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Because so many people are living so much longer than previously, it is probably time to talk about a new life stage, called “Very Old Age”. But first, let’s back up. There is Middle Age which has now been pushed to later in life to encompass the active years late in one’s career or early in retirement. Next is Old Age, when dying brain cells and the wearing out of the physical body result in some changes in the type and level of activity.
In Very Old Age, your mobility and functioning are restricted to the point that many of the activities that gave you pleasure or a sense of accomplishment are no longer possible. In addition, you must spend a lot more energy and money on body maintenance. There may be things you must do each day to deal with chronic health conditions or with physical and emotional pain. Your life expectancy may be less than five years; it may be zero or less. Of course the conditions of Very Old Age can be brought on by an accident or by serious illness, as well as by advancing years. As with other life stages, Very Old Age presents both positive possibilities and some new challenges.
There are several personality characteristics that can make a difference in the way you react to Very Old Age:
People differ in their response to adversity, such as that which is presented by being Very Old. Some people are fighters. They rise to a challenge and are energized by struggle. If there is nothing to fight, they will look around for something to attack and overcome. Others seek security and a life that proceeds at an even, predictable pace. They avoid challenges or try to find the way around them that takes the least energy.
For the fighters, Very Old Age is just another problem that they will meet as they have done in the past: head-on and with confidence. Some security seekers may find solace in leading a restricted life. Others might want to escape by leaving life.
4.1 How do you respond sudden major adversity? For example, what would you do if your house were leveled by a hurricane, if you were suddenly out of a job, or if you lost the use of one of your limbs:
Right away, I would begin to fight, to attack the problem; and, I might rally others to do the same.
I might be overwhelmed or devastated at first, but then I would begin to deal very actively with the problem.
I would need considerable emotional and other kinds of support in order to deal with any significant problem.
I have found that I have trouble with small problems, but that I can deal pretty well with important challenges.
I have trouble coping. I would probably not be able to deal adequately with a difficult problem, even with the help of others.
I am not sure.
Comments:
4.2 How you would feel and act if the doctor told you had six months to live? Which of these descriptions would apply to you:
I would fight on until the last breath.
I would want things to be over as quickly as possible.
At first I would be shocked and upset, but I would pull myself together and do the best I could for myself and for those around me.
I would try to remain calm so as not to upset others or drive them away, but I would be terrified inside.
I would be overwhelmed with fear and would need a great deal of help from those around me to get through whatever followed.
I would be a very bad patient, continually upset or angry, irritable and complaining.
I would use the same problem-solving skills that have served me well throughout my life. I would set goals and figure out how best to reach them.
It is impossible for me (and probably others) to predict how I would react.
Other reactions:
People differ in their capacity for pleasure. A high capacity here means the ability to enjoy a great many things and to enjoy them a lot. Its basic level depends both on brain chemistry and on heredity. Its level can vary depending on general health, sleep, nutrition, and exercise, and level of stress. A low capacity can be increased by antidepressant medication.
People with a high capacity for pleasure will be better able to enjoy activities with low levels of stimulation such as those allowed by the restrictions of Very Old Age.
4.3 Which of these apply to your ability to experience pleasure:
I think that I am pretty easy to please. I get pleasure from many activities, including those that do not require strength, agility or a lot of energy.
My capacity for enjoyment seems to be about average. My feelings of well-being do depend somewhat on activities which require physical ability, such as sports, travel, or active expressive activity, such as music performance, dance, painting or acting. So, I am not sure whether I would be able to give up or substitute for these activities without significant suffering or frustration
My pleasure threshold seems high. I get pleasure only from certain activities which have a high intensity of stimulation and require physical abilities that I probably won’t have when I am Very Old.
People also have a physical pain threshold that may be independent of their pleasure threshold. This threshold may increase or decrease with age, and is of course affected by medication. New medications are constantly being developed, and aggressive treatment for pain is becoming the norm. Pain is also affected by environmental and psychological factors.
Trying to predict your response to the increasing pains of aging is difficult because you may become less or more sensitive as you get older. It appears that some people can adapt to almost anything, so you may be able to get used to a lot more than you think. Also, pain is a complicated response that is affected by psychological and social, as well as physiological, factors. Still you may have developed a sense of your responsiveness to pain that may have some relationship to your potential for suffering from the changes of aging.
4.4 How would you rate your current physical pain threshold?
I have a low threshold for pain. I seem to hurt more from small wounds or muscle strains that others might tolerate pretty easily.
I have a moderate threshold for pain.
My pain threshold is high. I don’t seem to be bothered by the level of pain that distresses others. For example, I may tolerate postoperative pain or the pains of muscle strains or sprains better than others.
Your response to emotional pain or your emotional fragility is another characteristic which may predict how well a you will cope with Very Old Age. A history of emotional problems suggests that a person may not do well, especially if treatment has been unsuccessful. On the other hand, sometimes people get their first effective treatment during old age and are as happy, or happier, than they have ever been.
Very Old Age may bring a dulling of the emotions that can protect the person from emotional pain. The tendency of Very Old people to live in the present and in the distant past can protect them from the frustration that comes from comparing their lives to those who are younger.
Still, the transition from active Old or Middle Age to Very Old Age with its disappointments and frustrations can hit hard ...
4.5 How do you rate your emotional fragility:
Low. I have not had problems with anxiety or depression except perhaps under very stressful conditions.
Moderate. I have had some depression or anxiety but it was responsive to treatment or to improvements in the circumstances of my life.
High. I have had problems with chronic anxiety or depression that have not responded to treatment. Reducing stress or making other improvements in my life situation were not very successful either.
Many Very Old people don’t seem terribly upset with their lives, at least on the surface. They don’t continually complain, or say that they would rather not be living.
4.6 Why do you think that so many Very Old people seem to put up with a quality of life that appears to be so low -- or at least much lower than it used to be?
They have no choice but to do so because there are too many obstacles to improving their lives or to leaving it.
Many are really suffering but don't want to push others away by asking for help, or by complaining or acting depressed.
Many are suffering but are too weak to take the steps necessary to leave life or to do anything else about it.
The losses of function, pleasure and feelings of accomplishment happen so gradually that they get used to them.
They find things to do that seem boring or meaningless to younger people but which give Very Old people pleasure.
They adjust their expectations to correspond to what is possible.
They learn to live more in the present without comparing their lives to those of younger people or to their younger selves.
Other reasons:
Your Very Old Age may last a long time, and will last longer as medical science continues to extend our life expectancy. Your quality of life during this extension may not be very good. The questions that follow ask you to think about how you might react to the changes that can occur during this stage of life. Remember that you may be able to adapt much better than you imagine now, and that many of the problems listed are partially preventable.
If you are Very Old, you may want to skip this question and those like it rather than be reminded of losses to which you have already adjusted. Otherwise, you can respond to the questions as if they were asking you about your current thoughts and feelings.
4.7 How concerned are you about facing the potential problems of Very Old Age that are listed below?
You will be using a rating scale for concern that will reflect a combination of how likely you believe the situation will occur and how upset you will be if it does.
The other scale will show how well you think you would adapt to or cope with each change, as follows:
Very well: I could pretty easily deal with the problem or find substitute gratification.
Fairly well: I would be somewhat frustrated or upset, but I would probably be able to deal with how I would feel. I would get enough sense of accomplishment or pleasure from what I could still do.
Not well: I would not expect to be able to get used this change.
Not sure: I can’t be at all sure of how I would deal with this change.
___________________________________________
Concerned?
Very
Somewhat
Not concerned
Not sure
Could adapt or cope?
Very well
Fairly well
Not well
______________________________________
______________________________________________
Losing your senses of smell and hearing (not enjoying food and the outdoors as much, having to wear a hearing aid):
Losing your memory:
Living with increased probability of diseases which can threaten your life or reduce your quality of life:
Undergoing more frequent medical treatment such as: medication with uncomfortable side effects, operations, rehabilitation, and brief stays in a nursing home:
Being reminded of the fact that you are aging and of your mortality by: becoming hard of hearing, having stiff joints, being sensitive to cold, being on a restricted diet, taking a lot of medications, having sleep problems, having young people ignore you or treat you with exaggerated care, noticing that many people your age are dying...:
Having to move out of your house or apartment and into a retirement community:
4.8 List any other problems that you foresee (or problems you have):
The next two questions are similar to the one above. They ask about your adjustment to possible losses of Very Old Age.
4.9 Use this scale to describe your reaction to restrictions in the activities or abilities listed below:
OK=Loss or reduction would pose little or no problem;
Bad=Loss or reduction would be quite painful.
?=Not sure
Abilities
Having sex
Having an active intellectual life
Doing useful work
Being involved in the arts
Engaging in sports or exercise
Being able to move around without help
Being able to travel
Being in charge or control of:
My money
What I do everyday
My eating
Bathing and going to the toilet
What I wear.
4.10 If you were to wake up tomorrow and find that you were permanently bedridden, what steps would you take to make life bearable:
4.11 How might you deal with these additional potential problems:
· lowered self-esteem or respect from others:
· the reduction in the time others are willing to spend with you:
· reduced pleasure:
· reduced sense of accomplishment:
· envy of others' quality of life:
· the grief you would feel over the losses of functioning, relationships, and activities:
4.12 If you experienced losses such as those listed above, would you want to leave life? What would be your reaction if someone else wanted to leave life because of their inability to adjust to Very