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The Psychology of Dignity in Old Age

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What is it like to grow old? What are the psychological changes as we grow older? How do we cope and adapt? How do we maintain dignity as we age? What are the secrets of the ‘super-agers’; those who grow old more slowly than most; those who maintain or even develop abilities ahead of people enormously younger? How can we continue to thrive in old age or thrive even more because of old age?

Shakespeare, in As You Like It, with his usual eloquence, laid out the seven near-inevitable stages of life. If alive, we have no choice over growing old. However, we have a choice of whether to age with wisdom and dignity.

As we enter older age, for most people, there is a decline in physical ability. For most of us, diminishing physical capabilities are a result of:

  • Our genetic code becoming damaged by way of replication and other errors.
  • Wear and tear and cumulatively acquired injuries.
  • Knees and hips and other joints wear out. 
  • Fingers and hands pass their best.
  • Vision deteriorates, starting with presbyopia (the eyes lose their ability to focus on near objects through lens thickening and reduced flexibility) around 40.

For many people, presbyopia is the first time they have experienced the irreversible symptoms of growing older. If so, it can be a moment that requires some mental adjustment to the journey whose beginning it symbolises.

For most of us, in terms of physical fitness, we spend the first portion of life managing our ascent, the second tranche maintaining a brief plateau, and the third batch of time seeking to minimise our descent.

Some of the widely believed to be inevitable aspects of ageing are avoidable. The archetypal postural stoop associated with old age, often used in road signs, is not inevitable. Many, perhaps even most, old age stooping is related to loss of flexibility and supportive muscle mass.

Flexibility-enhancing exercises, such as Yoga and Pilates, can prevent the loss of flexibility and, in many cases, reverse it. Loss of muscle mass can also be prevented or reversed by regular exercise.

Well-adjusted people do not concern themselves with aspects of life which are outside of their control; they accept the reality of the passing of time while at the same time avoiding behaviours that speed up the ageing process, such as smoking, alcohol consumption, eating an unhealthy diet, being overweight, not exercising. Those steps are known as the big five health factors.

Here is a shocking figure: 75% of premature deaths are directly or indirectly caused by people not following the big five. What does that mean? That ageing in the sense of deterioration of health is accelerated by unhealthy living. The opposite is true: making healthy life choices slows down the ageing process.

Healthy living seems to account for most of the well-being of super-agers; those people who are extremely fit and healthy for their age, and in some cases, healthier than people who are several decades younger than them.

Diseases such as type two diabetes are mainly caused by unhealthy living. Sadly, upwards of 80% of people with type two diabetes do not follow the health regime necessary to maintain their health. Many of those who do, and go on a restricted diet, can remove diabetes from their lives.

Perhaps that indicates to us that health is a choice for many people and that the rate at which we grow older has an element of choice. We can choose to engage in health-enhancing behaviours and choose not to engage in health-harming behaviours.

Perhaps the greatest way of ensuring dignity in old age is to engage in the behaviours that keep us healthiest for the longest and avoid doing anything that damages our health. Super-agers do both.

However conscientious we are, some injuries are unavoidable and irreparable. In a few cases of severe long-term injury, no exercise is physically possible. The lack of exercise is a choice for many people who experience age-related deterioration or injury.

That choice is understandable; if a person has gone from being very fit and skilled in an activity, and age and or injury has deprived them of that joy, it is not unreasonable to feel a sense of loss or disappointment at being unable to continue.

That choice comes with consequences. You may have noticed that many people who acquire an irreversible injury cease doing all forms of exercise. That inactivity quickly leads to further health deterioration, which in turn makes exercising more difficult and less likely. The choices made create a downward spiral of deterioration.

By contrast, large numbers of people who were born with or have much more serious injuries than others choose to engage in exercise, and some even compete in Paralympic sports. Such people create a self-perpetuating cycle of health that gives them better quality and quantity of life, despite their challenges.

Those who make the best adjustment to their new situation find other ways of exercising. Within their new limits, they can still secure the health benefits of exercise and the reduced rate of ageing that it brings. As with so many aspects of life, George Bernard Shaw pinpointed the key issue:

‘We don’t stop playing because we grow old; we grow old because we stop playing.’

Previously it was thought that the brain declines with old age. That turns out to be false; the brain declines when not used for its higher purpose: as a learning organ. Studies have shown that nonagenarians continue to produce the neural growth hormones necessary for brain development. Assuming no brain disease or head injury, we can keep managing our intellectual ascent for life.

Indeed, the evidence is clear: brain inactive adults are 2.7 times more likely to develop forms of dementia than brain active people. It seems that the brain is a learning organ and, like all other organs, operates on a use it or lose basis. Perhaps in years to come, we will have the evidence to prove that those who keep learning throughout life are protecting their brains from the atrophy induced by lack of use.

For those who continue to learn into old and advanced old age, there is no reason their brain should not become more and more capable.

In many poverty-stricken parts of the world, dignity in old age seems unrelated to financial means and more related to mindset and attitude. In many eastern cultures, age is venerated, respected, and admired. By contrast, in many western cultures, age is seen as a liability and a problem to be managed.

A visit to any major hospital can show us that with exactly the same severe health conditions, some people are graceful and dignified, and others are not. Could dignity in old age and facing other challenges be a mindset, a choice?

Perhaps that is so for those who still have sufficient mental capacity to make a choice to be dignified. It seems the best way to be in that position into old age, and at any age, is to engage in healthy living, physically and mentally, for life.

Lived experiences shared by respected and admired people can often teach more than textbooks full of theory. Here are the words of someone who is facing an age-related challenge – Parkinson’s Disease:

‘One’s dignity may be assaulted, vandalised and cruelly mocked, but it can never be taken away unless it is surrendered.’ Michael J. Fox.

Professor Nigel MacLennan runs the performance coaching practice PsyPerform.


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