The Myth of "Diminished Capacity"

David Solie, MS, PA
December 22, 2004

David Solie, who was trained in developmental psychology and medicine, is an insurance broker specializing in the needs of the elderly. In the course of his work he's been confronted by repeated episodes of "elder frustration", which results from the inability of professionals to interact effectively with this age group. He has developed considerable insight into the problem, and distilled his experience in a book "How to Say It to Seniors". With his permission, we reproduce here another set of excerpts from his book. Robert Griffith, Editor.

The prevailing myth about aging - that it is nothing but slow and steady decline - is a by-product of our culture that worships youth and abhors getting old. It is not surprising that this view sees aging as nothing but systems failure when it looks at its older citizens. Bodies don't work as well when we age, so it seems reasonable to assume that brains don't work as well either. But if this were true, then how do we explain the composition of Otello by Verdi, the founding of the Christian Science Monitor by Mary Baker Eddy, or the design and construction of New York City's Guggenheim Museum by Frank Lloyd Wright. All of these masterpieces were created by adults between the ages of 70 and 91! A culture obsessed with staying young has missed the most important part of getting old: The brain's physiology changes in ways that promote the person's need for reflection, insight, and innovation.

We know that aging does have its share of medical problems that can have serious mental health repercussions. Mini-strokes, Alzheimer's disease, and depression are only a few examples of how medical problems can create true "diminished capacity" in the elderly population. While the occurrence of these medical problems increases the older a person gets, it is erroneous to assume that all changes in behavior and communication style in this age group are the result of these or other diseases. Our love of the biological model of aging has duped us into believing that "slowing down" is synonymous with diminished capacity. It is one of the most misunderstood and destructive ideas we harbor about aging.

What? we may wonder. Diminished capacity in the elder years a myth? Nonsense! Just look at my 75-year-old mother/colleague/neighbor. She has difficulty getting in and out of the car and now she's repeating herself. Twenty years ago she didn't do that. Must be diminished capacity!

Wrong! What looks like diminished capacity in the majority of the aging population is nothing more than an awareness by that person that he or she is on a different developmental mission. Yes, body parts are breaking down and wearing out, causing the elderly to move more slowly through their days. But research shows that the most important mental capabilities remain intact throughout the aging process. Furthermore, brain functions that do change in old age actually enhance an elderly person's ability to refocus life's priorities from the goal-oriented productivity of our middle-age years to the more reflective demands of this stage of life.

Résidence Yvon-Brunet

There's a nursing home - a public institution - in Montreal called Résidence Yvon-Brunet that puts as much emphasis on "home" as it does on "nursing." Residents there, no matter what their physical capabilities, are given a bill of 31 rights based on respect for the freedom of each person. Yvon-Brunet views old age as a stage of life, not a disease. The facility views itself not as an institution, but as the person's home. Just as you would knock on the door before entering a person's dwelling, everyone from medical directors to janitors must knock on residents' doors and be granted permission to enter. Residents may also lock that door, if they so desire, a basic right forbidden in many institutional settings.

A primary goal of Résidence Yvon-Brunet is to maintain the elderly person's interest in life. In the basement is a complete "Main Street" with shops that look like those of the 1910s and 1920s, when most of the residents were young. Residents look forward to getting their hair done at the beauty shop, shopping at the five-and-dime, going to the picture show, etc. Some other of the residents' 31 rights: to know the names of all staff members and what departments they work for; to be told the consequences of any medical procedure suggested - and to refuse the procedure if so desired. The elderly residents at Résidence Yvon-Brunet are free to express opinions, criticisms, and suggestions regarding life in the home. Residents have the right to organize their living space any way they wish.

What makes the rights so valuable is that control issues rarely arise to overwhelm the residents. Although they may have some physical limitations, they have no restrictions on the life of their minds and emotions. The facility recognizes that when biology restricts mobility, the person's psychological state becomes the key to maintaining good general health. At Yvon-Brunet, ambulatory status is unimportant; it's the residents' psychological health that the facility is interested in.

Many baby boomers with whom I've discussed Résidence Yvon-Brunet have an immediate response: It sounds like a better model for elder care than the one we've developed here. It balances the need for special assistance with the need to remain engaged with life. It causes us to rethink our role in seniors' lives. Seeing our elderly as diminished, nonproductive, high-maintenance people is fundamentally wrong. Becoming their legacy coaches suddenly seems more than a good idea; it's our mandate toward rehabilitating older folks into the fabric of life.

Building Our Own Legacies

There's another reason for our renewed interest in the well being of seniors: We're not that far away from the time when we'll begin to search for our own legacies. Why not accumulate the skills to help ourselves as well as others, as we discover what there is in our histories that might become part of our future. Not to take the opportunity to engage our elders would make us that much less skilled going forward. If we don't learn something about the aging process now, in 20 years our own happiness could be compromised.

Part of our assumption about the aging process is that biology is destiny and determines everything the older person can do, feel, and think. We assume that outside of biological issues, there isn't much else to say about this age group. But once we become clued in to an elderly person's developmental agenda, we realize they are less concerned with biology than they are with maintaining the control they need to fulfill their mission. That mission is not to come to terms with their impending death, but to make sense of their life.

We shall post further extracts from David Solie's book "How to Say It to Seniors" on HealthandAge.com. You can buy his book at Amazon.com; click here

Source

• David Solie, MS, PA. How to Say It to Seniors: Closing the Communications Gap with our Elders. (2004) Prentice Hall Press, New York.

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