OLD-OLD AND ON THEIR OWN: INDEPENDENT IN OUR LATEST YEARS
I set my alarm for 6:45, for if I don't start early, nothing much happens. It is distressing to me to lose so much time, but I have to take a two-hour nap in the middle of the day. On Mondays I do housework; Tuesdays I keep for visiting friends; Wednesday I swim; Thursday I keep for paperwork, bills, and such; and Friday I go to a lecture series.
An elder quoted in Life
Beyond 85 Years: The Aura of Survivorship
by Colleen L. Johnson and Barbara M. Barer (New York City: Springer Publishing
Company, 1997).
Only 10 years ago, very little research had focused on people ages 85 and older. Although the National Institutes of Health had agreed to fund projects on the country's old-old population beginning in 1984, authors Colleen Johnson and Barbara Barer were surprised to find little exploration of the differences between the oldest old and those younger than 85 when they began their research in 1987. Not much was known about how the oldest old spend their days, the contributions they make to family and society, and the extent to which their activities might play a role in their longevity.
Today, the oldest Americans are this nation's fastest-growing age group. The number of those ages 85 and older leaped by 300% between 1960 and 1990. In 2000, there will be 4.6 million Americans 85 or older; by 2030 there will be 8 million, according to the American Association of Retired Persons.
REMARKABLY BUSY
"People in their 80s and 90s are remarkably busy and active in their lives. They're not just doing routine household activities or basic self-care," said Ann L. Horgas, assistant professor at the Institute of Gerontology and College of Nursing at Wayne State University, Detroit, Mich. "Professionals working with the aging population should keep in mind that very old people still engage in leisure activities that are meaningful and positive."
In the article "Daily Life in Very Old Age: Everyday Activities as Expression of Successful Living," (The Gerontologist, October 1998), Horgas and coresearchers used the Berlin Aging Study to examine the comings and goings of 500 German adults ages 70105. Analysis of the Berlin data, one of the world's largest interdisciplinary studies of people age 70 or older, showed that most old-old people spend their days alone at home.
Elders who were surveyed spent nearly half the day watching television, reading, visiting with friends or family and performing other leisure activities. One-third of the day was spent on activities of daily living (adls), for example, bathing or eating, and on instrumental activities of daily living (IADLs) such as shopping and cooking. The remainder of the day was typically spent resting. Study participants were asked about every detail of the previous day's activities, from arising in the morning until retiring at night. Every activity and the amount of time spent on it was recorded.
Horgas did not expect to find that elders in the survey were watching nearly three hours of television per day on average. She commented, "At first glance, it really carries a negative connotation, because of the image of people sitting around doing nothing. But on second look, television watching can be seen as a positive activity, because the people living in nursing homes watched less television and read less than those still living at home independently. So it seems to be related to independent functioning. We don't know what they were watching, but if they were watching the news or, perhaps, game shows or something interactive, it could help to keep people engaged."
She stressed that it is essential that gerontological nurses and other service providers look beyond the fundamental ADL and IADL activities of the oldest old. "We have to think more broadly about what they're doing in their leisure time and find ways to help them do the things they still like. It's important to keep people engaged in activities for their mental and physical health in order to help them age successfully."
A SNAPSHOT
Also examining the activities and contributions of the oldest old has been Nina Silverstein, who directs the undergraduate gerontology program at the University of Massachusetts, Boston. Her study of old-old residents of suburban communities near Boston, "A Snapshot in the Lives of Community-Residing Elders 85 and Older: Their Lifestyles, Contributions and Concerns," revealed that among the more than 500 adults she interviewed about their previous month's activities, 43% still drove an automobile and 65% lived alone at home. Most of those included in the survey considered themselves to be in good health and were not cognitively impaired.
Silverstein noted that health and service professionals often consider living alone as a risk factor when planning services and programs for this age group. For some elders, particularly those with cognitive impairments, living alone is appropriately considered a risk factor. However, she said, the data in her study suggest that "not all elders should be presumed to be at risk when living alone. Living alone does not always mean homebound and isolated."
One-third of those in Silverstein's study helped family, friends and neighbors by providing childcare, running errands for homebound elders, doing yard work or repairs, taking care of pets for relatives on vacation, preparing meals or providing comfort to the sick.
"When looking at the aging population, it's so important to present a balanced picture: What does this population need and, just as importantly, what does this population provide to the community?" Silverstein said.
The major concerns elders expressed in Silverstein's study were loneliness, along with fear of outliving family and friends; poor health; apprehension about being placed in a nursing home; lack of transportation; inadequate finances; worries about children; and the risk of crime.
More than half of those surveyed who lived alone did not have someone regularly monitoring their well-being, such as through telephone calls, knocking on doors or checking to see if the garbage was emptied or newspapers were piling up.
"There is a danger for some people, considering that many of the community-living elders live alone and do not have regular systems by which someone checks up on them," Silverstein writes. Among her recommendations in planning community programs is that "all elders 85 and older have some form of daily, nonintrusive checking system, particularly those who may live alone or with an ill or disabled spouse, sibling or adult child." For example, some aging-related organizations have designed programs with local police to develop daily contacts with community elders, she said.
For more information contact Ann Horgas, Institute of Gerontology, Wayne State University, 87 E. Ferry, 226 Knapp Building, Detroit, MI 48202; e-mail: horgas@iog.wayne.edu. Contact Nina Silverstein at the Gerontology Institute, University of Massachusetts, Boston, 100 Morrissey Blvd., Boston, MA 02125-3393; (617) 287-7317; fax (617) 287-7080.
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