Caring for the OldThe old do not have to look exclusively to the past. Relieved of some of

Caring for the Old

The old do not have to look exclusively to the past. Relieved of some of life's responsibilities and fortified by many years of experience and knowledge, they may have a much better idea of how to spend their time enjoyably than they did in their youth. And not all enjoyment is restricted to the mental or philosophical. Healthy physical activity remains quite possible for most of us well into our later years.

Old people sometimes display surprising freedom and forthrightness in the expression of their thoughts and feelings, and an ability to transmit affection. It is as though some of the rituals which constrict us in earlier life fall away.

But a higher percentage of people suffer from emotional distress in old age than at any other time in adult life, and the gap between need and care is often filled by dubious measures, such as heavy-handed prescription of medicine. For many years it was assumed that old people were not appropriate candidates for psychotherapy. But a few clinicians have risen to the challenge and discovered that individual and group psychotherapy is just as effective with the old as with the young.

It is easy to understand why an earthquake causes terror. Yet in old age there may be terror of a very private nature, a sense of disintegration sometimes stemming from inner conflicts, sometimes from a premonition of death or the fear of becoming dependent.

Dependency is a grim choice: insecurity and deprivation must be weighed against loss of autonomy and integrity. But if there is nothing shameful about the dependency of a baby or a young child, there should be nothing shameful about the dependencies natural with old age and diminishing physical resources.

The complexity and impersonality of the bureaucratic establishments, which have the means to provide help, are often threatening to old people. The younger generation today, on the other hand, will have had many decades to interact with "the system" by the time they reach old age.

Many of us, including healthcare providers, assume that we know what old people and dying people want, but our assumptions are often a reflections of our won thoughts and feelings based on personal interpretations of scanty bits of observation. Such assumptions are really an excuse to avoid close contact with the terminally ill. Assuming we "know" what they want, we observe ourselves from being with them, and sharing their thoughts about the end of life.

We sometimes assume, wrongly, that old people are too confused or senile to be aware of the nearness of death. In consequence, communication between a dying and others is subject to extraordinary omissions and distortions. "Protecting" the dying from knowledge of their condition often serves to protect us from the uncomfortable prospect of talking about dying and death. Evasions like this only lead to increasing isolation at a time when emotional honesty and understanding are most needed.

A. Knowing better how to enjoy life

B. Freedom in expression

C. Psychotherapy effective with some of the old

D. Period of greater emotional distress

E. Dependency: a grim choice

F. Guiltiness: dependency

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