Perspectives on Aging Clients: Seeking the Individual

By Ira Rosofsky, PhD

Nursing home experiences demonstrate the importance among professionals of considering elders as individuals whose lives incorporate history, relationships, and meaning.

As an itinerant psychologist working in a number of nursing homes, I’ve developed a unique perspective on aging and mortality. The story of the blind men and the elephant illustrates an analogous quandary. Six blind men touched different parts of an elephant and each developed a different idea of it—a spear, a tree, a fan, a wall, a snake, and a rope. Because they were scientists, they argued about the essence of elephant. I don’t know whether they published a journal or set up colloquia. Today, there might be blindmenandtheelephant.com.

As a clinical psychologist, I have to guard against acting as a blind man, thinking of my clients as elephants. Thirty years ago, I worked with children. Without children of my own, I could have believed that childhood consisted of bed wetting, night terrors, abuse, school phobia, and self-mutilation. As my caseload expanded to adults, it seemed that childhood inevitably developed into agoraphobia, compulsive hand washing, impotence, infidelity, and addiction. For the last decade, I have been working with the end of the life span, and life appears to reach closure with frailty and confusion. But I have to remember that what I see is not all there is.

Traveling between nursing homes one day, I stopped for gas and at the next pump was a man in his late 70s or early 80s filling up his Lexus LS. I looked it up later. That model’s price starts at $61,500. He had on a cream-colored leisure suit—and I wondered whether they still make them. He wore white shoes and didn’t care that it was after Labor Day. Unlike my patients, Leisure-Suit-Lexus Man was out there with millions of others like him living independently—whether lives of joy or desperation—quite without the need of a blind man like me.

There are nearly 2 million residents in nursing homes, but living outside them are more than 35 million of their peers over the age of 65. Out there are the octogenarian triathletes, 91-year-old Walter Cronkite sailing his yacht, Pete Singer still singing, Harry Bernstein publishing his well-reviewed debut novel at age 97, and 68-year-old Melvin Cate, bank robber.

Appreciating the Person
Even within the confines of long-term institutions, I can have a blind man’s view of older adults. They come from significantly different life experiences. The preponderance of nursing home residents I see are members of the so-called Greatest Generation. Ten years from now, it will be Depression-era babies—kids who tended victory gardens and collected scrap metal to support the war effort. Later, they would have the dubious honor of fighting the Korean War.

And 20 years from now, it will be my own boomer generation. Will the Beatles’ songbook replace the Glen Miller sing-along? Will I nod off in my wheelchair in the face of an endless YouTube loop? Will fading memories be prodded by trivia games about Rootie Kazootie and the Brady Bunch? Will some of us be wondering why we can’t get some of that medicinal marijuana rather than the glass of wine some of my patients agitate for today?

All the people living together in uniform circumstances have led very different lives. Individually, they are very different. There are the serenely contented who are happy to have landed in a clean, well-lighted place, and there are the ever discontented, chafing yet again at the hand life has dealt them.

Among my and my wife’s parents, only my father spent significant time in a nursing home and not until he was past 85 years old and had broken two hips, sinking deep into vascular dementia. My mother-in-law spent only weeks in a nursing home, dying from the Clostridium difficile she caught during her hospitalization. Her husband survived an early stroke, and continued to live at home with more of a social life than me. He was perfectly cogent on the morning of the day he died at age 73 of a second stroke.

My mother would walk five miles for both the exercise and to save on bus fare until a heart valve sprung a leak at the age of 80. After surgery to insert an artificial valve, she gave up the walks but labored on at home for three more years until cardiac arrest killed her as she watched TV one evening.

So I have to remind myself yet again that what I see is not all there is. I recognize that my father is not only the angry, confused man sitting in a wheelchair who would yell at me and others to “get the hell out of here.” He was my father and a grandfather who lived a varied life that included walking across Europe with a rifle in his hands. There’s a resident I saw last week—a disheveled, shrunken lady with one somewhat good eye paired with a hollow socket—who studied at the Art Institute of Chicago.

A Challenging Assessment
It’s important for professionals of all ages and types to appreciate life beyond the narrow focus of their caseloads. Conversely, my work in nursing homes imparts a new view of the life I see outside. There’s a game I often play: Will you be in a nursing home?

Recently, I played it at a local convenience store while picking up a gallon of milk. In line was a 40-something woman, much heavier than I and one foot shorter. She asked for a couple packs of Marlboros. On the counter, she placed a Milky Way bar, a jumbo bag of chips, a Pepsi, a half-gallon of whole milk, and a loaf of white bread. She almost forgot $10 worth of lottery tickets. She’s thinking she’s lucky; I’m thinking chronic obstruction pulmonary disease, early-onset type 2 diabetes with peripheral neuropathy, and an early entrance into long-term care.

As I left the store, a runner went by, making good time. As a one-time marathoner myself, I estimated a six-minute-mile pace. Slim as he was, I predicted that barring any disease unrelated to fitness—Parkinson’s or Alzheimer’s—he’s good for a lifetime outside a nursing home.

Me? My marathon days are long gone, but I still exercise. Although I could lose more than a few pounds, on the plus side, I quit smoking more than 25 years ago, with only a one-year lapse along the way. On the negative side, quitting is not as good as never having smoked. My genes are decent. My mother made it into her 80s, and my father almost hit 90—with dementia. I have a reasonable shot at not being in a nursing home until I’m in my 80s or beyond. I also have a reasonable shot at keeling over dead before I’m frail or demented enough for a nursing home. None of this means that my right knee won’t ache when I stand up from my computer and it bears my weight.

Thriving on Positive Experiences
I’ve learned that even in a nursing home, old age can have happy endings. Consider a man I’ll call Sean Hanrahan. When I met him, he was one of the few humans alive to have experienced the personal enjoyment of the last two Red Sox World Series championships—in 1918 and 2004. On my way to his room, the nurse pulled me aside and warned me he was cranky, unfriendly, and in a world of pain. A fit 96 year old, he fell off a ladder while hanging a picture and broke his leg. At that age, a fracture is usually a one-way ticket to long-term confinement. But Sean was determined to get home.

Born in Boston in 1908, he wasn’t at the 1918 World Series clincher. He was poor, plus there were only 42,000 seats. “I didn’t even hear it on the radio. There was no radio,” he said. “I heard the newsboys down the street hawking the late-edition extra.”

I met Sean on my 58th birthday, October 27, 2004. I was almost old enough to cash in my IRA but still too young for Medicare. Sean, along with all the other residents, provided me with—apologies to William Wordsworth—intimations of my own mortality. I also remember that date because on that evening, the Sox finished their four-game sweep of the Cardinals. Despite the nurse’s warning, Sean was in a celebratory, talkative mood—wearing his Bosox hat.

“I’m a bit unhappy I can’t be at the game. My grandson told me if they ever made it this far, he’d take me,” he said. “But I got my TV right here, and the nurse has a beer cooling for me in the fridge.” The following week, when I returned, Sean was gone. My heart skipped a beat, but he wasn’t dead.  He’d gone home. Even at 96, life goes on.

If I live long enough, I will be 96 in 2042. I, too, will have a baseball story for some eager whippersnapper. It will sound equally quaint to the ears of someone long past computers, iPhones, and HDTV.

I was only 8 when the Brooklyn Dodgers won their only World Series. We took our baseball seriously in Brooklyn. There was no need to play hooky to follow the series. They wheeled those new-fangled TVs right into the classrooms. Although my family did have a TV by 1955, I belong to the last generation that didn’t automatically have one as a birthright. If the game wasn’t over when the school bell rang, no problem. Walking home, we could follow the game from the radios and TVs heard through the open windows along the way. The Bums—as we affectionately called them—clinched the series with a 2-0 complete game won by Johnny Podres. Outside my house, a Yankee was hanged in effigy from the street lamp. And who could sleep with all the firecrackers, cherry bombs, ash cans, and even gunfire through the night?

Pete Hamill would write, “In Brooklyn that day, it was the Liberation of Paris, VJ Day, New Year’s Day all rolled into one.”

In 1958, the Dodgers went west, never to return except as the enemies of my newfound love, the Mets. Even though I was able to give my heart, on the rebound, to another, my eyes were opened wide after the Dodgers helped plant the seeds of the cynical detachment with which I continue to live today.

I don’t know whether Sean is alive today, but it’s not a stretch to believe he lived to see the Sox win yet another championship in 2007 somewhere other than in a nursing home and lived without cynicism forever in the moment. His Sox never left him.

— Ira Rosofsky, PhD, is a psychologist who works in a number of long-term care facilities. This article is adapted in part from his book, Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare.