Lesley University

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Graduate School of Arts and Social Sciences

Expressive Therapies Dissertations (GSASS)

2011

Old Is an Attitude - Age Is a Concept: A Qualitative Study on Aging

and Ageism with Guidelines for Expressive Therapies Literature
Steven Durost
Lesley University

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Durost, Steven, "Old Is an Attitude - Age Is a Concept: A Qualitative Study on Aging and Ageism with
Guidelines for Expressive Therapies Literature" (2011). Expressive Therapies Dissertations. 36.
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Old Is an Attitude - Age Is a Concept:

A Qualitative Study on Aging and Ageism
with Guidelines for Expressive Therapies Literature

A DISSERTATION

(submitted by)

STEVEN DUROST

In partial fulfillment of the requirements

for the degree of
Doctor of Philosophy

LESLEY UNIVERSITY
May 21, 2011
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ACKNOWLEDGEMENTS

On the dissertation journey one meets, makes and sometimes loses friends. Since
starting at Lesley University, I have met amazing professors, collaborative peers,
encouraging companions, wonderful people from around the world and authentic older
adults who shared their lived experiences. I have had the support of life long friends and
family members who have been there before and are there even now. And, I have lost
one dear friend to an aneurysm, my grandmother to a stroke, and one participant to a
heart attack. My heart is deeply grateful to all these people for whom the following
thanks will not be enough to express how important they have been in my academic,
professional and personal growth and development. I am blessed to know you and this
dissertation is for you.
I offer deepest thanks to:
My Doctoral Committee who guided me in the early stages of my work, checked
in on me as I was out growing my counseling business, C.R.E.A.T.E!, and cheered for me
as I moved forward again to complete the work. Dr. Robyn Cruz who tossed around
ideas and helped weave those ideas into a great whole. Dr. Michele Forinash who helped
me learn collaboration in editing and whose leadership in the Doctoral Program is strong
and nurturing. Dr. Louise Morin-Davy who was willing to help someone she barely
knew on a long journey providing a third voice to the committee.
Dr. Carolyn Heller who rocked my concept of scientific research by showing me a
researcher can observe, be vulnerable, tell a story, and still be a scientist.
Dr. Vivien Marcow-Speiser who made my trips to Israel to teach possible, to Dr.
Mitchell Kossak who allowed me to student teach with him in Israel and Dr. Julia Byers
who supervised my first adjunct teaching assignment there in Israel. The first time I went
to Israel was during their war with Lebanon and the second was during a Passover
celebration. The students were tense both times. I am indebted to these three people for
their guidance, support, active concern as well as those amazing opportunities for growth.
Dr. Priscilla Daas-Brailsford for making possible the single most life learning
experience I have had to date. Her passion and love for South Africa and her dedication
in bringing a group of students to do a trauma internship in Capetown will always be
appreciated. The trauma internship was a pivotal time for me changing my worldview as
I came in contact with the ravages of the very worse of humanity as well as was amazed
by the human spirit arising from the very best humanity has to offer.
Ruth Levy for welcoming me into my first expressive therapies class making the
beginning of my journey possible, and for her accepting me as a student teacher for three
semesters. I am ever thankful of her generosity towards me.
All the members of my cohort who showed me I belonged and all the professors,
staff and students of Lesley University with whom this dissertation was made possible.
Nikki LaBarge, my friend, who died during the process of this dissertation and
who had such strong faith in my vision. Nikki did not get to see the finish products of
either my dissertation or of C.R.E.A.T.E! but her support has been formidable even now.
Thank you also goes to Nikki’s family who continues in her spirit and shows their love of
Nikki through their creation of the Nikki LaBarge Memorial Fund and through the
establishing of the non-profit Nikki’s Dream for Wellness and Education. Thank you to
Michelle, Andrea, Donna, Beeb, Denise, Jada, Keith and all the LaBarge Clan.
 5

Mike Howatt who said to me, when I was choosing between a Clinical
Psychology PhD or one in expressive therapies, “you are much more excited when you
talk about the expressive therapies doctorate. I think the choice is obvious.” Thank you
for your perceptive observation and for being alongside all these years.
JoAnne Pricer who has believed in the best of me since we met at 16. Your
presence is a joy and your joy is a light.
Frank Ponte who has journeyed along with me in friendship, has romped with me
in theater, and encouraged all my writing endeavors.
Richard Durost, my father, who gave me the entrepreneurial spirit that propels me
to dream, take risks and go on adventures. Theresa Ellis, my step-mother who has
cheered me all the way.
Nancy Durost, my mother and friend, who provides me the wisdom to solidly
build dreams, take secured risk and plan well for adventures. Thoreau said, “If you have
built castles in the air, your work need not be lost; that is where they should be. Now put
the foundations under them.” Mom, you make the Castle possible by providing me
foundation. Thank you.
My family who support me through the amazing gift of their love. Kim, Mike,
Chris, Tom, Mike, Ciara, Cailyn, Tommy, Griffin, and Emily thank you for every
moment you spend with me.
My church family…especially the Dixons and their clan…who have encouraged
my doctoral pursuit, probably even before I had doctoral pursuits.
All the people at and connected to C.R.E.A.T.E! the Center for Expressive Arts,
Therapy and Education. You are the most amazing group of clinicians, people and
friends with whom a person could ever have the pleasure of collaborating. Thank you
Susan, Marigrace, Carrie, Masha, Gail, Robin, Sarah, Mindy, Beth, Rachel, Donna,
Melissa, Kathy, Michelle, Courtney, Lindsay, Amanda, Cathy, Liz, Erica, Dianne, Diane
and all the people who have made C.R.E.A.T.E! possible. Thank you all for your
camaraderie and for making each day a pleasure.
All the amazing people around the world whom I have met on this journey.
Thank you for you support, for welcoming me in, for sharing stories and for supporting
this inquisitive American.
Mena, Ceil, Herb, Bernice, Irene, June, Janet, Nancy, Marguerite and Lorna for
sharing your life stories…to all of you I am deeply thankful. You showed me elders are
just us older.
Memere, Aunt Laura, Mema, Bepa, Aunt Lorraine and all the older adults who
believed in me and loved me during my formative years, gave me lasting memories of
joy, and role modeled for me how to be a great “older adult.”
With Deepest Thank,
Steven
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TABLE OF CONTENTS

LIST OF TABLES ...............................................................................................................9

ABSTRACT.......................................................................................................................10

1. INTRODUCTION .......................................................................................................11

2. LITERATURE REVIEW ............................................................................................15

Old Age and Older Adults: Statistics, Research and Reality .................................15
Old Age Stereotypes and the Perpetuation of Ageism...........................................16
Old Age and Older Adults: Words and Definitions ...............................................19
Older Adults and Elders .............................................................................23
Ageism .......................................................................................................23
Therapy versus Therapeutic .......................................................................24
Counseling Older Adults........................................................................................27
Counseling Older Adults: Ageism .............................................................27
Counseling Older Adults: Research ...........................................................30
Counseling Older Adults: Reminiscence and Life Review Therapy .........32
Counseling Older Adults: Trauma Work ...................................................37
Expressive Therapies with Older Adults ...............................................................43

3. METHOD ....................................................................................................................49

Participants .............................................................................................................49
Data Collection ......................................................................................................50
Data Analysis .........................................................................................................54

4. RESULTS ....................................................................................................................62

Lived Experience of Aging ....................................................................................62

Aging..........................................................................................................64
Changes Associate with Aging ..................................................................66
Career and Retirement ...................................................................66
Family ............................................................................................67
Mental Processing ..........................................................................68
Social Interactions ..........................................................................70
Time ...............................................................................................71
Physical Concerns ..........................................................................73
Descriptions of What is “Too Old” ............................................................76
Thoughts on Death and Dying ...................................................................79
Staying One’s Present Age ........................................................................81
Aging Well and Benefits of Age ............................................................................82
Aging Well .................................................................................................82
Different Actions the Participants Would Take with Regards to Aging ...83
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Tell the World about Aging .......................................................................84

Aging as a Concept or Attitude..................................................................84
Inner Age .......................................................................................85
Benefits of Aging .......................................................................................87
Societal Perceptions and the Impact on Older Adults ...........................................89
Perceptions of the Participants as Old by Others .......................................90
How Participant Feels about Being Seen as Old .......................................91
Connectedness........................................................................................................92
Meaning and Purpose .................................................................................96
Gift to the World ........................................................................................97

5. DISCUSSION ..............................................................................................................99

Connectedness......................................................................................................100
Death and Connectedness ........................................................................101
Purpose and Connectedness .....................................................................103
Old Was an Attitude - Age Was a Concept .........................................................104
Meaning and Attitude ..............................................................................107
Inner Age .................................................................................................107
Self-perception of Being an Older Adul ..................................................109
Old Was Someone Else............................................................................109
Attitude and Concept ...............................................................................110
Limitations of the Study.......................................................................................112
Suggestions for Further Research ........................................................................114
Conclusion ...........................................................................................................117

APPENDIX A ..................................................................................................................121

Guidelines for Ageism Awareness When Reviewing Literature and Research

about Expressive Therapies with Older Adults ...................................................122
Eliminate age bias and ageism stereotypes ..............................................123
Eliminate both positive and negative biases and stereotypes ..................124
Promote counseling as effective with older adults ..................................124
Differentiate arts-based therapy from arts-based therapeutic programs ..125
Represent the expressive therapist as a therapist .....................................125
Adjustments made based on client’s needs not on client’s age ...............126
Aim to increase older adult’s connectedness, purpose and meaning .......127
Honor client as a person who is older not as an old person .....................127
Show an understanding of the inner age of the client ..............................128
Encourage the creative potential of older adults ......................................128

APPENDIX B ..................................................................................................................130

Application of Guidelines for Ageism Awareness When Reviewing Literature and

Research about Expressive Therapies with Older Adults ....................................131
Expressive Therapies Literature ..............................................................131
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Art Therapy ..................................................................................131

Dance/Movement Therapy...........................................................132
Music Therapy .............................................................................133
Psychodrama/Drama Therapy......................................................134
Applications .............................................................................................135
Eliminate age bias and ageism stereotypes ..................................135
Eliminate both positive and negative biases and stereotypes ......140
Promote counseling as effective with older adults ......................141
Differentiate arts-based therapy from arts-based therapeutic
programs ......................................................................................142
Represent the expressive therapist as a therapist .........................145
Adjustments made based on client’s needs not on client’s age ...147
Aim to increase older adult’s connectedness, purpose and
meaning ........................................................................................149
Honor client as a person who is older not as an old person .........150
Show an understanding of the inner age of the client ..................151
Encourage the creative potential of older adults ..........................152
Finishing Comments ................................................................................153

REFERENCES ................................................................................................................154
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LIST OF TABLES

Table 1 Characteristic of Participants ...............................................................................49

Table 2 Length and Number of Interviews .......................................................................51

Table 3 Data Analysis Codes ............................................................................................57

Table 4 Atlas.ti’s Presentation of Co-occurring Codes ....................................................58

Table 5 Atlas.ti’s Presentation of Quotations Linked to a Code.......................................60

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ABSTRACT

Mental health professionals who work with people over 65 have been shown to

exhibit subtle and overt ageist attitudes. Many of these misconceptions were based on

societal perceptions and ageism stereotypes arising from contemporary research

performed on a non-representative portion of people over 65. Nursing home residents

representing only 4.2% of the older adult population have been studied and the results of

those studies have been generalized to represent all older adults. Few studies have given

voice to the 95.8% of well older adults living independently. It was held if older adults

were listened to, guiding information could be gained which could help professionals

working with older adults to become more aware of the trappings of ageism and age

stereotypes. A qualitative study was employed to explore the lived experience of aging

through the analysis and coding of interviews with ten independent people over 65 years

old living in diverse locations around the world. Though some of the findings supported

old age stereotypes, it was found that the participants held an “inner age” that was 30-40

years younger than their physical age, that the participants did not see themselves as

“old,” that “old” meant physical disability or poor attitude, and that “connectedness” was

important in life fulfillment. The findings were used to develop a set of guidelines for

critiquing expressive therapies literature about working with older adults. Applications

of the guidelines to a selection of expressive therapies literature was performed and

presented.

Keywords: Aging; Ageism; Phenomenology; Qualitative; Expressive therapies

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CHAPTER 1

Introduction

People with a positive attitude about aging have been shown to live seven years

longer than those whose attitudes were less favorable (Levy, Slade, Kunkel, & Kasl,

2002). Stereotypes about older adults have contributed to negative attitudes about aging.

Ageism stereotypes have included the idea that older adults were senile, more mentally

ill, frail, sick, inefficient, isolative, inflexible, stubborn and lacking interest in sex

(Edelstein & Kalish, 1999). Belief in these stereotypes have lead older adults to perform

less well than younger counterparts in research tests (Chasteen, Bhattacharyya, Horhota,

Tam, & Hasher, 2005; Hess, Hinson & Hodges, 2009) and also increased dependency

among the older adults in the study (Coudin & Alexopoulos, 2010). Psychologist, mental

health counselors and social worker were found to have age-related biases (Danzinger &

Welfel, 2000; Helmes & Gee, 2003; Kane, 2004; Kane 2008; Lee, Volans, & Gregory,

2003; Roberts, 2008). Mental health professionals misdiagnosed depression in older

adults due to age bias (Lasser, Siegel, Dukoff, & Sunderland, 1998). According to a

review of studies, mental health professionals were less likely to offer psychotherapy to

treat older adults with depression than to offer drugs and were more likely to offer a

poorer prognosis for older patients (Gatz & Pearson, 1988). Internalized ageism was

shown to prevent older adults from seeking help if they believed the symptoms (like

depression) were just part of growing older (Sarkisian, Lee-Henderson, & Mangione,

2003).

Many age-based misconceptions, biases, and ageism stereotypes were based on

contemporary research performed on a non-representative portion of people over 65,

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namely older adults in nursing homes (Butler, 1969; 1998b). Nursing home residents

were studied and the findings were incorrectly generalized to represent the entire older

adult population. Since 95.8% of people over 65 were not in nursing home and since

research on aging was performed on older adults in nursing homes, information on aging

lacked a proportional representation of well elders (Woolf, 1998b, para. 6).

Misconceptions of older adults and age-based biases permeated the literature on

counseling older adults. From Freud (1905/1953) to the National Institute on Health

(Scogin & McElreath, 1994, p. 69), ageism was found in all areas of counseling and care

of older adults. Thus, ageist thinking influenced mental health counselors and their work

with older adults. Danzinger & Welfel (2000) “found that mental health professionals

judged older clients significantly less competent and less likely to improve than younger

clients” (p. 135). Helmes & Gee (2003) found that when presented with two vignettes in

which only the client’s age had been changed, mental health professionals rated the older

client as being less able to connect with the counselor, less able to get well, and less

appropriate for counseling. The counselors were also less willing to accept the older

adult as a client. When Kane (2004) presented Bachelor and Master level Social Workers

with two vignettes in which only the age of the client had been change the participants

statically showed that they thought the older client was less likely to recover, had “lived

long enough” and the best way to counsel her was to help her “prepare for death.” The

client in one the vignette was 72 and in the other was 38. In addition, a significantly less

percentage of participants felt the client should be referred to psychotherapy (92.9%

versus 79.3%).
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It has been shown that mental health professionals misdiagnosed depression in

older adults due to age bias (Lasser, et al., 1998). According to a review of studies,

mental health professionals were less likely to offer psychotherapy to treat older adults

with depression than to offer drugs and were more likely to offer a poorer prognosis for

older patients (Gatz & Pearson, 1988). Ivey, Wieling, & Harris (2000) showed marriage

and family therapists did not perceive elder couple issues “as seriously as are identical

concerns presented by younger couples” (p. 163). By 2030, the older adult population

has been expected to be twice as large as it was in 2000, growing from 35 million to an

estimated 72 million, thereby representing 20% of the total population of America

(Federal Interagency Forum on Aging-Related Studies, 2010).

Emerging research discounted the previously believed age-based stereotypes. For

example, when creative lives were analyzed by “career age” and not physical age, no

difference was found in late life potential for creative output in older adults (Simonton,

1998). Although changes in creative resources (intellectual processes, knowledge,

personality, intellectual style, motivation, and environmental context) over the lifespan

were observed, creative performance averaged out to the same (Lubart & Sternberg,

1998). The aging process which involves the development of postformal thought was

shown to allow greater creativity in problem solving (Sinnott, 1996; Sinnott, 1998).

With regards to creativity and the arts, it was written that it might be the

challenges of aging that deepens and enriches the artistic process (Lindauer, 1998; Ravin

& Kenyon, 1998). Lindauer (1998) stated “the substantial number [of artists] who have

remained creative into old ages suggests that involvement in the arts may have a positive,
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healthy and therapeutic effect on those who become involved with the arts late in life” (p.

248).

Though there has been research on aging, the studies mentioned did not look at

the lived experience of aging as reported by older adults. Older adults were studied but

not listened to in the research. By contrast, this dissertation explored the lived experience

of aging through the analysis and coding of interviews with ten independent people over

65 years old living in diverse locations around the world. The researcher was an active

listener and diligent reporter, striving not to promote or isolate the more prevalent,

diverse, or sensational. With a desire to minimize bias data were presented as found even

when it reinforced existing stereotypes as well as when it presented otherwise unseen

angles of the aging experience.

Though some of the findings supported aging stereotypes, it was found that the

participants held an “inner age” that was 30-40 years younger than their physical age, that

the participants did not see themselves as “old,” that “old” meant physical disability or

poor attitude, and that “connectedness” was important in life fulfillment. These findings

were used to develop guidelines for critiquing expressive therapies literature which

discussed working with older adults (Appendix A). Expressive therapies was chosen for

the sample literature because of its wider therapy reach, dealing with both verbal and

non-verbal therapy interventions. Both positive and negative examples of the guideline

applications were chosen from expressive therapies literature (Appendix B).

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CHAPTER 2

Literature Review

Old Age and Older Adults: Statistics, Research and Reality

The Administration on Aging (2009) reported people turning 65 could expect to

live another 18.6 years. Thus, a person born in 2007 could expect to live 30 years longer

than someone born in 1900. Advances in medicine, health and healthcare have extended

the lives of elders by 4.2 years since 1960. With longevity increasing and the baby

boomer generation (people born between 1946 and 1964) turning 65 as of 2011, the

population of older adults (people 65 years or older) has been on the increase. As of

2008, older adults were 12.8% of the population or one in eight Americans

(Administration on Aging, 2009). By 2030, the number of people 65 years of age and

older has been expected to be twice as large as it was in 2000, growing from 35 million to

an estimated 72 million and representing 20% (or 1 in 5) of the total population of

America (Federal Interagency Forum on Aging-Related Studies, 2010).

However, the large portion of current research in psychology and similar fields

was performed by universities with college students as research subjects. Not only did

this bring generalizability into question but it also negated the ability to use the research

to explore developmental processes as it excludes other age groups (Hess & Blanchard-

Fields, 1999, p. xviii). In addition, the majority of research originally done on aging was

poorly controlled. Researchers went to where “the aging” were easily accessible, long-

term care facilities. Thus, the research done on aging and on older adults has been done

on “non-well, institutionalized older individuals” (Woolf, 1998b, para. 6). Since, “only 5

percent of the older adult population is institutionalized…poorly controlled

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gerontological studies have reinforced the negative image of the older adult” (para. 6)

without broadening the research to include the other 95% of well, active older adults.

Current research, limited though growing, countered the preconceived notions of

older adults and aging. Dr. Gene Cohen in The Creative Age: Awakening Human

Potential in the Second Half of Life (2000) and The Mature Mind: The Positive Power of

the Aging Brain (2005) presented that older adults were just as creative in their later years

as at any other time in their life. It has been shown through neurological scans that

emotional well-being (defined as emotional stability) improved over the human lifespan

(Williams, Brown, Liddell, Kemp, Olivieri, Peduto, & Gordon, 2006). Dr. Bill Thomas

in answering the title of his book What Are Old People for?: How Elders Will Save the

World (2004) argued it was a necessary evolutionary function that older adults existed

because through them the perpetuation of the species occurs. Thomas proponed that

evolution favored older adults as they carried the stories of survival, interacted with youth

freeing parents to hunt, and imparted to the youth and adults needed information for the

continuation of the species. Thomas put forth that without older adults, the human

species dies.

Old Age Stereotypes and the Perpetuation of Ageism

Research in the area of aging has failed to take in the experience of all older

adults, thereby limiting society’s understanding of older adults and their abilities (Woolf,

1998b). These narrow concepts have led to stereotypes, and a formalized prejudice

against older adults named ageism. Gerontologist, Robert N. Butler (1969) has been

given credit for coining the term “ageism.” However, the definition Butler originated

was strictly in relationship to prejudices against older adults. Only later was the term
 17

expanded by others to include discrimination against any group based on age (Robinson,

1994).

Woolf (1998a) acknowledged the broader definition of ageism but used Butler’s

definition when she stated there were two fundamental differences between prejudices

towards older adults and prejudices towards other types of people. First, Woolf stated

whereas “race and gender remain constant” (para. 3), age continually changes. Second,

unless one died early, one would become old. Thus, everyone (no matter what race,

gender, sexuality, ability, disability, etc) had the potential of experiencing prejudice

based on their age and thus also had the potential to internalize that prejudice lowering

their self-concept.

In discussing the basis for ageism in America, Woolf (1998b) reviewed four

possible contributing factors (a) fear of death, (b) a youth-based culture, (c) America’s

evaluation of value based on productivity and (d) a dominant amount of research

conducted on aging was conducted in long-term care institutions. Moller (2000)

commented that America’s fear of death could be seen in the movement of society to care

for the dying in one’s house to placing the dying in a hospital. By this movement from

home to hospital, “dying is removed from the social and moral fabric of the culture”

(Moller, 2000, para. 3). In an interesting commentary on American society, Wilson

(2007) stated Americans spent thousands of dollars on miracle medicines but did not

seem willing to exercise and eat healthy. America’s fear of death was so strong that “in

essence, many of us would rather live long, stretched out and possibly mediocre lives

rather than amazing yet short ones” (para. 11).

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America’s prejudice towards the elderly was also linked to its emphasis on the

youth-based culture. “For example, the media, ranging from television to novels, place

an emphasis on youth, physical beauty, and sexuality…The emphasis on youth not only

affects how older individuals are perceived but also how older individuals perceive

themselves” (Woolf, 1998b, para. 4). Another factor contributing to ageism was found to

be America’s evaluation of worth based on economic productivity. Elders and children

were considered a drain on society. Children, however, were seen as the future and thus

carry a redeeming value for economic investment. The aged, on the other hand, though

not considered “unproductive” per se, were devalued as economic liabilities. (Woolf,

1998b)

The final contributing factor in Woolf’s (1998b) review of the research on ageism

was the bulk of research originally done on aging was poorly controlled. Researchers

went to were the aging were easily accessible, long-term care facilities. Thus, the

research done on aging and the aged had been done on “non-well, institutionalized older

individuals” (para. 6). Since, “only 5 percent of the older population is

institutionalized…poorly controlled gerontological studies have reinforced the negative

image of the older adult” (para. 6) without broadening the research to include the other

95% of well, active older adults.

The impact of ageism on society and on older adult’s view of themselves was

found to be significant. For example, older adults given tests for recall performed

statistically poorer when indications were made the tests were harder for elders (Hess,

Hinson, & Hodges, 2009). Additionally, elders performed less well on tests when told

the research was to test “how good their memory is” as opposed to testing “their ability to
 19

learn facts” (Chasteen, et al., 2005). In both studies, control groups of elders mixed with

younger people revealed no difference between the elders’ and younger people’s abilities

to learn, remember and recall. The indication was that internalized stereotype beliefs

about aging (in this case memory being affected by age) was more a factor in poor

performance than a person’s age itself. The internalizing of age stereotypes was found to

be insidious, beginning up to 23 years prior to one being old (Levy, Slade, Kunkel &

Kasl, 2002). Additionally, a positive self-perceptions of aging has been linked to a 7.5

year increase in life expectancy (Levy, et al., 2002). The same study pointed out by

contrast that lowering cholesterol added only 3-4 years to a person’s life.

Old Age and Older Adults: Words and Definitions

Old age has been a topic not comfortably discussed. Even groups trying to

establish unbiased guidelines for writing about age found it difficult to strike the right

tone. Whether caution and courtesy on one hand or societal fears and ageism on the other

hand, adequate and non-offensive words have been hard to obtain. The American

Psychological Association’s Publications Manual (2010) seemed to struggle with the

wording in its section on “Reducing Bias by Topic.” On the topic of “Age,” the manual

read as follows:

Age should be reported as part of the description of participants in the Method

section. Be specific in providing age ranges; avoid open-ended definitions such

as “under 18 years” or “over 65 years.” Girl and boy are correct terms for

referring to individuals under the age of 12 years. Young man and young woman

and female adolescent and male adolescent may be used for individuals aged 13

to 17 years. For persons 18 years and older, use women and men. The terms
 20

elderly and senior are not acceptable as nouns; some may consider their use as

adjectives pejorative. Generational descriptors such as boomer or baby boomer

should not be used unless they are related to the study on this topic. The term

older adults is preferred. Age groups may also be described with adjectives.

Gerontologists may prefer to use combinations terms for older age groups (young-

old, old-old, very old, oldest old, and centenarians); provide the specific age of

these groups and use them only as adjectives. (p. 76)

The only noun the manual offered in this passage was “older adults” but exactly who the

population being referred to was not clear. The sentence might have been linked to the

one before in which “boomer” and “baby boomer” were mentioned, but the majority of

the baby boomer population (generally those born between 1946 and 1964) were still

within what was considered middle age (40-60 years old) when the manual was written.

Thus, the term “older adult” was a person 46 years old or older at that time. The same

passage referred to “elderly” and “seniors” which proceeded the statement about baby

boomers and the terms “young-old,” “old-old,” “very old,” “oldest old” and

“centenarian” which followed the statement. The reader had to question if the APA thus

allocated 46 year old people to the same over all category as centenarians.

In the quoted APA passage, there were no guidelines or definitions for terms

(unless one was a gerontologist) to use with “persons 18 years and older” except for

“women,” “men” and “older adults.” Whereas, there were clear definitions and age

ranges given for the use of “girl” and “boy” (under the age of 12 years) and “young

man,” “young woman,” “female adolescent” and “male adolescent” (for individuals aged

13 to 17 years). There were six words offered to describe people in the first 18 years of
 21

life but only three offered to describe people in the last 80+ years of life. Thus, a stated

time was established by the APA when a “young” woman could be referred to as a

“woman” or a “young” man could be called a “man” but no time at which a person was

referred to as an “old” woman or an “old” man.

The APA’s reserve on defining the “older adult” population by a numerical age

might have been sensitivity to bias-laden words and a caution to avoid being seen as

pejorative. The APA did allow gerontologist, schooled in terminology, more options for

words to describe later life (young-old, old-old, very old, oldest old and centenarian) but

the gerontologist still needed to define the parameters of the usage by age. For the non-

gerontologist, the only term offered was “older adults.” There was no reference point

offered for “adult” except through the supposition that “adult” was a person over the age

of 18, leaving a large range of age that could be considered “older.” The APA clearly

defined “youth” by a numerical age but offered no definition of old age by the number of

years lived. The APA might have been reflecting the fear of aging and death Woolf

(1998b) discussed or might have been so sensitive to the issue as to avoid taking a

position.

It was found that this hesitancy to define “old” by a number of years was not just

the APA’s. Webster’s New Collegiate Dictionary (1977) had an entry for “middle age”

which it defined as between “40-60” years old (p. 728) but had no entry for “old age.”

No term was offered for someone over 60 years old. “Older adult” did not have an entry

either. “Old” was defined as someone or something “advanced in years” (p. 798), but the

dictionary did not specify the number of years. The Concise Oxford American

Dictionary (2006) described “middle age” as “the period between early adulthood and old
 22

age, usually considered as the years from about 45-65” (p. 560). In that passage, “middle

age” was been redefined in the 29 years between these two dictionaries. The lower end

had increased from 40 to 45 and the upper end from 60 to 65. With this in mind, “old

age” was seen as starting at 65. However, the entry for “old age” read “the later part of

normal life” and “the state of being old” (p. 616). “Old” was “having lived for a long

time; no longer young” (p. 615). The best the Concise Oxford American Dictionary

(2006) offered was an inference of when old age begins but did not define it by numbers

as it does with middle age.

A person who lived to be 100 years old or older was defined as a “centenarian”

(Webster’s New Collegiate Dictionary, 1977, p. 180; Concise Oxford American

Dictionary, 2006, p. 142). This definition incorporated the number of years lived into the

description, “cent” referring to 100. On the other hand, “antique” was defined as “a work

of art, piece of furniture, or decorative object made at an earlier period and according to

various customs laws at least 100 years ago” (Webster’s New Collegiate Dictionary,

1977, p. 50). The Concise Oxford American Dictionary (2006) stated an “antique” was

“a collectible object such as a piece of furniture or work of art that has a high value

because of its considerable age” (p. 34). In these definitions, objects that were 100 years

old or of considerable age were seen as valuable. However, the term used to describe

people of age equal to the object’s age were given a term coined from the number of

years lived with no mention of their worth.

Whether the hesitancy of the dictionaries and APA to define old age was ageism

or just caution, they reflected society’s dislike and fear of the topic of aging. At some

undefined age the wonder of being young and growing up was replaced by a code of
 23

silence about being old. This dissertation did not shy away from defining its terms. By

doing so it was not trying to point out who was old, but rather to help society incorporate

all the realities that are found in aging for a greater comprehensive understanding of the

phenomenon.

Older Adults and Elders

With regards to the discussion above and taking parts of each definition, this

paper used the term “older adults” to describe people 65 years of age and older. In

addition, this paper sought to incorporate a sense of worth and value into the definition of

“older adult.” Thus, the term “elder” was chosen as an interchangeable term. An “elder”

was described as someone “advanced in age” as well as a “leader” in a “tribe or group”

(Concise Oxford American Dictionary 2006, p. 289). Additionally, the term “elder”

referred to someone “having authority by virtue of age and experience” (Webster’s New

Collegiate Dictionary, 1977, p. 365). The APA Publication Manual (2010) stated the use

of “elderly” as possibly “pejorative” (p. 76) when used as an adjective. With respect to

that, this paper used the term “elder” only as a noun. Thus, “older adult” and “elder”

were used interchangeably in this dissertation to refer to people 65 years of age or older,

connoting at the same time value and honor.

Ageism

Webster’s New Collegiate Dictionary (1977) defined ageism as “prejudice or

discrimination against a particular age-group and especially against the elderly” (p. 22).

Concise Oxford American Dictionary (2006) stated ageism as “prejudice or

discrimination on the basis of a person’s age” (p. 16). It left out any reference to

prejudice against “older adults.” This omitting kept with the modern reference to ageism
 24

which has been expanded to encompass any prejudice or stereotyping due to age, not just

with regards to older adults (Robinson, 1994). The predisposition to one age over

another was not in itself ageism, but rather ageism happened when one age excluded,

demeaned or ignored another individual or group because of their age. As has been

mentioned, Gerontologist, Robert N. Butler (1969) has been given credit for coining the

term “ageism.” However, the definition Butler originated was strictly in relationship to

prejudices against elders. Since this dissertation specifically focused on people 65 year

of age and older, the term “ageism” was used according to Butler’s original definition

being prejudices against older adults.

Therapy Versus Therapeutic

In counseling older adults, ageism and misconceptions of old age and older adults

have found their way into the words used to describe approaches to working with elders.

In a review of counseling terms, it was found the words “therapy” and “therapeutic” were

often used interchangeably and incorrectly. The repercussions of this misuse have been

subtle yet profound. The obvious difference between the two words was found to be

therapy was a noun and therapeutic was an adjective. Therapy was “the treatment of

mental or psychological disorders by psychological means” also a “treatment intended to

relieve or heal a disorder” (Concise Oxford American Dictionary, 2006, p. 943).

Therapeutic was defined as “having a good effect on the body or mind; contributing to a

sense of well-being” (p. 943).

The lines have blurred between these two terms as was found in an online article

called “Therapeutic Group Activities for the Elderly” (Jones, 2010). The preliminary part
 25

of the article stated, “as people age, their bodies and minds may get slower…” (para. 1),

revealing ageism stereotypes from the start. It continued by stating this slowing down…

can limit the type of activities that they can do. However, there are still many

options that provide much needed stimulation. Exercise classes, dancing and

outdoor adventures can be practiced individually or in group settings and offer

many therapeutic benefits for the elderly. (para. 1).

It was agreed that these activities have benefit for participants. However, exercise

classes, dancing and outdoor adventures, though beneficial, could not be seen as therapy.

The article talked about exercises such as hiking, yoga, tai chi and swimming.

Jones stated that yoga could be modified for older adults. Then, Jones quoted Dr. Zelter

as saying yoga was “highly therapeutic and safe for people with medical conditions,

including chronic pain.” Jones did not make mention of any training a leader of these

activities might need. In fact, the presentation that yoga was “safe” might imply to the

reader he could lead a yoga group for older adults without training even though Yoga

instructors should be trained and certified.

Even with these nuances, the article does not cross the therapeutic-therapy line

until it started to discuss dancing.

Dancing provides the elderly with an alternative way of expressing themselves

and can be a group therapy activity. According to the Health Professions

Network, dancing can be a tool used in managing stress, improving self-esteem

and confidence, and building relationships. (para. 5).

 26

When Jones used the term “group therapy,” he started to blur the line between the

“therapeutic group activities” in his title and “group therapy.” The article went on to

state,

There are many ways to incorporate group dancing, such as dance nights, partner

dancing, group-led dancing and team dancing. The American Dance Therapy

Association defines dance therapy as "the psycho-therapeutic use of movement to

promote emotional, cognitive, physical and social integration of individuals.”

(para. 6)

The quote within the quote above showed the author was familiar with the American

Dance Therapy Association’s (ADTA) description of dance as therapy. However, the

author’s use of the description was misleading. Though it was true the ADTA defined

the psychological benefits of dance therapy as described, the ADTA did not propone that

“dance nights, partner dancing, group-led dancing and team dancing” (para. 6) though

potentially therapeutic, were therapy. The use of the ADTA statement by the author and

the use of the term therapy in the paragraph prior misrepresented therapy as something

anyone could perform just by doing these activities.

The next section of the article described outside adventures and Jones finished the

article with the following statement. “Fishing, nature walks, gardening, bird and wildlife

watching, outdoor community service such as trash clean-up, and helping with outdoor

animal adoption events can all be used as group therapy” (para. 8) The last words of the

article clearly stated the “therapeutic activities” in the title were synonymous with “group

therapy” (para. 8).

 27

If the term therapy was seen as a “treatment” and treatment was defined as

“medical care given to a patient for an illness or injury” (Concise Oxford American

Dictionary, 2006, p. 970), one could not imagine a casual walk or picking up garbage as

“group therapy” as the article proponed. It was understood that under the right medical

professional, such activities could be utilized for therapy as could art making, dancing,

playing music, writing, acting, as well as talking. Also understood was that in talk

therapy or psychotherapy, a client who talked to a trained professional in a therapy

session could make greater and more direct progress than simply talking to a friend. This

proactive interaction was seen as true for the beneficial use of art supplies, movement,

instruments, paper and pens, and one’s body and voice when employed by a trained

professional.

Thus, the differentiation for this dissertation between the words therapy and

therapeutic was defined as follows. Therapeutic: an adjective to describe the beneficial

side effects of an activity, which promote a sense of health or well-being. Therapy: the

proactive use of beneficial activities combined with psychotherapy to promote health, to

gain sense of well-being and work towards resolution performed by a trained

professional. In other words, therapeutic was used to describe activities with non-

directive tangential gain whereas therapy was used to describe active approaches to those

gains.

Counseling Older Adults

Counseling Older Adults: Ageism.

 28

Since the inception of psychotherapy, ageism has been integrated into the

literature of counseling older adults. Sigmund Freud (1905/1953) ageist belief was seen

in his comparison between younger and older clients.

The age of the patients has this much importance in determining their fitness for

psycho-analytic treatment, that, on the one hand, near or above the age of fifty,

the elasticity of mental processes, on which treatment depends, is as a rule lacking

– old people are no longer educable – and, on the other hand, the mass of material

to be dealt with would prolong the duration of the treatment indefinitely. In the

other direction the age limit can be determined only individually; youthful

persons under the age of adolescence are often exceedingly amenable to

influence. (p. 264).

In addition to the ageist division of fitness for counseling between young people and

older adults, Freud made two clear statements concerning older adults and counseling.

First, older adults were unfit for psychotherapy because they were unable to learn due to

their lack of mental elasticity. And second, older adults had so much “material to be

dealt with” that treatment could be indefinite.

From Freud till now the belief that people over a certain age could not benefit

from psychotherapy continued.

The National Institute of Health (NIH) Consensus Development Conference on

Diagnosis and Treatment of Depression in Late Life (Washington, DC) concluded

that psychosocial interventions for older adults experiencing depressive symptoms

were only “moderately effective” and were listed third in a hierarchy of

 29

recommended treatments behind pharmacotherapy and electroconvulsive therapy.

(Scogin & McElreath, 1994, p. 69).

In other words, the NIH stated medication and electroconvulsive therapy were more

effective and preferred treatments for depression in late life than counseling.

The NIH’s position was reverberated in this story from Dr. Bill Thomas (1996).

Often I ask the medical students who study at my facility to choose which causes

more suffering in a typical nursing home: congestive heart failure or loneliness.

They nearly always answer that loneliness is the worse of the two. Then I ask,

“What is the most effective treatment for loneliness?” Usually, there is a moment

of painful thought before a student suggests that a course of haloperidol or

desipramine may do the trick. When I answer that providing companionship is

the most fitting response, a small smile of relief spread across their faces.

“Ah, it was just one of those funny nonmedical questions that Dr. Thomas

is always asking” (p. 23-24).

Just as the student in this example discounted the question because was

nonmedical, mental health professionals who work with people over 65 exhibited subtle

and overt ageist attitudes. Research studies on ageism among psychologist, mental health

counselors and social worker revealed age bias among all the mental health practitioners

(Danzinger & Welfel, 2000; Helmes & Gee, 2003; Kane, 2004; Kane, 2008; Lee, Volans,

& Gregory, 2003; Roberts, 2008). Danzinger & Welfel (2000) “found that mental health

professionals judged older clients significantly less competent and less likely to improve

than younger clients” (p. 135). Helmes & Gee (2003) found that mental health

professionals rated the older clients in two vignettes where only the age had been
 30

changed as being less able to connect with the counselor, less able to get well, and less

appropriate for counseling. The counselors were also less willing to accept the older

adult as a client. When Kane (2004) presented Bachelor and Master level Social Workers

with two vignettes in which only the age had been changed the participants statically

showed that they thought the older client was less likely to recover, had “live long

enough” and the best way to counsel her was to help her “prepare for death.” The client

in the vignette was 72 as opposed to the younger client in the other vignette who was 38.

A significantly less percentage of participants felt the client should be referred to

psychotherapy (92.9% versus 79.3%).

Mental health professionals misdiagnosed depression in older adults due to age

bias (Lasser, et al., 1998). And, according to a review of studies, mental health

professionals were less likely to offer psychotherapy to treat older adults with depression

than to offer drugs and were more likely to offer a poorer prognosis for older patients

(Gatz & Pearson, 1988). Ivey, Wieling and Harris (2000) showed marriage and family

therapists did not perceive elder couple issues “as seriously as are identical concerns

presented by younger couples” (p. 163).

Counseling Older Adults: Research.

In contrast to Freud (1905/1953), the NIH report and Thomas’ medical students,

there have been studies which showed psychotherapy was beneficial for older

participants suffering with major depressive disorders (Kennedy & Tanenbaum, 2000;

Knight, 1993; Knight, 1999; Knight & McCallum, 1998; Leszcz, Feigenbaum, Sadavoy,

& Robinson, 1985; Scogin & McElreath, 1994). In addition,

- Behavioral Therapy was shown to provide an equal recovery rate for older
 31

adults suffering from a major depressive disorder when compared to research

on recovery rates of similar therapies with younger depressed people

(Thompson, Gallagher, & Breckenridge, 1987).

- Bibliotherapy (the use of reading assignments in conjunction to therapy

sessions), though needing more research, was found in a small study to “be a

useful adjunct to psychotherapy for depressed older adults,” and might

“facilitate more rapid improvement and compensate for any limitations in the

number of psychotherapy sessions” (Floyd, 2003, p. 194).

- Brief Psychodynamic Therapy matched recovery rates of younger people with

depression to that of elders with major depressive disorder (Thompson, et al.,

1987).

- Cognitive Therapy was found to produce similar recovery rates for older

participants with a major depressive disorder as those found in the research

about Cognitive Therapy recovery rates for depressed younger people

(Thompson, et al., 1987).

- Interpersonal Psychotherapy (a goal-directed application of Brief Therapy)

was shown to produced similar results in a case study with an older adult

encumbered by major depressive disorder as in larger trials with young people

with various mental health issues (Hinrichsen, 1999).

- Reminiscence Therapy (an approach which utilized the natural developmental

aging process of retelling life stories) has been shown to reduce depressive

symptoms and increase life satisfaction in older adults (Arean, Perri, Nezu,

Schein, Christopher, & Joseph, 1993; Cook, 1998; Jones & Beck-Little, 2002;
 32

Pasupathi & Carstensen, 2003; Watt & Cappeliez, 2000).

- Social Problem-Solving Therapy (a skill-oriented Cognitive-behavioral

approach) was found to be effective in reducing symptoms and depression in

older adults (Arean, et al., 1993).

In some cases, the research actually showed the therapy worked better with elders,

countering Freud’s (1905/1953) assertion that older adults needed indefinite amount of

time to get well. Contributing factors to these findings might have been in the study of

Cognitive Behavioral Psychotherapy (Walker & Clarke, 2001), the elder’s attendance

was better and, in the study of Short-term Psychotherapy (Gorsuch, 1998), the

researchers remarked that elders had a greater commitment to the work of psychotherapy

knowing their “time” on earth was limited (p. 201).

Counseling Older Adults: Reminiscence and Life Review Therapy.

Knight (1999) has written that some adjustments might be needed when using a

therapy with an older adult but “not because they are older” (p. 931). Rather Knight

(1999) remarked the adjustments were needed because of the elder’s context (where they

live: retirement centers, nursing homes, etc), because of the elder’s cohort (having

different values, skills and life experiences), and/or because of the different therapeutic

skills and specific knowledge needed to work with older adults, but “not because of the

client’s age” (p. 932). Laidlaw (2001) stated “there is no evidence of therapeutic

necessity to adapt cognitive therapy in order to make it suitable and accessible for older

adults without cognitive impairment or in the absence of frailty” (p. 11). The

aforementioned studies listed above made no mention of age-based adaptations for the

counseling approaches that were researched. “There is no justification for arbitrary age
 33

cut-offs in making decisions about the appropriateness of psychological treatment, and

good practice with younger adults is just as applicable in later life” (Wood, 2003, p. 129).

Knight (1993) stated “psychotherapist who have worked with older adults, describe the

experience as valuable for the client and rewarding for the therapist, whereas those who

have not argue that the aged cannot benefit from psychotherapy” (para. 1).

Reminiscence therapy arose as particularly geared for work with elders for it has

been observed that people over the age of 65 naturally partake in the act of reminiscing.

Butler (1963), who was the first to make this observation, defined reminiscing as follows:

A naturally occurring, universal mental process characterized by the progressive

return to consciousness of past experience, and particularly, the resurgence of

unresolved conflicts; simultaneously, and normally, these revived experiences and

conflicts can be surveyed and reintegrated. Presumably this process is prompted

by the realization of approaching dissolution and death, and the inability to

maintain one's sense of personal invulnerability. It is further shaped by

contemporaneous experiences and its nature and outcome are affected by the

lifelong unfolding of character. (p. 66).

This naturally occurring act has been shown to benefit elders. Wong and Watt

(1991) summarized their research stating reminiscences increase self-understanding,

increase self-esteem, increase personal meaning, increase life satisfaction, help in

acceptance of one’s past, aid in the reconciliation of differences between ideal and

reality, help in acceptance of negative events, and increases resolution of past conflicts

(para. 11). Wong and Watt identified six forms of reminiscing: integrative, instrumental,

transmissive, escapist, obsessive, and narrative. Integrative reminiscence’s function was

 34

“to achieve a sense of self-worth, coherence, and reconciliation with regard to one’s past”

(para. 11). Instrumental reminiscence used “memories for providing evidence of past

successful coping and for identifying appropriate coping strategies” (para. 12).

Transmissive reminiscences helped to pass on one’s personal legacy and cultural heritage

(para. 13-14). Escapist reminiscence tended to down play the present and glorify the past

(para. 15-16). Obsessive reminiscence emerged from one’s guilt of one’s past or

ruminations over disturbing past experiences (para. 17). Finally, narrative reminiscences

primarily described rather than interpret recollections (para. 18-19). Wong and Watt

stated that successful agers had a greater occurrence of integrative and instrumental

reminiscences (para. 63). Reminiscence therapy provided an environment in which these

two forms of beneficial reminiscences were encouraged.

In practice, the therapist presented a topic and facilitated a discussion among the

participants. For example, a picture of a cast iron stove was shown and a conversation

about stoves, cooking, mealtimes, or baking bread might ensue. This approach aimed at

encouraging instrumental and integrative reminiscences. The benefits of reminiscence

therapy emerged from the natural healing by-products of a positive story-telling

environment. According to the definition of therapy versus therapeutic earlier in this

dissertation, this type of reminiscing activity could be considered therapeutic rather than

therapy in that the benefit was a by-product not the goal itself.

Life review therapy arose as distinct from reminiscence therapy as it focused on

purposeful resolution of life issues. As the name implies, life review therapy aided a

client through their life remembrances, stopping to deal with problematic time periods.

Through this process the synthesis and integration of the good and bad of a person’s life
 35

occurred and the person embraced their life as their “one and only life cycle” (Erikson,

1963, p. 269). When and if this happened, the participant was considered to have

resolved the Integrity vs. Despair stage of Erikson’s developmental model. In an attempt

to help facilitate the life cycle resolution, life review therapy had been adapted into

various formats and uses such as: guided autobiography (Malde, 1988) in which clients

record their life story and spiritual life review (Lewis, 2001) in which clients revisit

spiritually significant chapters of their life story. Life review therapy and its derivatives

sequentially called forth both positive and negative reminiscences and proactively sought

to integrate these recollections into the client’s larger life narrative.

Reminiscence and life review therapy were seen as different yet often referred to

interchangeably. Reminiscence was the act of recalling past life events whereas life

review was the act of recalling life events with an evaluation of those events (Burnside &

Haight, 1992; Staudigner, 2001). Though reminiscence was used in the life review

process, life review could not have been done through simple reminiscing.

Burnside & Haight (1992) differentiated between the two activities further by

insisting that life review therapy was done one-on-one with a “therapeutic listener” and

that a group format for life review therapy was at best a borderline use. In contrast,

Garland’s (1994) chapter on life review therapy noted group applications of the life

review process and their benefits (p. 28). In addition, other authors have referred to life

review therapy as group work (Aday & Aday, 1997; Toseland, 1995). Burlingame

(1995) stated that participants of life review therapy were “often in groups” (p.160).

Burnside and Haight (1992) also differentiated the two activities by listing the benefits of

reminiscence as mostly relating to social interaction (i.e. increased positive behavioral

 36

responses, increased communication skills, etc.) whereas the benefits of life review

therapy were listed as being more psychological in nature (i.e. increased life satisfaction,

decreased depression, increased sense of self, etc.) (p. 860). However, the delineation of

these benefits of reminiscing and life review were not as clear cut as Burnside and Haight

portrayed as there has been research which showed that reminiscing also increases life

satisfaction and decreases depressive symptoms (Cook, 1998; Pasupathi & Carstensen,

2003; Watt & Cappeliez, 2000). Thus the difference between reminiscence therapy and

life review therapy was not in their benefits (which overlap), nor in their application

(group vs. individual), but rather in their approach to reminiscences (casual vs.

proactive). Because they utilize at their foundation the beneficial advantages of

reminiscences, life review and reminiscence therapy seemed particularly suited for work

with older adults.

When one employed life review and reminiscence therapy, one needed to be

attentive to the potential uncovering of negative painful reminiscences. Regrettably,

reminiscence therapy has often been advertised to Recreation Directors of nursing homes

or adult day programs as a benign “therapeutic” activity geared to enhance participant’s

natural development process. Through group discussions on various topics like

memories of cooking, vacations, family houses, etc, staffs have been encouraged to

facilitate memory stimulating sessions. Caution needed to be taken against a blanket

application of this practice (and of the ageism such a blanket application represented).

The natural unprompted process of reminiscing could uncover both positive and negative

events which could amplify if proactively probed by group memory activities. Knowing

how to bear witness to an elder’s pain has been an important skill for those who engage
 37

in reminiscence-based work with older adults. Most recreation directors in a nursing

facility have not been trained nor hold proper credentials in counseling and, thus, when

participants become unduly agitated the leader has been unequipped with how to properly

respond.

Counseling Older Adults: Trauma Work.

One of the areas least looked at in counseling older adults has been trauma work.

It was proposed that people who work with older adults needed to be aware that an

elder’s behaviors and symptoms could have been the result of past trauma and not

necessarily connected to current activities. Many older adults have been reluctant to

discuss the past event, thus the connection of behavior to past trauma has not been

obvious. In a review of PTSD in elderly, Weintraub and Ruskin (1999) reported finding

up to 25% of heavy combat war veterans experienced symptoms of PTSD 45 years after

their return (p. 145). Holocaust survivors, people from war torn countries, displaced

South Africans, victims of torture and abuse survivors have existed, often unknown,

among the geriatric population. Thus, there has been a need for people working with

elders, no matter what the therapy approach or staff position, to be trained in trauma,

trauma symptoms and trauma recovery.

In the section on Posttraumatic Stress Disorder, the Diagnostic and Statistical

Manual of Mental Disorder IV-Text Revision (DSM-IV-TR) defined “extreme traumatic

stressors” as those that “involved actual or threatened death or serious injury, or a threat

to the physical integrity of self or others” (American Psychiatric Association, Diagnostic

and Statistics Manual IV Text Revision, 2000, p. 467). A person could either experience,

witness or be confronted with the event and their response could involve “intense fear,
 38

helplessness, or horror” (DSM-IV-TR, 2000, p. 467). In a less specific definition,

Webster’s New Collegiate Dictionary (1977) defined trauma as “a disordered psychic or

behavioral state resulting from mental or emotional stress or physical injury” (p. 1243).

In recent times, the term trauma had become overused to mean “a deeply distressing or

disturbing experience” (Concise Oxford American Dictionary, 2006, p. 969). Though it

might be remiss to include any distressing experience to the realm of trauma, it has been

thought the DSM-IV-TR’s definition has been too restrictive. In terms of counseling, it

seemed more appropriate to look at trauma by the effect the event had on the person

rather than to focus on the event itself. For, there has been a difference existed between

experiencing a traumatic event as opposed to being traumatized by the event. Some

people have been devastated by one instance of molestation whereas others have walked

away from years of sexual abuse relatively unscathed. Thus, the broader definition found

in the Oxford Dictionary of Psychology was employed here, which stated trauma as “a

powerful psychological shock that has damaging effects” (Colman, 2001, p. 755).

DSM-IV-TR’s description of Posttraumatic Stress Disorder included the

following list of potential symptoms of traumatic events: re-experiencing of the event,

avoidance of stimuli connected with the event, numbing of responsiveness, increased

arousal, and social functioning impairment (DSM-IV-TR, 2000, p. 468). Triggers for

these symptoms (whether active or previously latent) included media, people,

environmental, losses, and life changes (Murray, 2005). Though events which surfaced

during therapy with older adults might not have met the standard for clinical diagnosis

according to the DSM-IV-TR, the isolated symptoms have been viewed as still
 39

distressing to the older person involved. Attention needed to be paid to the effects of

trauma at whatever level they occurred not just when they were clinically significant.

Little has been written or researched on the application of present theories of

trauma recovery as they apply to elders (Busuttil, 2004). However, modern literature has

been divided into two categories: psychological approaches as with Dr. Judith Herman’s

work (1997) or psychobiological approaches as with Dr. Bessel A. van der Kolk’s work

(van der Kolk, McFarlane, & Weisaeth, 1996). The difference between these approaches

was seen in how they list the effect of trauma on the client. Herman listed the

psychological effects, such as alteration in affect regulation, consciousness, self-

perception, perception of perpetrator, relations with others and systems of meaning

(1997, p.121). On the other hand, van der Kolk (van der Kolk, et al., 1996) listed the

abnormalities as being related to the psychophysiological functioning, neurotransmitters,

hypothalamus-pituitary-adrenal axis, memory, neuroanatomical, and pyschoimmunologic

functioning (2001, p. S51). Thus, one approach focused on the psychological and

emotional effects of traumatic events and the other focused on the biological. Because of

their emphasis, the authors viewed the recovery process from different angles.

Herman (1997) proponed a three stage approach to working with trauma survivors

which employed “talk therapy.” In the first stage, the client was empowered to establish

safety, power and control in their lives. This process started with the client’s body and

eventually moved outward to the environment (pp. 155-174). Once the client had gained

some psychological integrity, the second stage of recovery began. Here telling the story

in detail and mourning the loss occurred (pp. 175-195). The third stage focused on

reconnecting with the world at large, first through one’s own being and then through
 40

others. In this stage, the traumatic event was integrated into the client’s larger personal

narrative. Though the symptoms could return from time to time, the client had been

empowered to no longer be a victim to them (pp. 196-213). Other writers such as Briere

(1996) and Chu (1998) aligned with the talk therapy approach. Chu (1998) even

presented a three stage recovery process that referenced Herman’s work (p. 86).

Van der Kolk (2002), on the other hand, approached trauma from the field of

Neuroscience detailing the effects of traumatic events on the brain. Through advanced

brain imaging, it was possible to view which areas of the brain were involved in which

function. Neuroscientists have noticed during traumatic events there was a deactivation

of the prefrontal cortex (the brain’s area of analysis and language) and an interference of

Broca’s area (the brain’s processing place which turns feelings into words). “Thus,

traumatized people are ill equipped to talk about their traumas in rational or analytical

fashion” (p. 385). Further, traumatic experiences were found to be stored in the

subcortical areas of the brain that “are not under conscious control and possess no

language” (p. 384). Trauma imprinted sensory information into the amygdala which then

acted as an alarm when trauma related stimuli was near (p. 385). The amygdala’s

position in the subcortical region of the brain explained why “when people with PTSD

relive their trauma, they have a great difficulty putting that experience into words” and

why “they tend to talk ‘around’ trauma rather than facing it” (p. 387).

When approaching recovery from trauma, van der Kolk (2002) stated that

traditional therapies, including Herman’s (p. 388), which involved discussing the event in

detail, had a high drop out rate “probably because patients feel too overstimulated re-

experiencing the trauma without immediate relief” (p. 389). Van der Kolk further stated
 41

that these therapies paid little attention to the body’s chemical processing of the trauma.

He made clients aware of the somatic states trauma produces and instructed them not to

avoid them. Clients were to allow feelings rather than see them as threats. Through this

process, clients were able to envision new solutions not merely react (p.389). Van der

Kolk offered Eye Movement and Desensitization and Reprocessing (EMDR) as an

example of a successful approach to trauma recovery that involved people remembering

events but not just talking about them (p. 390).

Earlier in this dissertation, it was discussed that Wong and Watt (1991) revealed

that two types of reminiscences were beneficial (instrumental and integrative). In the

same research, they found obsessive reminisces, those dealing with unresolved

“disturbing past events” (para. 17), were linked more frequently to “the unsuccessful

elderly” (para. 63). Thus, recollections, remembrances and naturally occurring

reminiscences were seen as negative and even detrimental. The frequency of each type

of reminiscence varied based on the person and their ability to synthesize the meaning of

these unresolved events. Thus, not all that has been recalled in old age could be seen as

positive.

Linking van der Kolk’s research which stated that trauma (disturbing past events)

were held in a non-verbal part of the brain and the knowledge that as one aged the

occurrence of reminiscing increase, it was proponed that reminiscences could also be

non-verbal and these non-verbal reminiscences could increase with age. Positive

example of reminiscences were memories stimulated by the smell of bread baking, the

feel of a child’s skin or the sound of a well-loved song. It was postulated that if there

were positive non-verbal recollections, then there were also negative non-verbal ones.
 42

The obsessive reminiscences that Wong and Watt (1991) discussed as being unadaptive

forms of reminiscences (para. 63), were thought to also occur non-verbally. Negative

non-verbal recalls happening to an adult below 60 are considered “flashbacks” and dealt

with as part of a post-traumatic stress disorder. Yet, the person over 60 who had

flashbacks was often medicated rather than offered psychotherapy. To complicate this

matter, one needed only to look at the possible dual diagnoses that occur in some elderly

people. Alzheimer’s, stroke, and aphasia could lead to an inability to express one’s self

verbally, let alone to present non-verbal recollections.

Nursing homes had used restraints to keep clients from wandering, falling out of

bed or harming themselves. Being restrained against one’s will was seen as traumatic

and thankfully many nursing homes have moved away from this practice. However for

the aphasic elder who was forcefully raped in childhood, restraints could augment non-

verbal reminiscences (flashbacks) and the elder would be unable to advocate for herself.

Her thrashing could appear as resistance and medication would have been applied. The

last years of this person’s life would have been lived in fear and sedation with the staff

believing they were acting with care and compassion.

The example above was one of many in which well-meaning yet myopic medical-

model staff lost sight of a more global view of an older person. Applying an expansive

holistic view of elder care with an understanding of the possible surge of non-verbal

traumatic reminiscences, a need was seen to approach older clients with an appreciation

of the client’s entire life story if one was to provide true “health care.” An understanding

of the role of reminiscences was seen as crucial and education on the impact of both

verbal and non-verbal negative recollections as essential.

 43

If one identified that an elder was experiencing psychological pain from non-

verbal reminiscences, one might attend to her. But how? As mentioned, van der Kolk

(2002, p. 385-389) did not propone that trauma-based memories have been fully relieved

through talk-based therapies. Thus, some thing more than talk-based therapies was

sought to help elders integrate all the possible range of verbal and non-verbal

reminiscences.

Expressive Therapies with Older Adults

Expressive therapies was seen to engage the symbolic and generally non-verbal

expression of the inner psyche through an intermodal application of art-based therapies.

These body-involved therapies, such as dance, music, art, drama, poetry and story-telling,

provided environments through which a client could explore non-verbal personal

narratives. At the foundation of expressive therapies theory was the belief that the mere

act of self-expression was healing in and of itself (Blatner, 1996, p. 12). Ellen Levine

wrote that “the imagination is implicitly therapeutic” (1999, p. 272). The imagination

was “…the bridge from the internal to the external world” (Meyers, 1999, p. 244)

allowing inner images to emerge from non-verbal hiding places.

“People require physical experiences that directly contradict the helplessness and

the inevitability of defeat associated with the trauma” (van der Kolk, 2002, p. 388).

Natalie Rogers, Carl Rogers’ daughter, added “when trauma is too great for words,

people may find that symbols, colors, movement, and sound provide acceptable paths for

expression” (1993, p.145). For “imagery can speak when there are no words” (p.143).

Art was seen as the documentation of imagery and imagery was the language of the non-

verbal parts of the brain. The expression of that language was seen as being healing and
 44

“often more expedient at revealing the psyche than talking” (Newham, 1999, p.90). Van

der Kolk (2002) mentioned as an example of the societal need for art-based healing that

theater had been used throughout history as a ritual for dealing with communal trauma.

In his own clinic, theater was employed as an action-oriented approach aimed at

transforming the participant’s traumatic experiences (p. 388).

The writers of the theory went on to say that art was also the sustainer of the soul

with a direct connection to one’s emotional, psychological and physical well-being.

Paolo Knill (1999) stipulated the regular practice of art might be part of a healthy diet (p.

50). Knill stated, “It would be reasonable to stipulate that dreams, imaginative thinking

and play may belong to the psychic substances that when not available or not metabolized

correctly may cause disturbances” (Knill, 1999, p. 50). Thus, providing environments of

creative exploration was important not only for elders who have experienced trauma but

for the well-being of all older adults. Limited access to creative output was seen to drain

a person’s imaginative energies. Yet, society has provided little opportunity to explore,

express and learn through art-based activities beyond a certain age.

It has been observed the aging process deepened and enriched the artistic process

and product (Ravin & Kenyon, 1998). Through the combined application of life review

and expressive therapies, the elder could be aided in a sequential retelling of life stories

while exploring those stories creatively. In this approach, reminiscences of the verbal

and non-verbal types could be given environments in which they were presented,

interacted with, integrated, ignored and/or discarded.

These art-based therapy opportunities could be important because “the body is

full of information about who we are, how we feel and what we think - a living body
 45

anthology" (Halprin, 1999, p. 133). For elders with no creative or therapeutic outlet, their

bodies could hold a life of stories and "what the soul cannot express, the body will

express" (Meyer, 1999, p. 242). The stories could find their way out through physical,

emotional and mental distress (Halprin, 1999, p. 133, 134). It was considered possible

that some of the symptoms that were currently being medicated could be relieved if

elders were given the opportunity to explore their non-verbal narratives through art-based

therapy.

The “work” of the expressive therapist was to create an environment in which the

client explored these inner images, worked with them in various forms and gave external

shape to them. Annette Brederode (1999) remarked, "My work with psychiatric patients

made me aware of how important it is to express and make visible with the help of

images that which cannot, or not yet, be verbalized...” (p.151). She stated,

Strangely enough, the internal images, as well as the images on the paper or in the

clay, are usually so primary and swift that they are far ahead of their meaning.

The images can always be trusted; it usually just takes time to realize and accept

this. (pp. 161-162)

"These images are the carriers of memory. They transport experiences from the past to

the here and now...The imaginative process becomes a healing process…" (p. 157). This

was not art in therapy; this was art as therapy.

Important to note, “it is the process, rather than the product, that heals...” (Rogers,

1993, p. 70). For many older adults (and people in general) there was a resistance to

creating art because they were afraid that the end result would not “look good.” It has

been stated it was important to provide quality materials that could contribute to an
 46

aesthetically pleasing result (Wald, 2003). However, the goal was not to produce “art.”

Art was the symbolic documentation of the process, the by-product of the therapy.

Helping participants overcome their focus on the product could lead to greater

exploration of their verbal and non-verbal reminiscences.

In applying expressive therapies to trauma work, especially as it applies to older

adults, Meyer’s (1999) description of people in transitional war-type camps was viewed

as interesting and applicable.

People who live in exile have often lost everything. They have lost the “house of

the family,” “the house of the community.” The only house they have left is “the

house of the body.” Because this house often contains so much pain and “bad

memories,” the owner “moves out” in order to save his soul....Being exile from

the body as a method to avoid the pain of trauma will, over time, give an

individual the experience of belonging to the “living dead,” a state where one

feels totally isolated from life (p. 241-242).

The theory writers would urge for the inclusion of expressive therapies in work

with traumatized elders with further research focused on the use of expressive therapies

as a viable conduit for naturally occurring non-verbal reminiscences, such as traumatic

memories, to be uncovered, processed, and integrated. The writers offered that

expressive therapies helped clients circumvent their protective layers of emotional

defenses, process events they could not give words to, find healing despite their inability

to verbalize their pain, contact their inner self, integrate their being and re-enter the

“house” of their bodies.

 47

In a study on the use of drama therapy with older adults, Johnson (1985) stated

that “by creating a playful and metaphorical atmosphere, conflictual material is expressed

more easily since, if necessary, it can be more easily disowned” (p, 124). Through the

process of disowning, the conflictual material was allowed to leave the body. As

evidence of the potential physical benefits of the use of expressive therapies with elders,

Johnson concluded by stating “the death rate in this group, which is in its fifth year, is

one-third that of the nursing home at large…” (p. 125). This study testified to the power

of inner symbols, of creative processing and of imaginative expression to stimulate

healing resolutions even for lifelong issues.

In another study that utilized theater as a healing modality, 122 older adults in

subsidized retirement homes participated in eight bi-weekly “theatrically based”

interventions in which “cognitive-affective-physiological” trainings were used as

“typically employed in college acting classes” (Noice & Noice, 2009, p. 56). A no-

treatment control group and a singing group were used for comparisons. The study found

using pre-test and post-test of “a battery of 11 cognitive/affective test measures” that

“gains were achieved despite the fact that no aspects of the intervention supplied specific

training or practice on the test measures” (p. 56). This study was a replication of a

previous study done with community-dwelling adults yet revealed similar results.

These studies showed the benefit of expressive therapies for trauma resolution

and other mental health concerns for older adults. Yet because the expressive therapies

literature, counseling literature, society and research has proponed stereotypes of older

adults, it was important to first ask older adults who were not in nursing homes, who

were well, and who were in the community, what their experience of aging has been and
 48

how they saw themselves as older adults. Then, it was important to take that information,

develop guidelines for evaluating literature on counseling older adults and apply those

guidelines. The rest of this dissertation followed these steps.

 49

CHAPTER 3

Method

Participants

The ten participants for this study were chosen from a group of 12 older adults

interviewed in four countries (America, Israel, New Zealand and Australia). These ten

participants represented a wide diversity of people living in these various countries. They

represented diversities in socioeconomics, marital status, ethnicity, spirituality, gender,

age and, obviously, location. Diversity was sought to provide perspective. Two

interviews were not included due to the quality of the audio recordings.

Each participant had to be 65 years or older, willing to be interviewed, their own

power of attorney, and sign the consent forms. Nine participants were female, one male.

All participants were Caucasian. Two participants were married to each other. Two were

close friends. Six were widowed. One never married and one was married to someone

12 ½ years younger than she. The average age of the participants was 79.7 and the

median age was 84. Other breakdowns were as follows in Table 1.

Table 1

Characteristics of Participants

Participant Age Gender Marital Economic Career Spiritual Place of

Status Background Orientation Interview

Bernice 82 Female Widow Middle Store Owner Jewish Jerusalem,

Class Nationalistic Israel

Ceil 74 Female Married Upper Model Jewish Marblehead,

Middle Store Owner Conservative Massachusetts,
Class Mother with United States
spiritual
mysticism

Herb 81 Male Married Upper Optometrist Jewish Marblehead,

Middle Nationalistic Massachusetts,
 50

Class United States

Irene 71 Female Widow Upper Business Owner Jewish Jerusalem,

Middle Moderate Israel
Class Lives in
Florida,
United States

Janet 80 Female Single Lower Class Catholic Nun Catholic Sydney,

Devote Australia

June 83 Female Widow Middle Red Cross None Wellington,

Class Agent Mentioned New Zealand

Lorna 72 Female Married Middle Psychodramatist Christian Wellington,

Class Counselor New Zealand
Lives in
Perth,
Australia

Marguerite 84 Female Widow Lower Created School Spiritual Auckland,

Middle Counseling in Non-specific New Zealand
Class New Zealand

Mena 75 Female Widow Lower Class Housewife and Raised “very Manchester,
Hospital Billing Catholic” no New
current Hampshire,
orientation United States

Nancy 94 Female Widow Lower Speech Spiritual Wellington,

Middle Therapist and Non-specific New Zealand
Class Theater
Instructor

Data Collection

A digital recorder captured the interviews. A video recorder, not aimed at the

participants, provided audio backup. Recordings began as soon as participants gave

verbal permission. Thus, all but the initial 10 minutes of each visit was preserved for

analysis.

It was understood that interviews with older adults needed to develop at their own

pace and not be forced (Butler, 1963; Bornat, 1994; Knight, 1996; Warnick, 1995). Thus,

participants were allowed to pace the interview with the interviewer being attuned to cues

the participant might be tiring. A balance between pace and length allowed the interview
 51

questions to be explored while allowing a conversational pace. Participants were

interviewed up to three times for varying lengths of time from 60 to 150 minutes. The

breakdown of the interviews was as follows in Table 2.

Table 2.

Length and Number of Interviews

Participant Number Total Length of Interviews

of Interviews Combined

Ceil 1 w/Herb 02:25:25 or 145:25 minutes

Herb 1 w/Ceil 02:25:25 or 145:25 minutes

Mena 1 02:04:07 or 124:07 minutes

Bernice 1 w/Irene 02:35:56 or 156 minutes

Irene 1 w/Bernice 02:35:56 or 156 minutes

Lorna 2 02:19:44 or 139:44 minutes

June 2 04:32:05 or 272:05 minutes

Janet 3 05:07:06 or 307:06 minutes

Marguerite 2 04:11:32 or 251:32 minutes

Nancy 2 04:11:55 or 251:55 minutes

Totals: 10 participants, 14 interviews, totaling 27 hours: 27 minutes: 50 seconds or

1647:50 minutes.

An hour or more of the total interview time was informal and focused on rapport

building with tours of the house and apartment, offers of hospitality, and “hellos” and

“goodbyes.” The formal parts of the interview contained three distinct sections: the

signing of the informed consent, life and background questions, and thoughts on aging.
 52

During the informed consent signing, all participants were given the opportunity

to remain anonymous for any or all disclosures of information. Each participant

expressed excitement to participate in the study and wanted to be connected to it through

full name disclosure. The participants felt transparency was a virtue. “I don’t have

anything to hide.” A decision was made during the writing of the report to use only the

participants’ first names to allow a personal connection to the study while maintaining

confidential distance.

The second part of the formal interview focused on the participant’s background.

It was held that perspectives on aging were not found in a vacuum, but connected to the

life of a person. Life experiences needed to be taken in context. Comments made on the

meaning of aging needed to be viewed through the lens of the whole lived experience

(Creswell, 1998, p. 51), not just the present phenomenon. Relevant parts of the

participant’s historical data were woven into the study when appropriate to deepen the

perspective of the resulting data.

The third part of the interview focused on the meaning of aging itself, inviting the

participants to discuss the aging process from different angles. All questions were open

ended and aimed at creating a conversational tone, fostering safety and developing

openness. Reflexive listening was employed to encourage elaboration. Whereas self-

disclosure has not been the norm in research interviews, self-disclosure when

interviewing older adults has been seen as important if appropriately used to build

comfort and rapport. Such disclosures were used sparingly and with discrimination.

Each interview began with the following research statement:

 53

You are invited to participate in a research project titled Cross-Cultural Analysis

of the Meaning of Aging for Seniors. The purpose of this study is to explore the

meaning of aging for seniors from different cultures. The researcher seeks,

through interviews with people over 65 years old in various countries, to

understand the meaning elders of different cultures give to the experience of

aging.

The following questions provided the general outline of information to be gathered. The

questions were used to stimulate conversation and direction, but the researcher was not

limited to nor bound by these questions.

Introductory, background and rapport building questions:

1. Tell me about your family when you were a child. For instance, describe

your parents, your siblings and other relatives.

2. Tell me about your ethnic background.

3. Tell me about your socioeconomic background.

4. Tell me about your religious background.

5. Tell me about your education.

6. Tell me about your work life.

7. Tell me about your adult family life.

8. Tell me about a significant life experience.

9. Tell me about a typical day in your present life.

10. Do you consider yourself a spiritual person? Tell me about that.

11. How do you experience this spirituality in your life?

Questions specifically on aging:

 54

12. Tell me about getting older. Tell me more.

13. What is your experience of being older?

14. How old are you?

15. Tell me a story about being your age.

16. What would you like to say about growing older?

17. Have you experienced any benefits of growing older? Tell me about them.

18. Do you think there is a part of aging that everyone experiences?

19. How do you think you are perceived by your culture as an older person?

20. How do you feel about being what some would call “old”?

21. How would you describe your age?

22. How old is “too old”?

23. Is there something you would do differently in relation to growing older? If

so, what would it have been?

Ending questions:

24. If you could live forever just as you are now, would you want to?

25. If you had one gift to give the world, what would it be?

The first set of questions were to build rapport and gather historical information. The

next set of questions were on the topic of aging itself. The two end questions were

developed to ease out of the interview.

Data analysis

Important information was sometimes exchanged in the non-specific discussions

before and after a formal interview. Even though the participants answered research

questions for 1 to 1 ½ hours, analysis was performed on the entirety of the recorded
 55

information, including the informed consent, salutations, “small talk” and rapport

building sections. The interviews were approached from a narrative therapy-informed

stance viewing the entire “visit” as a narrative on the subject of aging. The stories being

told as well as the environment in which the interviews were performed were observed

with care.

All recorded information was transcribed by the interviewer-researcher to

increase familiarity with the data. This approach allowed a third person stance when

analyzing the data which aided in the analysis and coding. The transcribing of the 27+

hours of interviews produced 275 pages of single spaced transcription.

After the initial transcription was complete, a second and third review of the

transcripts was performed to check precision and increase familiarity. Final copies of the

transcriptions were produced and then loaded into Atlas.ti, a qualitative software analysis

program. Atlas.ti did not analyze the data but rather allows for data to be read, coded,

and studied in a digital environment. Atlas.ti simplified the viewing of linkages between

salient passages and coded materials. Being able to manipulate the data in various ways

allowed more options for observing the data by various grouping outputs. The steps in

the analysis process were as follows.

First and second coding cycles followed guideline for initial coding described in

Saldana (2009, pp 81-85) and final coding cycle followed focused coding methods (pp.

155-159). Initial coding worked well for these interviews in that it dissected the text into

parts and examined them, looking for comparisons and differences. During focus coding,

the data was mined for themes and categories.

 56

Transcriptions of all the interviews were read as presented in Atlas.ti and codes

were methodically assigned based on the content of the passages (initial coding cycle).

Passages which seemed to hold content salient to the research or to the overall structures

of the interview were given a name which was used over and over when and if that

content arose again in the transcript. Multiple codes could be assigned to the same

passage if appropriate. During the second reading of all the transcripts, data were mined

for additional content-driven codes, while listening for passages whose content and

meaning might need additional coding (initial coding cycle). Also during the second

reading, the search function and the word count capabilities of Atlas.ti were used to

capture all connections to certain emerging key codes or themes. During the third coding

reading, emphasis was placed on eliciting references specifically concerned with the topic

of aging and all its auxiliaries (focused coding cycle).

Similar extensive coding was performed on three participant interviews in a pilot

study called Three on Aging: A Qualitative Study on Aging as Viewed by Three Elders.

In that study 180 codes were discovered, explored, analyzed and condensed into greater

themes. With the understanding produced through the pilot study, the three readings of

all the interviews for this study produced a list of 85 codes, leaving out topics not

specifically on aging, which had been included in the pilot study. Example of those

topics not coded as in the pilot study were questions about the interview process,

dialogue while explaining and signing the informed consent, rapport building, and

hospitality [towards the interviewer]. The codes split into two categories: information

based (i.e. age of participants, length of interview, etc.) and theme codes (aging, benefits,
 57

retirement, fears of aging, connectedness, etc). A complete alphabetical list was

produced and presented as Table 3.

Table 3

Data Analysis Codes

________________________________________________________________________
Adaptation Info - Marguerite
Address - Bernice Info - Mena
Address - Janet Info - Nancy
Address - Nancy Inner Life
Age - Bernice Inner age
Age - Ceil Interview Date - June
Age - Herb Length of Interview - Bernice and Irene
Age - Irene Length of Interview - Ceil and Herb
Age - Janet Length of Interview - Janet
Age - June Length of Interview - June
Age - Lorna Length of Interview - Lorna
Age - Mary Length of Interview - Marguerite
Age - Mena Length of Interviews - Additional
Age - Nancy Length of Interview - Nancy Live Forever
Age is a Concept Marguerite’s Conference Experiential
Aging Meaning/Purpose
Aging and Society Not Feeling Useful
Aging that everyone experiences Perceptions of you as old by others
Aging Well Physical Ailments
Benefits Retirement
Challenges Self Description - Janet
Changes - Career Self description - Mena
Changes - Family Spirituality - Ceil
Changes - Mental Spirituality - Herb
Changes - Physical Spirituality - Janet
Changes - Social Spirituality - Lorna
Children - Ceil and Herb Spirituality - Marguerite
Children - Nancy Spirituality - Mena
Connectedness Spirituality - Nancy
Cultural perception of being older Tell the world about aging
Date of Interview - Bernice and Irene Time being precious
Date of interview - Ceil and Herb Time Speeding Up
Date of Interview - Janet Tolerence
Date of Interview - Lorna Too Old
Death What would you change
Describe your age
Determination
Fears of Aging
Gift to the world
How feel about being called old
Importance of Affection
Increased sense that time is short
Info - Bernice
info - Ceil
Info - Herb
Info - Irene
Info - Janet
Info - June
Info - Lorna
 58

________________________________________________________________________

Atlas.ti was then used to produce two documents. The first was a report showing

each code and all co-occurring codes listed under it. For each code, the report showed all

other codes using the same passages as it did. This document aided in linking some

subjects together whose connections were not initially apparent. This document was 9

font and 27 pages long. From this document, themes like aging were seen to be linked to

20 other topics. Many of the other codes linked to aging were adaptation, benefits,

challenges and death. Atlas.ti presented all the quotes for each code connected to the

code aging and listed all the quotations under each co-occurring theme for easier

referencing. A partial presentation of the codes for the topic “Aging” was included as

Table 4.

Table 4

Atlas.ti’s Presentation of Co-occurring Codes

________________________________________________________________________
Aging {27-0} [20]

Adaptation {11-0} [4]

2:29 S: …that’s going (referring to.. (1232:1242):
2:30 C: How do you transition? S: Y.. (1234:1242):
6:27 Even quite much people very ol.. (352:364):
8:22 N: No age…you’re bring it up a.. (415:423):
Aging and Society {5-0} [4]
8:8 N: Two years ago, I was not ex.. (131:193):
8:16 N: I told you Saturday and I w.. (355:363):
8:23 S: And then this whole other p.. (481:491):
8:32 S: Final thoughts…I’m thinking.. (717:719):
Aging Well {21-0} [8]
5:12 P: Well it's hard to age grace.. (121:121):
5:13 P: Ah yes. Yes it's um quite a.. (119:119):
6:33 I don’t like talking about mys.. (376:376):
7:19 So you’ve been kind of talking.. (767:773):
7:21 And granted if you take better.. (769:769):
7:35 S: Yeah. So I’m hearing you sa.. (1069:1103):
8:8 N: Two years ago, I was not ex.. (131:193):
8:11 N: Can I ask you how old you a.. (251:277):
Benefits {23-0} [3]
3:15 S: So being who you are as you.. (132:137):
3:18 I don't find anything else muc.. (135:135):
8:11 N: Can I ask you how old you a.. (251:277):
Challenges {1-0} [1]
7:33 M: You know, there’s a disadva.. (993:993):
Changes - Family {4-0} [3]
 59

7:33 M: You know, there’s a disadva.. (993:993):

8:22 N: No age…you’re bring it up a.. (415:423):
8:23 S: And then this whole other p.. (481:491):
Changes - Mental {20-0} [5]
3:15 S: So being who you are as you.. (132:137):
3:16 P: It's frustrating because th.. (135:135):
3:19 I feel...but um...getting old .. (137:137):
5:11 S: So you're talking about slo.. (116:119):
5:13 P: Ah yes. Yes it's um quite a.. (119:119):
Changes - Physical {40-0} [16]
2:29 S: …that’s going (referring to.. (1232:1242):
2:30 C: How do you transition? S: Y.. (1234:1242):
3:15 S: So being who you are as you.. (132:137):
3:17 So but that's one of the thing.. (135:135):
5:11 S: So you're talking about slo.. (116:119):
5:13 P: Ah yes. Yes it's um quite a.. (119:119):
6:26 M: (Reading from her homework .. (348:352):
6:43 S: So how would you describe y.. (470:498):
7:19 So you’ve been kind of talking.. (767:773):
7:20 And of course, you don’t how l.. (769:769):
7:30 M: Really. Yeah. My kids even .. (955:955):
7:33 M: You know, there’s a disadva.. (993:993):
8:7 N: Two years ago, I was not ex.. (131:139):
8:8 N: Two years ago, I was not ex.. (131:193):
8:22 N: No age…you’re bring it up a.. (415:423):
8:23 S: And then this whole other p.. (481:491):
Changes - Social {8-0} [1]
8:22 N: No age…you’re bring it up a.. (415:423):
Connectedness {38-0} [4]
2:29 S: …that’s going (referring to.. (1232:1242):
2:30 C: How do you transition? S: Y.. (1234:1242):
5:12 P: Well it's hard to age grace.. (121:121):
7:35 S: Yeah. So I’m hearing you sa.. (1069:1103):
Cultural perception of being older {19-0} [5]
7:27 S: Yup. Yup. So you’re experie.. (881:887):
7:30 M: Really. Yeah. My kids even .. (955:955):
8:7 N: Two years ago, I was not ex.. (131:139):
8:8 N: Two years ago, I was not ex.. (131:193):
8:32 S: Final thoughts…I’m thinking.. (717:719):
Death {9-0} [3]
8:8 N: Two years ago, I was not ex.. (131:193):
8:16 N: I told you Saturday and I w.. (355:363):
8:31 he second world war began, she.. (651:681):

__________________________________________________________________________________________________

The second document produced contained all the quotations listed under each

code. This document was 9 font and 263 pages. This document allowed a re-reading of

the interviews in dissected format, rechecking if each passage was appropriate for the

coding assigned. In this format, the grouped quotations were searched for key passages

on a stated theme. Atlas.ti bolded the passage information first stating what document

the passage came from, the first words of the passage, the line numbers of the passage,
 60

the code it was under and the other codes to which it was linked. Table 5 was a partial

printout for the code adaptation.

Table 5

Atlas.ti’s Presentation of Quotations Linked to a Code

_______________________________________________________________________________

Code: Adaptation {11-0} is he? Nothing like that. We

expect nothing and just go with the
P 2: Ceil Transcription 001-A-004- flow. That’s all.
Steven Interview to End with
Reflection I and II - Final.doc - P 3: Janet - Australia -
2:30 [C: How do you transition? S: Transcription - 2010-11-28
Y..] (1234:1242) (Super) Final.doc - 3:21 [S: So at what age
Codes: [Adaptation] [Changes - were you whe..] (140:141) (Super)
Physical] [Connectedness] [Inner Codes: [Adaptation] [Changes -
Life] Physical] [Meaning/Purpose]
C: How do you transition? [Retirement]
S: Yeah, yeah… S: So at what age were you when you
C: You sort of… retired from all those duties?
H: It creeps up on you. P: Seventy. Yeah well I'd been
C: …play it play it as it lays. I looking after another nun three
mean it isn’t it isn’t a planned times a week and I just wore out. I
thing that today I decide that I’m just gradually got less and less
not going to be able to do all of energy and when she died I was
those other things that I love to do really completely spent because of
so now I’ll have to go on a the trauma of going up and seeing
different path. It’s just that it her getting lower and lower. I
happens. Whatever happens let’s say hadn't been in my, I had a magic
physically that changes my ability number in my head when I knew I was
to get a phone call from New York going to be again but when I was
saying be here tomorrow morning at seventy and she died and I had been
5:00 to see the first ??? you know going up there and taking public
the first client we have. It’s it’s transport which took an hour to go
like that. It’s, it’s not difficult up there and an hour to get home.
it just really it just happens. I I I'd get there and she'd say, “I
think no matter how much physically think it's gonna rain you'd better
I may be impaired, I still have an go home. Don't stay too long.” I'd
inner life that very wonderfully get there and she'd have ten minutes
working all the time. And and in my and then I'd come home again so it
mind I am everywhere. You know I was a big strain and stress for me
just can mentally transport myself. but I think I don’t know, I think
Am I fed by being at a piano bar, what I'd have is, I'd come home from
yes because it to me it’s like I’m there, I'd get home about two-o-
at the symphony. I mean I am in clock in the afternoon and then I'd
heaven when I am there. I’m have to go down there to visit
singing. I’m with my friends. I’m somebody and I would be completely
meeting new people. We have that done. I'd walk down and I'd ring the
common bond of whether it be a life doorbell and I didn't want to go in
style or whether it be the fact that there and listen to anyone's
they are musicians. We we are problems. I hadn't got anything left
there. We sing and we ask questions to give them. So I just had to come
later…or not. Really, I mean I I to terms with sort of stopping
might say, “gee, do you know who gradually. I didn't stop altogether
that person was who had that I just volunteered now to go to
wonderful voice?” But it doesn’t (50:30 unintelligible) a building
ever get heavy. You know, there’s down here you might have heard of
none of this, none of this well (unintelligible) but it's a big
what’s that person’s inner life…what building and there are people there
 61

with mental illness and drugs and and did a course there to become
elderly people. It's a big building accustomed to people that were
you can see it from there it's just psychiatricly ill because I was
(unintelligible). Well I had meeting a lot of them at (51:40
volunteered to go there once a week. unintelligible) and I didn't know
Just now decided. I saw it on how to handle it very well so I went
television and they were looking for there and did that. So I'm really
volunteers so I went down and said not afraid of people who are strange
to them, “I'll volunteer once a week or not overly managed. So I just
and I'll give you my time to look though and I said to the lady down
after the community center,” and there, “I'd like to volunteer,” and
these people come in all the time she said, “Oh we'd just love
and you talk to them and be with somebody to come.” You know. They
them sort of visit them. It's were just (52 unintelligible) but
something extraordinary to do this I'll be quite happy to go for a day
year. I just decided I'd like to do and do some work down there. Just be
that because I'm not frightened, I'm with them for the day. Have cups of
not afraid of psychiatricly ill coffee and just listen to them and
people. I had a course about twenty- just be around for them. So that's a
one years ago in Melbourne and little spark of extra life that I'm
worked in the psychiatric hospital going to do.
________________________________________________________________________

Coded themes were grouped together to create larger “families” on a main theme.

These “families” of meanings were reread and analyzed as they related to the topic of

aging and with the insight gained from the pilot study. The results were presented in the

chapter entitled Results.

 62

CHAPTER 4

Results

The umbrella categories from the data directly relating to the topic of aging were

the Lived Experience of Aging, Benefits of Aging and Aging Well, Societal Perceptions

vs. Personal Perceptions of Being Old, and Connectedness. The sub-categories were

listed below under the major themes. Each theme and sub-category was discussed in its

own section below.

Lived Experience of Aging

Ceil reported on an experience she had one day prior to the interview, which

reflected and was echoed in the interviews with other participants on their lived

experience of aging. Ceil was trying to recall exactly how old she was,

Well it’s funny because I was I was in the bedroom the other day and I don’t

know what made me think of it. And I thought of it [her age] and I said to myself,

“no, that couldn’t be right.” And then I thought again and I said, “my God, that’s

right.” It doesn’t seem possible to me. I don’t know what we thought people in

their seventies were going to be like because when we were growing up there

weren’t a lot of people that got to that stage and were still living their life so to

speak.

Herb confirmed Ceils surprise adding, “It creeps up on you.” When asked to

expand on this, Herb states, “Yeah, like it took me 14 years to put this place together.

And uh as I think back, I said if I had to do it today, no way. I would not be able to do

what I did then.” Herb then told how he would get up at 6 a.m., leave his home office in

Lynn, work on the house in Marblehead until noon, “drop the tools, go back to Lynn, take
 63

a shower, and see my first patient at one o’clock.” After his last patient, he would change

his clothes, go back to Marblehead and stay until he was so tired he “missed the nail and

hit my finger.” The next day he would do it all over again. He said, now “you’re aware

of your limitations. There are things that I want to do and I stop and I think about it.

Whereas before, I would just go ahead and do it.”

When Mena talked about being older, she said,

I can’t vision myself. I mean, I don’t know how other people see me. If other

people pass me on the street, am I an old lady when they look at me? This is what

I wonder sometimes. When I look at myself in the mirror, I say, “Yeah, that’s an

old lady in there.”

Mena did not like the idea of being older. She commented, it “is not fun…not at

all…my three kids, ‘specially since I’ve been sick, they treat me like an old lady. And I

tell them, ‘I’m fine. I’m fine.’” Mena told the story of being at her granddaughter’s

wedding recently. She was dancing and enjoying herself all night. When it came time to

leave everyone became overly attentive while she was going down the steps outside the

building.

Peter’s mother’s on this arm, one of the daughters is on this arm…you’re fine if

people want to help you, but I feel more secure if I’ve got something to hang on

to. So I said, “Dianne, I need to hang on to the railing.” So, she said, “Okay.” I

get down the stairs and there’s another guy there with his hand out…helping me

to the car. I said, “God, I mean I was up dancing.” And they’re treating me like a

helpless invalid.
 64

Mena said that time passed quickly. “It’s just that you know…it goes by so fast. It’s

unreal. You turn 30 and the next one’s 31 and the next one…and all of a sudden you’re

40. And it goes so fast…and you wonder where it went.”

Aging

All the participants had something to say about aging and unless specifically

prompted for a positive, they tended to lead the conversation to physical changes they

experience. Janet, who described herself as a very positive person, found it frustrating to

not be able to do all she liked to do.

It’s frustrating because there’s a lot of things I want to do. I keep losing things. I

lost my barrette before you came and I spent twenty minutes looking for it. I

thought, “this is a waste of time. Where did I put it?” And then I found it next to

the phone in there with a book on top of it…I find it limiting not to be able to do

what I used to do. I can’t. I get very tired in the afternoons. I used to go out in

the morning but I find I haven’t got the energy I used to have…I want to go and

do things and I can’t do them. I run out of energy.

Janet told the story of how she was invited by a friend twenty years younger than she to

go to the town hall and other such places. Janet, who was 80 years old, had been unable

at times because she no longer had the energy of a 60 year old.

Marguerite concurred with what Janet said and added that people “not only slow

down with their energy but they seem to slow down with their interest.” She explained

because older adults are not able to “keep up,” they lose interest in doing the thing

altogether. Along with slowing down, June stated, “after you’re 70 most people seem to

collect a few disabilities…You’re very lucky if you don’t get some.”

 65

These physical changes as well as age itself came on slow. Marguerite

commented, “Well, I didn’t really feel getting older.” Nancy stated, “I have never every

thought of people’s ages….So, I have never thought ‘I’m old.’ Or I am reaching old.”

Even though it came on slow, Lorna added, “Yes it's um quite a perceptible difference

between late sixties, seventy, and seventy-one…Not worse really but you have to change

your perceptions and how you think you want to be or you always will lie.” The “lie”

that Lorna mentioned was the lie one tells one’s self so as not to have to face the grief

which came with not being able to do what one had done in the past. Even when one has

aged, it was still hard to accept the reality stated June. “I still can’t think of myself as

really old, even though I know I am. It is very difficult. Your mind is not telling you

you’re old but you’re body sometimes tells you.”

Marguerite laughed when telling of the story of an ocean swim she took the year

before when she was 83 years old.

I went last summer…went swimming in the sea and it was lovely and I was

enjoying it and then I had to go back. I put my feet down and I couldn’t keep my

balance. I had a friend who had not gone swimming and I had to call her to have

her get me out. In the end, she tried to carry me out. So I couldn’t get out. I love

this story. So, I got down with my bottom out and she pulls me out. And I got

out and I look up and there are all sort of tourists and they are all taking pictures.

See what a sense of humor does. And you know how these Japanese are rich

people and they all got their photos. And I didn’t think at all except jeeze this is

funny. We laugh a lot about that. I am really lucky to have that sort of attitude.
 66

Marguerite was glad to have a sense of humor to get her through her later years. She

reiterated a statement attributed to Betty Davis, “Old age is no place for whimps.”

Changes Associated with Aging

All the participants described changes they had experienced as they aged. These

changes included retirement, family, mental processing, and social interactions. Along

with these external changes, participants had noticed a change in their perception and

concept of time. Predominately though, it was the physical changes that were most

discussed and disconcerting for the participants.

Career and retirement. Each of the participants was employed during their lives

though their careers varied. Mena was a housewife until her husband died. After that,

she went from cleaning the rooms in a hospital to working in the administration office in

the hospital. She was 65 when she chose to retire. She then got bored and started

volunteering at the hospital in the same office even though they offered to hire her part-

time. Mena declined their offer because she did not want to be tied to a job. She liked

the freedom that volunteering offered.

Herb, at 81, was still covering for vacationing optometrists. He had not ever

stated he was retired until the interview. His admission came as quite a surprise to his

wife, Ceil.

Herb: I’m retired.

Researcher: Retired.

Ceil: Semi-retired. You are still going in and filling in for other doctors.

Herb: I haven’t worked since January. So I think I’m retired.

 67

Ceil: That’s the first time I’ve heard him say that. This is news to me. You

consider yourself retired.

Herb: When the reality hits you, you go along.

Janet was a nun who had worked 15 years as a teacher and 15 years as a school principal.

Then into her 70s, she had done community work and eventually took care of an aging

nun. When the nun died, Janet decided it was enough and moved to doing more

volunteer work and resting more.

Lorna was a gifted group therapist who had taken a backseat to the other group

therapists she had trained, supervising now more than doing. Ceil no longer flew to New

York on a moment’s notice to help with trade and fashion shows. Marguerite created the

field of school psychology in New Zealand and longed for the days when she spoke in

front of audiences and did trainings. Nancy taught speech and theater but could not walk

well anymore and needed to leave teaching. She proudly stated many of her student still

kept in touch. June retired from her work with the Red Cross when her husband retired

due to his failing health. Irene worked in hospital and did some extra roles in movies.

Bernice worked with her husband in the store they set up in Jerusalem. All the

participants were retired. Though they enjoyed the time and freedom they had, they

looked back fondly remembering a time when there was more activity in their lives.

Family. Ceil saw the changes in her family through the loss of the traditional

Jewish celebrations she enjoyed. Her daughter and son-in-law attended the Unitarian

Universalist church. Ceil observed the changes in her family through the ending of the

spiritual tradition. “I think it will end with Herb and I as far as the family is concerned.

And I feel a loss about that….But you can’t direct the music in everybody’s life.”
 68

Mena discussed the changes in family roles more pragmatically.

You know, there’s a disadvantage in, in my case, because I don’t drive. So, I am

limited to doing a lot of things. And sometimes my kids get together and I

wonder why they didn’t ask me to go with them and do with them.

Mena stated her children have been doing a lot to get her to her appointments, refill

medication and get food. She had “no doubt at all in the world though that that my kids

love me.” Irene added,

I think the hardest part about getting old is that you can’t do anything and your

family doesn’t have time for you. So, I see how these people were in Florida and

I think that’s what frightened me more about getting old. To see these people

sitting around talking about their children and not hear from them.

Nancy had seen the shift in family from her giving the care to her receiving care

especially since she was brought back to her apartment to die, three years prior. Nancy

jokingly said she was quite a “disappointment” to the doctor in that she did not die.

Hospice had to be removed and she playfully said the doctor was quite upset to be wrong.

Her daughters arranged for an in-home agency to take care of Nancy and one of her

daughters flew in every three months to make sure all was well. Nancy stated, “I don’t

want to feel like a burden. I have been an independent person, very independent all my

life. All my life.” It was not the independence Nancy reacted to but rather the strain she

saw her “living” was on her family, even though they had not said anything of the sort.

Mental processing. Most participants made mention of the mental processes

which changed as they aged. Most notably were changes in memory. Bernice stated her

memory had changed “much.” She used to be able to remember names, addresses and
 69

phone numbers when meeting a person even one time. “But now if you’re not where I

met you and your face is familiar, it takes me a long time to remember a person’s name

and that frustrates me.” Indeed, during the interview, Bernice had trouble with finding

the work “incentive.” “You see, that’s what…I can’t remember words.”

Ceil’s experience of losing words was linked to her recent physical ailment.

“Sometimes, I find myself having hesitation about…it will be in my head and it’s not

coming as quickly as it would before I had the stroke.” Lorna had noticed she was “slow

to learn things.” June noticed,

my memory is just beginning to slip a little bit not…but not too badly yet. I find I

can think better now about the past and now really concentrating on that. And it

is the day to day things that I have to read up about all the time…to make sure I

am getting them right.

June enjoyed being able to remember the past well as she was writing her memoirs. Janet

simply stated, “I find I am forgetting things. I think that I’ve got a short term memory at

the moment.”

There were evidences in the interviews that the self-observations about memory

loss were justified. June had a hard time finding a file on the computer which she

accessed regularly. Several participants had trouble finding specific words or recalling

certain events. Marguerite’s thoughts wandered and she was unable to recall the town in

which she was born. Marguerite stated about her memory lapses that she got “flustered,”

“it irritates me,” “it’s frightening” and “it is a real norsen, norsen, norse...” The

researcher offered, “nuisance.” “Yeah,” Marguerite said, “it feels like you are losing
 70

yourself.” She added, “It is just that I am losing some parts of my brain, brain I guess.

It’s a nasty funny feeling.”

Janet did offer one consolation,

I tell you one advantage of getting old, if you've got a bad memory, five years

after you've read one book you go back and read it again. That's an advantage! It's

true! It's true! I used to read a lot of mysteries. I picked one up and read it the

other day and I went to the library to get books, and I picked this one up and it

was a mystery and I thought, “Have I read this before?” If I read the first

paragraph I'd know. So I read the first paragraph or so and I thought, “No I don't

remember reading this so that's alright.” I bring it home, I'm half way through it

and I thought, “Hmm some of this rings a bell.” Anyway I kept on going and I

kept on reading it and I got to the end and I found out who done it and I knew yes

I did read it…I've been going through all the books in the library and now I can

start again because it was five years ago and I've forgotten what they were. That's

something good.

Social interactions. The participants noted social interactions, even with their

families, had decreased. Bernice was not sorry in some ways for this. “The good thing

about having a small apartment is that I don’t have the space for 20 people.” She stated it

tires her out to have a large group over. “When I go to cook, it’s a big thing for me to

cook a meal. So, I am glad the kids can’t come all at one time.” Though she did still

enjoy her family and wanted them to connect more. Herb did not wait for his family to

come to him. He had been known to drive over to his son or daughter’s house and call

them from their driveway to see if they would enjoy a visitor.

 71

Marguerite, Nancy, Lorna, and Janet noted in various ways that as they had aged

their friends had become younger, well at least the median age of their friends had

become younger because there were less people in their generation. Marguerite stated,

I don’t know many people of my age and most of my friends are at the end of the

line. And a lot of people I know have died…towards the very end…you might

find yourself in a world which didn’t have anything else around you of your age

that knew you or know you or knew that life, that time.

They had noticed there were not as many people their age around, so they ended up

socializing with people 10 and 20 years younger. Socializing though became harder

because, as Marguerite pointed out, it became increasingly more difficult to go out.

Mena stated there are some days “I don’t even bother to get dressed, if I am not going

anywhere…It’s dull.” Marguerite seemed to sum up the sentiment for everyone,

I have got some good friends. But a lot of people who are my friends are still

working and probably quite a little bit younger than I am and haven’t got a lot of

time. I’ve got a lot of time but not a lot of people to spend it with.

Time. One of the perceptual changes the participants mentioned was in their

relationship to time. Lorna, Janet, Mena and Marguerite all mention that time seemed to

speed up the older they became. Janet stated, “Believe me. Yes. Before you sort of

realize that January’s come and gone, you’re up to November. Every year it speeds up

more and more as you get older.” She remarked she sees this a lot with appointments.

“‘I was only there last year’ and they say, ‘no you weren’t, it was two years ago.’” Mena

added, “It goes by so fast. It’s unreal. You turn 30 and the next one’s 31 and the next

one…and all of a sudden you’re 40. And it goes so fast.”

 72

Marguerite concurred but thinks that young people were experiencing this too in

today’s fast paced society. She postulated that it was not age that speeds time up but

being active and having things to do that affects time.

Yes it [time] seems, when you’re young it does seem quite long. Now I find it

going very fast…Yes I feel it is going very fast, very fast. But I have heard

people of much younger than I am saying the very same thing….so I don’t think it

is just the old age people. And some old age people don’t see it that way because

they don’t do anything…They just sit around all the time. It seems like, you

know, you know, a long time. But if you’re active then I think you feel it the

other way. I can’t believe it. I remember saying, “I wonder if I will get to the

millennium?” Well, we are well over it and passed it now!

Janet believed time speeds up as one ages “because you can get less done. You

have to slow down bodily, therefore you can’t achieve as much as you did before.” For

Janet, however, this shift in her perceptive and her advancing years came with an

increased sense of the preciousness of time.

I've never got enough time to do what I want to do. I just run out of time because

the day goes too quickly. It's very precious. That's the sense that I have. The

older I get, the more precious time is…I've got this real sense of not having much

time left and I need to spend it well. I need to make the most of it, enjoy it and use

it to the fullest. And that's important to me. Not to sort of squander the time that's

left. That time's too precious to be wasted.

Janet’s focus on the preciousness of time had got her to laugh at herself over the years.
 73

I drove into town to get a traveling blanket for somebody and there were two girls

talking behind the counter. It was Monday morning and they were exchanging

their weekend escapades. They looked at me and kept on talking and I was

standing there and I was just doing this [taps] on the top of the desk. One of them

turned round and I said, “Would you mind serving me because I haven't got much

time left.” I said, “Time's running out for me and I haven't got much time. So I

can't afford to waste it.” Such a startled look on their face she walked over and

said, “What can I get for you?” I said, “I just want that blanket there. That's all I'd

like. I'd like that.” So I bought it and then I was telling the others about it I said,

“The poor girl probably had a break down and went home and told her mother,

‘There was some woman that was dying in the shop.’” I said, “No I didn't mean it

that way. I just meant that I was wasting time standing there. I was just wasting

time.” I mean she's talking about the weather or something and here's me. I could

have been downstairs and doing something else and I could have been doing

things instead of wasting time but that's a true story and that's what happened and

I can still see the look on the girls' face. I think she thought I was going to drop

dead on the floor. I didn't mean it that way. I just meant that life's precious.

Physical concerns. Among the physical concerns the ten participants mentioned

were: difficulty walking, exhaustion, fatigue, underneath of teeth infected, hands losing

their dexterity, harder to stand, pain in legs, generally aches and pains in body, could not

walk as fast, balance was off, intermittent claudication, strokes, dystonia, gall stones,

stomach pains, circulatory issues, heart issues, stiffness, and slowness. Of all of them,

the one most mentioned by the participants was their lower energy level. This change in
 74

physical well-being was the one that prevented them from doing all they wanted more

than other concerns.

Ceil commented that when it comes to aging, one needed to “play it as it lays.”

Ceil stated,

It’s very difficult to find your path in another way. You don’t want people to

think of you as being sick all the time. And you’re helpless to help it when it

happens. I mean I was floored when the doctor said to them that I had a stroke. I

just had a little incident to me. I just had a little incident.

Ceil said that it was difficult to adjust to health concerns that did not go away like a cold

went away.

That is what is a difficult thing for me to adjust to because I want to be fine. I

want to get up in the morning and say to Herb, “it’s such a beautiful day. Let’s

just go to Ogunquit and...” And I’m upset with myself and when my body won’t

cooperate.

Still in all, Ceil said about the adjustment to aging that “it’s not difficult. It just really, it

just happens.”

Herb noticed when he was moving stones and working outside that he got stiff

and started to “huff and puff.” It was then he had to take a break until his breathing

returned to normal. Mena said,

It seems like the body is falling apart sometimes. And granted if you take better

care of yourself before your older age you might be in better shape…I mean…I

eat well, but you don’t exercise. You know. You put that off…I’ll start that
 75

tomorrow. Right? But no matter what, nobody’s going to be Jack LaLane.” [a

fitness guru who lived until he was 97]

Mena commented that along with physical concerns, “You end up on pills galore

because… I tell my kids, ‘I feel like I have a pharmacy here.’”

The ailments that bothered the participants most was anything that limited their

ability to get around. Ceil had dystonia which was “where the brain misfires and the

extremities are cramped. So the big toe is 90 degrees…across the top. The bottom toes

are crimped underneath” making it very painful to walk. Marguerite still drove but

remarked the driving was easy, it was getting to the car that was the real issue. Bernice

reported where she used to go climbing, she could not even walk fast now. It was

particularly hard this year as she was not able to attend the memorial anniversary picnic

of her daughter’s murder which was held in the field of flowers her daughter and son-in-

law visited just before being shot by terrorist in their home. She has attended every year

for the last four years but she could not go this year “because there was too much

climbing.” Bernice lived in Jerusalem and stated, “I like to travel. It’s getting a little

harder. I mean America seemed further away this last trip then it did before.”

It was these physical symptoms that alerted the participants to their age. June

remarked, “…some days when the aches and pains get at me I begin to think, ‘gosh, I

must be old.’ I never would have thought that before.” Janet added,

the body tells me I’m not but the head tells me I’m about 50 or 60. That’s what I

feel. I feel the same as I was when I was 50 or 60 but I know I’m not because I

get stiff and can’t walk quickly and get indigestion.

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The participants desired more independence. The independence sought was not from

societal restriction but rather from their body limitations. Ceil stated in regard to her

body not doing what she wanted it to do, “It’s that lack of control. [Control] would be

the one thing that I miss most about my life today.”

Though there was substantial talk about their physical ailments, the participants

did not want to be identified by these concerns. Ceil had spent many joyful times at a

Piano Bar in Ogunquit, Maine, USA. Over the years since the 70s, Ceil had drawn great

enjoyment from singing around the piano and making friends. She had experienced the

pain of losing some of those friends to AIDS and she had set up an AIDS Support

Network in her area. At an hour and fifteen minutes away, the piano bar which use to

give her such enjoyment was many times too far for her to travel. But when she was

there it had a new meaning for her. She felt “normal.”

The reason I love sitting at the piano bar, and I said this much earlier. Is that at

the piano bar, to me, and I hope to the people there, I look normal. They can’t see

that I can’t open my hand at all. This right hand, I can, I can’t open at all. And

the same thing with what’s going on you know with my other extremity [her

tangled toes]. And I forget it when I’m there…that’s one of the reasons that I am

so happy at the Porch. Because I am only seen at the piano bar from here up. No

one knows anything else.

It was important to Ceil that she had a place where she could be seen for whom she was

and not her physical ailment.

Descriptions of What is “Too Old”

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There was a concurrence among the participants as to what was considered “too

old.” Herb started off by stating “old” was “not being able to do what you did when you

were 20.” Ceil added, “I don’t know if I would have put it at 20 but, yes, being

physically unable to do the things that you wish to do.” If that was “old,” then “too old”

for Herb and Ceil was:

Herb: When you can’t take care of yourself…

Ceil: I was going to say the exact same thing.

Herb: …and you’re a burden to other people.

Ceil: I was going to say the exact same thing.

Physical and mental symptoms as indicators of being “too old” were contained in most of

the interviews. Bernice described and gave an example of “too old.”

Too old is when you can’t get up and you can’t go out and do things. And you’re

house bond and you have to have a Pilipino aid or something like that. Then then

you have no life you have no quality of life. As long as I can get up and go and

do things I am not old…I mean like I have a friend Sarah. I knew her when she

was driving a car going here and there. Now she is homebound. She goes from

her bed to her chase lounge and she can’t go any further. She has a Pilipino full

time and she has a hard time going from the bed to the chair. I mean that’s too

old. She just sits in her chair all day and watches television.

June stated, “‘too old’ is when your mind was not working anymore, I think. ‘Cause

we’ve got people like that down the corridor and I really feel sorry for them.” Lorna

stated it was when one had “fading health.”

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Marguerite and Mena both give approximate ages as to when one was “too old.”

Marguerite answered that someone she knew had people helping her, lived virtually in

one room, never went out, was always tired and was “103 nearly 104.” Mena placed a

rough age on being “too old,” “probably 80, 90, 100.” However when Mena started to

describe what it was like to be “too old,” she provided the following details:

There was a woman…celebrated her 102nd birthday…I don’t want my kids to

remember me that old. I want them to see me as the pretty lady that I am…or

was. I don’t want them seeing me all stooped over…and walking with a

walker…my mother was like that…my mother was always old…me, I was not

old and I am trying not to get there now.

Particularly important to Mena was that people remembered her as “the pretty lady that I

am.”

Janet, Marguerite and Nancy answered the question of “too old” not with a

specific number of years but rather with a concept. For them, “too old” was more about

being on the earth for “too long.” Marguerite, “Don’t go too soon…but don’t hang on

too.” Nancy, “I think I’m falling into ruin here…I’m going to be a hundred…and that

would horrify me…I think you can be in the world long enough.” For Janet, “too old”

was when a person has a negative attitude. “They start to grow old quickly and of course

by the time they reach this age they’re really old.” When asked to elaborate on what “too

old” was, Janet told this story:

My mother was ninety-three when she died and for the last six months of her life

she was bed ridden and she was sad because she wasn't able to do what she

needed to do and she was in a nursing home and she felt she wasn't being looked
 79

after very well and I felt she was too and she said to me, “I've been too long.” She

said, “This is too long to be here.” When the quality of life goes, when you can

no longer enjoy each day and like you can't, you can't be part of what's going on

around you, that's too long.

Thoughts on Death and Dying

The topic of death came up during the interviews. Ceil, Mena and Janet discussed

their respective mother’s deaths. Ceil and Herb mentioned several people they knew who

had died due to AIDS-related complications. Ceil, Herb, Nancy and Mena all mentioned

people who were now dead. Ceil, Nancy and Mena mentioned the death of relatives.

Whereas Ceil and Herb talked about other’s death, they only made mention of their

deaths in relation to getting their wills in order.

On the other hand, Mena made mention of her own death and stated exactly what

she thought about it.

Like I tell one of my kids, I says, “Okay my mother had her turn, she’d died. My

father, he died.” I said, “Now I’m the oldest one in our little family clan. And

now it’s my turn.” And of course, you don’t [know] how long you have. You can

be gone just like that, and I hate it.

Mena stated, “I think if I am going to die, I’d rather not have my mind. So, I don’t know

I’m dead or going to die, you know.”

Bernice mentioned that when one was not having a good day, death might not be

a bad alternative. When questioned by Irene, Bernice stated she did not support Dr.

Kevorkian (a doctor known for euthanasia). Thus, even though the day was bad, a

proactive approach to death was not the option. Nancy stated euthanasia was to be
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“recommended.” She stated she saw no reason why someone who had lived a full life

should not be able to choose the time of her death. “That little blue pill. I wish I had one.

Not that I would want to take it now.” Nancy was emphatic that this approach was not

playing God. “That’s rubbish. That’s rubbish.” Her thinking was that people are more

compassionate to animals than to our humans. People had the dog “put down because he

was in such pain. And the vet said there was nothing that could be done.” Nancy

postulated, “we should feel as much about our human relatives as we do about our pet

animals…but that we don’t. We let them suffer. Some for years. Some poor souls for

years.”

Nancy stated she has “been here long enough” and she “has no fear of dying.”

Why would you be afraid of dying for goodness sakes?...I have no fear of

dying…I am not a religious person who is frightened of going to hell or I

certainly would not want to have wings and fly around in Heaven. I think it

would be very boring. And I know that all plants die. All things that live die.

And are replaced by others. An that is how it is for human beings. And why

shouldn’t it be? Why should we be more special than the useful creatures in the

wild? Or a tree...everything dies. But we are so egotistical. We human beings.

Janet was a Catholic nun and spiritually on the opposite side of the spectrum of

beliefs from Marguerite, yet there was a similar quality to her response about death found

in the story she told about her Catholic order of nuns, the Sisters of Mercy, dying out. “I

really believe we just live in an age where we were able to do what we had to do and the

church needed us at that time. But I think the whole thing has moved on now.” She

stated the lay people had taken up what the sisters were doing. Janet was not saddened
 81

by this. In fact, she saw it in a historical perspective. “Most religious orders only last for

two or three hundred years.” With regards to aging, Janet’s story about the fading of the

Sisters of Mercy seemed to hold the sentiment for all the participants whether they like

the aging process or not.

And we just gradually fading out and going off. So, I think we are losing our

usefulness. So, I think we were there when we were needed and we are gradually

going out. And I don’t feel sad about that. I feel we did what we had to and we

were there at the right time. And now it’s time for us to fade back and fade away

and a new era will begin.

Staying One’s Present Age

When asked if the participants would choose to live forever at their present age,

Ceil recognized her own dodging of the question. “This is a cop out, but if my soul could

continue on, without being constricted by my body, I would live endlessly. Life to me is

very exciting.” Herb said, “I could tolerate it as it is right now. I wish it were earlier, but

I could manage.” Mena also responded similarly, “Yeah, if I don’t go any further this

wouldn’t be too bad. Yeah, I could stop here.” Irene stated, “it depends on the

wrinkles,” but then said with some good plastic surgery it might not be too bad. Bernice

was noncommittal saying it might be “okay.” Lorna responded she would live on just so

she could continue to make a difference. As a Catholic nun, Janet was remiss to stay for

she wanted to move on to her life with God. Both Marguerite and June were concerned

that they would get bored after a while if they stayed. Marguerite was not sure what she

would choose. However, June stated she would not want to stay unless “I could live with

all my eyesight and faculties.” Their present ages were no so bad when, as Bernice
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pointed out, “compared to the alternative.” Mena also offered this statement to help

understand her wanting to live on, “life to me is like a book. You want to keep reading it

and reading it, reading it, reading it, reading it. You ever think of it that way? I never

want to get to the end of it.”

Aging Well and Benefits of Age

Through the interview process, the participants revealed that, despite all the

changes expressed which could make one scared of aging, there were many benefits

especially if one did what they could to age well.

Aging Well

Though none of the participants spoke directly about aging well, most of the

information was given in response to other topics. Those topics included making more

out of the time one has, taking care of one’s body, being determined not to give in and

having a positive attitude. Janet thought,

the ordinary things that are everyday, you haven’t got to do them in a boring way.

You can do them creatively, interestingly and some new life out of them because

they give you life…that’s what I get my energy from, doing new things. I feel

energized by, always doing something different.

June at 83 and legally blind continued to go to the gym. She said she needed to stay

active or “your mind gets so sluggish.” She recommended eating well also. Marguerite’s

key was almost a mantra, “I don’t give up.” Lorna found she was best when she adapted

her abilities to her age though she admitted she was not doing so gracefully. Mena stated

that reducing the stress in one’s life was a good way to “live longer.” And, Nancy

recommended, with tongue in cheek, that if you were at a good age, “hang on to it.”
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Different Actions the Participants Would Take with Regards to Aging

Tough Ceil mentioned that she would not have changed her life one iota. Yet, she

also wished that they had been in a better financial position to travel more. Herb did not

enjoy traveling as much as Ceil. Ceil stated, “I thought, ‘it’s endless.’ I can’t do it now,

but when we work very very hard and earn the money to do it, we’ll be able to do it. And

that time never came.” Herb did not see how he would have done anything differently.

Except maybe to have moved to New York and lived on Long Island when an

opportunity in optometry had come his way. Yet even now he could not stand the

thought of being near to New York City. Marguerite echoed Ceils desire to have traveled

more and added that she wished she had saved more money.

Mena stated humorously that she would have invented a stopwatch to pause time.

After her joke, she stated very practical actions she would have done if given the

opportunity again. “You might take better care of yourself. You might exercise more.

And you might not say, ‘Oh, I don’t want to go. I’ve got this to do.’” She then

paraphrased a poem that she had read over the internet.

She would have used that…sexy nightgown had she known and not saved it. And

not saved the china for a special day because sometimes that special day never

comes…she would have gone with her friends…and the heck with the dishes.

Mena added, “We think we have all the time in the world…and we don’t.”

If she could do something differently, Irene stated she would have “liked more

schooling.” In this way she could have been able to work earlier in her life, been more

independent and then she could have “been freer to say, ‘go to hell’ if I had to. I wish I

had had the ability to be more independent during my marriage.” Lorna was less reserve
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with the number of things she would do different. “Yes, there’s always things you could

have done differently. Anytime wasting time, over sleeping too much or opting out” of

doing things as well as keeping in better physical shape. Bernice, June, Nancy and Janet

stated they would not have done anything different in regards to aging. Janet stated, “I

think I’ve prepared for it very well by having a lot of interests. That’s the secret.”

Tell the World about Aging

Lorna liked to tell people in regards to aging to “take heart.” She said it was hard

even for her sometimes as she aged. Marguerite said that people needed to recognize

early that they were aging so it did not suddenly surprise them. June offered this advice,

“take every possible opportunity to do anything differently that comes along…not just

getting into a grove.” Janet would have everyone “live life to the fullest…enjoy every

minute of it…just love everyone.”

One of the keys to maneuvering old age was adaptability. Ceil stated when things

change one had “to go on a different path.” Janet changed occupations when it was too

much for her to continue to care give. June had to learn how to use a computer for the

blind. She commented, “change happens all the time really…it doesn’t come smoothly.

It comes suddenly into your life and you have to adapt to it somehow.” Marguerite stated

“people really go to pieces” when they were not able to be adaptable to the changes

associated with aging. Bernice and Irene wanted people to know when it comes to aging,

“it ain’t too bad.”

Aging as a Concept or Attitude.

Two of the participants specifically pointed to age as a concept or attitude rather

than a chronological number. June said, “don’t think you’re old…You are not old until
 85

you jump in a hole you might say…until you feel you’re old….it is all in how you relate

in your mind. How you think of yourself.” Janet said, “That’s what it’s all about is your

attitude. That’s that’s for sure. I’m positive of that…the way you live life as a result of

the way you look at things.” Janet told the story of a friend who complained about

everything. “She’s ten years younger than me and she’s really old.”

Inner age. Even though the other participants did not comment directly on aging

as an attitude, all but one stated the age they thought of themselves (their inner age) was

different from their external (chronological) age. Ceil (74) reported an age that was the

youngest amongst the participants by stating, “my spirit is probably in its 20s. I don’t

feel spiritually any sense of aging. I feel constricted and confined by the outer part of

me. My body that won’t cooperate.” Ceil also stated, “I think no matter how much

physically I may be impaired, I still have an inner life that’s very wonderfully working all

the time. And in my mind I am everywhere. You know, I just can mentally transport

myself.”

Bernice stated, “I can’t believe I am 82,” then reported she feels “60, 65.” It was

a time in her life when she was taking courses and was very active. Irene quipped that

her inner age “depends on the day it is.” Bernice elaborated in jest, “depends on how the

arthritis is.” Irene (71) agreed that her inner age was around 60-65. Janet (80) stated she

feels about “60 or 50. That’s how I feel but I know I’m not. The body tells me I’m not,

but the head tells me I’m about 50 or 60.” Marguerite (84 ½) stated she felt almost 35

years younger then she was. “I have a young heart.” She placed her inner age at “40.

43.” Nancy (94) never thought about her age until she had to go to the hospital where

they were inconsiderate enough to ask a person their age “every ten minutes.” June (83)
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felt “not spry but middle age.” She continued, “Yes…I am feeling quite young inside.

About 40-50, I’d say.” June said that was the best time for her, the “very best age to be.”

Herb (81) felt his internal and external age were in sync but the discrepancy

between his aging process and other people’s was not lost on him.

Herb: I remember when I first started practice and I would see someone who was

65…

Ceil: You thought they were ancient…

Herb: Ahhh, my God…and then when I turned 65 I was still in full practice. And

I’d see some guy come in….ahh…barely walk in, sit down. I’d look at him and

I’d says, “God, this guy has got one foot in the grave.” I says, “how old are you?”

And he says, “oh, God, over sixty years old.” I says, “I’ll keep my mouth shut.”

And when I got to be 70 and 75 and still working and this people would come in

their sixties and complain me about their age and all. It’s funny, and when I read

in the paper and I see people dying at 55 and 48, I look. It’s amazing. How the

hell did I get this far?

Mena (75) reported that she felt 40-43. “I tell my doctor, you know, the mind and

body don’t work together. Mind you’re thinking young, but because you are not in the

best of shape sometimes…your body isn’t working or doing what your mind is telling.”

Mena added, “We always think younger. I still look at the good looking guys. I might

flirt a little bit.”

Lorna (72) did not specifically state an inner age but felt she related well to

people of all ages. She did acknowledge the idea of an inner age but framed it this way,
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Well the truth is from the time of your own conscious awareness of yourself, it is

the same person all the way through, you know? And I know other older people

say, “I'm so young inside,” and of course it doesn't mean young physically in

body it means I'm still the same being that I became aware of when I was three

year old and I remember being five and starting school. I'm still that person.

Lorna saw the discussion of inner age as more of a discussion of a person’s inner

conscious awareness of herself, an inner self that was different from one’s chronological

age.

Benefits of Aging

The difference between one’s inner and outer age was seen as a benefit of aging

or at least a clue to aging well. The participants reported other benefits to being older

including freedom. Irene enjoyed “freedom from responsibilities. You know, you don’t

have to take care of children.” Bernice added, “she doesn’t have to take care of her

husband anymore. He was very demanding.” Irene continued,

There are a lot of benefits. You can sleep when you want to. You can wake up

when you want to. You can go to the…I have a lot of advantages where I am

living because I have a club house and a swimming pool and a spa with all the

equipment. So you can do all these things and if you can get into a couple of card

games at night. And, watch television what you want to watch or read a book all

night if you wanted to. There are a lot of pluses. Nobody says, “Irene go to

sleep.” I use to hear that from my husband all the time.

Bernice added, “she found herself.” It was unclear if Irene’s self-discovery was related to

her husband’s death or to Irene’s aging process but likely it was some of both. Janet
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enjoyed the freedom to make her own plans for the day. Upon reflecting, she

acknowledged her “tremendous freedom” and remarked, “I just take it for granted I

think.”

Other advantages mentioned by the participants were getting a seat on the bus,

buying clothes they wanted, “spending my children’s inheritance” (mentioned in jest),

going to the movies or theater as one wanted, doing activities within one’s budget, having

the time to do new projects and to start new interests, being able to pay more attention to

nature, having a richer spiritual life, having more appreciation for sports, being in contact

with different people (namely doctors and nurses) and dressing as you like. Janet saw an

additional spiritual benefit in old age. “I think old age is a gift from God to have time

before we meet him. I think we should use it well.”

Wisdom was mentioned several times as a benefit of aging though sometimes it

was mentioned as a shift in perspective leading to greater practical understanding of the

world, less anxiety, and increased self-confidence. Ceil and Herb related that when one

was younger, one could take chances but as an older person one saw how unrealistic

some things were. June referred to wisdom as having a “width of experience.” Janet

reported being less anxious. “I don’t worry about things as much as I used to. I’ve been

a glad worrier all my life. I used to worry a good bit but then I thought I have got less

things to worry about.” Marguerite agreed, “We realize that we don’t need to be always

hollowed up and anxious and you can let go and have fun.”

Lorna stated she had gained self-confidence as she had aged and reflected, “If

you’ve got enough self confidence in the deepest sense, if you have enough knowledge of

who you are and you keep good heart, you can come to terms with the fact that we live
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life in our amount of time and that's about it.” June stated she “used to be very shy when

I was younger believe it or not. But not now….you just do what you want and say what

you want.” Janet then related these thoughts to her age,

Yes, I’ve got confidence in myself, even though I must look frightfully old…but

it doesn’t worry me anymore because you know who cares when you are that old

you might as well be who you are and not what someone thinks you should be.

In addition to the other benefits mentioned, Janet and Mena enjoyed blaming their

action on their age. Janet remarked,

I can do what I like. If you do something peculiar or funny, people think, “oh

she’s old. She doesn’t know any better.” And, you can wear funny things and

people think, “She’s peculiar.” I don’t care. I feel I can do what I want to do.

Mena enjoyed being “a little more outspoken” now that she was older. She told the story

of being in an elevator when a construction worker using the same elevator rolled in a

palette jack. To conserve space, Mena stood on the jack. She then turned to the worker

and asked, “Is this what you call ‘getting forked?’” Mena finished by saying, when you

were outspoken “You get to blame it to old age. ‘That’s what us old people do.’”

Societal Perceptions and the Impact on Older Adults

None of the participants were isolated but rather a part of a larger society in which

they had to function and interact. When asked about how they felt they are perceived by

the society around them, there were no differences defined by the different cultures of the

participants. Rather, the answers given crossed cultural and societal lines and were

unified by the experience of aging itself. This held true with one exception. Two of the
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three participants from New Zealand mentioned the number of older adults in the

population was a societal issue. Marguerite stated,

It’s a funny time now. Probably everywhere. Because there are so many older

people who don’t die and fewer babies being born. Therefore there’s a lot of

people going on in life or doing more in life than they would have done. And

there are not enough younger ones to hold it together. I mean it is very difficult to

get people to look after the older people.

Nancy said,

I haven’t been trying to think that people are living too long. And the lastest

census that there are more and more people in New Zealand living beyond a 100

years. That’s too long. I don’t think society is arranged…to accommodate

messes and messes of people of that age. They have to make way for the next

generation. We must. And let them get on with it.

Nancy reinforced Marguerite’s statement about how hard it was to get proper and even

non-abusive care for older adults.

Perceptions of the Participants as Old by Others

Ceil did not see herself as being treated any differently or perceived differently by

society. Even with her cane, she did not feel she was treated any way but normal. Herb

echoed Ceil adding a story about being discriminated against in the Navy and not

receiving job advances because he was Jewish. The story indicated Herb felt more

discrimination as a Jew in the Navy in his 20s than he did as an 81 year old man. Mena

also felt like “just one of the crowd…Just another older lady walking around.” However,

Mena later told a story about dancing at her granddaughter’s wedding. When she was
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ready to leave, four people helped her down the stairs to her car. It upset her because it

was more of a hassle than needed. She remarked, “God, I mean I was up dancing. And

they’re treating me like a helpless invalid.” So even though she did not mind being seen

as “another older lady” it did bother her to be seen as an “invalid” because of her age.

Janet felt she got along well with younger people, better than older adults most of

the time. However, she thought people in their 20s probably, “just see an old person and

they just put you in a category…they categorize you as being uninteresting and set [in

your ways] and all those things. I think that’s how young people see you.” Lorna agreed,

“The people in the culture, people who don't know me, when I'm not crossing the road or

going up steps will see me as an older, an older lady.” She believed that society probably

did not want older adults. However, Lorna acknowledged people who got to know her

probably saw her “as a withered person who can make meaning.” As Lorna was a

counselor, being seen as a “person who can make meaning” was equivalent to being seen

for who she really was.

How Participant Feels about Being Seen as Old

Irene realized she was being seen, not as she really was, but as “old” when

someone gave her a seat on the bus. “It’s demoralizing.” Bernice was not offended as

she knew she needed the seat on the bus and even asked for it sometimes. June stated

when it comes to being seen as old “I don’t mind because I can’t see myself. I can’t see

what young people see. So in my mind, I am the same as when I was young to look at.

But, I know I am not really but (since I cannot see in a mirror) I don’t know what I am

looking at.”
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In regards to how she felt about being viewed as old, Marguerite stated it was

most obvious when “some people look down on older people…They even know they do,

but they say, ‘well how are you dear? How’s it going…Oh, well done.’” She stated it

was “condescending” and “patronizing.” She added, “It’s not vicious. It’s not bad. But

it’s not at all that they’re aware.” Marguerites stated, older adults felt “squashed.” She

did not like it when people came in and “immediately start doing thing for you.” She

knew she could not do some things but this did not mean she wanted everything done for

her. “What I am able to do I want to go on and be able doing.” Marguerite said when

people “come in who sweep right over you and do it and do it and decide all for

you…and skip past [you],” it made “you feel light,” “rather silly, rather lonely, a bit

stupid,” and “feeling perhaps they’re right. Perhaps, I should just give up.”

Connectedness

Though the word “connectedness” was only used once by Ceil, it was a theme

that prevailed through much of the data. It was talked about in connection to family, to

friends, to people in the community, to humanity and to something larger than one’s self

was important to all participants. Further, it was this feeling of connectedness that added

meaning to the lives of the participants and helped during the aging process.

Ceil’s commented early in her interview,

I think my love of people, my connectedness [author’s emphasis] with people of

all ages stems from that experience of so young being in the mix of all, you know,

all these people that would come into the store and go out.

Ceil’s “connectedness” continued through her life. She continued to go out to eat every

month with a group of people who graduated from Salem State College with her almost
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50 years before. Once a year since college, they have spent a weekend together on Cape

Cod. Over the years, Ceil had made friends with priests, outcasts, homosexual men,

AIDS victims, families of the victims, and people singing around a piano bar to name a

few. Ceil felt connected still to the mother of the AIDS victim who wrote her on

holidays. “I know that I am the only link she has to her son that has passed.” Ceil said

she was the only one that understood what was happening at a time when this lady could

not tell her neighbors her son died of AIDS. “That wouldn’t have, you know, gone well.”

Ceil mentioned fondly the priest she worked with on AIDS Project North.

I gained a wonderful life time friend. I mean to this day, you know, when we see

each other, there is that special special connection. He’s such a fantastic guy. But

he can’t be himself in the community. He has to conduct himself in a certain way.

So even though he’s beloved by his congregation, it’s not the same as when you

want to hang out and just be.

Ceil delighted when singing with others at The Front Porch (a piano bar in Ogunquit,

Maine that Ceil and Herb frequented). Though she did not do it purposely, she was

connecting even there.

I’m singing and I see other people and it just happens. It’s not that I put my sites

out on one person or anything like that. It just is a spontaneity that comes and a

feeling of joy that is better than any med…I am just in heaven. I am just in my

happiest place to be at that time. So when my time does come, we are gonna have

to change the orthodox rules because we are not supposed to have music at a

funeral. But I want singing.

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Ceil had met “the most wonderful people” at the Front Porch. Every season there were

one or two people she ended up “chatting” with and “finding out more about them.”

Though these serendipitous meetings might have seemed random and by chance, Ceil

believed there was something greater going on. “I choose to believe that’s not by

accident. That’s what I believe. It is not by accident.” Whether the meeting with the

person turned out favorably or not Ceil said, “I believe it is ordained.”

I believe people come into your life…at a certain time in the course of a lifetime.

And you have a commonality. You have something that clicks. And now

sometimes you learn from the situation where you gave your all and at the end

there’s great disappointment. That happens. There are people that you meet that

are then life time friends and there are many many more of the latter. Many more.

Ceil felt connected by friendship, spiritual awareness, community and humanity to the

world around her. Music and her inner spirit were firm connectors to the outer world.

“I’m very content and feel very good about the friends I have made. And I have learned

so much about humanity. We are kindred.”

Herb stated they had a lot of friends whom they have met, “Years will pass and

when we meet again, it’s like we were there yesterday.” Yet, Herb was more pragmatic

in his view of friendship and connection. “I think also that, instead of coincidence, it’s if

you have your eyes open to what you’re looking for. The antennae are up and you’re

aware.” Herb then told a story of when they were furnishing their home. After the house

was completed, he happened across a renovation site down the road and saw four legs

sticking up from the piles of debris. He asked the workman and they were throwing it

out. As it turned out, it was a Victorian style chair which Herb had reupholstered and put
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in his living room. In much the same way, he told of a captain’s desk which he also

found and refined. Herb used these stories of items discarded by other which become

treasures to show how one person saw things that were barely visible to others. One just

needs to look with one’s “antennae up.” Herb stated they had acquired many friends this

way. Herb said they know so many people that they have actually met people who know

the same people. “So now we got friends who know friends.”

Mena also enjoyed people. “You know, you need someone to talk to.” Mena

stated later, “I think that’s why, one reason I went to work too. So I’d have somebody to

talk to, because you need adult companionship. Whether it’s constantly or just now and

then, you know.” Mena added, “I like volunteering. I like going in seeing the people I

use to work with…I get all kinds of hugs when they haven’t seen me for a while. It, it’s

just nice.” Besides, “I’m going to be without people when I’m dead. I’m with people

now. I want to be with people. I’m a people person.”

Bernice stated her “grandson calls once a day or so. My door is never locked.

She [Irene] just walks in.” Bernice wanted more connection with her grandchildren.

“They still love me so much. They don’t keep in touch that much. But, you know, they

have their own lives.” Marguerite enjoyed and desired more connections in her life.

Nancy very much enjoyed people and talked proudly about her theater and speech

students whom visit her even 12 years after their classes.

Janet remarked, “I love having a party. I love that. Luckily we have celebrations.

That’s the best thing. Having a good party and everyone coming and enjoying

themselves. I love doing things really for people.” Janet liked to stay connected to
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people whether through parties or sending cards or making phone calls. “I’m a good

communicator.”

Part of connectedness that was mentioned was connecting through touch. Nancy

stated that physical contact had increased in importance as she has aged. Her mother was

keen not to give any physical affection or verbal praise so Nancy would not become

“swollen headed.” Now that there were less people around, the desire for meaningful

hugs had increased. June stated affection had changed “in a way because you don’t get

as much of it, especially when you are a widow or widower. People don’t seem to touch

you much.” Besides, “you don’t seem to have as many contemporaries as you had

before. You’ve got practically none by the time you get to my age.”

Meaning and Purpose

Under the umbrella of connectedness came the sub-category of meaning. The

need for connectedness in aging was fueled by a desire to have purpose in one’s life and

to be meaningful to others. Bernice explained it this way,

The problem when you get old is you have a tendency not to be wanted, not to

feel wanted. Like you have no purpose in life. And in Florida, I found that

because older people sat around and played cards all day and to me it’s a waste of

life….I just keep going as long as I know I am helping.

When her daughter, living in Israel, was killed by terrorists, Bernice moved from Florida

to Jerusalem so she could be more present in her grandchildren’s lives. Bernice painted a

grim picture of older adults who did not have meaning in their life, “when you’re older,

most people have nothing to do. A lot of seniors commit suicide you know.” Bernice did

not know of any personally though. “So it’s good to feel that you’re wanted. And it’s
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good to be busy. I can’t stay at home because there is nothing to do in the house except

clean.”

Irene carried the need for meaning into her discussion about daily living, “I think

you have to have a reason for getting up in the morning, too.” Irene saw the need for

meaning to be prevalent everyday.

I could lie in bed sometimes…if I don’t have any plans, if I don’t go to class…I

can lie in bed until 9 o’clock. And then I figure what am I going to do when I get

up? So that’s why I make sure Ollie and them lots of times go to the museum on

Tuesdays so I get up and go some place. But you have to have a reason for

getting out of bed in the morning. And that’s why I am going to classes not

because I want to be studious or something…I am going because it’s a way to get

me up and out. Once I’m out I’m out. I go to class. I meet somebody for lunch.

We do something. But otherwise if you get up in the morning and you have

nothing to do…I mean clean house, forget it.

Herb loved to be over his son-in-law’s Ceil noted, “the more projects that Frank

does, he loves it. He’s over there. You know, instead of being here, he’s doing it over

there.” Janet kept meaning in her life after retiring by volunteering as did Mena. Mena

continued to volunteer at the hospital she did administration work. Janet volunteered to

look after a community center once a week, along with babysitting for the people next

door, baking scones once a month. Lorna stated she will never be ready to do nothing

and her continued work as a group counselor was very meaningful to her.

Gift to the World

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In closing off the interviews, the question was asked, “If you could give a gift to

the world, what would you give?” The participants reflected and then responded with

answers that reflected their continued “connectedness” to the world.

Ceil wanted to give the gift of “tolerance for every man. Tolerance.” Herb

wanted the world to have “people accepting other people in spite of their differences.”

Mena wanted to give “just the advice to keep peace. Try to get along. Treat others as

you want to be treated. Be nice to everyone because you never know whose relative

you’re going to run into.” Bernice wanted to “shoot all the leaders” and then she

softened her answer by stating she would just “get rid of the stupid leaders.” Irene

wanted to “wipe out poverty.” Lorna wanted everyone to learn “to love themselves in a

very real way, accept the love of the universe, live every moment and look after yourself.

Go for it.” Marguerite wanted to give unity, understanding and openness. Nancy wanted

to settle things (between countries and superpowers) verbally rather than physically.

Of all the participants, June was the only one actively working to make her gift

happen. She wanted to give the world a charitable trust to research the retina “so people

don’t have to go blind.” She continued to edit an on-line newsletter to create awareness

for macular degeneration, blindness due to genetics and retinal damage. “So I am trying

to do a little bit.”

Janet summed up the offerings to the world by stating she would give “Love, I

think. I think love’s the most important thing in the whole world. I think love is what

makes the world go round because without love we have nothing.”

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CHAPTER 5

Discussion

As the literature review pointed out, many factors contributed to stereotypes on

aging (Woolf, 1998b). The basis of these stereotypes have been external (imposed by

society) rather than informed by the lived experience of elders themselves (Hess &

Blanchard-Fields, 1999; Woolf, 1998b). Yet when reviewing the participants’ stories on

aging, many topics discussed aligned with the stereotypes that were discussed by

Edelstein and Kalish (1999). For example, aging was awful (Mena “hates” aging,

Marguerite said it was not for “whimps,” Janet found it “frustrating”). There were

physical disabilities and ailments associated with aging (Ceil had two strokes in eight

months and suffered with dsytonia, Herb had intermittent claudication, Bernice’s teeth

were infected, Nancy was sent home to die). Older adults were slower (Herb needed to

stop more while working, Janet noted a lack of energy, Bernice had days she could not

walk to the bus stop). Older adults talked about death and associated aging with death

(Mena saw herself as the next to die, Herb and Ceil recounted many stories of people

who were dead, Nancy welcomed death). Older adults were depressed and lonely (Mena

spent much time alone in her apartment, Bernice and Irene desired their children to

contact them more, Lorna lied to herself so as not to have to grieve about her age). Of

course, none of the participants stated that aging was wonderful, but they did say there

were benefits: wisdom, the ability to speak one’s mind, freedom to do what one wanted,

the freedom to make one’s own choices, having time to appreciate things and go to

events, decreased anxiety, increased confidence and a greater perspective. So though old

age had its challenges, as Irene said, “it ain’t too bad.” Though elements that contributed
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to stereotypes about aging were contained in the experiences of the participants, two

topics emerged and were looked at further, connectedness and old was an attitude - age

was a concept.

Connectedness

Connectedness or feeling connected to others and to society was a theme that

surfaced in many forms. When “listening with different ears” (Warnick, 1995) and being

vulnerable observers (Behar,1996), a possible connection was seen between how

intensely these participants talked about being connected to the people in their life, past

and present, and their attitude towards the aging experience. Ceil talked a great deal

about the people she knew and still felt very connected to many of them even though they

were separated by distance or death. This connectedness filled Ceil and allowed for her

to be “content.” Herb also felt connected to the people he had met and to his family. He

was at ease with his present age and continued to be active in his early 80’s. Janet was

always looking for reasons to connect with people and saw her present life in the positive.

Bernice knew her family loved her but wanted them to connect more with her. She was

ambivalent about her present age, enjoying what she could but also stated, “Well the

alternative [death] they say is bad…but sometimes when you don’t feel so good, the

alternative is good.” Nancy enjoyed her past students who still visited her but felt her

daughter had to do too much for her. She felt she had lived “too long.” Mena reported

having limited friends throughout her life and having distanced herself from a friend over

the past several years. Mena stated she “hates” aging. To say that there was a direct

correlation between connectedness and participants’ attitude on aging was not totally
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accurate, but there was evidence in the data that feeling connected played a role in these

participants’ ability to be content with their present status.

Death and Connectedness

Death was not seen with fear. It was just another topic of conversation. Bernice

mentioned it off-handedly as “the alternative” which on some days did not seem so bad.

Nancy approached it directly when she stated she felt she had been alive “too long” and

“I don’t feel a loss for dying. Why would you be afraid of dying for goodness sakes?”

She elaborated, “I mean all plants die, trees die, everything dies.” Janet’s statement about

her order “fading out and going off” paralleled Nancy’s thought on aging. Janet stated, “I

don’t feel sad about that. I feel we did what we had to and we were there at the right

time. And now it’s time for us to fade away and a new era will begin.” Marguerite stated

there were too many older adults for the young people to take care of properly. Of the

participants who mentioned death, only Mena mentioned she did not want to die. She

wanted to be around to see all the generations coming after her. For the other

participants, death was represented as a relief, a transition and a time of moving on so the

next group could move forward. Death was even considered socially responsible by two

New Zealand participants.

The fact that death was mentioned was not surprising as societal conception was

that older adults talk about death because it probably was the next significant event in

their life. What arose from the data was the casual nature in which death was mentioned.

Fear of death generally caused many people in society to avoid the topic, to use

euphemisms, and to avoid situations that brought them in contact with death or dying

unless absolutely necessary. By contrast, the participants who talked about death did so
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without hesitancy. It was matter of fact. The participants seemed to have an acceptance

of death as part of their lives.

In people younger than the participants, it might have been considered depressive

thinking to engage in thoughts about death. But as the next major life event, death for

these older adults was a reality. Some of the participants had resolved this and were not

afraid to die. These statements appeared without depression, sadness or depressive

thinking. Having the ability and freedom to engage healthily in the thoughts of death,

some of the participants had added meaning such as: social duty, being with God and

being one with the cycle of nature.

Being comfortable with death as a natural life process was seen as different from

being comfortable with death as a wish or desire. Nancy believed she had lived too long

and anticipated her death. One could easily see signs of depression in Nancy’s statement

and there were certainly evidences that she might have been. However, the belief that

discussing one’s death was a natural part of aging and/or that depression was a natural

part of being older lead to misdiagnosing (Lasser, et al., 1998). Thus, it was observed

that a counselor must look at each older adult individually to work towards proper

assessment.

Another point was the distinct difference between the data and the concept

proponed by Cumming and Henry (1961) as summed up in the title of their work

Growing Old: The Process of Disengagement. At first look, the focus on and acceptance

of death by the participants might have been seen as withdrawal from life and from

society on a whole. This movement away from society would be the disengagement

which Cumming and Henry stated was a natural part of the aging process. This point was
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especially present in the two New Zealand participants who believed they were doing

society a favor by dying. Cumming and Henry (1961) could have used this belief as

proof of their theory. For, Cumming and Henry stated death was the ultimate form of

disengagement from society and life. In the accepting of death, one was making room for

other people. When one was settled with that fact, one was “free to die” (p. 227). “The

ability to disengage” increased the emotional state of the older person (p. 209).

Though the discussion on death by the participants might have seemed to

correspond to Cumming and Henry’s (1961) work, an essential difference existed. In

Cumming and Henry’s work “morale” was achieved by the older adult who disengaged

well. In other words, older adults who accepted the role of disengaging from society had

a better sense of self. By contrast, the participants in this dissertation found their sense of

self (their morale) in their connectedness to others. Even when they talked about their

deaths, they talked about the connection it had to the society, to the universe, and to God.

Unlike the disengagement views proponed by Cumming and Henry, the participants of

this dissertation ultimately showed the acceptance of their death coincided with a sense of

their societal, natural, and universal connectedness.

Purpose and Connectedness

Dr. Bill Thomas (1996) stated older adults did not die from old age. They died

from loneliness, helplessness and boredom (p. 23). Loneliness was described as not

feeling connected to other people (connectedness). Boredom was a lack of spontaneity in

a person’s life. (Mena described her life as boring.) Helplessness was not the feeling of

being helpless, but rather it was the feeling one had when one was unable to help others.
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It was not having a purpose. Bernice: “I think the hardest part about getting old is that

you can’t do anything and your family doesn’t have time for you.”

The reason loneliness, helplessness, and boredom rage out of control is that they

are difficult to define in medical terms. Although they cause the bulk of

suffering, their roots cannot be traced back to an imbalance of the metabolism or

of the psyche. A survey of leading geriatric textbooks reveals that loneliness is

accorded less than a paragraph at best. Helplessness and boredom are not

mentioned at all.” (Thomas, 1996, p. 24).

Thomas and the participants of this study coincided. Being connected to other people

was important; being useful (having purpose and meaning) heightened the experience of

connectedness.

Old Was an Attitude - Age Was a Concept

In the pilot study for this dissertation called Three on Aging: A Qualitative Study

on Aging as Viewed by Three Elders, it was discussed that the data concerning influences

on aging well pointed to the following possible connections: (a) socio-economic levels,

(b) spiritual backgrounds and practice, (c) regions of one’s birth, childhood, adulthood

and elderhood, (d) positive and/or negative life experiences, (e) concepts of life and/or

death, (f) freedom of movement and (g) gender. “Aging well” in this case was considered

to be having a better experience with aging. The discussion section from the pilot study

on this topic read as follows:

Each of these areas seemed to correlate to a better or worse experience with aging

for each participant. Ceil and Herb were upper middle class and had a more

favorable view of aging. Mena self-described as poor and disliked the aging
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process. Ceil and Herb were more connected to their Jewish heritage. Mena was

not connected to her spiritual and/or religious background. Ceil and Herb lived in

larger wealthier towns. Mena lived in smaller, poorer towns. Ceil and Herb had

many stories of positive life affirming experiences, whereas Mena talked about

the harshness of her life and her marriage. Ceil and Mena discussed the death of

their mothers but only Mena mentioned the potential nearness of her own death.

Ceil and Mena were restricted in their present movement as they did not drive.

However, Ceil had had a lifetime of free movement, going to New York City

whenever she wanted to or was called to go for work. Mena had had limited

movement during her life and at the time of the interview. Ceil and Mena,

(females) both identified themselves as having different inner ages than physical

age. Herb (male) had an internal and physical age that matched.

Adding the research from the additional seven participants in this study to the three

participants who were also part of the pilot study, the data did not clearly support any of

the factors mentioned as a possible determining factor in aging well above except

freedom of movement. A variety of answers and attitudes were expressed which did not

favor one socio-economic level, spiritual backgrounds or practice, concept of life and/or

death, or positive and/or negative life experiences. As the participants were from four

different countries yet expressing the same thoughts on aging, regions of one’s birth,

childhood, adulthood and/or elderhood did not seem to influence one’s concept of aging

more than another. As Herb was the only male participant, no additional data was

gathered to inform the impact of gender on aging well. The new information did not
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mean these topics were not influences but rather that they were not as clearly defined

factors as were observed in the pilot study.

Freedom of movement was the exception. This topic had a great impact on the

participant’s attitude on their present situations. Whether the limitation were physical,

transportation related or both, the ability to move around freely impacted the participants

and their attitudes about aging. Ceil’s dsytonia made it painful for her to walk around.

Janet found the lack of energy “frustrating.” Bernice had days when she tired getting to

the bus stop. So even though there was good public transportation, she was unable to

access it at times. Nancy had a help aid who drove her around and did errands for her.

Being attended to made Nancy feel like a burden. Mena did not drive and relied on

others to take her to her appointments and out for shopping. This had been a factor

through her whole life but particularly harder now that she was not able to walk as far.

Marguerite was able to drive but had a hard time walking to the car. Restriction of

movement impacted all the participants’ concept of aging.

The participant’s experiences corresponded to research done on the impact of

decreased mobility on elders. Social integration was negatively impacted by driving

cessation (Mezuk & Rebok, 2008). Physical limitations affected the distance from home

an older adult traveled while cognitive abilities did not (Bendixen, Mann, & Tomita,

2005). Increase in interpersonal dependency correlated to an increase in depression and

mobility problems (Gardner & Helmes, 2006). Meaning, the more one needed other

people because of physical limitations, the more likely one was to develop more physical

limitations. Thus, a frustrating vicious circle was observed.

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Though most of the topics of influences on aging well from the pilot study did not

coincide with the results of this study, a greater theme grew out of the combined data. It

was not so much economic or physical abilities or life experience that created a better or

worse old age. It was the participant’s attitudes about those factors that impacted their

aging experience. It was the meaning they gave to their lives that supported or drained

their present experience.

Meaning and Attitude

Ultimately, it was the meaning the participant had about life in general and about

their present situation that aided in their feelings about their present age. Janet stated,

“that’s what it’s all about is your attitude.” Janet recalled when her father was dying.

He was lying there for weeks and it was very difficult to watch him. He was only

seventy-four and I remember back in the day I thought he was really old. He

wasn't really old at all, he was quite young. I don't think anyone's old now unless

they're ninety. That's the age of being really old now you know? Someone says

they're really old and I say, “How old?” then you find out and I say, “That's not

old.” They say, “They're sixty,” and I say, “No!” So you've got to be over ninety

now for me to say you're old but if I get there I might still feel that's not old either.

Janet’s perception of her father’s age was he was “really old.” He was dying. Now that

she was 80 years old, 74 was not old at all. In fact, 90 was “old.” But, she acknowledges

that when she arrives at her 90th year she “might still feel that's not old either.” Old age

was a concept that was fluid and changed. One was as old as one thinks. This concept

was very apparent when the participants discussed their inner age.

Inner Age
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Inner age was defined in this study as the age one perceived one’s self and

physical age was the actual number of years one had been alive. The concept of an

“inner age” surfaced in one of the early interviews and was followed up on in subsequent

interviews with other participants. Though the term “inner age” was not familiar to the

participants, they understood what was meant with minimal explanation. Ceil (74) stated

she felt 20 inside. Mena (75), Marguerite (84 ½) and June (83), all stated they were in

their 40’s internally. Janet (80) said she felt 50-60. Bernice (82) and Irene (71) said their

inner age was in their early 60s. Neither Lorna (72) nor Nancy (94) gave a specific age.

Herb (81) was the only participant who felt internally in sync with his physical age.

Thus, seven of the ten participants perceived themselves as being anywhere from a

seventh to a quarter of their actual age. The average age of all the participants was 79.7

years. The average inner age of those who responded (using 20 for Ceil, 43 for Mena,

Marguerite and June, 55 for Janet, 63 for Bernice and Irene and 81 for Herb) was 51.4

years. If one removes Herb as the male from the equation, then the average inner age of

the respondents was 47.1 years. Meaning, the participants felt about 30 years younger

than they were.

A search in Academic Search Premiere under “inner age,” “inner age and older

adults,” “external age,” “external age and older adults,” “psychological age” and

“psychological age and older adults” turned up studies about the “inner ear,” “inner-city,”

and “internal tibial torsia.” A search on the internet pulled up a quiz to find out what was

one’s internal “physical” age (or rather the health of one’s body). No research or articles

were found on this topic. The phenomenon of inner age as described in this study has not

been well studied (or studied at all). Yet, the implications of inner age on societal
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treatment of older adults could be dramatic. If instead of treating elders like they were

decades older then they were, society treated elders according to their inner age, then

there could be a shift which could have major implications for the societal reintegration

of older adults. This studied understood it might seem out of sync to treat an 80 year

old as the 40 years old they feel inside. However, society has already exhibited a

disconnection between an elder’s age and the age they were treated. For example, many

elders were treated as if they were 120 years old at one end or mere children at the other

end, too old to do anything and too childlike to make their own decisions. Since treating

elders as a different age has already been a societal reality, then treating elders according

to their self-declared inner age could be potentially positive for elders and society alike.

Self-perception of Being an Older Adult

Since the participants did not see themselves as being as old as they were, none of

the participants spent time ruminating about being old. Additionally, they did not spend

time thinking if others see them as old. The only time they reported thinking they were

old was if there was a physical challenge present. Even then the thoughts were that the

ache or pain was from a physical ailment, not from being old. For example, Ceil in

commenting about her stroke could have said she did not want to be seen as “old.”

Rather, she stated she did not want to be seen as “being sick all the time.” Even though a

stroke could be considered linked to her age, Ceil’s consideration was not to be seen as

“sick.” Being seen as “old,” was not part of her thinking because she did not see herself

as old. This held true for all the participants. They were not old. Old was the person

down the hall.

Old Was Someone Else

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When asked what was “too old,” Ceil and Herb stated it was when “you can’t take

care of yourself…and you’re a burden to other people.” Mena agreed “too old” was

having physical limitations, being “stooped over” and “walking with a walker.” Ceil and

Mena did not see themselves as “too old.” Herb at 81, whose inner and physical age he

reported as being the same, did not consider himself “too old.” June had sympathy for

the others down the hall from her whose minds were “not working anymore.” They were

“too old.” Even Nancy at 94 years old and who felt she had lived “long enough,” still

placed “too old” as an age beyond her present one. She stated if she reached 100 years

old “that would horrify me.” For all the participants, old was someone else. The idea did

not seem to be a disconnect between the participants and reality, but rather a viewing of

“oldness” as linked to one’s physical well-being instead of one’s physical age. Herb

stated that there were people coming to his practice that considered themselves old at 65

while Herb himself was 81.

The heightened self-concept expressed by the participants was in line with

Pinquart (2002) who observed older adults, when given information containing negative

old age stereotypes, exhibited a lowering of their perception of older adults while

showing a heightening of their own self-concept. Pinquart postulated older adults used

the negative stereotype as a baseline by which they were vastly better. In the same way,

the ten elders in this dissertation study did not self-identify as old. They understood they

were getting older, but did not see themselves as old yet. Their inner age and the

physical condition informed their concept of old and it was clearly someone else.

Attitude and Concept

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Attitude was defined as “a settled way of thinking or feeling about someone or

something, typically one that is reflected in a person’s behavior” (Concise Oxford

American Dictionary, 2006, p. 51). The following example from Janet linked this

definition of attitude to being old.

It's all about your attitude. That's, that's for sure. I'm positive of that. It's the way

you look at things and the way you, the way you carry out that looking at things.

The way you live life as a result of the way you look at things. If you look at

things in a negative way and you look at things in a non positive way that's what

life is for you. It's just negative. I've got a friend who'll be completely nameless

who is, for who nothing is right. We'll meet and go to town and she says, “It's too

windy here, there's a draft here.” So we move over here and she says, “It's too

glaring.” We move over somewhere else and it's something else and I think, “My

God, how can you live like this?” You know? Or if we go away together nothing

is right. You know? Nothing is right. There's something wrong with the window

and there's something wrong with the door. Now no wonder you get old. She's

ten years younger than me and she’s really old.

Janet’s friend whose attitude made her old gave evidence to Ron’s (2007) study,

which found there was a correlation between an older adult’s attitude towards old age and

their subjective description of having bad health. Blazer (2008) reviewed 30 years of

studies searching for the impact of self-perception on older adults. He concluded “we

have yet to learn in what ways unfavorable comparisons contribute to health outcomes,

but I believe that we have accumulated enough evidence from studies…that we should

explore the possibilities further” (p. 421). Negative attitudes toward aging impacted
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older adult’s overall sense of well-being (Lai, 2009). Thus, Janet’s friend’s negative

attitude lead to poorer concept of her health which potentially lead to poorer health which

lead to a poorer overall sense of well-being which lead to intensified negative attitude.

Janet’s friend was thereby caught in a vicious circle and had become old.

Concept was defined as “an abstract idea; a general notion” (Concise Oxford

American Dictionary, 2006, p. 186). It has been discussed that one’s age could be

internally influenced by one’s sense of self rather than the number of years one has lived.

This inner age was understood to be “an abstract idea,” “a general notion,” a “concept.”

June agreed that age was a “concept…now a days people much younger than 60 or even

50, they can start getting old. Depends on what happens to them.” She continued, “don’t

think you’re old…You are not old until you jump in a hole you might say…until you feel

you’re old….it is all in how you relate in your mind. How you think of yourself.”

For the participants, old was an attitude - age was a concept.

Limitations of the Study

This study was not seen to be generalizable but rather was seen as a snapshot of

the experience of these ten people ranging in age from 71 to 94. It told only of their lived

experience. It started the process of context-driven inquiry which could give voice to a

growing population of older adults with concerns, experiences, and diversity.

The snowball method of finding participants for this study contributed to the

homogeneity of the participants. Even though participants lived in diverse parts of the

world, they were all Caucasians from European descent. People contacted to help find

participants referred to people of like backgrounds who then referred to others of like

backgrounds. Though a cultural diversity of participants was sought, the snowball

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method limited the potential multiplicity of cultural representation that a proactive

approach might have achieved. The study could be strengthened and deepened by the

addition of the voices of elders from African, American Indian, Maori, and Aborigine

tribes.

This study was limited by the lengths of the interviews. Two to six hours was

hardly enough time to mine the richness of a life. This study was only a snapshot of their

lives. Expanding the study to include several interviews with the same participants at

different ages, pre and post physical ailments and pre and post nursing home admissions

could provide a three-dimensional view on age and aging.

Even with the adjustments made above, the fact was the participants in this study

had not spent a lot of time thinking about their aging process. Though they spent time

during their lives thinking about “getting old,” they did not spend a lot of time reflecting

on “being old.” They were no more or less self-reflective now than they had been in their

lives. The information they presented was spontaneous. Thus, the data might not have

been as rich as it could have been if the participants had agreed to meditate and journal

about their age and aging process.

In addition, there was also no way to factor out the impact of ageism, self-

prejudice due to age, and the influence of negative old age stereotypes. Though the study

listened to the lived experience of older adults, none of the elders interviewed existed in a

bell jar in which ageism had been removed. The experiences reported were, thus,

contained within a society full of negative and positive ageist beliefs. Thus, the

participants reported what they think they knew about aging rather than the actual

experience. It was most likely the participants allowed their own aging process to be
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influenced by society’s negative stereotype patterns. By doing so, realities other than

those influenced by ageist beliefs were hard to uncover as older adults uninfluenced by

society are hard to find. With this in mind, it was thought that research performed with

older adults in cultures where elders were honored might prove to hold important

counterpoint information.

Suggestions for Further Research

Instead of denying the process of aging or accepting as truth the stereotypes

proponed by ageism, this dissertation sought to explore what age and aging was for those

who were older in order to provide potentially important developmental, societal and,

possibly, policy-making information. This dissertation understood that as the baby

boomer generation becomes older adults, the concept of aging could change and alter.

Research that looked at what the experience of aging was for older adults could be

imperative to our understanding of how to relate to the growing, aging percentage of the

population.

An example of society’s disconnect in research and reality about age and aging

was found in the National Center for Health Statistics (with funding from the National

Institute on Aging and the Centers for Disease Control and Prevention) three wave

longitudinal “Study of Aging.” The entirety of the survey dealt with the living

arrangements, family situation, medical care, benefits used, healthcare assistance,

impairments, cognitive functioning, insurance, and final services provided to an elder

prior to the elder’s death (National Center for Health Statistics, 2002). The study

surveyed elders’ families after the death of the elder as the method to carrying out their

“study on aging.” Aging and death seemed synonymous in the make up of this
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questionnaire and no older adults were interviewed or surveyed. Data was obviously

slanted in the direction of the stereotypes as all the information concerned ailing and dead

older adults, not well elders. In fact, there was no place in the survey that offered

opportunity to discuss positives in the older adult’s life. Though it was true the elders in

this study were part of Wave 1 and Wave 2 which emphasized other parts of their lives,

the focus on just the elders who had died during Wave 3 slanted the data on aging and

presented a biased perspective. With other research stating longevity was increased by

positive self-perception of aging (Levy, et al., 2002), the CDC might consider a better

service to older adults, society and the concept of age and aging would be to focus on

how elders do live and can live better, rather than how they die.

In addition, further research based on this study could explore the definitions of

“connectedness” and its potential factor in healthy aging. Did people who had deeper

and more meaningful relationships throughout their lives age better? Were there ways of

increasing one’s feeling of connectedness?

An expanded investigation of “inner age” could reveal insights into the internal

human landscape. What percentage of people, especially elders, identified with a

different inner age than physical age? What was the impact of having an inner age that

differed from one’s physical age? What did elders in the general population believe was

“too old”? Was “too old” always linked with physical ability or disability? What were

the ramifications of inner age on how society works with, defines, treats, and interacts

with elders?

Further research could look to discover any correlations between attitudes on

aging and socio-economic levels, spiritual backgrounds and practices, regions of one’s
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birth, childhood, adulthood and elderhood, positive and/or negative life experiences,

concepts of life and/or death, and/or freedom of movement. What was the impact of a

positive attitude on age and aging on older adults? In addition, further studies could look

at the potential correlation between how one lived one’s life and the attitude one had

about aging. Did a good, healthy and exciting life lead to a better attitude towards aging?

To what extent did the emotional, physical, social, mental life one lived determine the

experience one had with aging?

Referring back to the research in the literature review, there was evidence that

older adults were impacted by implied and overt ageism when given memory tests which

implied age discrimination (Hess, Hinson & Hodges, 2009). Also, older adults did

statistically less well on test when even just the wording was changed to less ageim-

ladened phrases (Chasteen, et al., 2005). Follow-up research could test if older adults

performed better if they thought tests were skewed in their direction. In other words,

could there be “positive ageism,” stereotypes of older adults which helped elders to

perform and live better? These stereotypes could be as equally unfounded as the negative

ones. However, if a positive attitude on aging increased the length of one’s life by seven

years (Levy, Slade, Kunkel, & Kasl, 2002), then it could be important to explore the

impact and perpetuation of positive concepts of age and aging.

Further research could work with a larger sample and not be limited to Caucasian

elders of European descent as in this study. The research could extend to elders of all

ethnic backgrounds in all countries. What was the meaning of aging for people of

different ethnic backgrounds, or different geopolitical stresses? Was there some

connecting human experience found in the experience of aging? Were there differences?
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How did this information inform, challenge, alter, and instruct our concepts, approaches,

policies, and opinions of the elders we might be one day?

A curious study could be to ask older adults how they would like others to refer to

them. One older adult offered “experienced adult.” She thought the current term “older

adult” offered by the APA was pejorative. Thus, it would be interesting to survey elders

for terms they would like used to be referred to and to self-refer.

A possible response to this study could be to apply the literature review, data and

discussion to literature written about working with older adults. With a greater

understanding of the lived experience of older adults, their self-concept, and their inner

age, a set of guidelines could be developed by which literature on working with older

adults could be evaluated for overt and covert ageism as well sensitivity to the lived

experience of all elders. Such guidelines and applications were done and follow in

Appendix A and B.

Conclusion

People born today could expect to live years longer than those born even a few

decades ago (Levy, et al., 2002). Medical advances have been increasing exponentially

and every day one lives there has been a greater chance of living longer. Thus, a better

understanding of the concept of age and aging itself has been vitally important. Rather

than relying of society’s preconceived notions of aging, riddled with old age stereotypes,

this dissertation focused on the actual lived experience of ten elders as a starting point for

understanding. The participants in this study supported some of the stereotypes about old

age being harsh, debilitating, and reductionistic. However, the participants also

mentioned benefits to aging: wisdom, ability to speak one’s mind, and freedom.
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The participants in this study revealed that connectedness was very important to

them and to their sense of well-being. In this aspect, this study refuted the myth

presented by Cumming and Henry (1961) who proposed the role of the older adults was

to disengage from society and the role of society was to disengage from the elder. This

process was slow, lengthy, and ended with the ultimate disengagement, death. The older

adults in the qualitative part of this dissertation stated in various manners that

connectedness was an important part of their life and essential for meaning and purpose.

Even when the participants talked about death, it was in relation to being connected to

society, the universe, and/or God. So, though their present life involved disengagement

at some level, continued connectedness, even when thinking about death, provided

meaning and purpose. No meaning and purpose was found in disengaging from society

as Cumming and Henry proposed.

The disengagement Cumming and Henry observed might have been a result of

ageism, which they proceeded to perpetuate. Maybe it was not the elders who need to

accept disengagement from society but society who needed to re-engage with older

adults. Perhaps, the evolutionary and natural role of the older adult was, as Thomas

(1996) suggested, to engage meaningfully with society for the perpetuation of the race.

Maybe, the role of the older adult was, as the participants of this study naturally felt, to

stay connected. Maybe, the internal desire of the participants to increase connectedness

was their instinctual societal role calling from within. For if what Thomas (1996)

proposed was true, then society would do well to re-connect with its elder and in doing so

the “elders will save the world” (title).

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The participants reported having an inner age that was different from their

physical age. Many reported feeling internally like they were 30-40 years younger than

they were. The implication was that these elders felt viable, alive and willing to connect

and contribute. Leventhal (1988) suggested that physical deterioration was not inevitable

but rather occurred because of inactivity not because of aging itself.

While all these changes of ageing are well known, we do not really know how

much is due to the ageing process itself and how much results from our sedentary

lifestyle…physical inactivity can make a body age prematurely (p.70).

If we understood what Leventhal was saying here, we might begin to understand the

concept of inner age and be able to bring the inner and outer concept of age together. An

understanding of the phenomenon of inner age could help those who work with elders

understand the frustration of an older adult who is 80, saw herself as 40 but was being

treated like a 2 year old by her family and like a 200 year old by society.

Since older years have been seen as the creative years (Cohen, 2000), this dissertation

proposed that expressive therapist could hold a unique position in helping older adults

with mental health concerns to work through their issues. Arts-based therapies could

engage the client in a variety of ways and with various modalities in order to help the

client get what was inside out. Expressive therapies could help give voice to needs and

concerns when words were not enough.

In order to create the environment where older adults could feel safe, revive and

thrive, the expressive therapist needed to be active in neutralizing ageism wherever it was

found. For though Pinquart (2002) found that negative stereotypes might boost self-

concept because elders might gage themselves against the bad stereotype knowing they
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were doing better, it was still important to create bias-free literature and work towards an

ageism-free society. These guidelines, based on this dissertation, with an application

using expressive therapies literature were created and placed in Appendix A and B.

The lived experiences of the ten elders in this study helped gain insight into the

meaning of aging for these elders, while also giving direction for further research and

guidelines for expressive therapies literature about working with older adults. During the

study, many of elders stated that they could accept living eternally just as they were even

with limitations, ailments and irritations. Though it would be better to have life without

aging, they could accept aging if it meant life. Mena stated, “Life is to me is like a book.

You want to keep reading it and reading it, reading it, reading it, reading it…I never want

to get to the end of it.” It was seen that with proper research, it might not be possible to

perpetuate Mena’s book forever, but it could be possible to provide useful and insightful

information on the process for all who are aging…and thus help each person’s book be

fuller, longer and more enriched.

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Appendix A

Guidelines for Ageism Awareness When Reviewing Literature and Research about

Expressive Therapies with Older Adults

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Appendix A

Guidelines for Ageism Awareness When Reviewing Literature and Research about

Expressive Therapies with Older Adults

Whereas, ageism and age stereotypes have been shown to:

- impact the performance of older adults (Chasteen, et al., 2005; Hess, et al.,

2009),

- affect the diagnosing, interactions and treatment by the older adult’s health

professionals (Danzinger & Welfel, 2000; Gatz & Pearson, 1988; Helmes &

Gee, 2003; Kane, 2004; Kane 2008; Lasser, et al., 1998; Lee, et al., 2003;

Roberts, 2008),

- prevent older adults from seeking help (Sarikisian, et al., 2003), and

- increase dependency (Coudin & Alexopoulos, 2010)

and whereas age has been shown

- not to affect and possibly to improve creativity (Lindauer, 1998; Lubart &

Sternberg, 1998; Ravin & Kenyon, 1998; Simonton, 1998; Sinnott, 1996;

Sinnott, 1998),

and whereas it has also been shown that

- emotional stability improves with age (Williams, et al., 2006)

and whereas older adults in counseling were

- equally as able if not better able to improve (Arean, et al., 1993; Cook, 1998;

Floyd, 2003; Gorsuch, 1998; Hinrichsen, 1999; Jones & Beck-Little, 2002;

Kennedy & Tanenbaum, 2000; Knight, 1993; Knight, 1999; Knight &

McCallum, 1998; Leszcz, et al., 1985; Pasupathi & Carstensen, 2003; Scogin
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& McElreath, 1994; Thompson, et al., 1987; Walker & Clark, 2001; Watt &

Cappeliez, 2000; Wood, 2003),

and whereas it has been shown that

- people with positive attitudes on aging lived seven years longer (Levy, et al.,

2003)

it was seen as important that ageism, ageist belief, age stereotypes and misconceptions

about aging were found, reduced and eliminated wherever they arose. As health

professionals were many times the first people an older adult came in contact with when

they had concerns about physical or mental health, it was also seen as important that

health professionals were aware of their age bias (whether positive or negative) and its

potential damage.

With elders, words might not be the easiest or most comfortable form of

expression, especially in the counseling process. Since there was increasing research on

the potential for creativity in older adults (Labert & Sternberg, 1998; Lindauer, 1998;

Ravin & Kenyon, 1998, Simonton, 1998, Sinnott, 1996, Sinnott, 1998), there was a need

for mental health professionals who have an understanding of creativity to be involved in

the elder’s therapy process. Expressive therapists could provide just that service. Thus,

it was seen as important that expressive therapists were aware of the impact of ageism on

their literature, research and work. Because of this need and based on the qualitative

study on aging above, a set of guidelines was developed and presented here.

Eliminate Age Bias and Ageism Stereotypes

Articles about working with older adults sought to eliminate age bias and ageism

stereotypes in their language, content and/or omissions.

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Ageism has been shown to have an impact on older adults (Woolf, 1998b) and on

therapists (Danzinger & Welfel, 2000; Helmes & Gee, 2003; Kane, 2004; Kane 2008;

Lee, et al., 2003; Roberts, 2008). This awareness was important as it has been proponed

that people could internalized ageism stereotypes which then could turn into self-loathing

as one grew older (Woolf, 1998a). In addition, those internalized ageist beliefs could

negate the effects of therapy (Goodstein, 1985; Perlick & Atkins, 1984; Settin, 1982).

Thus, it was seen as important to eliminate ageism’s influence in the wording and

semantics of any article whether on aging or not.

Eliminate Both Positive and Negative Biases and Stereotypes

Articles about working with older adults sought to eliminate both positive and

negative age biases and stereotypes.

Positive and negative biases about aging and older adults impacted elders

(Roberts, 2008). Both were shown to lead to condescension and patronization

(Nussbaum, Pitts, Huber, Raup Krieger & Ohs, 2005) as well as misdiagnosises (Lasser,

et al., 1998). Acceptance of both positive and negative age stereotypes were shown to be

detrimental to interactions, treatment and planning (Danzinger & Welfel, 2000; Gatz &

Pearson, 1988; Helmes & Gee, 2003; Kane, 2004; Kane 2008; Lasser, et al., 1998; Lee, et

al., 2003; Roberts, 2008). Thus, it was seen as important to eliminate both negative and

positive stereotypes in the literature.

Promote Counseling as Effective with Older Adults

Articles about working with older adults expected elders were just as able to work

through their issues as anyone.

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Counseling for older adults was just as effective as counseling for other age

populations (Arean, et al., 1993; Cook, 1998; Floyd, 2003; Hinrichsen, 1999; Jones &

Beck-Little, 2002; Kennedy & Tanenbaum, 2000; Knight, 1993; Knight, 1999; Knight &

McCallum, 1998; Leszcz, et al., 1985; Pasupathi & Carstensen, 2003; Scogin &

McElreath, 1994; Thompson, et al., 1987; Watt & Cappeliez, 2000; Wood, 2003) and in

some cases more effective (Gorsuch, 1998; Walker & Clark, 2001). Thus, it was seen as

important to ask what goals the article sought for the older adult. Were the results and/or

goals aimed towards resolution (as in regular counseling) or were the goals lowered

based on ageist beliefs that resolution was not possible?

Differentiate Arts-based Therapy from Arts-based Therapeutic Programs

Articles about working with older adults differentiated arts-based therapy from

arts-based therapeutic programs.

As just noted, counseling for older adults was just as effective as counseling for

other age populations (Arean, et al., 1993; Cook, 1998; Floyd, 2003; Hinrichsen, 1999;

Jones & Beck-Little, 2002; Kennedy & Tanenbaum, 2000; Knight, 1993; Knight, 1999;

Knight & McCallum, 1998; Leszcz, et al., 1985; Pasupathi & Carstensen, 2003; Scogin &

McElreath, 1994; Thompson, et al., 1987; Watt & Cappeliez, 2000; Wood, 2003) and in

some cases more effective (Gorsuch, 1998; Walker & Clark, 2001). Thus, it was seen as

important that an article did not reduce therapy to “therapeutic programs” as was

described in the “therapy verus therapeutic” section of this dissertation. This semantic

nuance could effectively minimize the role of expressive therapies by presenting the

benefits as tangential rather than direct.

Represent the Expressive Therapist as a Therapist

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Articles about working with older adults were aware of the representation of the

expressive therapist.

Expressive therapists were seen as mental health professionals and not just

creative activity coordinators. Thus, it was seen as important that the expressive

therapies literature reflected this fact. Expressive therapist should be presented in the

literature as having all the rights and responsibilities of other mental health professionals,

exhibiting all the same ethics and following all the same ethical standards. The

expressive therapist should be represented in the literature as a therapist not a kind of

“recreation director” with little to no boundaries, confidentiality or therapy goals.

Though not a guideline specifically dealing with ageism, this guideline arose out

of the research performed to create these guidelines. In the same fashion that ageism

could create prejudice against one’s self as one ages (Woolf, 1998b), expressive

therapists reflected themselves in the literature as less than or different from other

healthcare professionals. This image stereotyped expressive therapists as different.

Thus, it was seen as important that expressive therapists presented themselves as the

professionals they were and not as alternatives. If either the client or the therapist had

lower expectations for improvement, the therapy could move towards what some have

termed “therapeutic nihilism” (American Psychological Association, 2004; Goodstein,

1985; Perlick & Atkins, 1984; Settin, 1982).

Adjustments Made Are Based on Client’s Needs Not on Client’s Age

Articles about working with older adults made adjustments to counseling

techniques based on the client’s actual need not on the client’s age.
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It has been shown that older adults might need adjustments to the setting of the

counseling but do not need adjustment to their therapy because they were older (Knight,

1999; Laidlaw, 2001). Thus, it was seen that adjustments to counseling approaches

should be based on client’s needs and therapy goals and not based on preconceived

notions of the needs of an older adult.

Aim to Increase Older Adult’s Connectedness, Purpose and Meaning

Articles about working with older adults aimed to increase the older adult’s level

of connectedness, purpose and meaning.

Connection, purpose and meaning were shown to be important aspects of

successful living for the older adults interviewed in this dissertation. Though not the only

reasons for counseling, an understanding of the importance of connection purpose and

meaning was seen as important for a thorough assessment of an older client’s needs and

for the enriching of the counseling experience.

Honor Client as a Person Who is Older Not as an Old Person

Articles about working with older adults treated the client as a person who is

older not as an old person.

Internalized ageist beliefs adversely affected older adults (Woolf, 1998a) and

impacted health professionals’ attitudes and diagnoses of an older adult (Danzinger &

Welfel, 2000; Gatz & Pearson, 1988; Helmes & Gee, 2003; Kane, 2004; Kane 2008;

Lasser, et al., 1998; Lee, et al., 2003; Roberts, 2008). The qualitative part of this

dissertation revealed that the participants did not see themselves as old. Old was the

person with physical disabilities or who had a poor attitude. Thus, it was seen as

important that articles about working with older adults showed an understanding of the
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concept that perceptions of age were linked to physical disability and attitude more than

physical age.

Show an Understanding of the Inner Age of the Client

Articles about working with older adults sought to honor the inner age of the

client.

The participants in this dissertation stated their inner age was 30-40 years less

than their physical age. Thus, potential, goals and prognosis for older adults could be

more accurately created if this concept of inner age was taken into account. Professionals

could reflect this observation by asking about a person’s inner age and their attitude on

aging during assessments. Even if an article was not dealing with inner age directly,

acknowledging the inner age concept could enrich the content of the material.

Encourage the Creative Potential of Older Adults

Articles about working with older adults reflected an understanding of what older

adults have to offer in their creative stage of life.

Emerging research showed that though the brain changes, problem solving

abilities stayed in tact as one age (Sinnott, 1996; Sinnott, 1998). Creativity remained the

same and possibly increased as one aged (Lubart & Sternberg, 1998). Creative output

from any field were not bound by physical age but rather “career age,” thus older adults

starting a new career or having a resurgence in their old career were just as capable of

producing the same number of creative outputs as those who started their creative careers

earlier in their lives (Simonton, 1998). Creative output was deepened and enriched by the

aging process (Lindauer, 1998; Ravin & Kenyon, 1998). Thus, it was seen as important
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for articles to contain an understanding of the creative potential of older adults even if

that was not the focus of the article.

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Appendix B

Applications of Guidelines for Ageism Awareness When Reviewing Literature and

Research about Expressive Therapies with Older Adults

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Appendix B

Applications of Guidelines for Ageism Awareness When Reviewing Literature and

Research about Expressive Therapies with Older Adults

Books and articles were sought for this section with the intent to include at least

two articles and/or books from each of different arts-based therapy modalities: art, music,

dance/movement, and psychodrama/drama. Though several books were looked at under

the heading of “expressive therapies,” the author or editor(s) often broke the topic into

chapters dedicated to each of the modalities individually and not to the intermodal use of

the arts as therapy. Thus, the chapters from the intermodal books (Weisberg & Wilder,

2001) or the book itself (Weiss, 1984) were placed under the appropriate modality

heading it best fit. All the chapters, books and articles were not chosen as an overall

representation of a modality itself but rather to show that no modality was without its

biases. Thus, selections were made based on illustrative merit not to promote one

modality over another. The texts were also selected to represent writings from the 1980s,

1990s and 2000s to show that ageist beliefs have not changed much. Because the texts

were from different times and because the politically correct words for older adults have

changed, no observations were offered on the use of terms that were period specific such

as “elderly,” “old person” or others. An annotated bibliography follows for each of the

selected books and articles. Abstracts or self-descriptions were presented if available.

Expressive Therapies Literature

Art Therapy

Wald, J. (2003). Clinical art therapy with older adults. In C. A. Malchiodi (Ed.),

Handbook of art therapy (pp. 294-307). New York: Guilford. Wald’s chapter
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discussed “age-related changes and losses that the elderly suffer” so “therapists

can help them to maintain hope despite physical, psychological, and/or cognitive

losses” (p. 295). The use of the word “losses” twice in the same sentence relating

to older adults showed the focus of this chapter to be on the negative of aging.

Wald did widen her scope while talking about treatment considerations stating

there were three types of older adult clients but then immediately refocused on the

worse case scenarios, “the frail and debilitated” (p. 298). Wald reviewed art

therapy goals with older adults, presented three case examples and outlined group

work with older adults.

Weiss, J. C. (1984). Expressive therapy with elders and the disabled: Touching the heart

of life. New York: Haworth. Weiss focused on arts-based therapy approaches in

long term care settings where he intermingled the approaches for older adults and

people with disabilities as if they were the same. Weiss presented many of the

standard arts-based therapy exercises and was obviously compassionate for the

older adults with whom he worked. However, the book was more subjective than

objective, especially demonstrated by the inclusion of two chapters spanning 58

pages which contained mostly pictures. Though title had the words “expressive

therapy” in it, the book itself was heavily art therapy based.

Dance/Movement Therapy.

Sandal, S. L., & Hollander, A. S. (1995). Dance/movement therapy with aging

populations. In F. J. Levy, Fried, J. P., & Leventhal, F. (Eds.), Dance and other

expressive art therapies: When words are not enough (pp. 133-143). New York:

Routledge. This compact chapter clearly defined the differences between

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“physical therapy, ‘fitness’ programs, creative movement, and dance/movement

therapy” (p. 133). It also defined the different types of older adult populations

with which one might use dance/movement therapy. It then offered many

examples of how dance/movement therapy could be used with older adults and

finished with a case study.

Stockley, S. (1992). Older lives, older dances: Dance movement therapy with older

people. In Payne, H. (Ed.), Dance movement therapy: theory and practice (pp.

81-101). New York: Routledge. Stockley presented an overview of the history of

dance/movement therapy with older adults along with models and approaches.

The author then described techniques and issues one should keep in mind when

using dance/movement therapy with an older adult. The chapter finished with a

sample group outline and three case illustrations.

Music Therapy

Palmer, M. (2001). Older adults are total people. In Weisberg, N., & Wilder, R. (Eds.),

Expressive arts with elders: A resource, 2nd ed. (pp. 179-187). Philadelphia:

Jessica Kingsley. This chapter first appeared in the 1985 edition of this book

whose original title was “Creative Arts with Older Adults: A Sourcebook”

(Weisberg & Wilder, 1985). Though much had changed in the world of therapy

in the intervening 16 years between editions, not much was changed in the

updated chapter. The chapter urged music therapist to consider and create

sessions around the physical, mental and psychosocial needs of the client, and to

see the older adult as a whole person. Palmer described the concerns the music

therapist should have when heading towards the goal of helping the client to be as
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independent as possible. Current research could have strengthened the valid

points in this chapter.

Wigram, T., Pedersen, I. N., & Bonde, L. O. (2002). A comprehensive guide to music

therapy: Theory, clinical practice, research and training. Philadelpia: Jessica

Kingsley. “This book is structured to follow a path starting in history and leading

the reader through to current research and clinical practice” (p. 12). The book had

a particular format for the presentation of material which made it easy to follow.

The small section (8 pages out of 380) which dealt with older adults seemed to

have been written by Hanne Mette Oshsner Ridder who was given only

parenthetical credit. The chapter contained two case study vignettes, a list of the

ways music could be used, the results of a review of studies dealing with people

with dementia, and a list of how therapy could be employed. Music therapy with

elders was a very short section of an otherwise detailed book.

Psychodrama/Drama Therapy

Horvatin, T., & Schreiber, E. (Eds.). (2006). The quintessential Zerka: Writings by

Zerka Toeman Moreno on psychodrama, sociometry and group psychotherapy.

New York: Routledge. This book:

Documents the origins and development of the theory and practice of

psychodrama, sociometry and group psychotherapy through the work and

innovation of its co-creator, Zerka Toeman Moreno. The comprehensive

handbook brings together history, philosophy, methodology and application. It

shows the pioneering role that Zerka, along with her husband J. L. Moreno,
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played in the development not only of the methods of psychodrama and

sociometry, but of the entire group psychotherapy movement worldwide. (p. i)

Johnson, D. R. (1985). Expressive group psychotherapy with the elderly: A drama

therapy approach. International Journal of Group Psychotherapy, 35(1), 109-127.

This article describes group psychotherapy with nursing home residents, ages 64-

96, which utilizes the nonverbal and symbolic activities of drama therapy to

facilitate an orientation to insight and transference phenomena, in contrast to the

purely supportive techniques often used with the elderly. A case study of a long-

term therapy group is described with examples of how the patients confronted

their physical limitations, the death of their parents and of themselves, and

transferences to the therapist. The media of creative drama, by concretizing and

symbolizing difficult feeling states, and thus encouraging verbalization, may be a

useful aid in extending the benefits of expressive psychotherapy to the impaired

elderly. (Abstract, p. 109)

Selections chosen for examples did not reflect the treatment of older adults by the

whole of the modality used. Society, therapists and individuals all exhibited age-based

stereotypes. None of the writers of these books, chapters and articles set out to

perpetuate ageism and stereotypes. In fact, it has been assumed the writers chose to work

with the older adults because they liked the population and were passionate about their

work. Positive examples were also included below to reflect that passion. In the end,

these selections have been chosen as learning examples so all might benefit.

Application

Eliminate Age Bias and Ageism Stereotypes

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Articles about working with older adults sought to eliminate age bias and ageism

stereotypes in their language, content and/or omissions.

The subtle, yet clearest when understood, examples of articles promoting age

stereotypes came through word associations. Often the title of an article stated it was

about therapy with older adults and then the text was about work done with people in

nursing homes. Older adults were associated with nursing home residents through the

omission of description which continued by also ascribing them similar physical

attributes.

Several examples of this type of ageism were found in “A Comprehensive Guide

to Music Therapy: Theory, Clinical Practice, Research and Training” in the chapter called

“Music Therapy with Older Adults” (Wigram et al., 2002, pp 188-196). The book stated

it was “comprehensive” yet dedicated only eight pages (2%) to music therapy with older

adults. Of these eight pages, only two sentences mentioned older adults as anything but

“weak and dependent,” “needing 100 percent help and care,” “suffering with dementia,”

and “with severe memory, communication and functional deficits” (p. 188). Those

opening two lines of the chapter (representing 2.5% of the chapter and but .05% of the

entire book) contained the only positive remarks about older adults. They were as

follows:

Working with older adults in music therapy means working with a very non-

homogeneous group. At one end of the spectrum of differences there is the group

of wise, serene elderly, representing big resources for younger generations. At

the opposite end of the spectrum are the weak and dependent, needing 100 per
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cent help and care, with severe memory, communication and functional deficits.

This group includes amongst others, older adults suffering from dementia. (p.188)

The positive words connected to older adults were “wise, serene elderly,” “a very non-

homogenous group,” and “a big resource for younger generations.” “Wise, serene

elderly” was an obvious positive stereotype as “weak and dependent” were obvious

negative stereotypes. Though presented as opposite extremes, it could be seen as

pejorative to some older adults to be placed in-between those ends. The value of elders

was subtly addressed in the sentence which placed older adults as a “big resource for

younger generations.” The statement implied that the value of older adults was through

their usefulness to the younger generation. This submission of value to youth was a

subtle example of ageism in a culture that values youth (Woolf , 1998b). Though the

statement mentioned that older adults represented a “very non-homogenous group,” the

statements after that and the rest of the chapter discussed older adults in “old people’s

home.” Both of the case studies were about people with Alzheimer’s Disease and/or

dementia. The chapter was not comprehensive, equated older adults to people in nursing

facilities and was not as “non-homogenous” as it stated the elder population to be.

Other misrepresentation of older adults found between the title of a text and the

content of the text itself were as follows:

Palmer’s “Older Adults are Total People” (2001) had a great title but the content

of the chapter was on music therapy with “elderly adults…in a health care facility or in a

community-living situation” (p. 180). The inference was that older adults lived in

nursing facilities.
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Johnson’s “Expressive Group Psychotherapy with the Elderly: A Drama Therapy

Approach” (1985) stated in the abstract “this article describes group psychotherapy with

nursing home residents” (p. 109). As the article was solely about the work done in a

nursing home, a more accurate title was thought to be “Expressive Group Psychotherapy

with Older Adults in a Nursing Home: A Drama Therapy Approach.”

Wald’s “Clinical Art Therapy with Older Adults” (2003) had a few mentions of

well elders but the bulk of the chapter rested on her work at a day treatment program.

The opening poem under the title was by “clients at a geriatric day treatment program”

(294). The four case studies were taken from day treatment programs. Though the

chapter acknowledged other older adults in the community, its focused was on work with

older adults in a geriatric program setting.

Weiss’ “Expressive Therapy with Elders and the Disabled: Touching the Heart of

Life” (1984) reflected the most grievous example in that the title itself equated elders to

disabled. The chapters, the examples and the case studies were about people in care

facilities. Chapter 2 was titled “Creative Arts Therapy for Various Elder Populations:

Techniques and Processes” (pp. 25-44). Though the title had “various elder populations”

in it, the chapter did not mention working with an elder who was not incapacitated in

some form. In fact, the chapter talked only of residents in care facilities and grouped

them into “minimally handicapped,” “moderately handicapped,” and “severely

handicapped (pp. 26-27). Weiss (1984) did mention in his introduction that the book was

a compilation of his years of work with “elders and disabled at various facilities (hospital,

institutions, senior citizens centers, adult day care programs, and mental health clinics)”

(p. xix). Knowing his work was with elders at facilities, the author could have avoided
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linking the concept of older adults to people with handicaps or in need of assistance

through a more accurate title.

Not directly related to the examples above, Sandel and Hollander’s (1995) chapter

titled “Dance/Movement Therapy with Aging Populations” showed a very subtle

semantic example of ageism. The term used to refer to older adults in the title was “aging

populations.” It was understood that all were aging. Thus, linking the aging process only

to older adults was a subtle, yet powerful form of ageism.

Ageism was also observed in omissions. Wigram et al. (2002), as was discussed,

limited their information on aging to 8 pages of a 381 page book or just 2%. In their

book which was self-described as “comprehensive,” most of the chapter on older adults

dealt with people with dementia. This representation of older adults did not accurately

reflect the elder population. Though the authors did not acknowledge their less than

“comprehensive” chapter on working with elders, they interestingly pointed out that the

major music therapy journals had minimized articles about music therapy with older

adults to a non-representational percentage of overall articles printed. Wigram et al.

(2002) presented a table which showed that between the years of 1998 and 2001 the

percentage in three major music therapy journals of article on working with older adults

was as follows:

Journal of Music Therapy – 0%

British Journal of Music Therapy – 4.1%

Nordic Journal of Music Therapy – 3.1%

(p. 231)
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As elders in America represent 12.8% of the population or one in eight Americans

(Administration on Aging, 2009), the percentage of time devoted to working with older

adults by these music therapy journals did not reflect the reality of the population itself.

The next was an unfair example in that the author of the text did not set out to

work with older adults nor write about older adults. Zerka Moreno was a co-creator in

the form of action therapy called psychodrama. Horvatin and Schreiber (2006) collected

all Moreno’s writing into a “quintessential” compilation. In 328 pages of article, Moreno

did not address applying psychodrama to work with older adults. With due respect, it

was noted that there were no articles about working with adolescents either. The one

reference to older adults stated, “Not only the aged are severely affected by death” (p.

241). The article continued by talking about adolescence who have contemplated or

attempted suicide. It was hard to differentiate if Moreno did not include elders in any of

her articles because she saw no need to alter the psychodrama process with different

populations or if older adults were simply in her blind spot. The reason this example was

included was because of all the arts-based therapy modalities, psychodrama was the one

with the least representation of articles dealing with elders in expressive therapies

literature. The absence seen in Moreno’s work was echoed in the modality itself.

Eliminate Both Positive and Negative Biases and Stereotypes

Articles about working with older adults sought to eliminate both positive and

negative age biases and stereotypes.

Wigram et el. (2002) used the phrase “wise, serene elderly” (p. 188). Though a

positive view of older adults, the phrase revealed a stereotype just the same. In this case,

the stereotypes was that older adults are wise. Several of the participants in this
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dissertation stated one of the benefits of aging was wisdom. However, realistically, it

was understood that age alone did not make one wise.

Weiss (1984) used the following definition for “elder”:

An Elder is a person who is still growing, still a learner, still with potential and

whose life continues to have within it promise for, and connection to the future.

An Elder is still in pursuit of happiness, joy, and pleasure, and her or his birthright

to these remain intact. Moreover, an Elder is a person who deserves respect and

honor and those whose work it is to synthesize wisdom form long-life experience

and formulate this into a legacy for future generations. (pp xix-xx)

Weiss stated the term was “used in a dignifying manner, to note a person who deserves to

have a sense of self-esteem, respect and opportunities for a fulfilling life” (p. xix). This

definition of an elder created a positive and even rosy picture of older adults. Weiss,

though passionate, worked with an overly positive definition created on overly positive

stereotypes.

Promote Counseling as Effective with Older Adults

Articles about working with older adults expected elders were just as able to work

through their issues as anyone.

A good example of the knowledge that older adults could work toward resolution

through arts-based therapies was presented by Wigram et al. (2002). The authors were

describing a music therapy session in which one of the participants

tried to join in the first lines, but every time he burst into tears, and cried while the

therapist sang the song. He was not able to put into words what was going on in

the music therapy. However, the fact that he, in this period, was searching for a
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way to express some very strong feelings can be construed as his way of handling

essential conflict-ridden themes without being badly affected by it (p. 191).

The passage showed positive and negative feelings handled in the therapy process and

older adults being able to do the work of therapy.

Wigram et al. (2002) further stated “the elderly individual will benefit from co-

ordinated activities and therapeutic interventions where a trained professional is able to

set up a safe structure that enables the participants to enter a dialogue” (p. 195). Though

the statement referred to “activities,” it was understood the authors were doing the work

of therapy in creating a safe space and entering into dialogue with the elder. These

statements were made with the knowledge that the effort would not be lost because older

adults could indeed work towards resolution and change.

Differentiate Arts-based Therapy from Arts-based Therapeutic Programs

Articles about working with older adults differentiated arts-based therapy from

arts-based therapeutic programs.

In the literature review of this dissertation, definitions were offered for the

difference between arts-based therapy and arts-based therapeutic programs. The

difference was that emotional well-being was a tangential result of therapeutic programs

whereas it was the primary goal of therapy. With this in mind, it was important to talk

about expressive therapies in the literature in a manner which reflected its equality as a

therapy. Weiss (1984) referred to his work as “creative arts programs” (p. 25) and

“creative arts therapy activities” (p. 27). Neither of these gave the impression that Weiss

was doing anything more than creating activity programs.

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This image of therapeutic programming continued in Wigram et al. (2002) who

employed these statements in examples of music therapy: “sing-a-long,” “music and

movement activity,” and “simple exercises” (p. 189). One of the groups referenced in the

text was called the “‘Friday coffee singing’ where residents, staff and relatives listened to

music in a calm and warm atmosphere, and sang, chatted and drank coffee” (p. 190). In

addition to music therapy described as a program, this example also revealed another

dramatic difference between programs and therapy. In this music activity, families and

staff were welcomed to share coffee with the participants during the program. Doubtful a

psychotherapy group would allow such activity.

The above example was not isolated. Palmer (2001) stated the following,

One of the interesting sidelights to music therapy programs with the elderly is the

reaction of the families involved. Attending a program where their family

member is involved or seeing them in new roles can help the family also to accept

the new living situation. There is improved communication, and visits become

more enjoyable. Frequently the families then become more involved within the

facility, and when this happens, everyone benefits” (p. 187).

Several issues surfaced in this statement. First, the benefit mentioned was for the family

(not the client). Second, if the family were present when they wanted, then where were

the boundaries for the therapy? Where was the safety for the other members? And most

importantly, where was the informed consent? The program described above was a

needed program and was therapeutic. But, it was not therapy and did not present itself as

therapy, otherwise it should have attended to boundaries and consent.

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Carrying this one step further, in this example not only was informed consent not

gathered, the therapist essentially tricked older adults into attending the group. Weiss

(1984) remarked, “I have seen a better response by elders to creative arts therapy sessions

when it is called ‘creativity in self-development’ to avoid the stigma of the term therapy”

(p. 26). Changing the name of the group in order to lure participants into therapy negated

their right to informed consent. Even if the group was beneficial, informed consent was

needed to treat a client. Some assumptions could be made about Weiss’ willingness to

alter the group title including: he did not view his work as therapy in the same manner as

talk therapist did, and he did not value the older adults with whom he worked in that he

did not see them as able to make proper informed decisions on their own. Though Weiss

assuredly believed he was acting in the best interest of the client, his actions might have

undermined his role as therapist and his participants sense of respect and self-worth.

Good examples of differentiating the differences between therapeutic

programming and expressive therapies were found in Sandel and Hollander (1995) and

Stockley (1992). The wording in both was almost identical but only Stockley referenced

the Association of Dance Movement Therapy which one had to assume Sandel and

Hollander are drawing from without reference. Despite this, the following example used

the Sandel and Hollander text as it was clearer and longer.

Right from the beginning of the chapter, Sandel and Hollander (1995) defined the

role of a dance/movement therapist. “Movement is a meaningful part of many different

treatment modalities for the aged. Although physical therapy, ‘fitness’ programs,

creative movement, and dance/movement therapy all use movement, each modality has

its own goals” (p. 133). The next three paragraphs defined the goals of each. Of note,
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the authors stated the goal of a fitness program were physically related and “emotional

well-being, if it comes, is a by-product of better physical functioning” (p. 133). The

comment that emotional well-being was a by-product demonstrates the authors had an

understanding of the difference between therapy and therapeutic programs as discussed in

the literature review section of this dissertation.

The next paragraph in the chapter discussed the goals of creative movement in a

nursing home or senior center. The authors acknowledged that creative movement had

some of the same physically-oriented goals as fitness programs with the additional goals

being “to encourage creativity, spontaneity, body awareness, increased self-esteem, and

social interaction” (p. 134).

Finally Sandel and Hollander (1995) discussed how the goals of dance/movement

therapy were broader than the other movement modalities in that it integrated physiology,

sociology and psychology. “Dance/movement therapy gives meaning to movement

through the development of images, encourages emotional responses and the processing

of the responses both positive and negative, and it facilitates and supports social

interaction” (p. 134). Importantly the authors noted, “movement activities are not the

primary goal of the group experience, but rather the tool for creating a therapeutic

environment” (p. 134). Sandel and Hollander (1995) displayed an understanding that the

arts-based activity (in this case dance/movement) was the setting for the therapy process

and resolution of positive and negative emotions was the therapy goal. This example was

art as therapy and not just as therapeutic activity.

Represent the Expressive Therapist as a Therapist

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Articles about working with older adults were aware of the representation of the

expressive therapist.

In the same manner that therapist misrepresented expressive therapies as

programs not therapy, they also misrepresented themselves as less than a therapist

through the language used and roles performed. Patricia A. Kinsella in the foreward of

Weiss’ (1984) book said about older adults, “he is still a living soul with a story” (p. xv).

Weiss’s book was subtitled “Touching the Heart of Life.” Terms like “soul” and “heart

of life” could lead readers to wonder if they could take the writer seriously as they

approach the metaphysical.

The therapist understanding of their role as somehow less than a mental health

counselor or other health care staff was reflected in Wald’s (2003) statement,

Most art therapists working in geriatric programs are required to lead other

groups besides art. This can serve an integrative function by combining art with

gardening, cooking, music, dance, and writing. For example, planting seeds,

watering them, and watching them grow into flowering plants can be nurturing

and reparative (p. 305).

Though gardening might be therapeutic, it was not therapy. The role here was less of a

therapist and more of a recreation director.

In the following examples, the therapist was reduced from recreation director to

the role of entertainer playing background music. “A music therapist accompanied the

songs on the piano and entertained with quiet, easy-listening music in a coffee break

halfway through” (Wigram et al., 2002, p. 189). One might imagine a talented doctor or
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administrator playing the piano on a rare occasion but this was not what was happening

here. For later in the chapter Wigram et al. described the work of the music therapist.

Working as a music therapist function in gerontology is an all-round job. You

will often see the music therapist function as a piano entertainer, leading very

different groups where music is integrated in some way, as well as carrying out

individual music therapy sessions” (p. 194).

A mental health counselor or social worker would not double as a piano entertainer as a

normal part of their job.

Downplaying the role of art as therapy by talking about creating “activities” and

“programs” as well as reducing the role of the expressive therapist to anything less than a

mental health professional could be seen to weaken the therapy in the minds of the

therapists, staff, family and, especially, the older adult clients themselves.

Adjustments Made Are Based on Client’s Needs Not on Client’s Age

Articles about working with older adults made adjustments to counseling

techniques based on the client’s actual need not on the client’s age.

Some articles on older adults included long lists of issues with which older adults

might be dealing. One example stated, “elderly people may cling to their grown-up

children, or become almost autistic and unable to respond to help or stimulation, so that

helping them to find a balance between dependence and autonomy seems to be an

important issue” (Stockley, 1992, p. 89). The text also listed these issues: stroke, loss of

physical health, loss of mental faculties, sensory impairments, deafness, blindness, loss of

speech, loss of skin sensation, cataracts, tinnitus, strokes, multiple sclerosis, Parkinson’s

disease, and so on (Stockley, 1992, p. 89). What was important to note about this list was
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there are no mention of common concerns that any adult might have had: finances, sexual

frustrations, relational issues, sexuality concerns, grief, etc. Listing potential concerns

found at times among older adult clients was important but neglecting to also list

common concerns that everyone dealt with did not reflect the reality. Most of the texts

examined failed to acknowledge a need to view the older person first as a person and then

build the therapy from there.

One adjustment that respected the older adult was to “be sure to provide good-

quality art materials, which help promote respect and dignity” (Wald, 2003, p. 299).

Because of budgets and financial constraints, many expressive therapists had to be

creative about the supplies they used. One needed only flash forward in her life 50 years

and imagine how invested one would be in making a popsicle stick craft to understand

the need for quality art materials when doing arts-based therapy.

As far as activities go, Stockley (1992) pointed out,

teachers often adopt a “Simon Says” style which reinforce their power as experts

and essentially invalidates the students themselves as individuals with specific

contributions to make, effectively keeping them at a distance. A dance movement

therapist will take a more creative and empathic stance, which empowers and

validates the participants’ individual experiences” (p. 84-85).

Doing “Simon Says” type activities was the dance/movement equivalent to making the

popsicle stick crafts mentioned above. The childishness of the activity (though fun,

spontaneous and playful at times) could be thought to be demeaning. Playing childlike

games with elders on a regular basis could encourage stereotypes and reduced

expectation of the older adults in the mind of the therapist and the participants. Stockley
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understood her role was as therapist not as leader. Her role was to empower not to

dictate.

Aim to Increase Older Adult’s Connectedness, Purpose and Meaning

Articles about working with older adults aimed to increase the older adult’s level

of connectedness, purpose and meaning.

The expressive therapies texts that were examined did a good job in presenting

connectedness as a goal of therapy. As expressive therapies was often done in group

format, it was not surprising the goal of connection was often mentioned. Providing or

helping a client find purpose and meaning was not directly presented but could be found

in the literature in the shadow of the goal of connectedness. Here were examples from

the texts that highlighted the goal of connectedness:

Weiss (1984) stated, “through a therapeutic creative arts program, individuals

may experience a closer communication with themselves and others, work through

problems and issues, and find channels for their feelings, thoughts, and creative

inspirations” (p. 25).

Wald (2003) stated the expressive therapies work can “bring clients out of

personal isolation and despair by encouraging socialization and group support in creative

therapy groups” (p. 300).

Wigram et al. (2002) presented a case study in which they reported, “Mrs. F was

one example of a person to whom the ‘being together with others’ in a musical situation

was essential to her quality of life” (p. 190).

Sandel and Hollander (1995) discussed several times that “social interaction” was

an important part of expressive therapies (p. 134).

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Stockley (1992) remarked, “the need to experience warm, loving contact

continues throughout life; it is not a prerogative of babies and young lovers,” (p. 90).

Palmer (2001) stated, “one of the great needs for all persons is recognition,” (p.

186).

Expressive therapist seemed to understand the need for connectedness which

could help in making expressive therapies a good fit for work with older adults.

Honor Client as a Person Who is Older Not as an Old Person

Articles about working with older adults treated the client as a person who is

older not as an old person.

Treating an older person as a person first could be seen as imperative to creating a

healthy and realistic therapy relation. One of the first places to start was with the image

of older adults as presented in the literature. Blanket statement were to be avoided as the

image of elders presented could be unrealistically negative as in these examples. Weiss

(1984) stated “often elders and the disabled feel their lives as impoverished. While trying

to cope with their changing life circumstances, they inadvertently neglect and lose

meaning of their inner feelings” (p. 117) and “verbal psychotherapy is often a difficult

modality of therapy for elders because the discussion of feelings and problems may seem

taboo to them” (p. 25). In the first example, the reader received a dreary picture of what

elders “often” experience. And even if there was truth in the second example (though it

might not be the case with the Baby Boomer generation who might be more counseling-

savvy), a blanket statement of this nature could establish blocks in the mind of the

therapist before they ever get to assess the client.

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Another example of an unrealistic blanket view of older adults was presented by

Palmer (2001) who stated, “the first goal [of the music therapist] is simply to counteract

the contracture which develops when the resident sits with fists clenched and arms

folded” (p. 180). Palmer added that this stance was “a common posture of residents in

nursing homes” (p. 180), effectively painting the vision of hallways of older adults with

“fists clenched and arms folded” (p. 180).

Another way in which the texts did not view the older person first as a person was

seen in the previously discussed issue of informed consent. Johnson (1985) stated he told

the drama therapy group participants that the goal was “to get to know each other and

share your feelings with the group” (p. 113). This statement did not provide proper

informed consent, especially when he stated,

For the therapist, the purposes of the group are (1) to serve as an orienting and

socializing environment, (2) to be an arena for sharing reminiscences about

important life events, and (3) to aid in the acceptance of one’s physical

limitations, interpersonal losses, and eventual death (p. 113).

These goals differed from the ones Johnson told the participants and these goals were

therapy goals. Thus, an informed consent with disclosure was needed. Anything less

removed the rights of the client as a person first. If the purpose of expressive therapies

(or any therapy) was to empower, then one could not start out a positive relationship with

an act of disempowerment.

Show an Understanding of the Inner Age of the Client

Articles about working with older adults sought to honor the inner age of the

client.
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No specific references were made in the texts to the concept of inner age. This

occurrence was not surprising in that the concept was one being put forth in this

dissertation. That said, expressive therapies’ “emphasis is on the inner life” (Weiss,

1984, p. 117). With that as the focus, expressive therapists were in some manner always

working with the older adult’s inner age and the inner concept the person had herself.

Statements like the following by Wald (2003) worked against the therapist’s

understanding of the concept of inner age and its usefulness in therapy. “The older adult

must cope with major life losses, physical decline, sexual changes, changes in

dependency status, role as receiver, and reduction in social contacts…” (p. 295). That

statement alone was not too concerning, but Wald (2003) continued by quoting Blau and

Berezin’s (1975) report which stated that the older adult was “expected to sustain mild

feelings of depression, anxiety, and grief, and one needs to reduce somewhat one’s

aspirations” (p. 226). The concept of inner age as revealed in this dissertation pushed

against the idea of a reduction in “one’s aspirations” while still acknowledging physical

age.

Encourage the Creative Potential of Older Adults

Articles about working with older adults reflected an understanding of what older

adults have to offer in their creative stage of life.

As has been mentioned, good quality materials was suggested to be provided to

older adults partaking in expressive therapies (Wald, 2003, p. 299) for creativity was

fostered in an environment of possibilities not one focused on issues. Because a wide

range of older adults existed, it was seen as important to make sure their diversity was

reflected in the writings rather than the group of elders being seen as one collective.
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Sandel and Hollander (1995) defined the wide range of elders one might work with by

describing how “aging populations differ” (p. 134). In their description they included

sections on “well-elderly,” “physically challenged,” “psychiatric disorders,” “cognitively

impaired,” and “frail elderly” (p. 134-136). By providing quality materials, being in the

role of therapist, and being open to the wide range of elder populations, one could work

with older adults to achieve their creative best.

Finishing Comment

“An important aspect of the work done by a dance movement therapist will lie in

combating ageism, particularly at the level at which older people have themselves

internalized it” (Stockley, 1992, p, 82). Combating internalized and external evidences of

ageism was seen in this dissertation not just the work of the dance/movement therapist

but of all expressive therapists working with older adults. One of the first places

expressive therapists begin learning about their future work was through expressive

therapies literature. The literature was also the place where practicing expressive

therapist learned new skills and practices. Thus, it was seen as important in combating

ageism and its influences that expressive therapies literature reflected the reality of aging.

Basing the articles on solid research, being attuned to overt and subtle ageist statements,

and incorporating the guidelines spelled out above, writers and researcher could help

expressive therapist enter the work with older adults not focusing on limitations but

envisioning possibilities.
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References

Aday, R. H., & Aday, K. L. (1997). Group work with the elderly: An annotated

bibliography (Vol. 33). Westport, CT: Greenwood.

Administration on Aging: U. S. Department of Health and Human Services. (2009). A

profile of older Americans: 2009.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental

disorder (4th ed. text revision ed.). Washington, DC: Author.

American Psychological Association. (2004). Guidelines for psychological practice with

older adults. American Psychologist, 59(4), pp. 236-260.

American Psychological Association. (2010). Publication Manual of the American

Psychological Association (6th ed.). Washington, D.C.: American Psychological

Association.

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