to do. Because of their age and "liability issues," many are unable to continue in their chosen careers, even as volunteer advisors or mentors, and may be found greeting you the next time you shop at Wal-Mart. In addition, more than a fair share finds it hard to do anything, for though they surely didn't hitch up the RV with the intention of getting sick, many do. What happens as a result of all that uselessness is, as one social worker put it, a pan-psychological crisis.
Reduced social, spiritual and cultural value
The elderly in America simply don't count in the same way Hannah Montana does. Clout in a material society is measured in consumer units, not in spiritual wisdom-unless of course that spirituality is translated into book sales, CD's, or sellout "seminars" at the Houston Astrodome.
This is a relatively new phenomenon in human history. Most cultures -- whether they be Judeo-Christian, Hindu, or Buddhist -- have placed great emphasis on the honor of one's ancestors and the respect of one's elders. In some traditions older people were even considered to be witnesses to the eternal. From that vantage point one honors God by honoring the elderly who, in the fullness of their age, reflect the presence of Spirit.
But in the modern age, we have placed more emphasis on success than on spirit, and in so doing have effectively shunned the elderly and denied both them and ourselves of the contribution they can make in their later years. We refuse to acknowledge that there is anything they can teach us. This arrogance eventually will exact a heavy price for we create the very world into which we ourselves will be received as old people, should we live long enough.
The effect on the aged is pronounced and expectable and may be compared to the emotional experience of standing outside alone when the party is going on inside. Even a Google search on aging drew forth thousands of sites dedicated to dermatology, plastic surgery, and youth-brews from the pharmaceutical companies, but comparatively little was found that directly commented on the cultural value of the elderly.
The elderly often suffer from some degree of loss of mental dexterity. This is not necessarily a function of Alzheimer's, but a more expectable result of the kind of longevity Americans have come to expect. Not only do they move a bit more slowly on the tennis court, but they're not thinking as fast or retaining information as long. In other cultures and in other times, that was not always considered such a gross deficit. In many cases, it was considered an appropriate spiritual preparation for the transition from this world to the next. As the earthly faculties fade, others -- far more important and lasting -- step forth. No longer. Because in our modern culture, this world -- and what you can do in it -- is the only one that matters. It is the civilization that was built on Descarte's precept: "I think therefore I am," which the post-modern world has amended with: "And I think fast." When a person can no longer "keep up" he may rightly feel like debris on rushing floodwaters.
"Dementia was the greatest problem I saw in the field," Mr. Quiles recalled as he looked back on his years of service with the elderly. "Not only does it affect the patient, it affects the caretaker whether it's a family member or a nurse. They get accused of all sorts of things because of the paranoia. So, the patients aren't thinking straight, they can't function well and they chase everyone who wants to help them away. It's a nightmare.
"I knew a railroad worker when I worked in Southern New Mexico in Protective Services. He was about 80 years old. His wife took care of the house, the kids and the finances. They came from the east coast. They retired to New Mexico away from all their kids and grandkids because of the cost of living back there. They lived in a mobile home and for a while they were okay. They did what everyone does when they move here. They drove around, bought chucheria [knick-knacks]. But then she got sick. And he started forgetting things. I was called in when she was admitted to the hospital several times for COPD and their finances (which she had handled) started falling apart. They couldn't afford anything anymore. There went their life.
"He became more and more overwhelmed and couldn't function by himself. The neighbors called us to investigate him because he was messing around with the boiler and they had to padlock it. Eventually his wife got placed into a home run by the government, because he'd served in WWII. When she died, his kids came and got him."
He paused. "He was actually one of the luckier ones. Dementia feeds on isolation."
Geriatric depression affects more than six million Americans age 65 and older. Often, due to social isolation and concomitant medical conditions (including substance abuse) depression is either misdiagnosed or not diagnosed at all with as many as 90 percent of those presumed to be suffering with it receiving no treatment (neither counseling nor medication). Contributing factors include sudden or unwanted retirement, pain, excessive alcohol intake or misuse of prescribed medications, specific medical conditions known to trigger depression (stroke, renal failure, radical loss of function, respiratory insufficiency), loss of a residence, loss of a loved one, particularly a spouse. According to the National Institute of Mental Health, depression in the elderly is a major public health crisis with suicide rates in people over 80 more than twice that of the general population.
Depression not only proceeds from unwanted radical life change but produces more of it: It has been linked with an increased risk of cardiac disease, death following a heart attack, and lengthier recoveries from any illness. In short, it seems that growing old in America is not only profoundly depressing but that once you're depressed you age more quickly.
Even if we are not actively caring for an elderly person, people like Mr. Garry and Sara are with us all the time. Contrary to current media spin, it does not take a whole village to change the situation of the elderly in this country. It takes one person, one moment, one conversation at a local park, and, like a sacred witness, the willingness to see them.
Judith Acosta is the co-author of The Worst Is Over: Verbal First Aid to Calm, Relieve Pain, Promote Healing and Save Lives (2002), She is a licensed psychotherapist, hypnotherapist and crisis counselor.