PERSPECTIVES ON AGING
Connie Corley, MSW, MA, PhD
Professor, Fielding Graduate University and
California State University, Los Angeles
In the United States and many countries globally, living to 65 and beyond is increasingly common. Although the age of 65 is typically used to define the older adult population in the United States, in fact, the body’s organs and sensory systems start aging much earlier. Yet what historically has been seen as the mark of aging, a number based on the original Social Security retirement age, is constantly being re-defined. Planning for longevity is a complex and comprehensive process and many people in life react after an issue arises or a crisis is faced. Recent economic factors have impacted the retirement plans of many, and people are staying in the workforce longer and/or “retooling” in order to find new sources of income. Entrepreneurship is also growing in the mid- to later life population due to economic factors as well as the desire among many to engage in work about which there is a sense of passion.
For centuries people have pondered the aging process and the ideal in many societies is to “stay young forever.” While this chapter will focus on theories of aging primarily from social and developmental psychology, the mystery of what causes the body to age is still elusive. An entire “anti-aging” industry has been flourishing in order to promote the proverbial “fountain of youth.” Ageism is now a “widely shared prejudice” (Moody, 2010; p. 12). However, the quality of life in the later years, given optimal circumstances and even in the context of challenging life situations, can be enhanced through a variety of measures. Since the fields of gerontology and geriatrics have emerged, particularly after World War II, there have been a number of themes throughout this time. Gerontology can be defined as “the field of study that focuses on understanding the biological, psychological, social and political factors that influence older people’s lives” while geriatrics refers to “clinical study and treatment of older people and the diseases that affect them” (Hooyman & Kiyak, 2008; p. 39). Early theories in gerontology focused on deficits and efforts to define “normal aging.” By the 1970’s the federal government invested major funding in research through the National Institutes of Health and the National Institute of Mental Health. The Department of Veterans Affairs launched specialized Geriatric Research, Education and Clinical Centers (GRECCs) and the Older Americans Act services under the U.S. Department of Health and Human Services expanded. As time progressed into the late 1990’s concepts such as “productive aging” and “successful aging” balanced the growing interest in detection, diagnosis, intervention and even prevention of diseases such as Alzheimer’s Disease.
Now into the “New Millenium” another sea change has taken hold, as interest in creative aging and discoveries about brain changes leading to new pathways for engagement in life have emerged (Cohen, 2006). Terms such as “positive aging” and “conscious aging” (Moody, 2010) have also come into the landscape and represent an interest in how people can access inner resources, while highlighting the contributions that older adults can make to society.
AWARENESS, ACTIVITY, AFFILIATION AND ATTITUDE IN AGING
In this article, contemporary approaches to understanding and optimizing the later years of life are presented, and focused around four major domains: Awareness, Activity, Affiliation and Attitude (Corley, 2007). The “4A” approach offers a simple moniker which can guide coaches to specific areas of attention when working with mid-life and older clients. A case example of “Rosa Guzman McMillan” will be used for each domain to illustrate the application of the evidence-based theories to coaching Rosa during her transition from retirement:
Rosa worked as an Executive Assistant to the President of a large state university. Right after college she started working at her alma mater, and rose to her high level position early in her career. Rosa decided to retire at age 60 due to having primary responsibility for caring for her parents in their 90’s and wanting more time with her 3 very young grandchildren. She is used to being “on the move” but wants to do more of the things she enjoys such as taking better care of her health (Awareness) and dancing (Activity). Rosa desires to still be involved with people socially and help others while also getting the support she needs in caregiving (Affiliation). Rosa is very contemplative about her life and is seeking ways to stay positive during this major life transition (Attitude).
Essential to optimal aging is to understand and prepare for the many changes which occur as people grow older, and to foster an appreciation and engagement in ways to manage challenges while thriving along the way. This chapter therefore addresses and builds upon theories related to successful aging, creative aging, and spiritual dimensions of growing older.
In 1997, two MacArthur Fellows, John Rowe and Robert Kahn, released a widely cited book called Successful Aging. Their research involved a longitudinal study of a cohort of men and women in their 70’s at the start of the study who lived in 3 different East Coast cities. One of the three principles Rowe and Kahn identify to age successfully is “avoidance of disease and disability.” Here this is conceptualized more broadly, including being aware of predisposition to illness. Various estimates suggest that up to one-third of aging can be attributed to genetic factors, hence knowing about family history of major causes of death like heart disease and cancer can lead to lifestyle changes which reduce the likelihood of disability associated with certain diseases.
Awareness of the benefits of exercise, moderation in alcohol consumption (http://www.nia.nih.gov/HealthInformation/Publications/alcohol.htm), and the importance of sleep are examples of seemingly simple and obvious factors that impact the quality of life as one ages, yet implementing lifestyle changes in these areas can be challenging. Several computer programs have been designed to give individuals a “life expectancy” calculated on the basis of family background and lifestyle factors (e.g. Live to 100: http://www.livingto100.com/ or the Vitality Compass: www.bluezones.com). These relatively simple programs can be accessed on the internet and are useful in helping people identify risk factors, many of which are modifiable, that impact their longevity.
ROSA: Illustrating coaching for AWARENESS with Rosa, it is clear that her pattern of a “happy hour” cocktail, wine with dinner and a nightcap to help her sleep can be modified by engaging her in identifying alternative stress-reduction approaches (e.g. meditation before dinner; journaling at night). While discussing her habit of smoking during her breaks at work as a means to “get outside” Rosa then pondered alternatives to replacing this habit. She reflected on how being out in nature was calming and yet she needed to keep her hands busy. Rosa then realized she could walk in her neighborhood when restless and bring a sketchbook to keep her hands busy (see also ACTIVITY next). Once Rosa saw that her lifestyle modifications increase her longevity, after examining a life expectancy calculator suggested to her, her motivation to engage in healthier habits was increased.
Early theories of aging focused on what apparently was seen as a withdrawal from social engagement. One theory called “disengagement” (Cumming & Henry, 1961) was countered by another approach called “activity theory” (Adams & Sanders, in press). While later it is noted under “Attitude” that reflection and solitude have positive benefits in later life, in many ways it is a matter of balance and also understanding the adaptive function of lifelong propensities of people (known as “continuity theory”; Neugarten, Havighurst & Tobin, 1968) to better advise them around optimal aging. There is concern about the “busy ethic” (Eckert, 1986, in Moody, 2010) which can lead some people to become more active to compensate for losses such as retirement or layoff from a job. In some instances, becoming “busy” leads to other challenges that come from avoiding the feelings that may be part of a natural grieving process, e.g. after loss of a spouse or partner. For some older adults, on the other hand, curtailing activities and social contacts is seen as a natural process “particularly to maximize positive affect and promote identity maintenance” according to socio-emotional selectivity theory (Frederickson & Carstensen, 1990; in Adams and Sanders, in press).
As people age, there are many opportunities for connection (see Affiliation) and fulfillment, and coaches can help people identify activities that are engaging and enlivening to people. For example, the groundbreaking work of Gene Cohen (Cohen, 2000; 2006) and colleagues has highlighted the role of the arts in promoting well-being. The National Center for Creative Arts (NCCA) identifies research as well as arts programs nationally that coaches can inform their clients about to become engaged in active participation in the arts (www.creativeaging.org). Cohen suggests that in the later years of later life, there is an “Encore” phase characterized by restating and reaffirming life themes and finding novel ways to explore these themes. This stage has parallels to Erikson’s Psychosocial Stage of “Generativity vs. Stagnation” (Eriksen, Erikson & Kivnick, 2010) which is more focused on care and concern for future generations, although Cohen’s Encore stage comes much later (age 70 and beyond). Vaillant’s longitudinal research on factors contributing to vital aging (2003) which highlight the importance of generativity, along with Rowe and Kahn’s designation of “involvement in society” as another component of successful aging, together reinforce the importance of meaningful activity in later life.
“High cognitive and physical function” is the third component of successful aging (Rowe and Kahn, 1997) and further suggests that activity engaging mind and body is crucial to midlife and later life wellness. Lifelong learning is another venue for mid-life and older adults to become intellectually stimulated and socially engaged and often physically active (Hooyman & Kiyak, 2008). There are numerous programs nationally, such as those associated with OASIS (www.oasisnet.org) and Osher Lifelong Learning Institutes (http://usm.maine.edu/olli/national/) where classes, events, and even volunteer opportunities are readily available.
Creating a “social portfolio” helps tap into creative potential in later life. Cohen (2000) suggests it is just as important as a financial portfolio in lifelong planning. The Social Portfolio is conceptualized along the dimensions of individual/group efforts, in relation to mobility/energy levels. Where a person is situated along these dimensions is associated with different types of activities (e.g. an individual activity for someone with low mobility and low energy might be the creation of a “Secret Recipes” family cookbook; Cohen, 2000, p. 167).
ROSA: Coaching Rosa in the ACTIVITY domain can involve brainstorming ways to “keep moving” since she had been used to walking across campus to meetings and to her weekday lunch with colleagues at the University Club. She notes that she would “dance her way from place to place” – a metaphor leading to a discussion of the local ballroom dancing association. Upon signing up for a Sunday afternoon Swing Dance class, she discovers that a campus employee is one of the instructors. They then go to the local vegan restaurant for a healthy dinner, so Rosa can stay connected (see also AFFILIATION next) and physically active. Rosa is invited by her colleague and burgeoning friend to teach an “Introduction to Salsa” at the university’s Lifelong Learning program since it allows her to proudly share her cultural heritage. These opportunities she has pursued arise from a discussion of her “Social Portfolio” (Cohen, 2000).
There is a vast body of research affirming the benefits of social engagement in many facets of life that enhance well-being, even in the face of illness, e.g. mind-body skills groups for cancer (Gordon and Harazduk, 1999). As people age, they may experience cumulative losses such as the death of parents, siblings, friends, spouses/partners and others. Some people are at a loss as to how to cope with and manage feelings of anger and sadness. Especially among couples who are at a distance from family members, having support beyond the initial stage of mourning the loss of a partner may be daunting. Churches/synagogues and even hospice organizations offer bereavement and social support which are great resources for coaches to recommend to grieving clients and their families, and to widowed older adults (Silverman, 2004).
Caring in a community is optimized by being part of a resilient community; resilient communities “grow out of positive personal relationships and sufficient nurturing resources” (Green, Cohen, Gonzalez, Lee & Evans, 2007; p. 229). For mid-life and older adults who are caregivers (and most are or will be caregivers for one or more older adults), assessments of the challenges and risks are important, along with the balance of identifying the “gifts of caregiving” (Goldman, 2002). Being in community, such as a support group for caregivers of persons with dementia or other debilitating conditions, provides reinforcement for this crucial role and often respite to help energize the caregiver and help the caregiver prepare for the known and the unknown challenges ahead.
Communities support social engagement; in fact, “(s)ocial connectivity is critical to longevity and aging in place” (Abbott, Carmen, Carmen & Scarfo, 2009; p. 4). Preparing for one’s own possible social, physical, psychological, spiritual and health needs requires awareness of the resources in one’s current living environment.
ROSA: It is clear that in her retirement she desires to stay connected with people (AFFILIATION) and to be helpful whenever possible. However, the daily visits to her parents who are struggling to live at home with multiple medical challenges, after a full day of caring for the two preschool-aged grandchildren, leave Rosa exhausted. Upon further discussion of her parents’ health conditions, Rosa mentions being aware of the Alzheimer’s Association. After checking the association website she identifies a local support group which meets monthly. Rosa’s interest in mind-body approaches leads her to a mind-body skills group which reinforces her new pattern of afternoon meditation and adds to her skills set guided imagery and biofeedback to manage her fears and anxieties about the future. Rosa reflects on the power of being able to “stay in the moment” (mindfulness), representing her positive view of life (see also ATTITUDE next).
Since the late 1990’s a new movement in psychology has emerged, positive psychology, which has taken hold in the popular press as well as in academic circles. While only limited attention has been paid specifically to older adults in this movement, there is a parallel interest in resilience associated with growing older (Hooyman and Kiyak, 2008), for example among survivors of earlier life trauma (Greene, in press; Corley, in press). The burgeoning area broadly defined as “positive aging” has spawned an annual conference and related activities. As noted by Moody (personal communication, February, 2010) about the conference: “It’s been said that the best way to predict the future is to create it… and positive aging is the future we want to create.”
In gerontology specifically, there are theories related to spirituality such as gerotranscendence (Tornstam, 2000) which shed light on the importance of reflection and represent a shift in perspective “from a materialistic, rational view of the world to a more cosmic and transcendent one, normally accompanied by an increase in life satisfaction” (Hooyman, 2008; p. 311). Erikson similarly posits that the final psychosocial stage of “ego integrity vs. despair” concerns finding meaning in the whole of one’s life and self-acceptance (Hooyman & Kiyak, 2008).
Greater attention to activities such as reminiscence, life review, and autobiography has flourished in the aging field to help older adults integrate their life experiences and leave a legacy when possible (Hooyman & Kiyak, 2008; Cohen, 2008). Structured approaches such as Guided Autobiography (Birren & Swenson, 2006; Birren & Cochran, 2001; Birren & Deutchman, 1991) and the Illuminated Life (www.illuminatedlife.hawaii.edu) provide a group experience for reflection and sharing of life experiences and world view, as well as engaging in a creative process around life themes.
ROSA: In the final coaching session with Rosa who strives to maintain a positive ATTITUDE in her post-retirement life, Rosa shares that she feels uplifted from being engaged in the caregiver support group, and she is invigorated by taking and teaching dance. In addition to reinforcing the positive benefits of these activities and her regular meditation, Rosa mentions hearing about a “memories and memoirs” class at the campus Lifelong Learning program. There she can share the positive memories of growing up in the rich Latino culture and the mentoring of diverse students in their educational journeys during her years of full-time employment at the university. She can reflect on her life changes experienced and those yet ahead with the class and in her journal, which has become her nighttime refuge for reflecting daily on her life and her needs, and a means of connecting with her inner life and higher power.
Finally, Rosa finds that “bibliotherapy” gives her practical ideas for managing the retirement transition and further inspiration to stay engaged in meaningful activity. She heard about two books that she thinks will inspire her and relate to people like herself: Work Wanted: Protect Your Retirement Plans in Uncertain Times (Walker & Lewis, 2009) and Encore: Finding Work that Matters in the Second Half of Life (Freedman, XXXX). She is encouraged to create a “Third Age Life Portfolio” to mindfully integrate and diversify her personal investments in “creativity, work, play, love, service, learning, community, selfcare, and spirituality” (Sadler, 2006; p. 17).
As the population of older adults burgeons worldwide, especially with the aging of the Baby Boomers (Moody, 2010), the creation and application of theories of gerontology is likewise burgeoning Different challenges and opportunities arise in looking at aging from a population perspective compared to an individual perspective. Advances in cognitive science are interfacing with the biological, social and behavioral sciences leading to “the changing tenor in the field of aging – from evitable decline to new opportunities” (Kryla-Lighthall & Mather, 2009; p. 38).
Growing older is inevitable and it is also about change. As author and journalist Connie Goldman so aptly states:
I’m convinced that the challenge of aging isn’t to stay young; it’s not only to grow old but to grow whole – to come into your own. The aging process is woven into human destiny. It’s your time to embrace that challenge and figure out who you are now that you’re not who you were. (Goldman, 2009; p.12)
Abbott, P., Carman, N., Carman, J. & Scarfo, B. (2009). Re-creating neighborhoods for successful aging. Baltimore, MD: Health Professions Press.
Adams, K. & Sanders, S. (2010). Measurement of developmental change in late life: A validation study of the Change in Activities and Interests Index. Clinical Gerontologist, 33, 1-17.
Birren, J. & Deutchman, D. (1991). Guiding autobiography groups for older adults: Exploring the fabric of life. Baltimore: Johns Hopkins University Press.
Birren, J. & Cochran, K. (2001). Telling the stories of life through guided autobiography groups. Baltimore: Johns Hopkins University Press.
Birren, J. & Svensson, C. (2006). Guided autobiography: Writing and telling the stories of lives. The LLI Review, 1, 113-119.
Cohen, G. (2000). The creative age: Awakening human potential in the second half of life. New York: Avon.
Cohen, G. (2006). Research on creativity and aging: The positive impact of the arts on health and illness. Generations, 30, 7-15.
Corley, C. (2007). Aging with success through lifelong learning. Unpublished manuscript.
Corley, C. (in press). Creative expression and resilience among Holocaust survivors. Human Behavior in the Social Environment.
Eckerdt, D. (2010). The busy ethic: Moral continuity between work and retirement. In H.R. Moody (2010), Aging: Concepts and controversies. Sixth edition. Thousand Oaks, CA: Pine Forge Press, pp. 416-424.
Erikson, Erik Homburger, Joan Mowat Erikson & Helen Q. Kivnick. Vital involvement in old age. Retrieved Feb. 28, 2010 from http://books.google.com/books?hl=en&lr=&id=SyOjkh6Q-L4C&oi=fnd&pg=PA7&dq=eric+erikson%27s+later+stages+of+development+&ots=ZgDD_K4xTz&sig=qgl8IybHX9fD2Gub-y-gcjzXfIE#v=onepage&q=&f=false .
Frederickson, B. & Carstensen, L. (1990). Choosing social partners: How old age and
anticipated endings make people more selective. Psychology and Aging, 5, 335 – 347.
Freedman, M. Encore: Finding work that matters in the second half of life. Cambridge: Perseus Books.
Goldman, Connie (2002). The gifts of caregiving: Stories of hardship, hope, and healing. Minneapolis: Fairview Press.
Goldman, Connie. (2009). Who am I…now that I’m not who I was? Conversations with women in mid-life and the years beyond. Minneapolis, MN: Nodin Press.
Gordon, J. & Harazduk, N. (June 12, 1999). Mind-body skills for cancer. The Center for Mind-Body Medicine. Retrieved Feb. 27, 2010 from http://www.cmbm.org/mind_body_medicine_RESEARCH/1999-Transcripts/sa15.html.
Greene, R., Cohen, H., Gonzalez, J., Lee, Y. & Evans, M. (2007). Cultural narratives, older adults , and resilient communities. In R. Greene (Ed.), Social work practice: A risk and resilience perspective. Belmont, CA: Thomson Brooks/Cole.
Greene, R. (in press). Holocaust survivors: Resilience revisited. Journal of Human Behavior in the Social Environment.
Hooyman, N. & Kiyak, A. (2008). Social gerontology: A multidisciplinary perspective. Boston: Allyn and Bacon.
Kryla-Lighthall, N. & Mather, M. (2009). The role of cognitive control in older adults’ emotional well-being. In V. Bengtson, D. Gans, N. Putney & M. Silverstein (Eds.), Handbook of theories of aging (pp. 323-344). Second edition. New York: Springer.
Moody, H.R. (2010). Aging: Concepts and controversies. Sixth edition. Thousand Oaks, CA: Pine Forge Press.
Sadler, W. (2006). Changing life options: Uncovering the riches of the Third Age. The LLI Review, 1, 11 – 20.
Silverman, P. (2004) Widow to widow: How the bereaved help one another. Second edition. Routledge
Vaillant, George E. 2002. Aging well: Surprising guideposts to a happier life from the landmark Harvard study of adult development. New York: Little, Brown and Company.