October 22, 2020
From my perspective as a social worker of over 25 years, and now as a Caregiver Program Manager at Elizz, there is a lot to love about The Future of Aging’s chapter on Health Interventions (Chapter Two). In my experience working with older adults and their adult daughters and sons (family caregivers), I know that there is a whole dimension of health and wellness beyond the biomedical focus.
That’s why the critique of the biomedical model of aging in this chapter is refreshing. There are a variety of social determinants of health, or other routes to wellness, such as emotional healing work and/or complimentary and alternate medicine that are discussed in this book. And they’re all seen through the lens that older adults are resilient, rather than frail and in decline. These are two of the main reasons that this chapter truly spoke to me and my clinical experience.
Emotional regulation, resilience and COVID-9
The authors point out that there is “… compelling evidence that emotional functioning actually improves as people age”. Older people experience negative emotions less.
This has been borne out during this COVID-19 pandemic. Compared with younger Canadians, those 65 years of age and older reported lower rates of symptoms of moderate to severe anxiety. Seniors are the least likely to report a negative impact on their mental health since physical distancing began.
It has been reported that every age group except seniors was less likely to report excellent or very good mental health during the COVID-19 pandemic compared with rates prior to the pandemic. This is despite the fact COVID-19 poses greater physical health risks to older adults and greater mental health risks with social isolation.
How can we make sense of this resilience? With life experience, it has been said that older adults have learned to take crises in stride, with an understanding that “…this, too, will pass.” In other words, they bring some wisdom of life experience to this latest crisis. Talk about an opportunity to create intergenerational connections and draw on older adults’ wisdom!
Resilience isn’t just about individual characteristics or personality
Michael Ungar, a long-time researcher on resilience, defines it as the capacity to navigate resources and negotiate for these resources to be provided in culturally meaningful ways. While his research often focuses on children, it equally applies to aging adults. As with children, resilience is more likely to occur when we provide the “…services, supports, and health resources that make it more likely for them to do well in ways that are meaningful to them their family, and the community.”
In this vein, I am thinking about social isolation and loneliness and the stark finding that it is a health risk on par with obesity and smoking 15 cigarette a day. Resilience, then, is related to providing social connections and solutions that work for those who are currently isolated. As highlighted in an excerpt from Helene Martel, at Kaiser: “It’s things like social isolation-people need connections-[and] good sleep, good nutrition, and physical activity…. Going back to the definition, what is needed to foster resilience is access to services, supports and all types of health resources. Access, access, access. The need for good nutrition, cited above, is often an access issue. In my experience as a homecare social worker, the block or deterrent to good nutrition is as much about not being able to afford to do so, as it was about making good decisions.
Looking beyond biomedical knowledge and interventions
In my experience, many older and aging adults are indeed active participants in shaping their worlds, trying to remain as healthy and well as possible. As just one example, I have met many older adults who have made changes to their sleep hygiene and have explored natural sleeping aids like magnesium to improve their sleep because of a reluctance to “take another da*n pill.” As the authors state, “If given the opportunity, many might choose instead to take advantage of complimentary practices for health and health.” In fact, alternate treatments are playing an increasing important role in people’s management of their health. One study for the year 2015/2016 found that 79% of Canadians have used at least one complementary or alternative medicine or therapy some time in their lives. Say hello to interventions and practices like acupuncture, yoga, massage therapy, breath work, meditation, energy medicine. And while I understand there are complex regulation issues, Canadians are voting for this with their pocket books, spending an estimated $8.8 billion on CAM in the latter half of 2015 and first half of 2016.
My biggest concern about utilizing complimentary and alternate medicine is the shroud of secrecy about it. While the number of medical schools that offer courses on complementary and alternative medicine (CAM) is on the rise in United States and Canada, there continues to be a great divide. In my experience as a homecare social worker and virtual caregiver coach, those who share about utilizing CAM usually do not share this with their doctor for fear of being mocked or criticized or dismissed. Physicians have limited knowledge about their use. If nothing else, pursuing these other routes to health and wellbeing is taking ownership, and, ideally, should be recognized, respected and incorporated into an overall health and wellness strategy.
The authors conclude nicely that “holistic health care interventions will need to be formed based not only on the underlying biological mechanisms of disease, but also, on the lifestyle, emotional and economic indicators tied to a person’s health.” That is the ticket to successful health interventions, now and in the future.
I have noticed that adult daughters and sons are more likely to be worried and anxious about their aging parent, and managing in their home, than are the parent themselves. This is sometimes the (unspoken and often, unrecognized) driver behind, suggestions at best, and at worst, demands that their parent to move into a retirement home or community. If their parent goes into a retirement home, for example, the daughter or son will worry less. This is of course one solution to worrying less. At the same time, I encourage the adult kids to work on their own fears and worries rather than focusing exclusively on their parents making changes so they feel better. I also wonder whether there isn’t some conscious or unconscious belief system about aging, associating it almost exclusively with illness and decline.
Jane Vock is a social worker with over 25 years of experience connecting with people in many settings; community counseling, home care and most recently as a Caregiver Program Manager for Elizz. Jane supports and assists family caregivers by providing caregiver coaching and creating caregiver focused content.