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May 23, 2009 True Grit: Growing Old in America

By 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."

"What?"

"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.

Why?

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.

Cognitive impairment

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.

Page Printed from: http://www.americanthinker.com/2009/..._in_ameri.html at April 24, 2010 - 10:03:42 AM CDT

Very interesting and thought provoking article. A coworker of mine surprised me when I was telling her about the whole 'respect your elders' and she said where she's from (Cambodia I think) people respect the young people wore. Very weird I think, but then again the whole concept of respecting (and perhaps also valueing the wisdom of) ones elders in this country seems to no longer being passed on to our future generations. Or so media would have us believe.

[Fresia]

Great article. I have spent a lot of time with retiree friends and with the elderly at care facilities, hospitals, and veteran's organizations. The isolation and depression that is felt is so real; people feel overlooked as they age. Several people at the assisted living facility nearby confirm feeling as if they don't exist anymore because their families don't visit and so few people talk to them. It is never about anything more than what they hate to eat, did they take their meds, and rarely anything more. They are delightful to talk with, humorous, and I have learned much for them. I have the privilege of getting to know them and still continue to visit even though my grandmother has since left the facility. Not seeing people and paying attention to them is a real problem at any age, so much self involvement, lack of consideration and lack of compassion. It seems to be getting worse. Meds can't help with this, only human interest and interaction can, and by placing yourself in someone else's shoes. Anyone who has ever felt loneliness can definitely relate. However, I will continue to hope for the best.

JMO--it is the advent of the "nuclear" family that has caused this in America.
You don't see generations of a family living together, as they did when I was a kid.

Right now, I live in an "Active 55 and Older Community"--it is not active at all.

Most of these people have been dumped here by their families, who don't want to deal with them--my son tried it on me--I was only 54 last year when he got me to live here, then took off with all my money for New Jersey.

I insisted, and am going to get back by virtue of my daughter and her spouse.
Hell, I don't want to vegetate in here.....I've been feeling as if I were dying this whole year...I've still got years of life I want to to stuff with!!!

One of them is get an advanced Degree as a Nurse Practitioner---

This way I can help the elderly, and be their family when their family dumps them.

-----------this is incredibly awful, I have felt it's impact on me, and I live amongst many lonely, and unhappy elderly-----I have tried to help, but they can't believe that their children have forgotten them. sooo sad--------theo

[Hunny]

I had a wonderful conversation with my son, in his 30's. He just believes in the older person and the elderly. He believes chronological age has not got much to do with say, fitness age, nutrition age, cognitive age. He has worked with old and young and he says, no more can we have the expectation of dying at 60, 70 or even 80. We must assume that we will all live until we are 90 or 100. With the advent of better medical treatments (nano technologies, etc I don't pretend to understand it all) and better nutrition (that is if we've smartened up and stopped eating junk) and more access to information than ever before (yes, we may need to join the seniors centre and teach the elderly computer skills, web surfing, etc) he claims we will live happier and stronger lives and live longer than ever before! Since he is in 'the' industry that will help us all be motivated to keep this up and he teaches others I am more encouraged than I am discouraged. This is the conversation we had in the car the other night.

He believes that fitness and nutrition are the focus here because seniors (me included although not truly senior yet) are now being offered more opportunity to access this help. I explained to him that motivation for us is a problem, because of various things like depression and he heard that but disagreed that it should stand in our way or should I say my way. I was so inspired after listening to him. I share this because although I am only one and you all are only one, we are one together. I didn't go out and run a marathon but I am thinking about putting 'one' out there as a goal for me (maybe I'll walk though). I am at least 40 to 50 pounds over-weight. I can't believe that he so pumped me up that I am truly thinking about this. He is training up many people, one, a guy his own age and that guy has been working toward the marathon too. He used to be a court recorder and has just now been hired as a fitness instructor. I mean it's really crazy! He got his certification through a class with my son.

I think if we can get the fitness instructors of this world to 'believe' in us that we are 'worth' it, we can find re-find our purpose, strength and even become healthy mentors to some really hurting young people. Can some of them take on one senior each as a goal for a nominal fee or for free? They can up the fee for others by half a dollar or so to compensate. Then, when we get fit we can tell and friend and they can tell a friend and that will up their business for them and give us motivation.

I would suggest that they have to have some knowledge of senior fitness though and there are many taking that on. Even we can eventually become fitness leaders to the older or elderly. There is insurance to cover the fitness leaders now. Also, I think it would be honouring to our young people to show them that we are capable, even if some can't walk or have other disabilities. It will show our young people that we do in fact have something to live for. We have them. They invest in us and we invest our wisdom and knowledge in them.

TB you have given and given of your wisdom and knowledge and others too, here and I think you and I and all older ones here are valuable enough to have this dream come true, don't you think?

I don't think we have to wait for the mean people to help us. We need to help each other. It is hard thinking about the ones who are not making it but we can and we have to, if we can be of any help and have that expectation that young people will want our wisdom.

When my dad was in a seniors centre they were starting to do exercises with the elderly, albeit sitting in chairs. It was hopelessly not enough activity but we are all learning that 50 year olds are like 40 year olds and 60 years olds are like 50 and on and on it goes. It may even be more gap. Like my son said it is NOT chronological age that we are looking at here. I sometimes feel much older but that is partially due to the weight and my fitness level being down somewhat. I am not talking about these crazy fitness competitions on TV. For one thing they never have anyone over 55 there. So, it is up to us to search for the well trained in seniors fitness to give us a hand and turn off the stupid media.

I just have no women in my family of origin that lived beyond the age of 54 so this is a huge challenge for me. Some people still have 90 parents that are models for them. I don't, so I have to make it up as I go along.

God forbid we have the technology to keep me alive till we are 180, wouldn't that be something. That is where I draw the line. LOL

[AAAAA]

I am from one of those families where we take care of the generation before. Perhaps it’s that experience taking care of them that has colored my opinion. When my eldest son was born, he was the sixth living generation. Pa, my great-great- grandfather took turns living between the households of his daughters, then granddaughters.

My memories of Pa are rather limited, as children we had to be quiet as not to disturb him. Pa was not a man of many words, nor was he an affectionate man. He immigrated from Germany during WWII. By the time I was in my late teens, Pa had reverted entirely to his native tongue. It was somewhat ironic, he refused to teach any of us German because “we’re Americans, we speak English”. We all took turns caring for him out of duty rather than affection.

His daughter, my beloved Great-grandmother was a different story. She had three generations fighting to care for her. When it became apparent she could no longer live on her own, it was actually a huge family dispute who would get the honor of having her live with them. Her oldest child, a daughter, won the honor because she had a bedroom on the first floor with an attached bathroom and had medical experience to deal with the vast amount of medication.

There is still a great deal of animosity between her children, grandchildren, and great-grandchildren because of the living arrangements to this day. She died sixteen years ago, but at every wedding, graduation, or family gathering of any kind there is an argument about why it should have been “me” that Gram lived with. We’re a big group, she had 14 children and each of those children had at least three children. It’s a testimony to her ability to make each and every single one of us feel like the favorite.

Her daughter, my Grandmother, well she somehow missed that maternal gene her mother and father had. Her second husband was an abusive jackass. She abandoned her two daughters (my mother being one of them) to start this new life with him. She had no time for my cousins and I, nor our children. It was like we did not exist. Until her husband required at home care. My cousin and I were CENA’s and we took care of him until his death. We were still treated as guests rather than family and there was no appreciation from either of them. My cousin had two small children, she cared for him at great personal sacrifice. There was never a discussion, he wanted to be at home, they couldn’t afford home care, Grandma couldn’t care for him and hospice needed qualified people there for him to qualify, a schedule was set up.

Then, when she became ill herself, again, no discussion, once again I had to rearrange my life so that I could be there to take care of her. This was not an act of love, but one of duty.

I will do it again, if the need ever arises, but the family I have left is very dear to me and it will not be a burden as it was with my grandparents. But, after my grandparents I have changed my opinion of what I want. I no longer wish to die in my own home with my loved ones caring for me. I have made it known that I would much rather be in a hospital or nursing home, I do not want to disrupt my children’s lives like that.

I agree with you 100% AAAAA; when I can no longer function for myself; I do not want to burden anyone---least of all Myself!!!

I believe in Quality of Life as opposed to Quantity........

When I am unable to enjoy, and do my own thing in life; I want to be put down (like we do for our pets)-----I am a big fan of Doctor Kevorkian (sp)--and Angels of Mercy.

Working a med surg unit; I had many patients who'd plead with me to let them just die.......it was heart breaking.

I don't think I'll go to a Nursing Home (ugh) or Assisted Living--I'll go to Oregon, or one of the other Suicide Legal states----------My children know how I feel about this; It is my hope that they will carry out my wishes--if not, I have a Living Will, and a friend who is a young nurse as my Health Care Proxy.

I value life-but I do not fear death.
So long as I can live a life of quality, I will go on---------------be well--theo