The Geriatric Gap

Alan spent countless hours scouring the real estate ads in Chicago to find the right condominium for his mother. His father had died ten years ago, and his mother, now in her early 80s, had stayed in their modest apartment, quietly but firmly dismissing suggestions that she should move. "What's wrong with where I live?" she would ask her son and daughter. Although there was nothing wrong with the small, tenth floor apartment, Alan and his sister wanted their mother to live in a nicer place, stop paying rent and reap the benefits of years of hard work and a frugal lifestyle. So he searched for the perfect condominium that would entice his mother to move. Just when he was about to give up, he found it.

His mother was initially hesitant, thought it cost too much, was too big, but eventually appeared to come around. Alan and his sister moved forward to arrange the purchase. On the day that the papers were to be signed, he called his mother to say he was on his way to pick her up. Before he could tell her that he would be at her apartment in a few minutes, his mother informed him she had changed her mind. She told him he didn't need to come and get her—she was not moving anywhere. Alan pulled his car over to the curb and just stared at his cell phone in disbelief.

Like so many baby boomers, Alan discovered that aging parents could "checkmate" the best ideas of their well-intended adult children. Even more confusing and frustrating, he was at a loss to explain why this happened. It turns out his experience is not unique. Adult children and professionals alike are finding themselves is similar situations. Whether the issue is living accommodations, declining health, the loss of a spouse or managing money, these conversations can quickly degenerate into a war of wills and painful communication breakdowns. Like Alan, they are asking themselves, "Why is this happening?" Part of the answer lies in what we don't know about older adults and the aging process, a deficit I call the "geriatric gap."

The Geriatric Gap

The geriatric gap is a "blind spot" in our knowledge about life-long personality development. While we are familiar with psychological growth stages of children through early adulthood, we know very little about the psychological agenda of the last phase of life. Our collective assumption is that older adults are merely diminished versions of their younger selves. This negative bias toward aging is reinforced by the loss of youth we see in our family, friends and colleagues. It seems obvious that older adults are not developing anymore because we see them declining right before our eyes. This might be true if mind and body were locked in parallel patterns of aging. Thankfully, they are not.

This is not to minimize the physical changes of aging—they are real, complicated and challenging. However, the assumption that the loss of physical capabilities implies a mandatory loss of mental capabilities and with it the end of personality development is a tragic flaw in our thinking. Research has shown just the opposite is occurring. The brain maintains the vast majority of its capabilities throughout life and personality development is as alive and well at 85 as it was at 45. If we are going to partner with older adults, be it our parents or our clients, we will have to upgrade our understanding of their psychological development. This means we will have to replace our bias and stereotypical thinking with new information about this phase of life.

Defining and understanding developmental stages has become a time-tested staple of how we raise children. Its acceptance and effectiveness lies in its practical approach to some of the most challenging "normal" behaviors in children. As important, it quickly gives parents both insights and tools to help them navigate the complex challenges of a developmental phase. Our goal with older adults should be the same. Understanding the psychological developmental agenda of older adults offers us three immediate benefits for professionals and laypersons alike:

1. It provides insights into the unique psychological tasks that influence how older adults perceive the world, make choices and set priorities.
2. It provides essential information on how to partner with them so they can successfully accomplish these tasks.
3. It highlights which communication strategies that will enhance our rapport with them as well as the ones that ineffective and potentially provocative.

Developmental Tasks Of Older Adults

Developmental stages in life are characterized by sets of two paradoxical tasks. These tasks are the drivers of personality growth, the internal psychological engine that propels a person forward. The psychological developmental tasks of young children and teenagers are well documented, but those of older adults have only recently been defined and understood. Like the preceding life stages, the "marching orders" of the final phase of life are change agents composed of two paradoxical tasks:

• 1. Maintain control in a world where all control is being lost on all fronts.
• 2. Create a legacy in a world where time is running short.

The control task requires hyper-vigilance to guard against an unending series of losses that threaten an older adult's independence and dignity. The legacy task requires a reflective pause to review of life's events as a prelude to arriving at a heart-felt legacy. Each task is pulling in a different psychological direction, one focused on the issues of lasting and one focused on the issues of leaving. Their opposition, and the internal conflict they produce, facilitates the transition for the end of life. To facilitate this monumental mission, we need to understand the complex interplay between these two tasks.

The Battle For Control

It is important to remember that developmental tasks exert a profound influence on every aspect of a person's life. They appear as mandates, psychological needs that operate as much unconsciously and consciously. Nowhere is this more apparent than in older adults' need for control. While we are well versed in their struggle with loss of health, we are less knowledgeable about other areas of significant loss, changes that intensify and complicate their need for control. These include:

1. Friends and Family: The mortality curve has its steepest slope between 70 and 100 years of age, a time when funerals are an all too common event for older adults. The steady attrition of family and friends and the dissolving of a life-long support system leave them feeling vulnerable and isolated.
2. Identity: The darker side of retirement is a loss of purpose, a sense that you are no longer part of the mainstream of life. Men can suffer significant set backs when they leave their jobs. Women suffer similar issues with their children growing up and living far away. This loss of purpose leaves older adults feeling like they have become unwilling outsiders who have moved from social contributors to a social burden.
3. Consultative Authority: Our culture makes no pretense to value the wisdom of older adults. We want to segregate them into communities, so that their perspective is not available to us. It is not just that we don't go to them for advice—we send them a message that they have no advice worthy of our consideration.
4. Living Space: Aging threatens an older adult's ability to control where they live (as well as their ability to drive a car). We want them to go someplace—assisted living or a retirement village—where they'll be safe and well cared for and part of a community of older adults just like themselves. But a person's identity may be closely tied to the comforts of the physical space she or he has occupied for years. The personal losses of close friends, identity and consultative authority leave an older person's living space as one of the last areas of their life where they have any control.
5. Finances: Older adults harbor two very real fears about money: running out of it or becoming financially dependent on the younger generation. Both scenarios symbolize a loss of control that they want to avoid under all circumstances.

As the losses mount and control is involuntarily surrendered, older adults run out of options. Younger adults fail to appreciate the intensity of this battle for control and are surprised by decisions that seem to fly in the face or reason or efficiency. However, the need for some element of control is greater than the need for political, medical or financial correctness. In many cases, the only choice left is to say "no" without comment.

The Need To Create A Legacy

Conflicting with the need to exert control is the need to create a legacy, which ferments beneath the surface of an older adult's awareness. While they feel a subconscious urge to hang on tight, they are also faced with the daunting task of discovering how they'll be remembered. The last developmental stage in life ushers in an unflinching look back at a person's life called the life review process. The "doing phase" of earlier stages is replace by the "reviewing phase." This is not simply a time of glorifying the "good old days." This is an active growth period where older adults realize that are not going to be here forever, and they become aware that it's not clear what it meant to be here at all. Ideally, the reviewing leads to legacy in which they:

1. Arrive at some understanding of their life
2. Want to pass along what they have learned

It is important to remember that life review and the search for legacy are a demanding process, one that needs time and support to sort out life's events, both the good and the bad. The past is brought forward and older adults are asked to reconsider the meaning of an exhaustive inventory of events. The process goes beyond a mere recording of history for future generations—it is a search for definition, for purpose and for meaning.

Like all previous developmental tasks, life review and the search for legacy were never meant to done alone. Ideally they emerge through an ongoing dialogue between young and old. At the heart of this dialogue is the telling of stories, revisiting events that shaped a person's life. One hundred years ago this process was an accepted part of the communal society, a world where most families lived in close proximity and were connected. In that world, older adults were true elders and were expected to pass on the family stories and their lessons between generations. It was an environment that facilitated the final tasks. But all that has changed, and the communal society has given way to a fragmented social fabric, a world where families are disconnected, overbooked and chronically pressed for time. Intergenerational dialogues have been shorten or are nonexistent. Older adults are often left to fend for themselves, a situation where things can quickly take a turn for the worse.

Losing Legacy In The Battle For Control

The push-pull of control versus legacy can easily wind up with the battle for control dominating the agenda. The pressure of mounting losses, the complexity of the health care system and the exhaustion of living all conspire to make control issues the central theme of the finals stage of life. Sadly, this leaves little time or opportunity for older adults to address life review and legacy issues. If you added on battles for control with adult children, the outcome can be grim. This is where Alan's mother found herself with her children, battling for the last stronghold of control while being pressured to do things their way. To them, she was being stubborn and illogical. For her, she was simply exercising one of the only options she had left to exercise control. From either perspective, the situation ground into a stalemate, one in which no one could move with both sides feeling like losers.

It would have remained that way if Alan and his sister hadn't decided to give up. Out of frustration, they stopped their campaign to get their mother to move. They weren't happy about it, but they simply dropped the subject. After a few months, and to their amazement, the subject suddenly reappeared. But this time it was their mother who brought it up, who stated that she wanted to live closer to her daughter's family, to have more access to her grandchildren. She wasn't ready to live a place that just had old people, but she was ready to move. So Alan found her a nice apartment close to his sister's house, and with little fanfare, his mother moved in.

Alan and his sister inadvertently discovered that returning control to their mother changed the quality and direction of their relationship. In retrospect they realized that she needed to decide, to be the one to choose the solution. Stay or leave, it didn't matter. What mattered was that she was offered the dignity and power to choose. They, in turn, needed to support her choices, to relinquish control and mean it. Once she knew she had it, events took a different course.

But the payoff for Alan and his sister went beyond simply getting her to move. Leaving her apartment necessitated a physical sorting and packing of their mother's belongings, an inventory of memories collected from the years of living in the same place. Those items turned out to be powerful triggers for life review. So in the middle of packing there emerged stories, tears, laughter and a close look at the events that shaped their mother and father's lives. Unknown facts, new perspectives and long forgotten events wound up giving Alan, his sister and his mother more than they bargained for, more than they ever dreamed possible.

Older adults are crossing the most challenging and complex frontier of their lives. They are engaging developmental tasks that provoke an overwhelming need to maintain some element of control in their lives while at the same time coming face to face with the meaning and significance of their lives as they prepare for the end. This is their mission, their last contribution while they are still here. If we are going to facilitate their mission, we are going to have to learn more about how older adults think and communicate. Our increased knowledge and skills will allow us to bridge the geriatric gap while giving us the compassion and tools we need to work with them, not against them.