Helping Relationships With Older Adults. Adelle M. Williams

Practice Exercise 3.1

      Successful aging is a subjective phenomenon that is comprised of various dimensions. Each elderly person experiences it differently, and it varies based on situational experiences. As a mental health practitioner, can an elderly person be seen as aging successfully if he or she has numerous health problems and limited income? Explore your feelings as to what constitutes successful aging. Visit a nearby senior center and examine how individuals with limited education, few financial resources, and multiple health challenges define successful aging. Share this information with your peers and examine if your definition of successful aging has changed.

      Successful aging is a perspective that assumes that healthy functioning and even achievement of certain gains is possible in later life. A series of studies called the MacArthur Study explores these possibilities (Rowe & Kahn, 1998). The fruits of 10 years of intensive investigations involving thousands of participants, millions of dollars, and the combined expertise of biologists, neuropsychologists, sociologists, epidemiologists, geneticists, and gerontologists, among others, tell us a great deal about successful aging.

      Most importantly, the MacArthur Study provides evidence for positively influencing the aging process and enhancing the quality of life in later years. The more physically and mentally fit older individuals are, the more likely they will age successfully. One’s lifestyle prior to old age can have a tremendous influence on the quality of later life. A healthy diet and regular exercise, including aerobics and weight training, confers a real physical advantage. Although maintaining healthy habits provides protection from disease and should ideally be maintained consistently, the MacArthur Study revealed that positive changes in eating and exercise habits, even in old age, can help people live longer and healthier lives. Equally important to successful aging are social relationships. Older people benefit more from emotional rather than instrumental support in many cases.

      Some potential gains in old age relate to the task of obtaining fulfillment in meeting social and civic obligations. For example, older people accumulate knowledge about life (e.g., wisdom) and can thus contribute to the development of other (younger) people and to society, providing wins for all. As the proportion of older people continues to increase, advancements in understanding the aging process will likely lead to identifying further developmental tasks associated with gains for and purposeful lives among older adults (Wrosch, 2006). In addition, the presence of meaning in life that refers to the extent to which people comprehend, make sense of, or see significance in their lives, accompanied by the degree to which they perceive themselves to have a purpose, mission, or overarching aim in life (Steger, Oishi, & Kashdan, 2009), was found to increase throughout the life span. Older adults reported the highest levels of meaning in their lives. Therefore, meaning thus emerges as an important resource for well-being, especially in later life (Steger et al., 2009).

      Reichstadt Sengupta, Depp, Palinkas, and Jeste (2010) conducted qualitative interviews with 22 community-dwelling adults over 60 to obtain older adults’ perspectives on what constitutes successful aging. Reichstadt and colleagues (2010) found that older adults viewed successful aging as a balance between self-acceptance and self-contentedness on one hand and engagement with life and self-growth in later life on the other. This perspective supports the concept of wisdom as a major contributor to successful aging.

      Productive, Healthy, and Active Aging

      In addition to successful aging, concepts such as productive aging (the ability to contribute directly and indirectly to society in older age) and healthy aging (the ability to remain physically and mentally fit) have been identified. Active aging has been identified as well. It refers to continuing participation in social, economic, cultural, spiritual, and civic affairs, not just being physically or economically active. This type of aging encompasses individuals who have retired as well as those who are frail, disabled, or in need of care, and it takes place within a broader social context of friends, family, neighbors, associates, and the workplace. Active aging recognizes principles of independence, participation, dignity, care, and self-fulfillment. A life course approach to active aging recognizes older people not as a homogeneous group, but as individuals who, collectively, are as diverse as younger members of a society (Kinsella & Phillips, 2005).

      A sense of being productive appears to be a benchmark of healthy aging as well. Healthy men and women are three times more likely than those with physical or mental health problems to be engaged in paid work or volunteer activities. However, even people with physical limitations often manage, with some creativity, to engage in activities that keep them in touch with the world. Productive engagement with others, in whatever form it takes, is linked to a sense of mastery or personal self-efficacy. A “can-do” attitude contributes enormously to well-being.

      Mental Wellness

      The term mental wellness is used to reflect the belief that health and illness are not dichotomously arranged in nature or in life and because people can, in collaboration with knowledgeable helpers, move along the continuum toward optimal wellness at each stage of life by their own efforts. People have more options than to be sick or healthy. They do not have to be sick to improve wellness. This is an especially important outlook for aging as a process—people can have an array of illnesses as they age yet still enjoy wellness and a good quality of life.

      Feinberg’s (2001) work added another layer of richness to the analysis of how “the self,” as a unifying perpetually created process of the brain, is a lifelong process. He shed importance on the intricate, fluid, lifelong nature in which the holistic nature of mind–body unity are demonstrated throughout the life span. Mental wellness is important, but it is not intended to be ignorant of the fact that frailties, problems, and dependencies may exist for some aging individuals. However, there exists a need to focus on the strengths of aging persons throughout their development.

      Older adults are generally challenged to create a positive sense of their lives as a whole. The feeling that life has had order and meaning is expected to result in happiness (ego-integrity) (Erikson, 1986). Older adults must adjust to decreasing physical strength and health. Thus, older adults might be confronted with life situations that are characterized by not being in perfect health, serious illness, and dependency on other people’s help. Moreover, older adults also have to adjust to the death of their spouses; this task arises more frequently for women than for men. After having lived with their spouses for several decades, widowhood might force older individuals to adjust to emotional states of loneliness, moving to smaller places, and learning about business matters. Having an optimistic outlook on life can help older adults cope with and compensate for these adjustments in healthy ways and continue on their path to successful aging. Guided Practice Exercise 3.2 will help counseling professionals identify factors integral to successful aging. These factors can be integrated into the therapeutic sessions to promote and improve the quality of life for older clients.

      Guided Practice Exercise 3.2

      Interview an older woman and investigate her perception of successful aging. Compare her responses to those factors identified in the chapter. What similarities and differences have been identified? What do you feel constitutes successful aging?

      Positive Aging Characteristics

      Many of today’s older adults lead active, productive lives. For example, 83.6% of persons 65 and older in 2014 had completed high school or higher education, and 26.3% of these older adults earned a bachelor’s degree or higher (U.S. Census Bureau, 2014). The majority of adults over 65 continue to work, volunteer for humanitarian causes, serve in public office, travel, and remain otherwise active (Centers for Disease Control and Prevention, 2009).

      Typically, people who have aged successfully have the following characteristics:

       In general, they have managed to avoid serious debilitating diseases and disability.

       They function well physically, live independently, and engage in most normal activities of daily living.

       They have maintained cognitive function and are actively engaged in mentally challenging and stimulating activities and in social and productive