By Rod Benson
This article presents biblical, psychospiritual and pastoral perspectives on ageing and older people. It demonstrates the magnitude of the cultural shift from biblical culture to our own, summarises key gerontological theories, and examines problems and issues relating to older people in the context of pastoral care within the setting of a Christian faith community.
When I first watched Titanic, I was most impressed by the unforgettable teenage Rose (played by Kate Winslet) who also appears as the 101-year-old Rose DeWitt Bukater (played by Gloria Stuart, an actress whose credits reach back to the early days of ‘talkies’). The older Rose, reminiscing about her experiences as a young single woman who fled wretchedness and found romance aboard the ill-fated liner, appears wise, in control and deeply satisfied with her life.
Screen images of older people are generally not so positive. From the ambiguous portrayal of the main characters in Cocoon to the witty pathos of Ruth Cracknell in Mother and Son, media representations of older persons tend toward sentimentality or caricature. Their time is up; they have had their day; the young now rule. And this is never more apparent than in advertising – unless you’re selling pensioners’ insurance or home security.
Secular trends easily establish currency in the church, especially in urban contexts. Generational differences lead to misunderstanding. Lack of meaningful dialogue and shared experiences result in conflict. There are battles over music styles and quality of lyrics, questions about sermon content and dress standards. We hear nostalgic ruminations about successful church programs of yesteryear.
Delegates to denominational assemblies (at least among the Baptist churches with which I am familiar) are predominantly pastors and retired persons. There is growing emphasis among Christian community service agencies on retirement projects – with the notable exception of the Salvation Army. National statistics point to the ‘greying’ of the church, especially since the so-called baby-boomers began to reach retirement.
The Bible and ageing
Those of us who are ‘younger’ can easily dismiss or marginalise older people. But they have a great deal to offer, and many older people feel a need to interact and to continue experiencing a full life. So it is time to bridge the generations and subvert the stereotypes. Consider this poem by Jean Thompson:
White hair: relegation.
Instant dismissal. Just one of those oldies.
Past action or thought.
White hair: anonymity.
Faceless old nuisance to put into care.
One more for the file.
But white hair is freedom.
Release from convention. At last unrestricted.
To act as you please.
Yes, white hair’s a distinction.
It shines in the sunshine like snowfall in winter,
A badge of experience.
One who survives.
Although age-related changes occur throughout the life cycle, ageing may be defined as the process of change after maturity is reached. Ageing is culturally assumed to onset between about the ages of 55 and 65 years, often coinciding with retirement from fulltime work. Research generally demonstrates the heterogeneity and unpredictability of the aging process. Life experiences, attitude and psychospiritual factors all have a bearing on one’s outlook as retirement age passes and the existential ‘autumn’ and ‘winter’ of life set in.
In contrast, Scripture accepts the transitoriness of youth and reflects realism regarding the problems and issues of old age. Yet it presents ageing people as dignified, venerable and wise.
In Scripture longevity is considered a reward for a virtuous life, and advanced age is a gift from God. Jewish and Christian communities were led by elders – older men and women possessing a wealth of knowledge and skill built over a lifetime of experience. Special respect and care were given to aging members of Christian communities, and developing leaders were educated and trained in pastoral care of older persons.
Throughout Scripture, while finitude and other effects of ageing are clearly experienced by elders, the concept of permanent retirement from vocation or profession is unknown. From a biblical perspective, human life involves development and change rather than stasis; ageing is divinely intentional and part of what it means to be a human person; and the capacity to ‘do’ is not the definitive measure for determining the worth or value of a human person.
To reflect on verses such as Genesis 3:19, Exodus 20:12, Proverbs 3:1-2 and 16:31 is to recognise how far we have drifted culturally from the image of ageing as a sign of wisdom, long life as a symbol of divine blessing, grey hair as glorious, and the unequivocal care of those who can no longer independently care for themselves.
With this awareness, Christians (whether voluntary or paid) are well placed to provide professional yet personal pastoral care to elders, to train lay pastoral carers, and to assist elders in finding the specialised care they require. Yet pastoral carers require knowledge of gerontological theory and competency about ageing issues, and specific gerontology-related training is often missing from seminary and college curricula – although this is certainly not the case for Morling College where I work.
What it’s like to grow old
Ageing is inescapable in a universe prone to anomie and entropy. There are various explanations for this. The genetic theory argues that human cells are designed to expire after a certain number of divisions, perhaps from damage to cellular DNA. The ‘wear and tear’ theory suggests that cells naturally reduce functionality over time. The physiological theory postulates that organ systems deteriorate, leading ultimately to death. Ageing is perhaps best understood as a combination of these theories.
Practical theological and psychospiritual issues arising from this observation. For example, loss of paid work may lead to loss of a primary source of meaning, identity and mental health because the self is grounded in vocation. There are also problems for older people who do have paid work. A Sydney Morning Herald poll published on 28 February 2004 revealed that 97 per cent of respondents believed that employers did not really value older workers.
In addition, gradual limitation of life choices and options usually occurs in later adulthood, where one is forced toward acceptance or rejection of one’s life direction decided in earlier years. Further, elders are sometimes confronted with anxiety associated with the possibility of non-being, or the existential awareness of the certainty of their mortality.
These issues are closely related. It can be difficult to affirm eternity in the face of frailty and temporality, and to celebrate stability when transitoriness seems pervasive. It can also be difficult to offer effective, theologically nuanced pastoral care in such circumstances.
Some older persons ask anguished questions about theodicy such as, ‘Why can I not die when it is time to die? What kind of life is this?” In his Introduction to Pastoral Care, Charles Gerkin bravely responds by saying that “Any answer is hidden within the mystery of God, a mystery that at times seems to be more cruel than loving … pastoral theological thinking must ask the hardest questions about God and God’s justice.”
A complex process
Various metaphors and systems seek to express or explain the ageing process. Many pastoral carers unconsciously approach their ministry armed with powerful metaphors drawn from medical disciplines. This may illuminate issues but can also muddy the waters of effective and wholistic pastoral care.
Carers may benefit from interdisciplinary theory and the introduction of new, integrative metaphors. For example, it is helpful for elders and their carers to be aware of the dialectical forces that hold negative and positive aspects of aging in creative tension. It is undoubtedly healthy to maintain the capacity to be ‘in process’ throughout one’s lifetime.
Lifespan theories of human development often emphasise multidimensionality and multidirectionality. Life may be perceived as a process of mastering a set of loosely connected age-related tasks. But not all gerontological theorists agree with each other. For example, some acknowledge the flexibility and paradoxes of later adulthood, casting elders as capable of self-actualisation and of affecting their own continued development. Others argue that elders naturally withdraw from social roles and become more self-preoccupied, disengaging from earlier roles and limiting personal horizons.
While both of these perspectives are reflected to some degree in actual situations, pastoral carers generally discourage disengagement in favour of outlooks offering realistic substitutes for those no longer possible due to finitude and related issues.
Yet therapeutically effective or economically viable substitutes may be unavailable, and many elders are uninterested in substitutes for dearly loved outlooks, roles and activities. As one grows older, the level of social integration and quality of relationships rather than the number of activities experienced often increasingly defines wellbeing.
Theorists of psychotherapy and counselling have interpreted the changes associated with ageing in various ways. Swiss analytical psychologist Carl Jung, for example, divided the lifespan into four quarters. In the first, childhood, the individual created problems for others but was not yet conscious of their own. Quarters two and three constituted stages where one dealt with conscious problems of life. In the final stage the individual again became increasingly a problem to others.
Jung argued that personality development was not fixed by early childhood experiences. He believed that mid-life presented a fundamental reorientation in personal outlook as changes become necessary to make the most of the opportunities afforded in the later years. This has a major bearing on the kinds of pastoral care delivered to ageing persons, and the mode of their delivery.
Spiritual factors were, for Jung, necessary influences on human development. This suggests that spirituality may play a role in delivering meaning and hope to elders and may provide a psychologically healthy view of dying. Further, as self-centredness diminished with age, energy could be channelled to the deeper spiritual issues of life.
Of greatest significance for gerontology, however, is the work of Eric Erikson, a German-Jewish psychoanalyst who spent much of his life in New England. In 1950 Erikson described eight ‘stages’ of psychosocial development, each characterised by a core life task whose achievement allowed smooth transition to the next task – a process he called ‘epigenesis.’
After childhood stages came stage six – ‘young adulthood’ (ages 20-40) where the dialectical focus was seen as intimacy versus isolation. Stage seven, ‘adulthood’ (40-65), represented generativity versus stagnation. Stage eight, ‘maturity’ (65+), involved a tension between integrity and despair. For Erikson, realising epigenesis depended largely on successful negotiation of earlier developmental tasks that may not have been successfully completed due to illness, accident or other misfortunes.
In Aging and God, Harold Koenig suggests that spirituality may provide a key to achieving intimacy, generativity and integrity. A spiritual worldview may integrate one’s perception of meaning, provide continuity between this life and the next, and offer a grid by which errors in one’s past may be forgiven and a new life commenced. Erikson saw the potential of spirituality (what he called the ‘numinous’) for achieving integration in later adulthood.
Another important perspective is that of Charles Gerkin, who taught pastoral theology at Candler School of Theology. Rather than adhere strictly to chronological models, Gerkin formulated a loose typology of ageing styles drawn from literature of ageing and from personal experience: ‘continuity’ (where work resembling what one did during earlier adulthood is pursued); ‘radical change of vocation or location’; ‘withdrawal’ (slowing of pace and closing in of boundaries); ‘heroic aging’ (“ability to cope with the exigencies of aging, but [using] that period of the life cycle to overcome lifelong disabilities and [sharing oneself] with others in unusual and creative ways”); and ‘tragic aging’ (the experience of ageing without semblance of dignity or self-respect).
The gerontological revolution
For many older adults, a balance among faith, culture, community and individual wellbeing is only tenuously maintained, and all are contained within a dynamic, interactive process. The diversity of approaches to our understanding of the ageing process highlights the fact that ageing is a complex and multifaceted process attenuated by paradox, discontinuity and mystery. Yet it is deeply practical.
In the Western world life expectancy has never been greater. With notable exceptions, those immediately above the median Australian retirement age and those rapidly approaching it are the most affluent and self-centred elders this nation has witnessed (in contrast to Jung’s much earlier observations). And there are so many of them!
The trend is expected to rise. As this ageing population expands and encounters unprecedented levels of physical frailty, cognitive decline and psychospiritual distress, its members will exert increasing pressure and influence on social, economic, political and religious structures.
Government policies and programs will increasingly cater to ‘grey’ voters at the expense of the younger. Already this has been institutionalised, with state governments establishing Departments of Ageing, and the Commonwealth government’s Department of Health and Ageing. There are also research institutions and political lobby groups dedicated to aged care issues. The church too will continue to be faced with significant age-related issues. If you thought the church culture wars were coming to an end, think again.
In this context, we can speak of an emerging gerontological revolution in Western countries. It is a challenge that demands a significant increase in effective and wholistic pastoral care of ageing persons. But it is also a challenge that may be informed by biblical principles, a challenge that the church has been working at for centuries, and a challenge that can best be met, I argue, through the ministry of an informed and servant-oriented faith community.
Someone has said, “If you want to know what it is like to be old, you should smear dirt on your glasses, stuff cotton in your ears, put on heavy shoes that are too big for you, and wear gloves, then try to spend the day in a normal way.”
Admitted to hospital a few years ago, I found myself in a ward of older men and discovered that my illness, though life-threatening, was relatively insignificant compared to the serious illnesses these men were fighting.
One octogenarian said, “Both my children work, and have families. They have their own lives to deal with without being burdened by someone like me.”
“I have nothing to live for,” another reflected. “My wife’s gone, my kids have their own lives to lead. What have I got to live for? I live in my own home, but [the doctors] won’t let me go there. I can’t walk. I don’t care. I just don’t care any more.” Then, with tears filling his eyes, he confided to me, “I prayed last night that God would take me away.”
Despite much media preoccupation with youth and youthfulness, Australian society is rapidly greying. Soon one in four Australians will be over 60 years old. Younger adults will feel increasing pressure to care for them through church-based and other services, as well as to fund their health and other needs through taxes. Politicians and policy makers will feel the strongest pressures as they listen to the perspectives and desires of ageing people and respond accordingly.
To be old is not necessarily to feel unviable. Some things are not ordinarily graspable except as the result of experience in extended lives. Affirmation of the richness and dignity of elderhood, informed by a biblical theology of aging, offers an excellent starting point for effective pastoral care of elders.
A multitude of issues confront elders, presenting problems associated with impairment, change and loss. Issues may be physical, intellectual, emotional, spiritual and social – or a combination of these. As pastoral counsellor William Clements observes, “the issues remaining toward the end of life are some of the most significant of the entire human life cycle, and the manner in which these final crises are handled will have an impact on personhood and even physical survival.”
Stress is generally seen as the most important environmental factor aging the rate of ageing. There are various causes and symptoms of stress; each person presents a distinctive profile. One often overlooked issue of ageing attended by significant stress is the crisis of recognition illustrated by Simone de Beauvoir’s self-revelation after looking at her reflection in a mirror at the age of 55:
I often stop flabbergasted at the sight of this incredible thing that serves as my face … I had the impression once of caring very little about what sort of figure I cut … I loathe my appearance now … when I look, I see my face as it was, attacked by the pox of time for which there is no cure.
The longer one lives, the greater the likelihood of experiencing physical disability. Some elders respond in depression; others refuse to recognise themselves as their physical appearance dictates; still others derive significant status, fulfilment and joy from possessing physical signs of ageing.
Many ageing adults suffer some form of physical impairment (such as hearing loss, visual impairment, arthritis, brittle bones, or psychomotor loss resulting in inability to walk unaided). Many elders are unable to distinguish high pitched audio tones, leading to the practice of turning on the television or radio very loud, or preventing them from fully engaging in the experience of a live concert or worship service.
Others suffer from a wide variety of visual impairments. They may have difficulty driving or walking at night; they may lose their driver’s license. They may become unable to read, or recognise others’ faces, or locate familiar objects in their home.
For these reasons elders are often helped immeasurably by maintaining a familiar, reassuring and consistent environment. Having a trusted confidant (such as a daughter or friend) is another key to maintaining good mental health in later adulthood, especially for those who live alone. Regular (preferably daily) contact with a confidant assists the elder in debriefing on daily routines and enables them to receive empathy.
Others who can provide similar ministry include health care professionals, nutritionists, pastors – even lawyers. Carers should, however, be aware of the possibility of transference and countertransference behaviours, and learn to manage these.
Intellectual and psychological factors
In the intellectual realm, often the most acute problem associated with ageing is short term memory loss – “long, detailed and rich stories of the life they lived years ago contrast sharply with the inability to maintain a few facts or pieces of new information needed to conduct the day’s activities.”
Perhaps the next most common problem is depression. This is often misunderstood or overlooked. Depression may be caused by chemical or biological factors, but may also result from the overall situation in life, which an elder feels powerless to change. Some elders develop paranoid reactions to events and individuals in their lives. They may display exaggerated suspicion and mistrust of others; and may accuse others of control behaviours, working against their interests, or stealing from them. A central feature of paranoia is the tendency to project blame on others.
Senile confusion also affects some elders. Symptoms may include severe memory loss, disorientation, emotional instability, and significant impairment of mental and physical functioning. Those presenting such symptoms may be suffering a condition known as Organic Brain Syndrome, or Alzheimer’s disease, or another related disorder.
Many elders today live alone or are isolated from social interaction by various impairments. Some live in uncaring and possessive relationships where individuality and personal rights are neglected or infringed. There will often be tension between a desire for privacy and the need for human contact. For pastoral carers, lack of punctuality in visitation, or failure to properly identify oneself, may lead to unnecessary anxiety. It may take a long time, or several visits, for the social ‘ice’ to break.
When visiting, care needs to be taken to minimise problems associated with hearing loss (sit in a good place, speaking slowly and clearly but not patronisingly). Delivery of a church bulletin or newsletter often reduces anxiety and promotes dialogue. Reading Scripture, engaging in prayer and dispensing communion may also be appropriate, depending on the situation of the elder’s faith journey. It is also important to maintain a balance between supportive care and nurturing change, between pastoral direction and allowing for independent personal growth.
Grief is a reality for all elders. John Bowlby, best known for his work on attachment theory, proposed four stages of significant grief: numbness (involving disbelief, confusion, restlessness, feelings of unreality); yearning (actively seeking wholeness or the deceased); disorganisation and despair (acceptance of the loss accompanied by depression or a sense of helplessness, and often great fatigue); and reorganisation (retaking of control of one’s life accompanied by forgetting, renewed energy, hope and a decline in depression). These responses will often occur as themes rather than (or in addition to) chronological stages.
There are also different kinds of grieving: normal grieving (high distress immediately following the loss with rapid recovery); chronic grieving (continuing high distress over several years); delayed grieving (little distress in the first few months but high levels at a later point); and absent grieving (no notable level of distress immediately or later). Elders may also suffer multiple losses in a relatively brief period, which can result in a telescoped and chronic grief reaction.
Spiritual needs are deeply felt and increasingly central to the experience of many elders. Spiritual needs may be defined as conscious or unconscious strivings that arise from the influence of the human spirit on the biopsychosocial natures. These include desires for meaning, purpose and hope, to transcend circumstances, for support in dealing with loss, for continuity, for validation and support of religious behaviours, to engage in religious behaviours, for personal dignity and a sense of worthiness, for unconditional love, to express anger and doubt, to feel that God is on their side, to love and serve others, to be thankful, to forgive and be forgiven, and to prepare for death and dying.
Given the diversity of these spiritual needs, and the frequency of experience, it is important for professional and lay pastoral carers to be aware of the needs and how they may be met. Elders generally express more traditional religious beliefs than younger persons today, and are less inclined to embrace moral or spiritual relativism. They are more likely to pray to an objective ultimate being, to read the Bible, and to be exposed to religious electronic media.
In my experience, the happiest and healthiest elders are those who attend church most often, and poor adjustment is found in those with low or declining participation in regular church activities. What is not clear is to what extent this correlation means that healthy elders can keep active in religion, or whether their religious participation keeps them healthy and happy.
The practice of spiritual rites and ordinances provides continuity in elders’ lives, enables them to accomplish and celebrate life transitions, aids in recalling cherished beliefs and experiences, and reinforces healthy traditions. Pastoral carers may also find it beneficial to perform rites of entrance on infirmity, and rituals that focus on death as an event to be welcomed rather than feared. The funeral itself should not be viewed exclusively as a therapeutic vehicle for the living – still less as merely an opportunity for evangelism – but as an important rite of passage, conveying the individual into a new status in the faith community.
The most significant loss an older person will experience is often the death of a spouse or life partner. Other major causes of grief among elders include violent deaths of loved ones, the death of a son or daughter or friend; and a range of bodily losses including loss of meaningful work, loss of hearing and sight, diminution of mental awareness, loss of the ability to urinate and defecate unassisted, and loss of sexual function. This last item is a particularly acute problem for some elders who feel unable to speak with professionals about the subject and who are unaware of the widespread nature of sexual dysfunction among aging persons.
Retirement from career or full time employment is also often experienced as acute loss. Since a career, for many people, meets a cluster of psychological, social and financial needs, its loss may be attended by physical and/or psychological illness. Additional forms of loss felt by elders include loss of a sense of youth; loss of a familiar world; loss of one’s home and associated memories and emotional investments; loss of independence (often accompanied by loss of dignity and control); loss of a sense of value to others; and decline in general health.
Other impairments and losses experienced by elders include being regarded as part of a homogenous group whose needs and circumstances are relatively uniform; relocating (for example, as a result of retirement), leading to the cutting of some family and social ties and the need to develop new social networks; loneliness, especially following the death of a spouse; fear of criminal behaviour (such as stealing or assault); and coming to terms with finitude.
Elders often engage in pastoral care themselves, especially of their own children and grandchildren, and perhaps friends and neighbours. This provides excellent opportunities for activity and stimulation, but may also strain physical, emotional and financial resources. Regular habits of self-nurture will help replenish physical and emotional resources.
One of the greatest barriers to effective pastoral care by elders is the presence of unresolved relational issues from the past. Three ways to resolve these hurts are for the elder to spend quality time with alienated parties; to write heating letters to perpetrators/victims (in order to get in touch with one’s deep and possibly buried feelings); and to pursue the process of forgiveness and reconciliation.
Dealing with death and dying
The last issue elders face is dying. About 75 per cent of all deaths in Australia today occur among those aged 65 and over – perhaps as much as 30-40 years after retirement. Death defines the endpoint of human life and may be viewed as punishment, transition or simply loss (of the ability to complete projects or carry out plans, loss of one’s body, or experiencing the physical and relational world).
In her seminal book On Death and Dying, Elizabeth Kübler-Ross suggested that the process of dying involves five sequential steps: denial, anger, bargaining, depression and acceptance. These are positive changes, but her thesis has been widely critiqued fore its methodological weaknesses and cultural specificity. Instead of stages, it may be more helpful to consider the dying process as having a range of themes or common elements that appear, disappear and reappear in the process of dying in any one person. Themes may include terror, pervasive uncertainty, fantasies of being rescued, incredulity, feelings of unfairness, a concern for reputation after death, the fight against pain, and so on.
Many elders today die in hospitals rather than at home or in nursing homes. Hospice care offers a positive alternative. The philosophy underlying hospice care has several aspects. Death is viewed as a normal and inevitable part of life, not to be avoided but embraced. The patient and family prepare for death by examining their feelings and planning for later life. The family is involved in the patients care as fully as possible, so each family member can resolve their relationship with the dying person. The patient and family retain control of care and the care-receiving setting. Medical care provided is palliative rather than curative, with a minimum of invasive or life-prolonging measures taken.
Problems for caregivers
In each of the above pastoral care contexts different degrees of knowledge and skills are required, and different levels of intervention are appropriate to meet the particular needs. Another way to approach effective delivery of pastoral care to elders is to focus on the roles and functions of the caregiver. One could also identify organisational and attitudinal factors that tend to deliver successful pastoral care outcomes.
There are many voluntary activities and ministries in which most elders may engage such as churches and church camps, missions and other parachurch agencies, hospitals, school events, public gardens, exhibitions and zoos. As physical mobility and mental health decline, the balance tends to shift from activity to passivity, and from offering to receiving care.
Elders experience certain problems of which carers need to be aware and to which they need to be ready to respond in appropriate and sensitive ways. First, elders may refuse help or advice. Some older parents avoid relying on adult children or pastoral carers until they have no other choice, perhaps thinking they will be seen as burdensome. Some conceal their needs for care because they fear the imposition of nursing home care. Others reject services provided by non-family for fear that family contact will diminish, or due to inexperience with professional people in their home.
Second, elders are increasingly subject to ageism and physical, emotional, sexual and spiritual abuse. Elders often suffer serious physical and psychological consequences of such abuse. This may range from ignoring toilet needs to physical violence, or expressing the attitude that elders are out of touch with (cultural) reality or that they are useful only in their capacity for prayer. Ironically, age is not in itself a badge of sanctity, and elders’ prayers are no more special than those of anyone else.
Third, since daughters care for many elders, the rise of women’s employment has led to a diminution of this form of care, with negative consequences. Pastoral carers outside the family cannot completely replace such care, but much can still be done.
Perhaps I have cast an excessively pessimistic vision of ageing and the autumn and winter of the human lifespan. I have tried to be realistic. One who sought to be both realistic and optimistic was John Wesley, the great seventeenth-century preacher and pastor. He lived to 88, and many of his most productive years of ministry came after age 60. On his 85th birthday, in 1788, Wesley wrote in his diary: “I am not so agile as I was in time past. I have daily some pain … I find likewise some decay in my memory in regard to names and things lately passed.” Then he moved from prose to poetry, revealing the philosophy of life that inspired and focused his extraordinary achievement:
My remnant of days
I spend to his praise
Who died the whole world to redeem:
Be they many or few,
My days are his due,
And they all are devoted to him.
Rev Rod Benson is Ethicist and Public Theologian at the Tinsley Institute, Morling College, Sydney. This article was published in Zadok Perspectives 83, Winter 2004, pp. 15-19. For references see the published version.