Rethinking Age: How the Elderly and their Family can Thrive in the Modern Age

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Are older adults really as helpless as we think? Consultant geriatrician Professor Dr Tan Maw Pin challenges the outdated view of ageing in Asia. As the sandwich generation feels the squeeze, she argues it’s time to empower the elderly — not pity them — and rethink what ageing truly means.

WORDS LIM TECK CHOON

FEATURED EXPERT PROFESSOR DR TAN MAW PIN Consultant Geriatrician Faculty of Medicine Universiti Malaya

RETHINKING THE CONCEPT OF AGEING

Age is a multi-dimensional concept.

• We often think of chronological age, which measures the number of years we have lived.
• However, the concept of age also encompasses physiological, cognitive, social and psychological ages — all of which may not necessarily coincide with our chronological age.
• One may be chronologically old, but their physiological, cognitive and psychological ages may be younger, allowing the person to still stay sharp and active.

For example, Professor Ephraim Engleman was an active professor affiliated with the University of California, San Francisco, up to his passing at the age of 104 in 2015.

Who can forget Mother Mary Teresa Bojaxhiu, who was still overseeing the Missionaries of Charity in Calcutta, India, until her death in 1997 at the age of 87?

AGEING IS A LIFELONG, PASSIONATE PROCESS

In the past, people tend to attach descriptions such as ‘weak’, ‘frail’ and ‘senile’ to older persons.

Research has shown that this perception is inaccurate: growing old is not an inevitable descent into decrepitude.

In fact, Professor Dr Tan Maw Pin points out that advances made in research and development have enabled more older persons to still lead active and fulfilling lives.

Self Sufficiency

• There are more opportunities than before for older persons to continue learning and being self- sufficient.
• These opportunities in turn help to keep their mind sharp and reduces the risk of dementia and diseases that affect the nerves and brain, such as Alzheimer’s disease.

Sexual Activity

• There are also studies which show that sexual activity among older persons is beneficial, as it promotes an increased sense of contentment as well as a feeling of kinship with their loved ones.
• This is a complete 180º turn from the prevalent belief in this part of the world that elder persons are not supposed to be experiencing sexual desire, much less having sexual relationships.

Creativity Persists and Can Peak in Older Years

• History has shown that a considerable amount of the best works from creative artists as well as scientists often result during their later years.
• This is because the brain ages like fine wine. Life experiences shape the way one looks at our world, and life-long passions may simmer and evolve to produce a period of creative bloom later in life.
• The famous Colonel Harland David Sanders, the face of Kentucky Fried Chicken, for instance, opened his first outlet in Utah in 1952, when he was in his 60s, and the rest was history.

Professor Dr Tan therefore reiterates that we should stop assuming that older persons must be coddled because they are physically and mentally infirm.

Older persons have the capacity to be self-sufficient, productive, and passionate — just like everyone else!

WHY WE NEED TO CHANGE HOW WE VIEW OLDER PERSONS

The Challenges of the Sandwich Generation

The term ‘sandwich generation’ is used to describe the generation of people, usually in their 30s and 40s, who juggle between their parents and their own children.

• In an ageing country such as Malaysia, this term describes a significant slice of the population.
• The challenges of being in the sandwich generation especially affect women, as they are traditionally viewed as the primary supporter in the family.
• Men aren’t fully exempted either, as their role is typically seen as the primary breadwinner.

As a result, a typical couple in a sandwich generation faces the challenge of having to be financially, emotionally and physically available for both parents and children.

The Added Pressures of Filial Piety and Moral Obligations

Further compounding the pressure is the typical Asian mentality which considers supporting the parents a moral obligation.

The inability to do this well is often viewed as a sign of personal failure as well as a mark of shame and guilt.

Those who fail to provide adequate care for older members of the family may even face censure from society, causing them to cover up their problems and preventing them from seeking help.

Once the family reaches a breaking point, desperation may cause them to abandon their parents, while stress and various negative emotions may lead to other forms of abuse.

• According to a study, the prevalence of such abuse in each country in Asia ranges from 2.2% to as high as 66%.
• Such abuse doesn’t just include physical violence.
• Other forms of abuse include psychological abuse (the most common form of abuse, in fact), financial abuse (which includes withholding the older persons’ money, defrauding and theft), sexual abuse and neglect.

It may seem natural to call for harsher laws to punish those responsible for such abuse, but Professor Dr Tan believes that doing so will not address issues of abuse that are caused by desperation.

CHANGE THE PRESENT TO RESHAPE THE FUTURE

Professor Dr Tan Maw Pin believes that an attitude shift towards older persons is key to untangling the complex issues facing the sandwich generation and the older persons they care for.

Older Persons Can and Should Remain Self-Sufficient for as Long as They are Able to

• If we treat older persons as venerable individuals who are also weak, infirm and sickly, younger people will stop seeing them as human beings capable of making their own decisions and having emotions.
• When things get tough, they may even start to view these older persons as unwanted anchors around their knees that will drag them down further!

“I have seen many instances in my clinic, during which the children of the older persons insist that I talk to them instead of addressing the older person,” Professor Dr Tan recalls.

Given that the older person is the one with a health issue, to her it makes perfect sense to ask the person how they are feeling.

Yet, quite often the older person’s children believe that the person is incapable of explaining things on his or her own and insists that Prof Dr Tan talk to them instead!

This “Older persons should be seen but not heard!” attitude tends to persist in all areas of family life.

• For example, many older persons lose financial independence despite being still capable of managing their own money, as overzealous younger members of the family insist on making financial decisions for them.
• Many older persons also buy into the belief that they are incapable of managing their own money just because they are of certain age, and willingly hand over the responsibility away. Such arrangement is also ripe for financial abuse.

The more an older person is deprived of his or her independence, the more dependent the person is on often busy and stressed-out younger family members.

This creates a sense of helplessness when the older person begins to perceive himself or herself as a burden to the family.

“What is needed is an outlook change on both older persons and their younger family members,” Professor Dr Tan.

A PROFESSOR’S ADVICE TO OLDER PERSONS

These days, family units are becoming smaller and increasingly fractured as younger people move to major cities or abroad to study and work.

Therefore, we cannot take for granted that every family will be able to fully provide for older loved ones.

Older family members can therefore take measures to stay as independent and self-sufficient as possible.

Live Well and Healthy

• This includes eating right and being physically active on a regular basis (incorporating age-appropriate exercises and other activities).
• If any non-communicable diseases are present, work closely with the healthcare team to keep these diseases well controlled.

Keep Working

• This allows older persons to continue being financially independent.
• Consider opportunities that allow working from home or on a flexible schedule: freelancing, bookkeeping, et cetera.

Learn Something New

• Learning new skills allows an older person to lead a fulfilling life, without having to take time and attention from younger family members who have children to tend to.
• New skills don’t have to be elaborate; they can be something on a smaller scale as learning a new language, mastering how to play a new instrument, and getting the hang of social media.

Make Plans for the Inevitable

• This includes planning for one’s funeral arrangements, having a will done up as well as discovering options and making plans for palliative care.
• Doing this allows the older person to experience the satisfaction of planning the days ahead on his or her own terms.
• It also eliminates the need to involve younger family members in what could be a time-consuming process.

A PROFESSOR’S ADVICE TO YOUNGER FAMILY MEMBERS

Be Open

• Ask the older persons what they want, instead of assuming or making decisions for them.

Plan Your Finances

• A financial planner may be a helpful ally when it comes to assessing current financial situation, and whether some areas of spending can be reduced to free up spending for caregiving

Get Help

• There’s no need to do everything alone. Trying to do everything will only lead to both physical and mental burnout.
• Delegate responsibilities instead. For example:
  • Can the family afford getting cleaners to come in a few days each week to do the housework, leaving the family members free to tend to other needs?
  • Instead of a single family member having to drive the older persons back and forth to various hospitals because only that person has a car, can other family members take turns to order a Grab car and accompany the older persons?
• It’s okay to let go.
  • Some caregivers feel that they are the only ones who can understand and care for their loved ones.
  • Hence, they want to do everything on their own, to the point that they soon burn themselves out by overextending beyond their physical and emotional limits.
  • These caregivers need to let go and allow others to step in to assist; if they find it hard to do this, they can seek advice from a counsellor or a member of the older person’s healthcare team.
• Reach out to other caregivers.
  • Caregiving can be an isolating responsibility; caregivers may feel that they are sacrificing their own needs and relationships with other people to tend to the loved one.
  • This can build resentment.
  • Professor Dr Tan advises caregivers to reaching out to other caregivers, either online or in real life, for support.
  • Furthermore, in this age of social media, they can still form and maintain strong relationships even when they lack the time and opportunity to mingle in real life.

Most Importantly, Tend to Your Own Needs Too

• If caregiving is delegated across several people or is planned well to allow the caregiver(s) to have their much needed me-time, the people involved in caregiving will be able to tend to their own personal needs as well.
• This allows them to stay healthy and sound in both body and mind.

Maintain Open and Honest Communication

This is an often overlooked but very important aspect of family life.

• Often, older persons either stay quiet in fear of offending younger family members, or they assume that they are the smartest (and loudest!) person in the room.
• Meanwhile, younger family members treat older persons as incapable of adult thought, often making decisions for them without consulting them.
• All this can generate friction and resentment on both sides.

Communication should instead be open, honest and respectful. Decades of resentment and unspoken hurt – which could bleed into daily interactions to create tension and dissent – can start to heal once everyone opens up and takes the time to understand one another.

Professor Dr Tan suggests that, should a family find it hard to initiate open conversations on their own, try asking a third party such as a family friend to mediate during the initial stages of communication.

This article is part of a series that shines the spotlight on healthy ageing. Click here for more articles by or featuring Professor Dr Tan Maw Pin. Click here for more articles on how to stay healthy as you age.