Caring: Solving the Elder Life Crisis
By Bill Thomas and Jennifer Tucker
Imagine, if you will, waking up one day to find that you are no longer an accountant or a lawyer or an editor. Instead you are a caregiver. This is what happens to many people who are thrust into that role for a loved one — a job for which they are underprepared and untrained. They may also lack adequate support. Yet more and more adult sons and daughters are finding themselves in this situation as demographics shift and the elder population rapidly expands.
Fortunately, there’s a solution: professional caregivers, who are trained and educated to provide enriching care that empowers their patients. They understand that ultimately caring should involve a give-and-take relationship in which both people learn and grow. These partnerships have many benefits, as we have seen through our experience delivering person-centered, in-home care.
For instance, consider two approaches. In the first, a 90-year-old woman who was living with dementia defied stereotypes and taught her caregiver to knit. Now, the two spend much of their time together making blankets for soldiers and their families. The caregiver in this partnership was invested in “deeply knowing” the woman’s simple pleasures. As a result, not only did she learn a new skill, but she also developed a deeper relationship with the woman. This, in turn, allowed her to create a sense of purpose for an elder whose life and abilities had drastically changed. Meanwhile, a more traditional approach to care might have simply involved a caregiver coming in to dispense medications, change linens, and serve meals, without getting to deeply know the person for whom she was providing care.
Yet people who are included in their own care — whether by professionals, family, or friends — have more meaningful experiences that allow them to continue growing and developing as human beings regardless of age or ability. With care for elders increasingly turning toward the first type of approach, we have found ourselves at a turning point as we face a growing crisis.
Elder Life Crisis
Elders suffer from what we call an “elder life crisis” when they are not aging optimally in a caring environment that encourages them to find purpose in life. An elder dealing with an elder life crisis may experience what The Eden Alternative® has termed the “three plagues” — loneliness, helplessness and boredom — caused by a lack of true companionship, spontaneity, and the feeling that they have no purpose. Often, elders will show symptoms of crisis after a major life change, such as a move or a decline in their health that limits their abilities or changes their lifestyle. This decline in quality of life will often cause a decline in an elder’s will to independently manage their activities of daily living. So The Eden Alternative® seeks to alleviate these plagues through meaningful relationships. Working to build meaningful relationships can help restore a sense of “can do” in people of all abilities.
Consider a woman in her 70s who suffered a fall and broke her hip. During recovery, she used a wheelchair and needed assistance with some of her daily activities at home. Her adult children hired professional caregivers to help provide this care while they were at work. One of these caregivers noticed that the once-vibrant woman, who had a full social calendar before the accident, had become quiet and kept to herself. The caregiver engaged the woman in a conversation about her past social endeavors and discovered how much the woman enjoyed cooking, and in particular, how proud she was of her white bean chili recipe. Rather than just make the chili for the client, who currently could not do any cooking, the caregiver sat down and made a list. They embarked on a grocery-shopping trip that afternoon to make the chili together. Once home, the caregiver allowed her client to become “queen of the kitchen” once again and carefully followed the woman’s instructions. In the end, they made the dish together: one person the hands, the other the expert. On the next visit, the woman said she had been to a potluck in her building and had taken her chili. Soon, she was calling the caregiving agency to schedule — or cancel — caregiving for herself since she was now filling her social calendar again.
In a scenario where a well-meaning caregiver simply cooks and serves food to someone, the caregiver can render that person helpless and bored. Often, elders have enjoyed years of cooking for themselves and their families, and are deeply affected by the loss of this ability. Though the elder may be in need of some assistance and care, a loss in their ability to keep performing routine tasks can lead to a loss in physical and cognitive skills. Over time, this lack of involvement in day-to-day life can lend itself to the symptoms of elder life crisis. These symptoms can appear at any time, but may hit an elder particularly hard after the loss of a loved one, a big move, or a health setback. They may exhibit social withdrawal, apathy, moodiness, agitation, and aggression — none of which are normal parts of aging — potential signs of underlying feelings of loneliness and disengagement.
This phenomenon is not new to the 21st century, but it has been exacerbated by trends of modern life. There is no golden age of caregiving for us to look to as we develop new approaches to care at a time when the structure of families and society is rapidly changing. On top of the demographic changes brought on by longer lifespans and the aging of the baby boomers, the past few decades have seen major changes in the economy and the work lives of women. Families are now spread out around the globe, rather than living in the same town, much less the same house. This, combined with the greater number of women in the workforce, has created a situation where there is not necessarily a “default” caregiver available to support a parent in the advanced stages of Alzheimer’s disease, for example, or some other chronic health condition. The Administration on Aging predicts that by 2030, there will be 72.1 million people over age 65 in the United States — more than twice the number in 2000, so there’s a pressing need for solutions. The care models we establish for elders today affect the type of care we can all expect for ourselves.
Collectively, it is a good thing for tribes, families, societies, and nations to join in taking care of their elders. Yet there are potential burdens that individuals may keep private despite the challenges this brings. Even caring for a beloved older relative can be overwhelming for someone as they grapple with the financial, physical and emotional demands of providing care.
Caring About Care
In order to combat an elder life crisis, we need new ways of thinking about how to approach elder care and the aging process in general, especially as the baby boomers continue to age. The boomers are among the most active and independent generations in history. Losing independence and freedom can come as a particularly tough blow for boomers, making it even more important for us to improve the standards of care as this huge generation begins to need it. Without new ways for seniors to receive adequate support in their homes, this soon-to-be enormous portion of the population is at risk for loneliness, boredom, and depression, which could lead to even more problems. Numerous studies have linked late-life depression to increased risk for Alzheimer’s disease and vascular dementia.
The goal of optimal aging is not to deny that one is physically changing, but to accept it with humor and grace. In other words, we need to help our elder loved ones maintain a life “worth living,” so aging becomes a positive experience. The people who seem to do the best with aging are the people who are comfortable in their own skin and at peace with the changes their body is going through. Of course, these people may still experience strokes, fractures and other health ailments that come with age. No one gets to be 86 years old in absolutely perfect health.
Aging optimally is not only about maintaining a realistic and healthy attitude, but also about continuing to find purpose and meaning in life. Many studies have shown that having a purpose can extend life expectancy. Of course, it is critical to address health care issues and the immediate needs of elders. But their emotional needs and personal preferences, which are all too often ignored, must be taken into consideration for their overall well-being.
We must also change the way we approach care for the elder population by considering what a person can do for themselves rather than focusing on what they can no longer do. Empowering elders with the choice to take on a larger decision-making role in their health care can be a beneficial first step. When people become more engaged and empowered in their daily lives, those supporting them are more than just givers of care. They become “care partners” in a healthy relationship of give and take.
There are no simple answers as we seek to improve elder care. It is not the same as seeing a specialist about a specific health concern and having them simply write a prescription or suggest a change in habits. Instead, it entails a thoughtful approach to interacting with people of all abilities and ages. We must start now to find ways to care for people so we put their quality of life first and make optimal aging the norm.
About the Authors: Bill Thomas, M.D., co-founder of The Eden Alternative, is an international authority on geriatric medicine and author of Second Wind: Navigating the Passage to a Slower, Deeper, and More Connected Life.
Jennifer Tucker is vice president of Homewatch CareGivers, which has partnered with Eden to educate caregivers and help them work towards better care strategies for their loved ones.