LOOKING FOR THE FOUNTAIN

OR

Where is Ponce When You Really Need Him

I address today a topic that touches everyone.  And yet, it is a topic that receives relatively little attention.  Usually, we are forced to confront it when someone in our sphere loses capacity or dies.  The topic is aging or growing old.  As usual, I learn from my patients and increasingly I am treating contemporaries, people in their 70’s and 80’s.  Interestingly, there is great commonality in the journey but precious little discussion about it.  Psychologists like myself believe that the fear of death is the basis of all anxiety and the denial of aging and death in our society is a clear expression of that discomfort.  Younger people tend to stay away from any reminders of advancing age and of course that includes not just the habitats of older people but the older people themselves.  Nursing homes and geriatric ghettos are not usually on the list of regular or frequent visits.  With the loss of multigenerational homes, there is much greater isolation of older people today from the larger population and therefore an “out of sight, out of mind” attitude.  The result then is that the problems of aging, indeed the process of aging, are largely hidden from ordinary life.

As I indicated there are a number of common changes that occur as we age.  Chief among them is that the sins of our youth catch up with us and our bodies break down, leading to aches, pains, losses of balance and mobility and an increasing focus of attention inward.  The world becomes increasingly smaller as we age.  It isn’t necessarily that we care less about the outside world but our interaction with it is greatly reduced.  Some of it is a loss of energy.  I realized a year or so ago that I had lost about two or three hours out of my day.  For almost all of my life, I was productive from 7:00AM to about 10:00PM.  Today my productivity ends between 5:00 and 6:00.  I may have the intention and the interest but I do not have the energy or will to do much more than watch TV.  Losing fifteen to twenty percent of the hours in a day means I am 15 to 20 percent less productive than I used to be.  I accomplish less and therefore have less to show for my efforts.  The other major change is that visits to doctors become a dominating activity in the elderly’s lives.  And discussion of the conditions that drive those visits becomes a central topic at the dinner table, easily nudging out national and international politics and events.  When I was Blue Cross of Rhode Island, we did a little counting survey and found out that the average Medicare member was taking ten prescription medications, ordered by four doctors.  Health and healthcare are therefore often at the very center of the aging person’s life.

In addition to the aches and pains that accompany aging, cognitive changes also occur.  Short-term memory is particularly troublesome and is a hallmark of getting old.  For many years, I had breakfast every Monday morning with my mentor, colleague and best friend until his death.  Neither of us could ever remember who had paid the previous week.  I could have paid every week because there was literally no recollection, not even a hazy one, none.  I have come to believe that a large part of the short-term memory problem is really a problem of attention and not memory.  If the memory never reaches the shelf in the brain, then when we go to retrieve it, it’s not there.  This is a normal process of aging and is not to be confused with brain pathology like dementia.

Retirement is often associated with aging and is not usually the glamorous phase of life that one imagines.  For one thing, our main sources of self-worth are derived from work either outside the home or inside as is the case with parenting.  In retirement, those are gone and need to be replaced.  Easier said than done I’m afraid.  The colleague mentioned earlier used to remark about the men he observed obsessively cutting their lawns on a riding mower.  He thought that these men were looking for meaning in their lives that was lost when they stopped working.  Without meaning and purpose and with less and less interaction with the outside world, the elderly can become depressed which only exacerbates all the issues described above.  Losing a partner is sometimes a nail in the coffin of the survivor who already has little in the way of meaning or purpose in their lives.

The last observation I’ll make is that time is relative.  The difference between 72 and 73 is much smaller than it is between 77 and 78.  The losses of function both physically and cognitively increase with age and with them the realization that death is getting closer and closer. 

How are you feeling as your read about aging?  Worth a little reflection, I think.