Late Adult Stage of Life

The following interview was conducted over several sessions with “Jean” who is in the late adult stage of life. Jean resides at an assisted care facility in Sherman Oaks, California. She is a widow, her husband of over 50 years having passed away some six years ago. She had an elder brother who also is deceased. She has three adult children and six grandchildren, four of whom are adults. She is 83 years old and is in Erikson’s eighth and final stage of psychosocial development.

Erikson characterized the psychosocial crisis of this state as “integrity” versus “despair.” The related element in society is “wisdom.” “Integrity” for Erikson has two meanings. The first is “consistency” of actions, values, methods, measures, principles, expectations and outcomes. In this sense it describes or evaluates a person’s ability to achieve her/his goals. The second is a subjective quality of being honest and truthful as motivations for one’s actions. The antonym of this sense is “hypocrisy.” “Despair” is an existential condition characterized by the absence of hope. It acknowledges the contingent nature of one’s existence and the fallibility of human institutions, which are unable to articulate or give it intelligible meaning. One nonetheless must navigate the passage of one’s life and make choices even in an environment of uncertainty. One must rely on factors like one’s personal authenticity and wisdom in order for it to make sense.

Broderick & Blewett suggest several other factors that are pertinent to the assessment of psycho-social development in late adulthood. Two common and debilitating declines are increasing sensory deficits and osteoarthritis. Persons at this stage of life are subject to gradual decrements in fluid intelligence (processing speed slows and inhibitory functions decline). In extreme cases this actually may result in dementia. Dementia also may be caused by stroke or Alzheimer’s disease.

Another declining cognitive function is autobiographical memory, or one’s remembered self. Exacerbating the loss of autobiographical memory is the “shrinking social convoy,” which is the dying or disability of friends and family members who otherwise would be able to provide cues and support. Experiencing loss (facing death, reconciling oneself to the death of others, being bereaved, coping with grief) is one of old age’s most vexing challenges.

Broderick & Blewitt (at p. 473) cite a study by Baltes & Baltes identifying three processes that are key to successful coping in the later years. The first is selection: realistically narrowing one’s goals and limiting the domains in which one expends effort. One can’t remain concerned about everything so the scope of one’s interests necessarily contracts. The second is optimization: enhancing the profile of those goals that remain and only accepting those social-emotional experiences that contribute to one’s growth or development. The third is compensation: dealing with loss by transferring interest and attention to something else. These three processes when successfully implemented significantly increase psychological autonomy and well-being.

Other theorists (p. 473) propose a hierarchy of needs that are particularly salient in old age: autonomy, competence and relatedness. “Autonomy” is defined as being in control of oneself, feeling that one’s behavior is congruent with one’s “true self.” “Competence” is feeling effective in one’s interactions with the social environment and experiencing opportunities to exercise and express one’s capacities. “Relatedness” is the feeling that one is important to others and valued by them. The degree to which these basic needs are met substantially determines a person’s sense of well-being and life satisfaction. As one ages one has less control over this process.

General Assessment

Physical Development: Physical changes, health issues, outstanding abilities. Jean is experiencing gradual physical decay. She has undergone two recent hospitalizations, one following a fall and then another following a respiratory attack. She has a medical history of asthma and cardiac arrhythmia. She is ambulatory and uses a walker to assist her in locomotion. She does not get enough exercise and has been refractive to physical therapy. In addition to support from the assisted care facility she presently also has a private attendant during the day. Her primary support contact is her eldest daughter who lives locally. Her other children (a daughter and a son) live out of state. The out-of-state daughter is a RN who does some liaison with the assisted care facility concerning her medical needs and requirements.

Cognitive Development: Intellectual level, problem solving skills, language abilities. Although not suffering from dementia Jean is mildly senescent. She is forgetful about names, the location of objects, facts about her life and current state of affairs and her daily schedule. When she cannot find something she is predisposed to believing she has been a victim of theft. She lacks practical coping skills and would be unable to navigate an unfamiliar environment. She does not present an elopement risk from the assisted care facility. She has good procedural memory for activities such as playing cards. She spends most of her day watching television. She suffers from mild aphasia and occasionally is incontinent.

Social Development: Interactions with significant others, personal values, types of socialization. Jean is friendly towards her fellow residents and says “hello” to them as she passes them in the corridor. She formerly was a resident of Phoenix, Arizona and lived at an assisted care facility there for two years. She was able to develop reasonably good peer group relationships at the Phoenix facility. She moved to the Sherman Oaks facility six months ago, where she has not yet been able to develop adequate peer-group relationships. She attributes this to the other residents being “stuck up.” In fact it just may take some time for her to integrate into the de facto cliques and social groupings her new environment presents. Jean’s religion is Catholic however she is not overtly religious. She attends Mass weekly with her eldest daughter and son-in-law.

Emotional Development: Personality characteristics, current and past social functioning, mental health and well being. Jean’s emotional environment is constrained. She is not overtly affectionate. She has no emotional interactions outside of her immediate family. She likes to be the center of attention and can be overly directive with respect to minor matters (i.e. telling people where to stand or where to sit). She is cantankerous and frequently complains about issues such as the capability of the facility’s cleaning staff and the quality of the food. She misses her deceased husband dearly.

Before Jean married she was a schoolteacher. After she married she became a full-time housewife. She came to inhabit a role and develop a personal style characteristic of the time. Historically her life activities primarily were taking care of her husband and children and some social outlets such as playing golf and various ladies’ clubs. Her present mental health overall is acceptable with some mild situational depression, but not that much different from what it historically has been.

Current life issues: Impairment (if any), school, work, marriage, parenthood, friendship, physical activity, health, retirement. Jean’s current life issues primarily involve the circumscribed nature of her circumstances. Lacking a well-developed sense of who she is she defines herself primarily in terms of being her deceased husband’s wife and the mother of her children. Although aware of her physical impairments and lack of mobility she has been reluctant to accept or acknowledge her changed circumstances. While her financial resources are adequate she worries about not having enough money.

Questions and Answers

The following responses are paraphrases based on notes taken during the interview sessions.

What is different about this stage in your life? “I regret my loss of mobility and independence, my ability to do things on my own.”

What do you like about being at this stage in your life? “Not much! I am grateful for my children and grandchildren.”

What do you dislike? “Just being old. I can’t go shopping or do anything without assistance. Some days it’s hard for me even to get around.”

What surprises you about this stage? “Well I’m happy I’ve made it this far, even as my life and social circle contract.”

Who is the most important person in your life? “My deceased husband and my children and grandchildren.”

Who have been your heroes? “Heroes? None, really.”

What were the significant personal events shaping your life? “I grew up on a farm in the Midwest. My parents were loving and kind, although somewhat distant. My brother was something of a ne’er-do-well. The happiest days of my life were getting married to my husband and having my children.”

What were the significant historical events in your life? “We lived through the great depression and the Second World War.”

What do you worry about now? “Although I understand it’s not an issue of immediate concern, I worry about not having enough money. And dying.”

Has that changed from earlier in your life? “Formerly I was concerned with the day-to-day issues of my life such as taking care of my husband and children. Now however he’s gone and my children are grown. So the scope of what I worry about has narrowed considerably.”

What are you afraid of? “Dying, growing older than I am already. I feel very much alone in the world.”

What do you look forward to? “I look forward to meals each day, to going to the movies and to watching my favorite shows on TV.”

What makes you happy? “I enjoy seeing my children and grandchildren.”

What makes you sad? “I miss my husband.”

What makes you angry? “I get so upset at the staff here at the facility when they don’t do a good job of cleaning or taking care of things.”

What do you enjoy doing most now? “Going to meals, going to a movie, watching TV, spending time with my children.”

Personal Reactions in Conducting the Interview

What did you learn from this person? I learned that one of the most important parts of aging is to have interests. These may be intellectual, creative or social. They need not result in the accomplishment of any goal or objective, rather it is the process of engaging with them that is important. They are crucial to maintaining a sense of self-identity. It is not clear that Erikson’s antinomy between “integrity” versus “despair” adequately captures the nuances of growing old. Both of these are end-states, not part of a process along a journey. Contra to Erikson, nobody cares if you’re wise or foolish. Rather the main challenge is to live with uncertainty yet not be caught in hesitation; to retain a sense of wonder; to remain curious about life and all it offers.

Another interesting perspective is that offered by Jung who characterized two basic archetypes of aging, which are the “wise old man” and the “old woman.” Jung intended these as antinomies or reciprocals of each other. While the “old woman” part makes sense it is not clear how it juxtaposes with the “wise old man.” In her confirmation hearings to become a justice of the U.S. Supreme Court, Sonja Sotomayor characterized herself as a “wise Latina woman.” Regardless of whether this is true or pertinent it suggests that either male or female may achieve wisdom in old age – significantly, the synthesis of Erikson’s thesis and antithesis.

What did you learn about yourself?

I learned that the process of aging is difficult and that one’s time on earth is short. There is a significant sense in which one’s past history becomes reduced to a fleeting series of impressions. Images from previous stages of development can be cycled through quickly. For many people at this last stage of life the main issue is dying, that is, one’s physical demise. This means the end of one’s projects, interests and concerns. For most people even one’s grandparents are alien beings. The tasks and things that interested them, and what they accomplished, simply are unknown. Even famous people don’t matter after a generation or two, or are reduced to a line or two in a history book. Given this the most significant challenge is to maintain one’s personal authenticity by confidently pressing forward into the possibilities life presents. Life is not a race; if and to the extent it is, it is won by running slowly. Just as one has been influenced by one’s background, history and circumstances one must maneuver through them and not let them constrict one’s attitude, orientation and outlook.