Transitions with the Aging Rebels

I know how it feels to be old. The wrinkles do not diminish the desire to love and be loved, to touch and be touched, to be socially engaged, and to help myself and others find meaning and purpose.  

On a personal level, I have been widowed after a 48-year marriage, followed by going online and meeting an 85-year-old man who became my partner for five years until he developed dementia. For the first time I am living alone, but with the same need I always had for connection, affection, and attachment. 

Professionally, as a 90-year-old counseling psychologist and retired professor, it seems like only yesterday that I was promoting attachments, even romance, hugging and kissing for those 80 and over. In fact, my last book Too Young to Be Old (2017) highlights the importance of social engagement, even romance if you want it. 

Now we are in the midst of a dramatic transition from being encouraged to keep our 'dance card' full with the names of prospective partners, or where we could actually hire a 'hugger' to combat the loneliness epidemic, to a world where isolation is a necessity and there is no touching. The spread of the disease has forced us into this unexpected, unwanted transition that is changing our way of being in the world. It is filled with ambiguity, has no end point, and is out of our control.

For example, Jill is very depressed. Her husband's dementia is accelerating; he sleeps most of the time. Except for her weekly visit to the grocery store, she is afraid to leave him since he falls. As she said, "If I knew when this would end maybe I could relax. I feel like spaghetti without the sauce."

The importance of transition

My professional work has focused on developing a theory that identified the factors that influence how people understand and manage the inevitable transitions all through life. My understanding of the pandemic's effect on older people is guided by my research on numerous transitions (2017), plus my volunteer work with the Senior Friendship Centers in Sarasota, Florida. As co-leader with Michael Karp, retired lawyer, our group, The Aging Rebels, discuss issues of intimacy, loneliness, invisibility, irrelevance… and now, the impact of Covid-19. 

The need for attachment, connections, intimacy coupled with the fact that our attachments are growing fewer and weaker is of paramount concern. Older people are always in danger of losing attachments, but the risk is even greater now. Since the virus entered our lives, we lose attachments not just from 'natural' death or other typical causes such as moving to a new area or retiring. Now our personal connections, whether with family, neighbors or peers, are also threatened by the new, more restrictive dimensions of our lives: isolation in our homes to avoid social contact, and especially, the need to abstain from physical contact.

Attachments keep us going from day to day, they give us purpose, and they play a key role in making life worth living. We all need to be loved and to love, to hug and be hugged, to have one person to count on for unconditional support, and to have others we care about who care about us. In other words, we need multiple attachments. 

Psychiatrist John Bowlby coined the term attachment theory (1956). His original work focused on children's fundamental need to have a steady, stable attachment figure, defining attachment as a 'lasting psychological connectedness between human beings'. Since then, a number of articles and books have focused on adults' need for attachment. This literature covers the components of attachment theory, the importance of attachments as buffers to loss, and the central role that attachments play in promoting well-being as one ages, especially since 'given the increased potential for separation, loss, and vulnerability associated with aging' (Bradley & Cafferty, 2001, p.20). Clearly, this is no longer a children's issue; it is a lifelong concern. 

The loss of attachments can result in a deadly affliction – loneliness. The development of a Social Isolation Index pointed out that social isolation and loneliness cause mortality in older men and women (Steptoe et al., 2013.) More recently, anarticle in AARP Magazine summed up these startling findings: 'Loneliness is a killer … It makes us more vulnerable to Alzheimer's disease, high blood pressure, suicide, even the common cold. It's more dangerous to our health, researchers tell us, than obesity, and it's the equivalent of smoking fifteen cigarettes a day' (Darling, 2019, 2020). It is imperative that we develop strategies to avoid loneliness. 

The pandemic transition

Seniors respond differently to the virus and social distancing depending on the degree to which the pandemic has changed four aspects of their lives: assumptions, routines, roles and relationships. The more changes, the more challenges. 

A transition can be an event like the pandemic or retirement or great grandparenthood. But it can also be a non-event like not getting to retire as planned, missing the birth of a great grandchild or the delay in your daughter's wedding. In either case, a transition has the effect of changing, our assumptions, routines, roles and / or relationships (Schlossberg, 2017, p.46). I discussed these changes with members of The Aging Rebel Group, plus other community and professional groups with which I am involved. Their comments and experiences offer clues to how our own, as well as society's, response to the virus may shape the futures of the elderly. 

Assumptions: We have expectations about our lives, our world, our futures. Covid-19 has forced all of us, but especially older individuals, to realize that we are vulnerable to a virus that could kill us. Death and disease can remind us that our time to accomplish goals or complete 'bucket lists' may be more limited than we thought.

Yet the restrictions on our lives have also created time gaps that can lead in new, productive directions, even as we are locked down in our homes. For example, the New York Times reported on a 90-year-old man who is starting a literary agency (Leland, May 3, 2020). Another example is Richard, 82, an artist whose gallery is closed, who bought and refurbished a guitar and is learning how to read music. 

Michael Karp, co-leader of Aging Rebels, summed up his changing assumptions: "The virus and how it is changing our lives and assumptions about the world is something I think about and discuss with my groups all the time. It is under the heading, 'What is the New Normal?' What will the New Normal look like when this is behind us? How will we, as people, communicate with each other? Will we continue to practice safe distancing? Will we ever again hug and embrace a good friend? Will this experience teach us more about the meaning of love and provide more compassion for others? Will this make us more sensitive to what less use of fossil fuels can do to purify our air and water quality and make the Planet a safer place?"

Routines: For many, going from a fairly structured life to what feels like a free fall can be unnerving. Natalie shared her need to organise her day. "I do something educational like reading a book, or watching YouTube on a challenging topic; volunteer to be part of a helping committee in my community; and do something fun and/or creative. Yesterday I learned about Churchill's life, volunteered to call people to see how they were doing and ordered Maine lobsters for dinner."

Marcia and her significant other Stan, both in their mid-80s, had a monogamous relationship for several years but lived in separate apartments in the same city. Instead of weathering the crisis reading, cooking or listening to music alone in separate apartments, they offer each other mutual support and make the best of the situation by ascending to the roof of her apartment building to dance free-style. 

Myra lives in a senior community with a great deal of outdoor space. During this period, she and several others agreed to meet every night at 7 pm to bike around the property. This provides structure to her evenings, provides socialisation, and is fun. She added, "And if I don't go, I don't feel guilty." 

Roles: Carol, a 67-year-old nurse practitioner in a neurology clinic, had to give up community outreach and educational projects to become a virtual and phone 'clinician'. Interacting 'in different ways with patients' families has been nice', and she is pleased to virtually see patients whose dementia makes it hard for them to get to the clinic. But she also suffers from the loss of human contact, both with patients and with clinic staff. Although the exact details are not clear, she knows that she will not be able to slide back into her previous role in a system where revenue has declined and many staff have been laid off.  

Relationships: As described earlier, loss or weakening of attachments as a result of social distancing and isolation is one of the biggest challenges of this period in our lives. 

On the negative side, I feel the loss of physical, in-person connection with my children and grandchildren. Zoom and FaceTime are great but they do not substitute for a hug or the visit my daughter and two grandchildren had to cancel recently because of the virus.  

On the positive side, Henry, 82, one of the Aging Rebel members who became a pastor in his seventies wrote: 'We have the luxury of using this enforced down time for reading, conversation and reflection on life past and future. We grieve for the many neighbors who have a less comfortable present and an uncertain future.' 

One of the Aging Rebels finds that people are calling to see how she is, not just to make arrangements to meet. And many are reconnecting with people from the past. I read about two Holocaust survivors who lost touch after the war. They recently found each other and developed a meaningful relationship. And then there is a new UK study which found: '70% percent of the nation admit they've been in contact with elderly relatives more in recent weeks, than in the past year. 54% of older (over 65's) Brits feel closer to family & that relationships with family members have strengthened, & 61% feel more loved by family since lockdown.' (Press Release, April 30, 2020.) 

Paths to the future

For the elderly who are poor, unemployed, homeless, or suffering from chronic illness, the change occurring now is almost certainly exaggerating the difficulties they already faced. We also knew that there was 'a loneliness epidemic' before Covid-19 appeared – an epidemic that affected people across the socio-economic spectrum. But I am suggesting that while all older individuals face enormous changes as a result of the pandemic, within this group the ones who suffer the most are those with fewer resources (financial and emotional).

Seniors can respond to the transition by analyzing the degree to which their life has changed and then strategise ways to shore up the weak spots to enhance their prospects for the future. For example, if a planned retirement is delayed – maybe forever – a worker will probably experience a period of grieving for what might have been. If the pandemic has forced a change in our routines, we can develop a new structure for the day. If the change has interrupted relationships, we can stay in touch – if not by physical touch, instead by e-mail, phone, or Zoom. And most important, when our assumptions have been shattered, we must strive to realize today is not forever and we will survive this.  

There's a tendency to focus on the litany of negatives that the virus has brought to the lives of the elderly – worries about dying alone, grieving for friends or relatives who have died, inability to play with grandkids, or to join friends for coffee at a local café every day – as well as uncertainty about the future. However, if we try to address the transition in the ways I describe above, 'The New Normal' for older persons for the next six months and beyond will not necessarily be all gloomy; the elderly in many cases are very resilient. My research and conversations have also suggested some paths to the future for individuals and for society as a whole. In yesterday's Zoom meeting with The Aging Rebels here are some comments made: "I was frightened about living alone, but I see that I can be alone and be happy." Another, "I am learning how to filter out the unimportant and realize I am self-reliant." 

Since the disease has intruded on so many aspects of our lives, we see the beginnings of improved outreach to the isolated elderly – food delivery to their homes, volunteers who check in regularly by phone, and enhancing their ability to communicate through tele-medicine and other Internet technology. For example, volunteers for the Senior Friendship Centers call all their participants regularly to check on them, offer suggestions about free food delivery, and answer their questions. In addition, many individuals have pro-actively learned to reduce stress and loneliness by incorporating activities such as meditation, yoga and exercise into their routines.  

Where we live can make a big difference in how we will cope in this new environment. One of the members of the Aging Rebels is grateful for choosing to reside in a community that both takes strong steps to keep them safe, and offers opportunities for human interaction even if the residents cannot sit closer than six feet apart. Similarly, Marcia and her companion moved into one apartment because they believed that togetherness would help them confront the impact of the virus. My guess is that it will become more common for the healthy aging to search for residential options – whether in a retirement community, a neighborhood or a building – that offer psychological support from neighbors, as well as social services. On the other hand, we can only hope that, for those who are seriously ill, this episode will bring improvements to conditions in nursing homes and other residences where the elderly have suffered disproportionately from the virus and its effects. 

Finally, the virus has compelled many of us to see this as a pause – a 'moratorium' period in which we ponder what we want from the future. Michael Karp suggests that 'if we use this time wisely and thoughtfully, to raise and try to answer fundamental questions about the future, we may all come out of this as better people and custodians of our planet.'

No one can predict exactly how much the assumptions, routines, roles and relationships of our daily lives will change in the coming months and years. But this enforced opportunity for individuals to pause, reflect and even to plan, may ultimately amount to a collective focus that will eventually reveal how each of us wants to, and will, live that future. Let us hope that someday we will once again be able to keep our dance cards full.

Nancy K. Schlossberg, Professor Emerita, University of Maryland, author of Too Young to be Old: Love, Learn, Work, and Play as you Age. American Psychological Association, 2017. 

References

Anderson, M.L., Goodman, J., Schlossberg, N.K. Counseling Adults in Transition: Linking Schlossberg's Theory With Practice in a Diverse World. (2012). New York: Springer Publishing Co.

Andrew Steptoe, Aparna Shankar, Panayotes Demakakos, and Jane Wardle. Proceedings of the National Academy of Sciences, vol. 110, no. 15, April 9, 2013 

John Bowlby.  Loss: Sadness and Depression. Basic Books, 1980.

Bradley, J.M. & Cafferty, T.P. (2001) Attachment among older adults: Current issues and directions for future research. Attachment & Human Development, 3(2), 220-221 2001 

Darling, L. Is There a Cure For Loneliness, The Magazine AARP, p. 54, December 2019, January 2020. Home Instead Senior UK Press Release, April 30, 2020.) 

Schlossberg, N. K. (2017). Too Young to be Old: Love, Learn, Work, and Play as You Age. Washington, D.C. American Psychological Association, p. 46. 

Update - added 29 June

Smoothing your way through the Covid-19 transition 

For the last two months I have effectively been prohibited from joining a few friends for dinner at a restaurant, meeting in person with members of the Aging Rebels group I co-lead at a senior center, having my hair cut in a salon; or basking in the art collection at the Ringling Museum in Sarasota, Florida, where I live. I was denied these and other routine pleasures by federal and local guidelines designed to protect the community's health and my own. 

When I was invited to celebrate my birthday at a gathering with family and friends, I knew that attending could flow in the face of all the medical advice about how to protect ourselves from Covid-19 – at least one week ago. Now the norms for our daily lives are in flux. 

Put another way, we are clearly in the middle of a transition. The virus has forced Americans to make important, unexpected changes in our daily life. For several months we had clear expectations about what to do to stem the pandemic. For most of us, there was no choice about whether to follow the guidelines if we were able to do so in the confines of our homes. When the transition to a stay-at-home society started – a transition designed to alter, i.e., improve, our response to a deadly disease, we just did it. 

Recently this Covid-19 transition has entered another stage: moving from strict guidelines about what to do into a period (who knows how long) filled with ambiguity and ups and downs. As The New York Times reported on June 5, "The United States has crossed an uneasy threshold, with all 50 states beginning to reopen in some way after the coronavirus thrust the country into lockdown." Now we are suddenly faced with choices. The President and many of our governors are telling us to leave our homes, to go to restaurants and shops and spend money. At the same time, epidemiologists send out warning signals that it is too soon, and that the possibility of a second wave of the virus is real.

Anthropologists call the period we are in "liminal space…(the) transition from what has been to what will be." The word "liminal" comes from the Latin root, limen, which means "threshold." So liminal space is the "crossing over" space – where you have left something behind, yet you are not yet fully in something else. (Google dictionary.)  And that is exactly where we are now. We are betwixt and between. We had established new social rules and norms and now they are being shaken. Choices have become difficult. Should I go out to celebrate my birthday. Should I go shopping? Should I march in a peaceful protest? We know where we were but not where we are going. 

Here are a few examples of decisions confronting members of the Aging Rebel group as they consider how far to "put their toes in the water."  Henry and his wife have been isolated during the past few months. Recently he received a phone call from a member of his church choir inviting him to join them when they meet for the first time since the shutdown in a nearby park. Tempting as it was, he declined and told them, "I want to socialize but I need to play it safe." Another member of the group, Virginia, offered to host anyone for a visit to Selby Gardens. She reported there was so much to see and we can stay far apart. Irene, another member, responded, "I love the idea of Selby but I'm reluctant to go. I've taken such good care."  And Pat chimed in saying , "My decision is when to prepare for the trip back to California. How do I make the decision?" 

Individuals will respond to this liminal period in different ways. Our responses will depend on each person's resources, both material and psychological. Some people are rich, others poor; some healthy, others disabled; some young, others old. Some will thrive; others may suffer, to varying degrees. 

Trying to figure out what makes the difference in our responses, in my work I identified four aspects of our lives that are central to coping with any transition. Each individual has these potential resources – Situation, Supports, Self, and Strategies – to defray the cost of change. These potential resources – what I label the 4 S's – help explain the differences in how individuals handle any change. Asking ourselves how we stand with regard to each of these factors can improve our understanding of a transition and how to cope with it.

So how can we make use of the 4 S's as the country moves into new phases of the "reopening"? How can this tool help us cope with this transition and enhance our chances of emerging from it with our mental and physical health intact? The above reference to the dilemma of how to celebrate my birthday is a real-life example I confronted recently. Here are the questions I posed to myself to arrive at a decision. 

Situation: How do you view the transition? What is going on in your life during this time of change? Do you face multiple stresses? Or does your daily life feel stable and calm? I am fortunate to live in a retirement complex where, despite the vulnerability of people in my age group, no one has had the virus. With rare, protected exceptions, all of us have stayed at home, avoiding the possibility of bringing the virus in from outside. This has helped me to feel relatively calm in the face of the crisis as well as ambiguity about the future.

Self: What are your inner resources, your personal strengths? How do you deal with change? Are you optimistic, resilient, able to deal with ambiguity? How have you navigated transitions in the past? I consider myself an optimistic person, but also a practical one. I am hopeful that both a cure and a vaccination for Covid-19 will be found soon.  But as much as I want to hug my grandchild rather than just watch her on a video screen, I realized that attending a party with a number of guests could expose me to people who have had contact with the virus. 

Supports: What people and activities can you count on for support during this transition? Do you have friends and family who may help you through the changes?  My living environment fortunately provides both the psychological support of friendly neighbors and the opportunity to socialize – in effect, stay at home – with others who both face the same challenges I do, and who have been following the Covid-19 guidelines. 

Strategies: How do you cope with transitions? Do you employ a range of strategies, such as talking to others, gathering information, or participating in a support group? Or do you tend to rely mostly on your own personal resources? To keep my professional brain working and reinforce personal relationships, I use video technology for meetings with the Aging Rebels, a group I co-lead at a senior center in Sarasota. Frequent socially-distanced meals with a limited number of neighbors keep my spirits up. Zoom videoconferencing and phone calls help me stay in close contact with my family. Yet I really miss seeing them.

Thinking through the 4S's helped me arrive at a compromise decision: To celebrate with family only, taking as many precautions as possible. I drove myself, we met for lunch at a club, at an outside, socially-distanced table, we wore masks except while eating, and the only people with me were my son, my daughter-in-law and my granddaughter. It was great to be with them, even if I could not engage in hugs,

As we advance into this new phase of "reopening," we will face more of these types of decisions and in many cases they will be much more challenging. People will be asking: Should I return to work in a store, an office, or a plant where employees have had the virus? Is it time to resume the after-work happy hour in a bar down the street? Is it necessary for me to pray inside my church building, even if the governor has not required social distancing in the sanctuary? Should I fly cross- country to take the summer vacation I planned, or just try to get a refund on the plane ticket?

There is never just one "right" answer to questions that force us to choose between our health and our economic status, let alone the normal routines that add happiness to our lives. But there are things we can do to alleviate the stress that so often accompanies transitions: Try to avoid impulsive decisions. Instead, do the best you can to strengthen your Situation, Supports, Self, and Strategies so that you are prepared when you are confronted by the next challenge.

And there will be challenges. From our vantage points of spotty compliance with the requirements of Phase One or Phase Two as laid out by the White House, and predictions of a "second wave," we can see that this transition to the as-yet undefined "new normal" is going to be with us for a long time.