Helping Relationships With Older Adults. Adelle M. Williams

it poses serious long-term health risks. Practitioners will be confronted with clients with diabetes and will be challenged to address their noncompliance issues in a constructive manner.

      Guided Practice Exercise 3.6

      Diabetes is a chronic disease that affects many older persons. This disease is managed by altering one’s diet, exercise, and/or medication. Many older persons live comfortable lives and manage this chronic disease effectively. Visit an assisted living facility and discuss your knowledge of diabetes with an elderly individual. Find ways to convince your resident of the necessity in following a diabetic diet to decrease his or her potential for insulin injections. Make sure you have thoroughly researched the topic and obtained data pertinent to diabetes management and older adults. What did you learn from this experience and how will it help you when working with older clients?

      Table 3.2

      Source: USDA Human Nutrition Research Center on Aging (2011).

      Active Engagement

      Many elements affect the quality of life for older adults. Developing and maintaining healthy relationships is one essential element. Social bonds lend vigor and energy to life. Giving to others and seeking a variety of relationships provides older adults with diverse acquaintances and experiences. Interacting with diverse persons brings different points of view and different perspectives on life. Enriching spirituality also enhances quality of life. Cultivating a relationship with nature, the environment, a higher being, and oneself is a key factor in personal growth and development. It is also important that older adults take time for thought and contemplation, enjoying the sunset, sounds, and energy of life. By engaging in these behaviors, elders will be better able to cope with the challenges posed by simply living, especially as the body undergoes many physiological changes in the aging process (Koenig, McCullough, & Larson, 2001). Guided Practice Exercise 3.7 provides the opportunity to identify and explore current activities and the extent to which they may be continued in later years of life.

      Guided Practice Exercise 3.7

      Examine the activities that you engage in regularly. Now specifically identify benefits that you derive from these activities. Is there a social component to any of your identified activities? If so, why is the social component important to you? Which of your activities do you expect to continue into your later years of development? Are there any activities you have deleted from your list? If so, discuss your reasoning.

      Accumulated evidence suggests that better health and community engagement lead to greater well-being later in life. Successful aging has been defined as the absence of disease and disability, high levels of physical and cognitive functioning, and active engagement in life (Rowe & Khan, 1997). The literature on successful aging suggests that to comprehensively understand “living well” and “being well,” one must attend to factors beyond the aging body, including the social and physical environment in which one lives. Researchers argue further that the subjective experiences related to the interaction between aging bodies and an ever-changing social and physical world exert a meaningful force on overall health and well-being (Cermin, Lysack, & Lichtenberg, 2011; Strawbridge, Wallhagen, & Cohen, 2002). Gerontology theorists and researchers also point to the complex relationships between the environment, both home and extended, and health and functioning in older adults (Stark, 2001; Wahl, Fange, Oswald, Gitlin, & Ivarsson, 2009; Yen, Michael, & Perdue, 2009). This research leaves little doubt that the physical location in which one lives shapes the activities that are possible to engage in and ultimately contributes to health (Yen, Shim, Martinez, & Barker, 2012). Case Illustration 3.3 demonstrates the capabilities of an elderly gentleman who, despite his advancing chronological years, remains actively engaged in life. Age is one point on the continuum, and numerous factors impact the aging experience.

      Case Illustration 3.3

      Mr. Simmons is an 85-year-old, happily married, retired university professor in physics. He has no chronic diseases and continues his longtime exercise routine: running 5 times a week and strength training 3 times per week. He also swims twice per week and gardens when the weather permits. His primary care physician tells him that he has the vital signs of a highly functioning 50-year-old.

      Mr. Simmons keeps his mind sharp by learning new activities and has decided to try three new activities each year and retain the one activity he likes the most. He is taking violin lessons and is learning to speak Spanish. He learns this language through auditing courses within his former university environment. He socializes with family and friends regularly and takes long distance trips 3 times a year. He is very religious and very active within his synagogue. He is an optimistic, easily engaged individual who believes that every day is a new beginning.

      Social Participation

      According to data from the National Social Life, Health, and Aging Project (NSHAP), age is positively associated with increased participation in social activities (e.g., volunteering, religious events) in part because older adults have more time after they retire (Cornwell, Laumann, & Schumm, 2008). Participating in one’s social world is seen to be a significant factor for maintaining overall health and well-being. African-American and white older adults have cited social activity as an important contributor to aging well (Corwin, Laditka, Laditka, Wilcox, & Liu, 2009). Greater community engagement and social participation, in turn, are associated with better health in old age and much reduced risk of mortality—as significant an effect as smoking, drinking, exercise, and diet (Holt-Lunstad, Smith, & Layton, 2010).

      Perspective

      Many adults reaching the age of 50 or 60 begin to free themselves from cultural constraints and express themselves in ways that they had not dared before. They become less defined by what others think of them and more by what they think of themselves. Increasingly freed from the burden of always having to fulfill other people’s expectations, their lives start to reflect a new kind of willingness to be exactly who they are. They break free from histories of physical stress, neglect, and abuse. They become more alive (Robbins, 2007). Guided Practice Exercise 3.8 provides the opportunity to explore why and how older persons choose to reinvent themselves in their later years.

      Guided Practice Exercise 3.8

      Are you familiar with older persons who have decided to “live life to the fullest”? This newfound freedom is not unusual later in life. What activities does he or she now participate in? Examine why this behavior is different from his or her youth. What do you think motivates him or her to break free from past roles, responsibilities, and normative behavior? How do you feel when you hear an older person discussing that he or she just went skydiving at the age of 85?

      Scientific studies have found that attitude is profoundly important to health. In 1984, the MacArthur Foundation Research Network on Successful Aging began one of the largest and most interesting aging studies ever undertaken. Recognizing that the field of gerontology had become preoccupied with studies of disability and disease, the Research Network began studying healthy elderly people. A central goal of the MacArthur study was to determine what factors enable some people to retain their mental faculties as they age. The researchers found that one of the most statistically significant predictors of maintaining cognitive functioning with age is the sense of self-efficacy. Elders who have a “can do” attitude are far more likely to retain intact mental abilities (Rowe & Kahn, 1998).

      Instead of thinking of it as a tragedy when their bodies begin to slow down, happy older adults accept the limitations that arise and see the transitions they are going through as opportunities to ground themselves in a deeper sense of self and a greater wisdom. Their love for others and the world becomes more accepting. They increasingly let go of minutiae and the nonessentials of life. Their perspective shifts, details soften, and the larger panorama comes into focus. They are able to enjoy life more than when they were young because they have a deeper understanding of it (Robbins, 2007). These are people who do not conform to a youth-obsessed culture’s expectations of what their later years will be like. Instead, their lives come to enact an entirely