Valuing the elderly and keeping them socially connected
Staff of The Nathaniel Centre
We often read or hear the term 'grey tsunami' used to describe the large numbers of 'baby boomers' who are reaching the age of retirement, and we are increasingly warned about their negative economic impact, particularly the effects of a shrinking workforce and the increased demand for health care services. While many would challenge these assumptions, arguing for an alternative and more optimistic view based on people working past retirement and experiencing healthier years later in life due to improvements in diet and access to medical care, still it is the negative language that seems to prevail. The constant use of phrases such as 'old-age dependency ratio', 'decline in functional capacity' and 'the economic burden of an ageing population' to describe the elderly, arguably reveal more about ourselves and our attitudes to ageing than about the elderly – symptomatic of a society that fears growing old, that fears dependency and vulnerability and is willing to judge the elderly more and more in deficit terms, often through an economic filter.
The growing rates of elder abuse in New Zealand are well-documented and growing rates of social isolation amongst the elderly are further manifestations of a society in which the elderly are becoming disenfranchised and marginalised.
A recent article in the New Zealand Listener (April 4-10, 2015) describes a 'loneliness epidemic' affecting the elderly in this country. Recent New Zealand studies reveal that around 8 percent are severely lonely and up to 45 percent moderately lonely1. Meanwhile other research shows clearly that loneliness is related to lower levels of physical and mental health.
Many elderly people, but especially those who are socially isolated, suffer from depression2. The coroner's report for 2014 found that the number of suicides recorded in over-60 year olds went up from 75 in 2012-13 to 97 in 2013-14. "The rise in older people taking their own lives is something I highlighted last year, and this trend has continued, particularly for the above-80-year-old age cohort."3 We also know that in places where assisted suicide or euthanasia is available, the most common end of life concerns are not pain-related but existential, including loss of autonomy, fear of being a burden, a decreasing ability to participate in activities that made life enjoyable, fear of losing control and social isolation4.
The isolation of the elderly is partly explained by the fact that families are smaller, more fragmented and more likely to be geographically dispersed. Significant numbers of the elderly now live in different cities and even different countries than their children or their siblings, and even when living nearby, adult children are often 'time poor' – i.e. busy with their own children and jobs.
Where elder abuse is happening, families are very often part of the problem; 50 percent of alleged abusers are family members, usually sons and daughters. It is conservatively estimated that around 9,000 older New Zealanders suffer some sort of abuse or neglect each year,5 psychological abuse being the most common, followed by financial abuse. Loneliness or isolation is a known risk factor for abuse, and often the abuse is not reported due to feelings of shame.
The isolation, loneliness and abuse of the elderly are symptomatic of a culture that views the elderly as having outlived their usefulness. This has been described as 'ageism', a systematic stereotyping of people because they are old which leads to them being viewed as "lesser beings, asexual, intellectually inflexible and at the same time forgetful and unproductive."6 Describing this shift, Pope Francis has repeatedly criticised the fact that the elderly are ignored, or seen as a burden who do not produce and can be discarded: "Then when we become older, especially if we are poor, sick and alone, we experience the shortcomings of a society planned on efficiency, which consequently ignores the elderly." Pope Francis warns of a 'poisonous' culture where the elderly are 'abandoned in institutions' where they may suffer physical neglect or loneliness. He sees older people and children as being particularly at risk because they are not economically productive. "But this culture of 'discarding' human beings hurts our world ... How many times we discard older people with attitudes that are akin to a hidden form of euthanasia."7
Thankfully, there are various commentators who are challenging the utilitarian view of the elderly exemplified in a number of extremely positive and imaginative developments taking place internationally.
Atul Gawande, for example, writes of 'nursing home' managers in the United States who have questioned the rigid focus on safety and have given autonomy back to the residents in a variety of ways. He describes how in one home the new Medical Director found 'despair in every room' and identified the 'three plagues' of nursing home existence as boredom, loneliness and helplessness. The response of the new Director was to inject life back into the home in the form of animals, plants and people: "The inhabitants of Chase Memorial Nursing Home now included one hundred parakeets, four dogs, two cats, plus a colony of rabbits and a flock of laying hens. There were also hundreds of indoor plants and a thriving vegetable and flower garden. The home had on-site child care for the staff and a new after-school programme. Researchers studied the effects of this programme over two years, comparing a variety of measures for Chase's residents with those of residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half that of the control nursing home. Psycho¬tropic drugs for agitation, like Haldol, decreased in particular. The total drug costs fell to only 38 per cent of the comparison facility. Deaths fell 15 per cent. The study couldn't say why. But Thomas [the Medical Director] thought he could. 'I believe that the difference in death rates can be traced to the fundamental human need for a reason to live' ... The most important finding was that it is possible to provide them with reasons to live, period. Even residents with dementia so severe that they had lost the ability to grasp much of what was going on could experience a life with greater meaning and pleasure and satisfaction."8
In the Netherlands there is now a nursing home that allows students to live there for free in exchange for spending at least 30 hours a month with the home's senior citizens. "They go see the pensioners for a chat, they play games, go with them to the shopping centre, (and) do shopping for those who can't."9 The students also cook meals and plan activities based on their interests. For example, one student provided a group who were curious about graffiti with spray cans and cardboard to help them learn about the art form.
Meanwhile a nursing home in Seattle has pre-schoolers come in for their classes and to spend time with the elderly. The pre-schoolers come with "no assumptions, no judgement and no awkwardness – just lots of time to spend and heaps of love to give."10 Filmmaker Evan Briggs shot a film of the retirement home over the year 2012-2013; she said residents had a "complete transformation in the presence of the children. Moments before the kids came in, sometimes the people seemed half alive, sometimes asleep. It was a depressing scene. As soon as the kids walked in for art or music or making sandwiches for the homeless or whatever the project that day was, the residents came alive."11 As the school describes, the program has benefits for both the children and the elderly; the elderly find a new sense of self-worth and enjoy the joy and laughter that toddlers bring to any setting. The children learn about the aging process, learn to accept people with disabilities and receive unconditional love and attention from the residents12.
A community-based initiative closer to home, operated by St Joseph's Malvern parish in Melbourne, engages residents as volunteers or recipients for services offered by Jo Care.13 Theirs is a free service aimed at encouraging friendship and support within the local area. The volunteers might visit for a chat, share a book, go for a walk, or teach a new skill, but the focus of the program is to engage with socially isolated individuals.
In Limerick, Ireland, there is The Compassionate Communities Project14 which works in partnership with individuals, groups and communities to provide a range of support to people living with a serious life-threatening illness, as well as those facing loss and those experiencing bereavement. One of their groups, the Good Neighbourhood Partnership15 , has volunteers providing social and practical support to people with palliative care needs. The aim of the project is to enable people to identify their social and practical needs and have them met from within their own circle of community. The project had identified that often friends and neighbours want to help but are sometimes unsure how to. The Partnership makes links between those who need social and practical support and those living close-by who would like to offer help. Activities include "walking the dog, doing the shopping, collecting a prescription, going to the library, filling a coal bucket, lighting the fire, mowing the lawn, making a snack, tidying up or sitting with a person who needs a break."16
Developments such as these provide real and effective opportunities to challenge the growing spread of ageism; they have the potential to help us all view the elderly differently, understand better the contribution that they make to the community, allow them real value and dignity, and at the same time enrich our communities with demonstrations of care and compassion.
Staff of The Nathaniel Centre
 An Auckland Council commissioned study found that 9 percent of Auckland residents aged over 50 were severely lonely and 44.5 percent moderately lonely; the New Zealand Longitudinal Study of Aging found that 3 percent of those between the ages of 48 and 90 years were very severely lonely, 7 percent were severely lonely and 41.2 percent were moderately lonely.
 Depression affects 15-20 percent of older people. Ministry of Health: Mental Health and Addiction Services for Older People and Dementia Services. 2011. http://www.health.govt.nz/system/files/documents/publications/mental-health-addiction-services-20jun.pdf
 Report of Chief Coroner 20 August 2014. http://www.justice.govt.nz/courts/coroners-court/suicide-in-new-zealand/suicide-statistics-1/2013-14-annual-suicide-stats-press-release
 See “‘Be Careful what you wish for.’ Euthanasia and Rob Jonquiere’s ‘ideal’ society”. The Nathaniel Report, issue 45, pp. 4-5.
 Age Concern reports 1500 confirmed cases of elder abuse or neglect; it is estimated that only 16% of all abuse incidents come to the attention of service agencies. https://www.ageconcern.org.nz/ACNZPublic/Services/EANP/ACNZ_Public/Elder_Abuse_and_Neglect.aspx#howmuch
 Families Commission: Elder Abuse and Neglect. Exploration of Risk and Protective Factors. Research Report No. 1/08, January 2008. P. 16
 Gawande, Atul “Being Mortal: Illness, Medicine and What Matters in the End”. Profile Books Ltd, London. 2014.