The statistics concern me. Most of the adults now entering the mental health professions (who were born in the 80s and 90s) lived in two generation households while growing up. According to a Pew Research Center Social and Demographic Trends project, by 1980, only 12% of Americans lived in families of three generations or more.
That trend is slowly reversing because of current economic pressures, up to 16% by 2008. But that is still only 16%. Many young clinicians only saw grandparents on holidays. Many have never known an elderly person up close and personal.
Those of us who work with seniors know that the last quarter of life has its own richness, delights and challenges. The “golden years” can indeed be golden. Those fortunate to have good health, to be surrounded by family and friends who are physically well and who have a good enough retirement income can enjoy an active social life, travel, and activities that may have been put off when time was limited by work and raising a family.
But those are not generally the people we see in treatment. For seniors who make it to a therapist’s door, the golden years aren’t all that golden. To serve them well, Millennials, Generation Y, and Gen Next (those who are now between ages 24 – 38) who haven’t had the opportunity to personally know elders, need to educate themselves and be specifically supervised to be effective with senior clients.
The following challenges are common for all seniors. But seniors in distress often don’t have the internal resiliency or the external supports they need to manage them well.
Physical limitations: My 90-year-old friend George told me that any gathering of his peers starts with an “organ concert.” “How’s your kidney?” “How’s your heart?” “My stomach is bothering me.” It’s not morbid. It’s usually not just a litany of complaints. It’s an attempt to manage health concerns with humor while at the same time updating each other on their vulnerabilities. Treating elders means supporting them while they deal with the normal and difficult physical limitations that come at some point to everyone.
Memory and cognitive decline: People with advancing dementia talk about the frustration and fear that accompanies a gradual loss of memory, common skills of everyday living, and ability to communicate. Some are very worried about what will happen if their families find out. Will they lose their license? Will they be infantilized?
(For an excellent overview of patient experience, see Suffering from dementia – the patient’s perspective: a review of the literature by Marike E. de Boer,1 Cees M. P. M. Hertogh,1 Rose-Marie Droes, ¨ 2 Ingrid I. Riphagen,3 Cees Jonker2 and Jan A. Eefsting1: International Psychogeriatrics (2007), 19:6, 1021–1039) Clinicians need to educate themselves about the various forms of dementia and how best to support clients and their families as the disease progresses.
Change in identity: Those who retire from a career, even a career they didn’t like, often suffer from a loss of the identity that came with it. Those whose career was raising children and being active in the community sometimes don’t quite know who they are when those roles are dramatically reduced or over. Our clinical work includes redefining the source of self-esteem and supporting efforts to find new activities that are meaningful and pleasurable.
Loss of friends and family: Sometimes our patient is the last of a friend and family circle. As one of my patients said, “I’m the last one standing.” She was 95. As the youngest of eight siblings, she had attended funerals of all of her sibs, all of her sibs’ spouses, and most of her nieces and nephews.
All of her closest friends were already gone. The few who were left had dementia and were sick. She felt alone and lonely. Even those fortunate enough to still have peers who are alive and well know that the situation can change in a moment. Our job is to help our clients grieve those they have lost, find ways to be there for friends who are sick and dying, and find new social relationships.
Letting go of “stuff”: The kids have grown. The house gets too big. The stuff accumulated over 40 or so years begins to be overwhelming – and the kids make it clear they don’t want most of it. Sometimes, it’s liberating to start downsizing. Sometimes, it’s very difficult to realize that things they’ve treasured aren’t valued by others.
Senior clients may need help to sort out their feelings as they sort out their material possessions.
Family tensions: More than a few seniors have been brought to me by their adult children. “Maybe you can talk sense into him!” they say. Or: “She’s always been difficult. Make her change.” Changing a 80+ year old’s personality and behavior is unlikely. Changing the family dynamics isn’t.
Although I’m happy to have a session or two with the senior, ultimately I want the family to join us to try to make peace with each other. Often members in a conflicted family are willing to give it a try as they understand it’s a “last chance.”
Mortality: Seniors who come for therapy usually want to talk about end of life. No matter how physically and mentally fit they are, they know death is inevitable. Some respond with fear, some with depression, some with a basket of “should ofs-could ofs-would ofs”that only make them feel badly.
Some react with acceptance and even some relief. Their challenge – and ours – is to find ways to heal the things that can be healed and to make peace with those that can’t; to let go of old hurts and pain; and to embrace the parts of their history that have been well-lived.