Aging, by definition, takes time. If it happened in an instant we would all get a dreadful shock. If we went to bed one night looking like a 21 year old, and awoke the next morning and saw an 80 year old looking back at us in the bathroom mirror. Having just written that, it just struck me that that experience can actually happen to some 21 year olds after a bad night out, but they usually recover from it. The aging process is slow and gentle, so slow and gentle that we don’t notice it on a daily basis. We see the changes if we look back at photographs of ourselves taken several years ago. Do we like the change that has happened to us over those years? Maybe not, but there is not at lot we can do about it, and so long as we can keep on living an active life and doing the things we have been doing, we can accept it and life can be good.

From middle to older age, there is a difference between our actual age (as per our birth cert) and the age that we believe, think, act and feel like. If we can act and feel like we are 20 to 30 years younger than we are – then that’s a good thing. Feeling “old” is usually a complaint.

If we accept this, then it is important not to overlook the fact that this 20 to 30 year perception difference does not disappear once an elderly person needs care.

In a recent Sunday Miscellany radio broadcast at about 24 minutes and 24 seconds into the program, the writer Brian Leyden has a wonderful piece on aging. In it, he talks about a friend of his who is in her 90s and still living in her own home in rural Ireland. Her blood boils at this discrepency between what she considers her rightful age to be and her actual age. She does not want to “give in” to being old at all. She was not happy when her doctor’s medical report on her failing eyesight meant the loss of her driving licence. This loss of freedom to sit into her car and drive off at a whim to wherever she wanted to go was deeply felt.

As care givers, we are all too consumed with trying to do what we believe is best for the person we care for that we don’t think about their perspective as to how they want to live, and the age they perceive themselves to be and want to live at. This is a challenge.

Brian mentions that his friend’s energies are focused on:

• Living in her own home, on her own terms
• Staying out of hospital
• Avoiding being caught up in the “care for the elderly”

The last point can be readily recognised by many relatives as they hit this resistance on the part of their elderly relatives, to receiving “extra care”. Nobody likes to accept the fact that they need someone else to help them do things that they have always done for themselves.

An important point in Brian’s piece is the perception that institutional care is not for the person’s own good, but to keep the family happy. The institution keeps the person “safe”, sheltered and fed. Brian’s friend does not want to be “wrapped in cotton wool” and be deprived of living. We are invited to question the way in which institutions deliver care. Are they “robbing the elderly of choice, purpose and even conversation”? Brian says that “having things to do, gives people something to talk about”. So if our care delivery keeps the person so “safe” that they have nothing to do, then they will just sit in silence. And isn’t that too often the experience in nursing homes?

We are reminded that “what keeps a person engaged in life is the knowledge that there are things that won’t get done unless they do it themselves. This is what gets us out of bed in the morning. This is what drives us on. Knowing that we are responsible for keeping ourselves warm, fed, the bills paid, and our social rounds going”

This is a real challenge for care givers, especially nursing homes as they are businesses which need to be efficient and that leads to processes and standardisation, treating their clients in the same way. It is easier and more efficient to “wrap them all up in cotton wool” and keep them “safe”, than to deal with each as an individual, and encouraging, facilitating and challenging each in his/her own way to his/her own limits, to do more, to make choices, to have purpose.

Dare a nursing home leave some task undone which the client could do for him/herself? Or would the home stand accused (by family or inspectors) of poor standards and lack of care?

How much independence are we happy for the person to keep? Do we take it all away so that we can rest easy that they are “safe”, or do we give them as much as they are able for, accepting that there are consequences, and sometimes mishaps, sometimes severe or even fatal?

Brian tells us that from his friend’s perspective, “Being responsible for whatever happens is not the price to be paid for her independence, it is the reward“.