A new book challenges concepts of "successful aging" and counters cultural notions that equate aging with decline.
In Contesting Aging & Loss (University of Toronto Press), medical anthropologists Janice Graham and Peter Stephenson invite readers to listen to the views of elders themselves.
The co-editors bring together a rich, though disturbing, collection of studies in this powerful book. Lively voices from Canada, the Netherlands, South Africa and Australia maintain that later life is important and full of potential.
Dr. Graham is Canada Research Chair in Bioethics and Director of the Qualitative Research Commons & Studio in the Faculty of Medicine at Dalhousie University, Halifax, Nova Scotia and Dr. Stephenson is a Michael Smith Foundation Research Associate at the Centre on Aging, and Director of the School of Environmental Studies, University of Victoria, British Columbia.
To learn more, AHB tracked Dr. Stephenson down at the University of Victoria.
Ruth Dempsey: Experts have defined successful aging as the avoidance of disease, plus engagement in social and productive activities. So what did octogenarians have to say about it?
Peter Stephenson: You are referring to the study led by researchers at the University of Amsterdam. They found Dutch elders did not define "success" in the way that social workers or gerontological researchers did. They defined it as accepting their limitations in a more-or-less cheerful but realistic way. So rather than focusing on physical health, they emphasized the importance of adapting to health problems and maintaining social connections.
The point is most of the people in the study, who thought of themselves as aging successfully, would not have met the "professional" criteria for successful aging – things like how frequently one goes to the bathroom during the night or gets out to events during the day.
I find this both sad and a frustrating. Expecting our elders to live up to a list of externally defined expectations is like saying to them, "You’re not cutting it any more." After all, it is how individuals define their own life that helps them to maintain dignity and well-being.
RD: Researchers also talked to Italian-Canadians about la buona vecchiaia ("the good old age").
PS: That’s right. The Italian Canadians, mainly living around Hamilton in Ontario, had a similar response to the Dutch elders despite obvious cultural differences.
They talked about successful aging as the ability to cope and understand, to empathize and to see one’s own situation clearly. Again, the meaning older adults attach to a good old age go far beyond physical health.
It’s all about how people in a community define success, and, for Italian Canadians, a lot of that definition was about relationships, especially relations with the broader Italian community itself.
RD: That reminds me of Zia Rosina. She is the 83-year-old widow who was unable to get out of bed one morning due to a severe case of osteoporosis. Determined to remain in her own house, she purchased a cane and walker. She received homecare assistance and struggled through months of physiotherapy until she was again able to care for her needs. Rosina viewed her ability to manage this setback as an accomplishment and spoke about it with pride.
PS: That’s why the current view of aging is a problem. It gives rise to an image of older adults as only victims. It masks the rich diversity of the aging experience. The point is elders like Zia Rosina are not passive.
RD: So you looked at what happens when older adults land in the hospital. You interviewed patients, who were hospitalized for acute care in one of three major hospitals in Victoria, B.C. What stands out for you?
PS: The most un-nerving discovery for me was the over-crowding and the lack of cleanliness, brought on by cuts to hospital cleaning staff. These are optimal conditions for breeding all manner of bacterial and viral agents that can kill weakened people, including of course, lots of elderly people. I’m thinking mainly of Clostridium difficile, but these conditions give rise to many other diseases, including big killers like pneumonia.
I think of the elderly patients whom we interviewed as being very observant "canaries" in the proverbial mineshaft. These people know what hygiene looks like because they grew up in an era where it was the main way of combating infection. So when they describe a modern hospital as a "swamp", we fail to listen at our own peril, as well as theirs.
RD: Many patients expressed frustration. For example, Mike couldn’t reach his food because somebody didn’t put the tray in close. Others had to endure long waits to get to the bathroom because bed rails had to be adjusted. And patients with insurance for private and semi-private rooms couldn’t get access because of overcrowding.
PS: I think a big part of the frustration is a loss of "agency." That makes people feel like they have no power, particularly if they do not speak out against mistreatment. They are in a kind of double bind. If they are quiet and docile, they get run over. If they speak out, they are considered a "troublesome" old person. Neither is likely true, but it’s a pretty common for people to feel trapped in that way.
We really need to listen to what older people tell us. And we need to avoid scripting them based on questionnaires that reflect what researchers or caregivers deem important. That’s extremely condescending.
What does the older person think might be helpful? Easier access? Lowered bed rails? The point is to see the difficulty as being one for the older person, not just the care attendant.
RD: Older adults wanted low-tech support to remain in the community . . .
PS: We should never underestimate the importance of:
- meaningful social contact;
- a clean environment;
- decent home-cooked meals;
- better lightweight wheelchairs and walkers;
- good hearing aids;
- the right prescription for eyewear; or
- a visit from a friend with a dog on a regular basis.
These things keep people engaged in ways that they want to be engaged so they are in some control and a have sense of security. And that means tailoring care to individuals, not just creating policies for groups.
A lot of that begins with respect. If older people are not being respected, legal steps can be taken to remedy the situation. I think we need a lot more advocacy for older people in the arena of human rights tribunals, and we also need legal action taken against those who discriminate against older citizens. I haven’t really seen a lot of that yet. Much of what gets called "advocacy" is consumer lobbying by groups trying to get better insurance rates or less expensive pharmaceuticals.
Meanwhile, the atmosphere – of unrelenting loss around aging – is depressing. I’m sure that it contributes not only to a lower quality of life, but earlier death in some cases. After all, depression lowers resistance to disease and increases self-destructive behaviors.