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John William Tuohy lives in Washington DC

Good news about getting old



Most of us cope with diminishing abilities and get happier in our later years

By Marnin E. Fischbach

Recent research from around the world indicates a startling and counterintuitive truth: Older age is one of the happiest, perhaps the happiest, period of life.
Happiness has been studied by economists in many countries, and the bottom line is this: Happiness tends to make a U-shaped curve over the span of a life. People are happy in their younger years, considerably less so in middle age, and then become progressively happier as they grow older, without regard to finances or children.
Happiness in youth and older age is driven by quite different factors. Younger people thrive on excitement and novelty, which help them build a sense of identity. This youthful approach to life, given its ubiquity across cultures, may be biologically and genetically determined. Older people, in contrast, find happiness not in excitement but rather in smaller joys near to home: family, friends and hobbies.
Judging from my own patients, I would confirm these observations.
Allegheny County has the second-oldest population in the country, behind only Dade County in Florida. As a result, I see quite a few older people in my practice of psychiatry and have been more than impressed by the coping skills of many of them.
Even those with emotional problems often still live in their homes and are self-sufficient and optimistic into their late 70s and 80s. Many remain surprisingly youthful in appearance and attitude. Many still golf, vacation at the shore, visit friends and family, care for grandchildren, write poetry and pursue hobbies. Some chuckle over my own failure to follow their footsteps into a pleasant and comfortable retirement. These well-adjusted older people, by the way, are by no means wealthy — they fall very much in the middle class.
Older persons generally have established their identities long ago and have no more need to prove themselves or build a career. They have raised their children and are benefiting from years of accumulated experience and wisdom. It is no wonder that many traditional cultures reverentially turn to the elderly for counsel.
But how can we square the U-shaped happiness data with the many physical ailments which also accumulate in older age? Who can be happy in the face of arthritis, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, cancer or combinations of these ailments? And why is it that many elderly, unlike those who are young but also happy, seem not especially afraid of dying, despite being far closer to their end?
I recall struggling with these questions when I was young and quite fearful of death. My patients and older associates have provided some answers.
Every chronic malady produces physical symptoms. There’s pain, difficulty breathing, unsteady gait, fatigue or chest discomfort. There are frequent knee or hip injuries, fading eyesight, cataracts, hearing problems and lower back pain. The list goes on and on.
Each ailment results in some loss of prior activities or functionality. Arthritis can make it difficult to walk, let alone run, or to play the piano or knit. Visual or hearing problems can make reading or hearing people in a restaurant difficult or impossible. Pulmonary disease can leave someone too fatigued to do much of anything. In many cases, independence of action is significantly compromised.
Everyone, including the elderly, undergoes a subtle grieving process over each lost function caused by injury or illness. When older people get together, conversation frequently turns to their latest symptoms and the things they no longer can do. Nevertheless, there is often laughter, not unlike what one sees during a Catholic wake or Jewish shiva. These discussions help people come to terms with their bereavement.
Grieving may seem negative, but it is a biological, universal process with quite positive effects. And it helps explain the paradox of the U-shaped curve.
First, the older person who successfully navigates the grief process comes to accept a loss of function, as opposed to being emotionally paralyzed by it. This is no small gift, as I have interviewed a number of elderly people who have gotten stuck in their grief and consequently spent much of their remaining lives in sadness and regret.
Another positive outcome is the development of a new sense of self. Having lost some skills that previously defined them (such as tennis, crocheting, running, piano, etc.), older individuals often develop new skills more aligned with their residual abilities. They might attend college courses, study a new language, draw closer to their children and grandchildren or take up swimming. Often, older people tend to see life in ways they had not previously considered.
Finally, having grieved the loss of multiple parts of their lives, seniors become more accepting of the end of life. Death is less fraught with the fears that terrified many of us in our youth.
Growing comfortable with death is good news, a great treasure. Wouldn’t you rather go gently into that dark night, content and accepting, than go kicking and screaming? Wouldn’t you rather feel a sense of completion than feel cheated out of time that is rightfully yours?
Not everyone enjoys the silver linings of older age, of course. Many people cannot find in themselves the ability to go through these many small grieving episodes. A caring therapist might be able to help them negotiate the process and find the peace they seek.
But for many of us, maybe even most of us, Mother Nature offers happiness in old age and a mechanism to ease us into a comfortable parting with this world.

Marnin E. Fischbach practices psychiatry at several locations in the Pittsburgh area and lives in Squirrel Hill.




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