BROTHERHOOD OF ST. LAURENCE
67 BRUNSWICK STREET, FITZROY
ARCHIVES'
AGE
CONCERN
SEMINAR
ALBURY
16TH MARCH 1979
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NEVILLE BROOKE.
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First of all I would like to express my grateful thanks
for the opportunity to participate in this most important
conference.
I am delighted to be here and I have no doubt that the
objectives laid down for this seminar by the organisers, will
be achieved, however it is my sincere hope that in addition to
finding solutions associated with physical aspects, such as
accommodation, this forum will also prove to be an effective
catalyst for change in both community and personal attitudes
towards elderly people and the ageing process.
Without doubt
this is the most exigent task we can undertake as the real answer
lies in the psychology of.ageing and not in the provision of more
services and support networks, as important as these may appear
to be at the present time.
Today I intend to adopt a more philosophical approach by
concentrating at least in part, on preventive measures through
a better understanding of the ageing process, as this is. certainly
fundamental to any architectural brief, whatever building we may
contemplate and we must know the expectations, of- the occupiers.
In Flouren's book -
"On the Duration of Life" published in
France in 1855, he described the first period of manhood Cas
opposed to childhood and youth) as being from 40-55, with the
second from 55-70.
He further asserted that the first phase
of old age was from 70-85 and the second from 85 onwards.
At
a time when the life span of a new born child was a mere 40 years,
it is understandable that his critics viewed such a statement as
fanciful, to say the least.
Yet today, 120 years later, we
generally accept the latter as reasonably accurate.
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The same Monsieur Floureris. said ^ ’’the true sign of
completion of growth, is the union of the shaft of the long
bones to their own bone ends, which takes place at about 21
man then lives to about 90 or 100.
He assigned 20 years
to full growth and up to 80 years to full decline".
Again,
a remarkable forecast, as this thesis was written 40 years
before Xray and radiology established when long bone growth
ceases.
These hypotheses have long since been supported by
medical research and with the exception of accident and a
few unpredictable terminal illnesses, we should all be relatively
confident of at least entering Flourens second phase of old
age, that is from 85 onwards.
From this viewpoint, the probability of living well into
the 70s and 80s is not governed so much by physiological or
biological limitations, but by one's personal ability to adapt
to the ever-changing psychological and sociological stresses
which are intrinsic with longevity.
If we accept this premise, we can then begin to look
at some of the pending adversities.
The most crucial aspect of old age is the capacity to
adjust to a modified life style - new values must be injected
to replace or reshape the old, otherwise there will be a tendency
to reduce initiative and subsequent input, culminating in the
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acceptance of a passive role in both the family and community.
Once this situation is reached and maintained for any length
of time, it is improbable that a lasting regeneration can be
achieved.
Within the third world countries, old age is still
considered an advantage,' as it brings with it respect, honour,
authority and even reverence from the younger age groups..
Often three or more generations may reside in the same household,
yet the oldest person is the undisputed head and usually the
sole decision maker, over both economic and personal issues.
The aged are held in high esteem and receive special
care and attention by the family, only, when required.
•By comparison, western society unfortunately has an
entirely different value judgement and one^s worth or prestige
is measured in terms of productivity and achievements.
On
withdrawal from the workforce at the prescribed age, the
criteria for assessment no longer exists and one is* then invited
and even coerced into accepting the so-called benefits of old
age.
If there is adequate planning,and* appropriate adjustments
are made, then life can take on a new and compensating dimension.
The most damaging repercussions of old age are isolation
and loneliness.
Research continually identifies loneliness
as the most destructive of all the side effects of ageing,
as it usually breeds cynicism and dejection with regard to
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the future.
The lonely person will often become preoccupied
with their own misery leading to boredom, fear and frustration
which in turn induces a range of chronic limiting illnesses.
The majority of these ailments, which I believe to be as high
as 80%, are psycho-sematic in origin, but nevertheless physio­
logically factual - others are caused by inactivity or a total
disregard for adequate diet through lethargy.
These derivatives of isolation are of course, socially
unacceptable - no one wants to associate with the person who
is always miserable and complaining so they are quickly ostracised.
Yet these are the obvious signs that the individual's coping
capacity is under great stress and the condition could often
be completely reversed by good advice and the establishment,
of meaningful relationships.
When the necessary interaction does not occur, those
suffering from loneliness frequently develop symptoms which can
be medically treated and the subconscious ailment becomes their
passport back into the human race.
Dr. Cess Van Tiggelen,
Consultant Psycho-Geriatrician, Mental Health Authority, calls
this "help demanding behaviour" and of course, the medicine
chest.does not hold the answer, it only compounds and perpetuates
the problem.
The obvious cause of loneliness is lack of regular
contact with other people which may be the result of retirement,
out-living one's friends and associates, relocation to an
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unfamiliar environment, decreased mobility or personality
traits - even a combination of two or. more.
Some may be
avoided, others must be faced and adaptions made to neutralise
the intensity and duration of their effect.
In years gone by an elderly person maintained at.
least minimal contact through the butcher, baker, milkman or
greengrocer, two of whom probably called daily, and provided
a very real sense of security, especially for the single person,
who knew that help could be summoned if necessary, by way of
these tradesmen.
Today such delivery services are' outmoded of too expensive
so these vague indirect, but extremely effective relationships
are lost forever.
The second cause of loneliness and which is seldom,
acknowledged, is that of deafness.
The elderly person suffering
from this defect bears no obvious sign like his or her blind
contemporary, who ironically often finds that their disability
fosters social contact, through emotional and sympathetic concern.
The deaf who partially hear a question or comment and
make a disassociated reply, are in most cases labelled as dis­
orientated, inept or even mentally malfunctional - either way,
they are ostracised or merely tolerated at a distance.
Hearing aids can alleviate or improve the situation in
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many instances, but often the effected individual fails to
recognise their need for mechanical assistance.
Perhaps
one answer would be to follow the example of the rich elderly
widow who, following an illness which left her partially deaf,
had an onyx earring made with the words "Out of Order" picked
out in tiny diamonds.
The final point I wish to raise regarding loneliness
relates to the death of a spouse.
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There are exceptions of course, but this is surely the
most traumatic cause of isolation and which so often cannot
be more than partially resolved.
One. frequently finds couples
who are complete in each other's company, and the death of a
partner leaves the other devoid of meaningful associations.
A similar situation can also occur where long term hospitalisation
is required and visitation becomes an impossibility for the
spouse, due to geographic difficulties.
Although an enforced
separation of this nature may not initially appear as permanent
as death, it still may have the same diabolical effect.
It is obvious that the emotional and psychological
ramifications of a partner's death or permanent separation
cannot be fully gauged or understood unless experienced.
Whilst ‘
little practical support can be given at this level, there are
numerous material issues which also arise out of this tragic
event.
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The person who has little knowledge of finance, insurance,
common legal matters or house maintenance etc. will be placed
in an unfamiliar and often vulnerable position which may be
just as destructive, unless advice and assistance is freely
available.
Whether loneliness is precipitated by physical, emotional,
behavioural problems, a partner's death or separation, it remains
a critical aspect of ageing which demands* full focus during the
latter years.
There are however, some individuals who are able and
indeed prefer to live in relative seclusion.
Although few
and far between, these people will-often resent even the
occasional invasion into their private worlds.
There is such
a thing as 'aloneness' as opposed to 'loneliness' and this must
be recognised.
In addition to these pertinent and predictable problems
associated with ageing, -
I would like to spend a little time
analysing the subtle influence exerted by Community and. Family
attitudes.
To introduce this segment of my paper, I quote Marcello
Cesa-Bianchi, Professor of Psychology and Director, of the
Medical Faculty, State University of Milan, who states: "Any solution to the problems posed by aged persons in a
society is largely governed by the conscious and subconscious
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attitudes of that society towards them.
Today we can
see two, apparently contradictory tendencies at work:,
to remove the aged to a place where they no longer trouble
our conscience, and to take pity on them-and to try to do
something to help.
Yet both, in fact express the same
aggressive feeling that is directed not at the aged person,
but at old age and death
feeling.
prejudice,
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it is a subjective not objective
Attitudes such as these are the product of
social mores, false beliefs, ignorance about
the biological and psychological aspects of growing old
the childish rejection of all that is unpleasant, and of
factors connected with immaturity and cultural, insufficiency.,r
Whilst these comments may appear to be both harsh and
cynical, they do however provide some insight into our distorted
philosophy.
Some time ago I was invited to address a reasonably
large group of people on the subject of "Ageing”
As the majority
appeared to be pre-occupied with the need for hospitals, nursing
homes and other intensive services, I suggested that each person
might conjure up a mental picture which personified the aged,
and then record their description.
The composite result was a wrinkle-skinned, grey haired,
dependent female.
We can accept the first two without much question as
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changes to the skin and hair colour are generally associated
with, and expected to accompany old age.
With some licence
we can also let the latter pass, as it is an undeniable fact
that the average female will outlive the male.
Dependent is a description we must completely reject
as totally without grounds.
If we look for one moment at statistics, we find that
in Australia over 90% of the aged population reside in private
housing, surely that doesn't suggest anything but independence.
To be fair, one must concede that a small proportion do receive
some degree of essential support from the Royal and District
Nursing Services, as well as through meals-on-wheels, home
help etc.
. But I cannot over-emphasise the fact that age
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is not synonomous with sickness and dependency, nor does the
60th or the 65th birthday herald in loss of initiative, pro­
ductivity or purpose.
Under no circumstances should those in the immediate
pre-pension age group be lulled into believing that rapid
deterioration in physical and mental competence is part of
the ageing process.
Unfortunately some members of the medical profession
are inclined to
view the aged patient as having a limited
future and therefore requires little more than a brief
superficial examination.
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We would do well to take heed o£ the 80 year old who
visited the doctor because of reduced movement in the left
knee joint.
After no more than a cursory look, he declared
that she must expect that sort of thing, as after all, the
knee was 80 years old.
Her classic reply, "But Doctor, the
other knee is the same age and it is perfectly alright".
She was of the substance that centenarians are made of I
There is no doubt that community attitudes create many
of the hazards of ageing and a significant number of the
elderly bear witness to this fact.
They are the ones who
have succumbed to the subtle pressures, given up their interests
and involvement and awaited the onset of debilitation.
Closer to home, but as difficult to combat, is the
influence of the family.
This is usually motivated by a
genuine concern and love for the parent or other aged relative.
The only problem is that so often, the advice given or action
taken on their behalf is based on youthful logic, or lack of
real understanding.
Middle aged children and concerned friends
can adopt a very dominant stand for the good of parents and
aged people who may in their eyes, appear too old to make a
rational decision.
I recall an interview some years ago with a very genuine
middle aged couple who were concerned about the wife's mother,
who had lived with them for approximately 10 years.
With
her approval, they sought to place her in one of our nursing
homes.
The inference was, that she had deteriorated beyond
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their ability to cope - the medical assessment however indicated
that the change in the previous three years was minute.
The
real problem lay not with the mother but the couple who had
failed to adapt to their own changing scene.
This is a
perfect example of three common faults: -
a)
Failure to plan and adapt to middle age
b)
Making decisions on behalf of an aged relative on
wrong or insufficient evidence.
c)
Over protection.
The final episode of this example is that the mother
still resides with the family, but. now plays' an. important and
productive role and provides much more support than she receives.
From the outset all she really needed was companionship and
security which her children could readily provide.
The over-protective child or associate is a real threat
to the independence of the aged person and again there are
numerous examples, one could use to illustrate this point.
The daughter who will not allow even the extremely active
resident mother to help with meals, housework or even make
a cup of tea.
The reason for this attitude is first and foremost a
subconscious belief that the child should 'look after' the
parent - possibly in appreciation and repayment for the many
benefits received in the past.
To a lesser extent, it may
be that the daughter does not want another woman to encroach
into her domain.
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In such cases the subsequent inactivity will most surely
erode the independence of the aged parent and consequently a
more demanding relationship will develop.
Of course, not all offspring unconsciously create such
hazards for their parents.
Many are astute enought to recognise
the pitfalls and blend the level of help and self-help in a
manner which will enhance both independence and inter-dependence.
Finally the individual can be his own worst enemy by
taking the easy negative approach to old age.
This requires no
planning and no initiative, other than to gust sit by and
let it happen.
An attitude fostered by ignorance, fear and
insidious indoctrination.
Those who prefer, adopt or blindly follow this course,
usually anticipate and indeed experience a rapid decline in
mental and physical competence.
For them, old age does mean
dependency.
They must be givers as well as receivers and doers as
well as passive observers.
In my paper to this point, I have attempted to' emphasise
that age is a natural process which is not synonomous with
rapid physical or mental deterioration - that the psychological
and sociological aspects must take precedence over the physio­
logical and biological as any reduction in personal performance
can usually be reversed or at least arrested if the proper
steps are taken through a rehabilitation process at an early stage
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The elderly must be encouraged to raise their own expec­
tations and as David Hobman, the Director of 'Age Concern',
England has stated - 'to live dangerously'.
However the
greatest threat to those who strive for a long purposeful
independent life is the societal attitude and it is our respon­
sibility to move towards the Eastern philosophy so that'every
person is valued and respected for his or. her wisdom and
experience.
People are still being admitted to nursing homes, and other
forms of residential care when less demanding home support
services would often be more appropriate and stimulate greater
independence.
Meals on wheels* are .delivered on a- permanent
arrangement often without reassessment, when the recipients may
well be encouraged to take turns in being 'hostess' for 4 or 5
others in the immediate area.
The elderly are continuing
to relocate in homes for the aged in order to gain security
against some unknown nebulous breakdown which they fear may
occur in the future - others are committed to a life of
loneliness because the community doesn't really care.
One would not deny that housing is a prime pre-requisite
in old age, but we must not forget that the benefits derived by
the recipients of any service must always be measured against
the disadvantages and these of course, are not easily recog­
nised without systematic analysis.
Today throughout the western world there is a far greater
emphasis- on keeping people in private independent acconirriodation.
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and many new initiatives are being tested towards this end.
In the remaining minutes I would like to share some of these
concepts with you.
Private enterprise is now developing modern compact
housing specifically for older people with the appropriate focus
being placed on the physical aspects of accommodation, whilst the
servicing of residents is left to those with experience and know­
ledge to assess the need as opposed to the individual's desire.
Many traditional voluntary organisations are contemplating
the sponsorship of Equity Housing programmes and initially
intend to incorporate the three stages of care from independent
living through to long term nursing.
.Again private enterprise
in Victoria is already engaged in the construction of villages
for elderly people but these are so diverse in their financial
policy that the Victorian Council on the Ageing
is currently
undertaking a full assessment with a possible aim of requesting,
the State Government to accredit those which have acceptable
operational criteria.
These projects are predominantly
housing only with some extending to a resident manager or
nursing sister in the event of an emergency.
The various State Government housing authorities now have
far greater flexibility and can enter into partnership with other
organisations, purchase ready built flats either at random or
in blocks, renovate older dwellings and even- rent suitable
buildings, so there is no doubt that we will see far greater
involvement through this source than in past years, providing
we continue to present properly documented submissions which
clearly define local need.
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My own organisation, The Brotherhood of St Laurencehas recently introduced two experimental programmes.
Firstly
the Home Improvement Service, broadly based on a Swedish system
whereby home owners with limited resources can seek assistance
to upgrade their own homes to make them more convenient, com­
fortable and at the same time, reduce risk factors.
The work
will be undertaken on a contractual basis and the cost will
either be met by the home owner, the Brotherhood or a combination
of both.
The second experience (called SPAN) has been established
in the inner suburb' of Northcote where endeavours are being made
to create community interaction and interdependence- by linking
all age groups and utilising their respective strengths and
talents in a reciprocal support system.
The elderly are engaged in local schools, teaching slow
learners, working in the library
guidance.
and giving, first hand career
The children are responding by cleaning windows,
mowing lawns, shopping, visiting etc.
This project does', not
require a sophisticated structure, but rather attempts to bring
to the city an attitude and philosophy which is common practice
in small rural areas.
Foster-grandparents as
sponsored by the Victorian Council
on the Ageing is yet another positive step towards injecting
purpose into the lives of those whom the community classifies
as being no longer able to contribute.
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Our aim wherever possible should be to assist the elderly
to help themselves and not to take over the management of
their lives as we are so often prone to do.
Our endeavours to care for and accommodate people are no
doubt based on the highest possible motives but how often do we
really look at the recipients requirement through their eyes.
We could do well to remember Benjamin Franklin's words: "Want of care does us more damage than want of knowledge".
In closing may I share with you a personal belief that
'Old age is not a disease but a reward for living a long time'.
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NEVILLE BROOKE.