Notes for carers. Prepared: Victor Barnes PhD © 2005


In traditional Chinese and other Asian cultures the aged were highly
respected and cared for.

The Igabo tribesmen of Eastern Nigeria value dependency in their aged
and involve them in care of children and the administration of tribal
affairs (Shelton, A. in Kalish R. Uni Michigan 1969).

In Eskimo culture the grandmother was pushed out into the ice-flow to die
as soon as she became useless.

Western societies today usually resemble to some degree the Eskimo culture,
only the ice-flows have names such a Golden Age Homes. Younger
generations no longer assign status to the aged and their abandonment
is always in danger of becoming the social norm.

There has been a tendency to remove the aged from their homes and put them
in custodial care. To some degree the government provides domiciliary care
services to prevent or delay this, but the motivation probably has more
to do with expense than humanity.

In Canada and some parts of the USA old people are being utilised as
foster-grandparents in child care agencies.


What is Aging?

Aging: Aging is a natural phenomenon that refers to changes occurring
throughout the life span and result in differences in structure and
function between the youthful and elder generation.

Gerontology: Gerontology is the study of aging and includes science,
psychology and sociology.

Geriatrics: A relatively new field of medicine specialising in the
health problems of advanced age.

Social aging: Refers to the social habits and roles of individuals
with respect to their culture and society. As social aging increases
the individual usually experiences a decrease in meaningful social

Biological aging: Refers to the physical changes in the body systems
during the later decades of life. It may begin long before the individual
reaches chronological age 65.

Cognitive aging: Refers to decreasing ability to assimilate new
information and learn new behaviours and skills.


Eric Erikson (Youth and the life cycle. Children. 7:43-49
Mch/April 1960) developed an Ages and stages theory of human
development that involved 8 stages after birth each of which involved a
basic dichotomy representing best case and worst case outcomes. Below are the dichotomies and their developmental relevance:

Prenatal stage - conception to birth.
1. Infancy. Birth to 2 years - basic vs basic distrust. Hope.
2. Early childhood, 3 to 4 years. Autonomy vs. self doubt/shame. Will.
3. Play age, 5 to 8 years, Initiative vs. guilt. Purpose.
4. School age, 9 to 12, Industry vs. inferiority. Competence.
5. Adolescence, 13 to 19 - identity vs. identity confusion. Fidelity.
6. Young adulthoodhood, Intimacy vs. isolation. Love.
7. Adulthood, Generativity vs. self absorption. Care.
8. Mature age- Ego Integrity vs. Despair. Wisdom

This stage of older adulthood, i.e. stage 8, begins about the
time of retirement and continues throughout one's life. Achieving ego integrity
is a sign of maturity while failing to reach this stage is
an indication of poor development in prior stages through the
life course.

Ego integrity: This means coming to accept one's whole life and
reflecting on it in a positive manner. According to Erikson, achieving
a sense of integrity means fully accepting our self and coming to terms
with death. Accepting responsibility for our life and being able to review
the past and experience satisfaction with one's "self" is essential. The
inability to do this leads to despair and the individual will begin to fear
death. If a favourable balance is achieved during this stage, then wisdom
is developed.

Psychological and personality aspects:
Aging has psychological implications. Next to dying our recognition that we
are aging may be one of the most profound shocks we ever receive. Once we pass
the invisible of 65 our years are benchmarked for the remainder of
the game of life. We are no longer mature age we are
instead classified as “Old or senior citizens. How we cope with the
considerable changes we face and stresses of altered status depends on
our basic personality. Here are 3 basic personality types that have
been identified. It may be a gross oversimplification but it makes the point
about personality effectively:

a. The autonomous people who seem to have the resources for self-renewal. They
may be dedicated to a goal or idea and committed to continuing productivity
all which appears to protect them somewhat even against physiological aging.

b.The adjusted people who are perhaps rigid and lacking in adaptability but
are supported by their power, prestige or a well structured routine. But if
their situation changes drastically they become psychiatric casualties.

c.The anomic. These are people who do not have clear inner values or a
protective life situation. Such people have been described as prematurely weary and resigned
and they may deteriorate rapidly.

Summary of stresses of old age.

a. Retirement and reduced income. Most people rely on work for self worth,
identity and social interaction. Forced retirement can be demoralising.

b. Fear of invalidism and death. The increased probability of falling prey
to a condition from which there is no recovery is a continual
source of anxiety. When one has a heart attack or stroke the
stress becomes much worse.

Some persons face death with equanimity, often psychologically supported by
a religion or philosophy. Others may welcome death as an end to suffering or
insoluble problems and with little concern for life or human existence. Still
others face impending death with suffering of great stress against which they
have no ego defences.

c. Isolation and loneliness. Older people face inevitable loss of loved ones,
friends and contemporaries. The loss of a spouse whom one has depended on for
companionship and moral support is particularly distressing. Children grow up,
marry and become preoccupied or move away. Failing memory, visual and aural
impairment may all work to make social interaction more difficult. And if this
then leads to a souring of outlook and rigidity of attitude then social
interaction becomes further lessened and the individual may not even
utilise the avenues for social activity that are still available.

d. Reduction in sexual function and physical attractiveness.
Kinsey et al, in their Sexual behaviour in the human male,
(Phil., Saunders, 1948) found that there is a gradual decrease
in sexual activity with advancing age and that reasonably gratifying
patterns of sexual activity can continue into extreme old age. The aging
person also has to adapt to loss of sexual attractiveness in a society which
puts extreme emphasis on sexual attractiveness. The adjustment in self image
and self concept that are required can be very hard to make.

e. Forces tending to self devaluation. Often the experience of the older
generation has little perceived relevance to the problems of the young and
the older person becomes deprived of participation in decision making both
in occupational and family settings. Many parents are seen as unwanted
burdens and their children may secretly wish they would die so they can
be free of the burden and experience some financial relief or benefit.
Senior citizens may be pushed into the role of being an old person with
all this implies in terms of self devaluation.

4 Major Categories of Problems or Needs:

Income maintenance.
Interpersonal relations.


Physiological Changes: Catabolism (the breakdown of protoplasm) overtakes
anabolism (the build-up of protoplasm). All body systems are affected and
repair systems become slowed. The aging process occurs at different rates
in different individuals.

Physical appearance and other changes:
Loss of subcutaneous fat and less elastic skin gives rise to wrinkled
appearance, sagging and loss of smoothness of body contours. Joints stiffen
and become painful and range of joint movement becomes restricted, general
mobility lessened.

Respiratory changes:
Increase of fibrous tissue in chest walls and lungs leads restricts
respiratory movement and less oxygen is consumed. Older people more likely
to have lower respiratory infections whereas young people have upper
respiratory infections.

Nutritive changes:
Tooth decay and loss of teeth can detract from ease and enjoyment in
eating. Atrophy of the taste buds means food is inclined to be tasteless
and this should be taken into account by carers. Digestive changes occur
from lack of exercise (stimulating intestines) and decrease in digestive
juice production. Constipation and indigestion are likely to follow as a
result. Financial problems can lead to the elderly eating an excess of cheap
carbohydrates rather than the more expensive protein and vegetable foods
and this exacerbates the problem, leading to reduced vitamin intake and
such problems as anaemia and increased susceptibility to infection.

Adaptation to stress:
All of us face stress at all ages. Adaptation to stress requires
the consumption of energy. The 3 main phases of stress are:

1. Initial alarm reaction. 2. Resistance. 3. Exhaustion
and if stress continues tissue damage or aging occurs. Older persons have
had a lifetime of dealing with stresses. Energy reserves are depleted
and the older person succumbs to stress earlier than the younger person.
Stress is cumulative over a lifetime. Research results, including experiments with animals
suggests that each stress leaves us more vulnerable to the next
and that although we might think we’ve bounced back 100% in fact
each stress leaves it scar. Further, stress is psycho-biological meaning
the kind of stress is irrelevant. A physical stress may leave one
more vulnerable to psychological stress and vice versa. Rest does not completely
restore one after a stressor. Care workers need to be mindful of
this and cognizant of the kinds of things that can produce stress
for aged persons.

COGNITIVE CHANGE Habitual Behaviour:
Sigmund Freud noted that after the age of 50, treatment of
neuroses via psychoanalysis was difficult because the opinions and reactions of
older people were relatively fixed and hard to shift.

Over-learned behaviour: This is behaviour that has been learned so well
and repeated so often that it has become automatic, like for example
typing or running down stairs. Over-learned behaviour is hard to change.
If one has lived a long time one is likely to have fixed opinions and
ritualised behaviour patterns or habits.

Compulsive behaviour: Habits and attitudes that have been learned in the
course of finding ways to overcome frustration and difficulty are very
hard to break. Tension reducing habits such as nail biting, incessant
humming, smoking or drinking alcohol are especially hard to change at
any age and particularly hard for persons who have been practising them
over a life time.

The psychology of over-learned and compulsive behaviours has severe
implications for older persons who find they have to live in what for
them is a new and alien environment with new rules and power

Information acquisition:

Older people have a continual background of neural noise making
it more difficult for them to sort out and interpret complex sensory
input. In talking to an older person one should turn off the TV,
eliminate as many noises and distractions as possible, talk slowly
and relate to one message or idea at a time.

Memories from the distant past are stronger than more recent memories.
New memories are the first to fade and last to return.

Time patterns also can get mixed, old and new may get mixed.
Intelligence reaches a peak and can stay high with little
deterioration if there is no neurological damage. People who have unusually high intelligence to begin with seem to suffer the least decline.
Education and stimulation also seem to play a role in maintaining intelligence.

Intellectual impairment. Two diseases of old age causing cognitive decline are
Alzheimers syndrome and Picks syndrome. There is an inability
to concentrate and learn and also affective responses are impaired.

Degenerative Diseases.
Slow progressive physical degeneration of cells in the nervous system.

Genetics appear to be an important factor.

Usually start after age 40 (but can occur as early as 20s).

ALZHEIMERS DISEASE Degeneration of all areas of cortex but particularly frontal and
temporal lobes. The affected cells actually die.

Early symptoms resemble neurotic disorders: Anxiety, depression,
restlessness sleep difficulties.

Progressive deterioration of all intellectual faculties (memory
deficiency being the most well known and obvious).

Total mass of the brain decreases, ventricles become larger.

No established treatment.

PICKs DISEASE Rare degenerative disease.

Similar to Alzheimer’s in terms of onset, symptomatology and possible genetic
aetiology. However it affects circumscribed areas of the brain, particularly
the frontal areas which leads to a loss of normal affect.

PARKINSONS DISEASE Neuropathology: Loss of neurons in the basal ganglia.

Symptoms: Movement abnormalities: rhythmical alternating tremor of extremities,
eyelids and tongue along with rigidity of the muscles and slowness of movement

It was once thought that Parkinsons disease was not associated with intellectual
deterioration, but it is now known that there is an association between global
intellectual impairment and Parkinsons where it occurs late in life.

The cells lost in Parkinsons are associated with the neuro-chemical Dopamin
and the motor symptoms of Parkinsons are associated the dopamine deficiency.
Treatment involves administration of dopamine precursor L-dopa which can
alleviate symptoms including intellectual impairment. Research suggests
it may possibly bring to the fore emotional effects in patients who have had
psychiatric illness at some prior stage in their lives.

AFFECTIVE DOMAIN In old age our self concept gets its final revision. We make a
final assessment of the value of our lives and our balance of success
and failures.

How well a person adapts to old age may be predicated by how well the person
adapted to earlier significant changes. If the person suffered an emotional
crisis each time a significant change was needed then adaptation to the
exigencies of old age may also be difficult. Factors such as economic
security, geographic location and physical health are important to the
adaptive process.

Need Fulfilment: For all of us, according to Maslows Hierarchy of Needs
theory, we are not free to pursue the higher needs of self actualisation
unless the basic needs are secured. When one considers that many, perhaps
most, old people are living in poverty and continually concerned with
basic survival needs, they are not likely to be happily satisfying needs
related to prestige, achievement and beauty.

Maslow's Hierarchy

Belonging, love, identification
Esteem: Achievement, prestige, success, self respect
Self actualisation: Expressing interests and talents to the full.

Note: Old people who have secured their basic needs may be motivated to work
on tasks in the highest levels in the hierarchy, activities concerned
with aesthetics, creativity and altruistic matters, as compensation for loss
of sexual attractiveness and athleticism. Aged care workers fixated on getting
old people to focus on social activities may only succeed in frustrating and
irritating them if their basic survival concerns are not secured to their satisfaction.


Social aging according to Cumming, E. and Henry, W. (Growing old:
the aging process of disengagement, NY, Basic 1961) follows a well defined

1. Change in role. Change in occupation and productivity. Possibly change
in attitude to work.
2. Loss of role, e.g. retirement or death of a husband.
3. Reduced social interaction. With loss of role social interactions are
diminished, eccentric adjustment can further reduce social interaction, damage
to self concept, depression.
4. Awareness of scarcity of remaining time. This produces further curtailment of
activity in interest of saving time.

Havighurst, R. et al (in B. Neugarten (ed.) Middle age and aging, U. of Chicago,
1968) and others have suggested that disengagement is not an inevitable process.
They believe the needs of the old are essentially the same as in middle age and
the activities of middle age should be extended as long as possible. Havighurst
points out the decrease in social interaction of the aged is often largely the
result of society withdrawing from the individual as much as the reverse. To
combat this he believes the individual must vigorously resist the limitations
of his social world.

DEATH The fear of the dead amongst tribal societies is well established. Persons who
had ministered to the dead were taboo and required observe various rituals
including seclusion for varying periods of time. In some societies from South
America to Australia it is taboo for certain persons to utter the name of the
dead. Widows and widowers are expected to observe rituals in respect for the dead.
Widows in the Highlands of New Guinea around Goroka chop of one of their own fingers.
The dead continue their existence as spirits and upsetting them can bring dire

Wahl, C in The fear of Death, 1959 noted that the fear of death occurs as early
as the 3rd year of life. When a child loses a pet or grandparent fears reside in
the unspoken questions: Did I cause it? Will happen to you (parent) soon? Will this
happen to me? The child in such situations needs to re-assure that the departure is
not a censure, and that the parent is not likely to depart soon. Love, grief, guilt,
anger are a mix of conflicting emotions that are experienced.


Our culture places high value on youth, beauty, high status occupations,
social class and anticipated future activities and achievement. Aging and
dying are denied and avoided in this system. The death of each person reminds
us of our own mortality.

The death of the elderly is less disturbing to members of Western society
because the aged are not especially valued. Surveys have established that
nurses for example attach more importance to saving a young life than an old
life. In Western society there is a pattern of avoiding dealing with the aged
and dying aged patient.

Stages of dying. Elisabeth Kubler Ross has specialised in working with dying
patients and in her On death and dying, NY, Macmillan, 1969, summarised 5 v stages in dying.

1. Denial and isolation. No, not me!
2. Anger. I’ve lived a good life so why me?BR> 3. Bargaining. Secret deals are struck with God. If I can live until…I
promise to….
4. Depression. (In general the greatest psychological problem of the aged
is depression). Depression results from real and threatened loss.
5. Acceptance of the inevitable.


The aged share with the young the same needs: However, the aged often have fewer
or weaker resources to meet those needs. Their need for social interaction may be
ignored by family and care workers.

Family should make time to visit their aged members and invite them to their homes.
The aged like to visit children and relate to them through games and stories.

Meaningful relationships can be developed via foster-grandparent programs.
Some aged are not aware of their income and health entitlements. Family and
friends should take the time to explain these. Some aged are too proud to access
their entitlements and this problem should be addressed in a kindly way where it

It is best that the aged be allowed as much choice as possible in matters related
to living arrangements, social life and lifestyle.

Communities serving the aged need to provide for the aged via such things
as lower curbing, and ramps.

Carers need to examine their own attitude to aging and dying. Denial
in the carer is detected by the aged person and it can inhibit the aged
person from expressing negative feelings: ear, anger. If the person
can express these feelings to someone then that person is less likely to
die with a sense of isolation and bitterness.


The following notes are my interpretation of a Dr. Depak Chopra lecture
entitled, which he presented to the 13th
Scientific Conference of the American Holistic Medical Association.
Dr. Depak Chopra is an endocrinologist and a former Chief of Staff of
New England Hospital, Massachusetts. I am deliberately omitting the detail
of his explanations of the more abstract, ephemeral and controversial ideas.
Original material from 735 Walnut Street, Boulder, Colorado 83002,
Phone. +303 449 6229.

In the lecture Dr. Chopra presents a model of the universe and of all
organisms as structures of interacting centres of electromagnetic energy
linked to each other in such a way that anything affecting one part of a
system or structure has ramifications throughout the entire structure. This
model becomes an analogue not only for what happens within the structure or
organism itself, but between the organism and both its physical and social
environments. In other words there is a correlation between psychological
conditions, health and the aging process. Dr. Chopra in his lecture
reconciles ancient Vedic (Hindu) philosophy with modern psychology
and quantum physics.

Premature Precognitive Commitment: Dr. Chopra invokes experiments that
have shown that flies kept for a long time in a jar do not quickly leave
the jar when the top is taken off. Instead they accept the jar as the limit
of their universe. He also points out that in India baby elephants are often
kept tethered to a small twig or sapling. In adulthood when the elephant is
capable of pulling over a medium sized tree it can still be successfully tethered
to a twig! As another example he points to experiments in which fish are bred on
2 sides of a fish tank containing a divider between the 2 sides. When the divider
is removed the fish are slow to learn that they can now swim throughout the whole
tank but rather stay in the section that they accept as their universe. Other
experiments have demonstrated that kittens brought up in an environment of
vertical stripes and structures, when released in adulthood keep bumping into
anything aligned horizontally as if they were unable to see anything that is
horizontal. Conversely kittens brought up in an environment of horizontal stripes
when released bump into vertical structures, apparently unable to see them.

The whole point of the above experiments is that they demonstrate Premature
Precognitive Commitment. The lesson to be learned is that our sensory apparatus
develops as a result of initial experience and how we have been taught to interpret it.

What is the real look of the world? It does not exist. The way the world looks to
us is determined by the sensory receptors we have and our interpretation of that
look is determined by our premature precognitive commitments. Dr Chopra makes the
point that less than a billionth of the available stimuli make it into our nervous
systems. Most of it is screened, and what gets through to us is whatever we are
expecting to find on the basis of our precognitive commitments.

Dr. Chopra also discusses the diseases that are actually caused by mainstream
medical interventions, but this material gets too far away from my central
intention. Dr. Chopra discusses in lay terms the physics of matter, energy and
time by way of establishing the wider context of our existence. He makes the
point that our bodies including the bodies of plants are mirrors of cosmic
rhythms and exhibit changes correlating even with the tides.

Dr. Chopra cites the experiments of Dr. Herbert Spencer of the US National
Institute of Health. He injected mice with Poly-IC, an immuno-stimulant while
making the mice repeatedly smell camphor. After the effect of the Poly-IC had
worn off he again exposed the mice to the camphor smell. The smell of camphor
had the effect of causing the mice’s immune system to automatically strengthen
as if they had been injected with the stimulant. He then took another batch of
mice and injected them with cyclophosphamide which tends to destroy the immune
system while exposing them to the smell of camphor. Later after being returned
to normal just the smell of camphor was enough to cause destruction of their
immune system. Dr. Chopra points out that whether or not camphor enhanced or
destroyed the mice immune system was entirely determined by an interpretation
of the meaning of the smell of camphor. The interpretation is not just in the
brain but in each cell of the organism. We are bound to our imagination and our
early experiences.

Chopra cites a study by the Massachusetts Dept of Health Education and Welfare
into risk factors for heart disease – family history, cholesterol etc. The 2
most important risk factors were found to be psychological measures: Self
Happiness Rating and Job Satisfaction. They found most people died of heart
disease on a Monday!

Chopra says that for every feeling there is a molecule. If you are
experiencing tranquillity your body will be producing natural valium. Chemical
changes in the brain are reflected by changes in other cells including blood
cells. The brain produces neuropeptides and brain structures are chemically
tuned to these neuropeptide receptors. Neuropeptides (neurotransmitters) are
the chemical concommitants of thought. Chopra points out the white blood cells
(a part of the immune system) have neuropeptide receptors and are eavesdropping
on our thinking. Conversely the immune system produces its own neuropeptides which
can influence the nervous system. He goes on to say that cells in all parts of the
body including heart and kidneys for example also produce neuropeptides and
neuropeptide sensitivity. Chopra assures us that most neurologists would agree
that the nervous system and the immune system are parallel systems.

Other studies in physiology: The blood interlukin-2 levels of medical students
decreased as exam time neared and their interlukin receptor capacities also
lowered. Chopra says if we are having fun to the point of exhilaration our natural
interlukin-2 levels become higher. Interlukin-2 is a powerful and very expensive
anti-cancer drug. The body is a printout of consciousness. If we could
change the way we look at our bodies at a genuine, profound level then our bodies
would actually change.

On the subject of Time, Chopra cites Sir Thomas Gall and Steven Hawkins,
stating that our description of the universe as having a past, present, and
future are constructed entirely out of our interpretation of change. But in
reality, linear time does not exist.

Chopra explains the work of Alexander Leaf a former Harvard Professor of
Preventative Medicine who toured the world investigating societies where
people commonly live beyond 100 years (these included parts of Afghanistan,
Soviet Georgia, Southern Andes). He looked a variety of possible factors
including climate, genetics, and diet. Leaf concluded the most important
and consistent factor was the collective perception of aging in these societies.

Amongst the Tama Humara of the Southern Andes there was a collective belief
that the older you got the more physically able you got. They had a tradition
of running and the older one became then generally the better at running one got.
The best runner was aged 60. Lung capacity and other measures actually improved
with age. People were healthy until well into their 100s and died in
their sleep. Chopra remarks that things have changed since the introduction
of Budweiser (beer) and TV.

[DISCUSSION: How might TV be a factor in changing the former ideal state of things?]

Chopra refers to the work of Dr. Ellen Langor a former Harvard Psychology professor.
Langor advertised for 100 volunteers aged over 70 years. She took them to a
Monastery outside Boston to play Let’s Pretend. They were divided into 2
groups each of which resided in a different part of the building. One group,
the control group spent several days talking about the 1950s. The other group,
the experimental group had to live as if in the year 1959 and talk about it in
the present tense. What appeared on their TV screens were the old newscasts
and movies. They read old newspapers and magazines of the period. After 3 days
everyone was photographed and the photographs judged by independent judges who
knew nothing of the nature of the experiment. The experimental group seemed to
have gotten younger in appearance. Langor then arranged for them to be tested
for 100 physiological parameters of aging which included of course blood pressure,
near point vision and DHEA levels. After 10 days of living as if in 1959 all
parameters had reversed by the equivalent of at least 20 years.

Chopra concludes from the Langor experiment:
We are the metabolic end product of our sensory experiences. How we interpret
them depends on the collective mindset which influences individual biological
entropy and aging.

Can one escape the current collective mindset and reap the benefits in longevity
and health? Langor says, society will not let you escape. There are too many reminders
of how most people think linear time is and how it expresses itself in entropy and
aging: men are naughty at 40 and on Social Welfare at 55, women reach menopause at
40 etc. We get to see so many other people aging and dying that it sets the pattern
that we follow.

Chopra concludes we are the metabolic product of our sensory experience and our
interpretation gets structured in our biology itself. Real change comes from change
in the collective consciousness, otherwise it cannot occur within the individual.

Chopra, D. The New Physics of Healing. 735 Walnut Street, Boulder, Colorado 83002,
Phone. +303 449 6229.
Coleman, J. C. Abnormal psychology and modern life. Scott Foresman & Co.
Lugo, J. and Hershey, L. Human development a multidisciplinary approach to the
psychology of individual growth, NY, Macmillan.
Dennis. Psychology of human behaviour for nurses. Lond. W. B.Saunders.