Nearly 50 million Americans are over the age of 65; by 2030, that number will surpass 70 million and account for about 20% of the population. While for some, late adulthood can be a time of great fulfillment, for many, our culture’s emphasis on youth and a fast-paced life leads to a declining role for older adults in their social and work life. Often, they are victims of false cultural expectations and stereotypes. And for people living with serious mental illnesses (SMI), all of these experiences have exacerbated greater physical and social challenges. For them, it can be a time of tremendous despair and isolation.
In his 1963 seminal work on the eight stages of development, Erik Erikson referenced the later years of one’s life as a period where one endures either integrity or despair. From their mid-60s to the end of life, he believed that people in late adulthood reflected on their lives and felt either a sense of fulfillment or a sense of failure. He concluded that people proud of their accomplishments felt a sense of integrity and looked back on their lives with few regrets while people who did not feel successful felt their life had been wasted. They felt great regret, dwelling on “would haves” “should haves,” and “could haves”. They often faced the end of their lives with bitterness, depression, and despair.
While Erickson’s work was important and groundbreaking for its time, today we live in a world offering many more opportunities in one’s later years. Today many older adults are thriving and enjoying life well into their 80’s and 90’s, celebrating accomplishments, re-connecting with families, working, volunteering and more than ever – engaging in intimate relationships. As behavioral health practitioners, it is our responsibility to help older adults see well beyond Erikson’s premise and encourage the understanding that, regardless of age or life situation, people are capable of living a fulfilling and satisfying life.
To be most effective in this work, we have a shared responsibility to help our staff recognize the innate strength and resilience of all individuals we serve. While complex on its face, this process is actually very simple and parallels the principles that many in our field learned in their training on recovery constructs. If we examine SAMHSA’s 1991 “recovery roadmap,” we believe that the 10 principles outlined are applicable to older adults. For example, the idea that there is “not one single pathway to recovery” is very true for older adults, many choose to participate in social activities every day while others spend their later years caring for grandchildren. The SAMHSA principle that “recovery is supported by peers and allies,” can be very powerful for older adults. For those who have struggled with mental health challenges, making amends and re-connecting with family members after many years of trauma and family abandonment can be powerful and healing. Viewing older adults through a “holistic” lens supports the practice of whole person health that takes into account the “emotional dimensions of health.” In his 2017 book of the same name, Woodlock discusses the importance of “feeling needed and having a sense of self-worth” and argues that human beings – regardless of age- have “a desire to thrive and people who are merely existing and not thriving suffer from diseases of the emotions, the body or both.”
Some argue that the main issues concerning aging and mental health are prevention, early diagnosis, recognition of major diseases, treatment and quality of life interventions, at both individual and community levels (Fernandes & Paul, 2017). Many in our field say that staff tend to take on a parental stance when working with older adults and we can do a better job of involving individuals around their personal choices and significant decisions that impact their lives.
To work successfully with older adults requires us to support the concept of a person-driven approach to health care and to embrace the value of hope and dispel myths and stereotypes about the aging process. By doing this we can affirm that later adulthood is much more than simply matters of integrity or despair but a time where many individuals continue to celebrate their accomplishments, engage in meaningful activities, connect with social supports– to live life to the fullest extent possible.
Ageism or negative attitudes toward older adults serve an ego-protective function for the stereotyping individual. (Snyder & Meine, 1994) Stereotypes help younger people deny the threatening aspects of old age such as the idea that one will become frail and eventually die (Nelson, 2005) When younger people encounter people who represent a threat, their perceptions of and behaviors toward the threatening person tend to be more negative. So younger people may lessen their own anxiety associated with aging to avoid their own inevitable future selves (Edwards & Wetzler, 1998).
To more effectively help older adults, a strengths-based approach to care rather than a paternalistic approach is essential. Older adults have a vast wealth of knowledge as well as a wide range of skill sets and while their quality of life may decline in the face of their life circumstances, we should not view them as “high risk” but instead “able and capable”. When we look at the individual, we should not see them as a victim but rather someone that has hopes and dreams, someone who is powerful, someone who has been through adversity and developed coping mechanisms. Often older adults hold on to their spiritual belief system which contributes to their openness to accept help and support as their lives change. Of course, growing older brings on very complex challenges that threatens health and well-being and the ability to successfully adapt. However, working with older adults from a strength-based approach allows us to focus on promoting health and wellness rather than on deficits. This will further allow the individual to be more receptive to a healthier life. In layman’s terms, we are talking about a self-fulfilling prophecy.
It is important throughout life to dream big and never give up on what you really want. Older adults should be afforded those same opportunities to live boldly and to take risks. This approach also allows for a greater sense of empowerment with people becoming more involved in the decisions regarding their own lives.
We must educate our staff that aging is filled with opportunities and that individuals should never give up on what they really want. Having an optimistic view of aging has a positive effect on subjective health and life satisfaction (Wurm et al. 2008). More and more we see the behavioral health industry focusing on strengths rather than deficits of people with serious mental illness. A paradigm shift toward self-management and self-direction is even more critical among older people. Professionals need to continually assess their own attitudes toward older people, understand and confront ageism where it arises, and become well-informed on what happens when we age (Nelson, 2005). Adjusting oneself to growing older and the changes that comes with it can be daunting for many of the people we serve. To be successful in our work, we need to understand that older adults can adapt if we take the following approaches:
- Understand the person in their environment and having conversations about their hopes and dreams.
- Help them to see how they can live, happy, healthy and active lives
- Affirm the individual’s resilience; discuss openly and honestly their vulnerabilities and recognize that there are widely accepted social and health care strategies
- Imagine a new way of conceptualizing risk by seeing older adults as strong and capable
- Connect individuals to resources that will help the person maintain a balanced and whole health approach to living
As behavioral health professionals it is incumbent upon us to lead this charge and help shape this important ideological shift. The premises we’ve presented here are a starting point—this critically important work takes time and a true commitment. Yes, the population is aging – but great opportunities abound.
About the authors: Elisa Chow, PhD, is Vice President, Innovations, Outcomes Evaluation; David Kamnitzer, LCSW-R, is Chief Clinical Officer/Senior Vice President; Eleanor Lalor, LMSW, is Vice President, Residential, Rehabilitation and Support Services. ICL at the Institute for Community Living.