Emotional health is as important to quality of life as it is to physical health. Sometimes even more so. A strong sense of self and a clear sense of purpose can go a long way toward making even the most difficult situation a rich personal experience. And if the challenges of life get us down, prolonged sadness—depression— is not just a normal hazard of aging that has to be endured. It’s a bona fide medical condition with biological roots. Fortunately, there are many ways to address and treat depression.
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Emotional well-being
It was long thought that with the decline in physical abilities, older adults would also experience a decline in emotional well-being, happiness, and life satisfaction. To the surprise of many, researcher Dr. Laura Carstensen found the opposite. Older adults tend to be quite content. They experience fewer negative emotions and less emotional reactivity than do younger adults.
The sweet spot seems to be between age fifty-five and seventy. Those in Carstensen’s study who were older than seventy-five started having more negative emotions, correlating in part with poor health or cognitive impairment. But even their bad days did not tend to go as low as those of younger adults. These tendencies have been confirmed across multiple studies and in multiple countries.
What is at the root of this emotional positivity?
Consciously avoiding stressors. As our time becomes more our own (for example, retirement), we are able to avoid common stressors. In fact, we make a point of it. Don’t drive during rush hour. Limit contact with disagreeable people. Establish routines that are predictable and don’t create stress. Pursue pleasant leisure activities.
A focus on what’s important. With limited time on the planet, older adults tend to embody a “don’t sweat the small stuff” ethic. Life is too short to get upset. Instead, focus on those things that bring joy and meaning. Often this means a smaller social circle, but one that is more closely knit.
Contentment is a goal. When we are young, our emotional expectations are for more extreme stimulation. We want to feel very happy, very often. We seek highly activating emotions and excitement. With maturation, however, we tend to get more realistic about our expectations and are pleased with “happy enough.” Interestingly, older adults may be happier overall because it’s easier for them to reliably achieve their emotional goals of being happy enough.
Being positive when they can be. Research finds that older adults tend to give others the benefit of the doubt more often than do younger adults. They might ascribe difficult behavior as someone having a bad day rather than a character flaw or unkind intentions. They tend to make interpretations that preserve peace between people rather than confrontation.
Of course, we’ve all met older adults who are grumpy and seem to prefer that state. This is more common in later old age when life stressors may emerge that are not avoidable. Isolation and feeling out of sync with the world seem to contribute. And certainly, if there is significant cognitive impairment (dementia), then emotional regulation diminishes.
Accessible anytime. The good news about emotional regulation is that you don’t need to wait until you are fifty-five to benefit from these strategies. They may be easier to implement as we grow older, but they are available to all. It’s primarily a shift in focus and priorities. Where you put your attention.
Our sense of self changes as we age and is greatly affected by our feelings about getting older.
Likely those feelings began with negative cultural messages we observed in our early childhood. These messages basically told us old people are slow, senile, and decrepit. Over the years we were bombarded by ads and media that fed negative feelings about growing older. (Check out the snarky messages in birthday cards. Or all the antiaging ads urging us to rid ourselves of wrinkles and gray hair.) And then one day we are older ourselves and realize that we now belong to this stigmatized group. It’s extremely common for the ageism we weren’t even conscious of in our youth, to turn around and bite us in our older years. Instead of valuing the benefits of being older, we often internalize ageist beliefs and are the worse for it.
In her book, “Breaking the Age Code,” Yale researcher Dr. Becca Levy discovered that negative age beliefs are associated with a loss in life expectancy of seven and a half years. (Put differently, those with positive views about aging live an average of seven and a half years longer than do those with negative views. This was after factoring out any biases due to poor health.) She suggests three reasons:
With negative age beliefs, we lose the will to live. Not necessarily that we want to die. But if being old is bad, why invest in life? Things are only going to get worse. Conversely, studies of those who live a long and healthy life reveal that a commitment to purpose—a reason to get up in the morning—is a strong protective factor in their longevity. It’s worth cultivating a belief that life is worth it despite the challenges of old age.
People with negative age beliefs tend to have a higher level of C-reactive protein. This is a marker of chronic inflammation that seems to be at the root of many common conditions associated with age (cancer, heart disease, dementia, diabetes). Those with positive age beliefs had lower C-reactive protein levels. They were better able to fend off stress and chronic conditions at the biological level.
Those with negative age beliefs are less likely to engage in healthy behaviors. Why bother if they feel futile? Those with positive age beliefs don’t expect that they are going to be unwell just because they are a particular age. As a result, they tend to be proactive about doing what they can to stay healthy and independent.
This is not to say that attitude alone can cause ill health. But it’s worth noting that shifting one’s focus away from the limiting ageist messages in our culture and emphasizing the positives of living long and well can do a lot for our sense of self and well-being. (Part of Dr. Levy’s studies included participants in other countries where aging and elders are held in high regard. The health, well-being, and self-esteem of older adults were much higher in those countries than in the United States and other western cultures she surveyed.)
If you are caring for an older adult, learn to recognize ageist thoughts (within yourself and within others). Question whether that negative belief is truly due to actual life challenges or just negative assumptions about age.
To counteract years of ageist messages, consider the following:
Engage socially with agemates. Celebrate the positives of having an expansive life story.
Stay physically active. Even people with arthritis and other disabilities can participate in strength, balance, and stretching exercises such as tai chi, resistance training, and yoga. More physical confidence builds confidence about other areas of life.
Keep the brain stimulated. Make it a point to learn something new or different. The brain responds to challenges by growing new pathways. This is called “brain plasticity.” Help the brain stay flexible and in the habit of growing. There’s no expiration date on curiosity!
Manage stress and anxious thoughts. Lack of confidence undermines a positive sense of self. Practice the art of “reframing” to remove blame and limiting thoughts while also objectively acknowledging progress that has been made. For instance, “I can’t do the smartphone,” can be reframed to, “I may not understand all that my smartphone has to offer as yet, but I have mastered texting and I do enjoy taking pictures.”
Spend time with young children. They are less indoctrinated and more open to people who show a general interest in what they are doing. In addition, studies show that children with close relationships to older adults grow up with far fewer ageist assumptions. Invest in the future!
What does aging mean to you? “Who is that old person in the mirror? Inside I feel like I’m still 30.”
Who we are inside is actually the accumulation of all our experiences, whether we are twenty or eighty. The older we are, the more experiences we have to draw from in our personal portfolio. We are our thirty-year-old self as well as all the other ages we’ve been.
When we are surprised by the image in the mirror, it is because our experience of being older doesn’t match what we thought we would feel when we had wrinkles or gray hair. Our picture of aging has been far too limited.
It’s time to throw off the preconceptions. Part of accepting our aging selves is to be curious and open to exploring who we might become on this journey. Not necessarily expecting to become an age-defying superachiever. But looking at our inner world and appreciating the continuing growth of our insights and understanding.
Ask a ninety-year-old if a sixty-year-old still seems to have a lot to learn, and they will probably laugh. And if they are honest, they will say “yes.”
We don’t stop absorbing and learning just because we hit a certain age.
Milestones in aging
No one disagrees that there are developmental tasks or milestones at the forefront in our earlier years.
The same holds true in the natural cycle of life as we confront the issues of our later years. According to noted developmental psychologist Erik Erikson, the task of the elder is to reflect on their life and construct meaning from their experiences.
Opportunities for growth
There are many growth opportunities in our later chapters. Here are a few that rise to the top:
Separating abilities from self-worth In a culture that values independence and self-sufficiency, it can be difficult to acknowledge declining abilities. Aside from the practical inconvenience, symbolic meanings also are in play. Part of the aging process involves learning to separate our self-worth from our ability to produce and get things done. And ultimately, from our ability to attend to our basic needs. We are human beings, not human doings. That said, it is challenging to confront the feelings of anxiety and low self-esteem that arise when physical abilities decline.
Controlling what you can In middle age, the world is our oyster. We get used to feelings of power or “agency.” We know what we can get done as we navigate career, family, and community. Challenges typically involve time more than ability. We are outward focused, and it’s easy to live under the illusion that we have control. As older adults, however, things shift. We ultimately realize that nature bats last. Try as we might, our bodies have their own agenda. Friends move. Spouses die. In order not to feel so powerless, we strive to control what we can. Getting to choose, no matter the size of the decision, becomes vitally important. Whether it’s which clothes you put on in the morning or where you live. It’s critical that families and professionals respect this need.
Making amends Everyone has things they wish they had done differently in life. Now is a good time to reflect and think about what you might have done differently. If you hurt people along the way, it might be healing for both of you if you were to ask forgiveness. Many an estranged family has mended fences and been given the gift of renewed relationships. They often regret the years that have been lost and cannot be recovered. (Even if the people involved are not reachable—through death or a lack of desire to connect—write a letter. You don’t have to send it. Just the act of getting your thoughts on paper and making amends internally can be healing.) On the other end of things, there may be people who have caused you harm or hurt. It’s an act of courage to extend forgiveness. You don’t have to condone what they did. But reaching out with a merciful heart and sharing that you understand everyone does the best they can at any given time can be healing for all of you. Most of all, you lose the weight of carrying that burden any further down your path.
Expressing gratitude Just as we may have regrets, we may also want to thank those who have supported us. This might be mentors, a spouse, friends, children. Expressing your appreciation can open doors in the relationship that lead to even greater exchange. It’s never too late to say thank-you.
Letting go as needed
Vital as it is to feel in control, we have fewer bumps and bruises if we also learn how to graciously let go of control as the situation warrants. It requires trust. And great courage. It requires finding new ways to express ourselves and discovering deeper sources of personal dignity. Learning to release control is one of the parts about aging that makes it “not for sissies.”
Finding meaning or purpose Even in the face of decreased physical abilities, we have the opportunity to turn inward and learn and grow in that dimension. We reflect on our lives. This is the gift of our later years. We have the opportunity to focus on what’s truly important to us and to live those priorities. Whether it’s cultivating relationships or spending time in the garden. This inner journey is more than your bucket list. And more rewarding. By concentrating on meaning and purpose, we create a new sense of self as we continue to question, “Who am I now?”
The Surgeon General has identified a “loneliness epidemic” in our country. He raised concerns that our isolation and sometimes subsequent loneliness is contributing to widespread mental health issues, such as depression and anxiety. But loneliness also has a profound impact on our physical health. Loneliness and social isolation are associated with nearly a 29% increased risk of heart disease and 32% increased risk of stroke. Fully half of socially isolated adults have an increased risk of dementia, and over 60% have an increased risk of dying prematurely.
Between transportation challenges, widowhood, and friends moving, getting sick, or dying, older adults are quite susceptible to isolation and loneliness. It appears that 24% of people over age sixty-five who do not live in facilities are socially isolated, and 43% of individuals over age sixty report feeling lonely.
What about natural “loners”? It’s important to make a distinction between social isolation and loneliness. Social isolation is a measure of one’s social safety net. It’s the number of people one can talk to about “things that matter.” People who live with at least one other person, who are part of a religious community, or who are involved in other social activities, are considered socially engaged. (Having people who know you and would recognize if something were wrong is very protective to our health.)
If a person has only one or even no individuals they could talk to about things that matter, they are considered socially isolated. It’s hard to set an exact number for healthy social engagement, but Canadian public health guidelines suggest that having three to five individuals you could call on in a pinch provides a reliable safety net should something come up.
Loneliness is different than isolation. Loneliness is more of a feeling and relates to the gap between how many quality friends you would like to have versus how many you actually have. A person can be socially isolated but not lonely. They may like their own company (an introvert) and do not wish they had more close contacts. Admittedly, their social safety net may be small, but they are not unhappy.
Loneliness, however, is a feeling of discontent about the quantity and quality of one’s relationships. A person can feel lonely in a crowd, for instance. Loneliness is more insidious than isolation alone.
Making friends in later life In our youth, we are in school or at work, where we are repeatedly exposed to the same people and can identify those whom we enjoy. In our later years, that does not occur so naturally. We really do need to make an effort if we want to make new friends. According to AARP, it takes fifty hours of contact to develop a casual friendship. It takes ninety hours to cultivate to a “real” friendship.
Consider the following:
Join activities that allow for multiple exposures. Think book club rather than a lecture on a particular book. For instance, consider a group that gets together regularly for walking. Then you address two issues at once (exercise and socializing). Look for classes, volunteer work, or even a part-time job.
Remember you are likeable! Studies show that people usually underestimate how much others like them. We actually become warmer and friendlier when we think of ourselves as a person people like.
Look for opportunities to help. People say they look for helpfulness in friends, so be helpful. Whether it’s offering a ride when needed or bringing in the trash cans, keep your eyes open for ways to be of service.
Use text and email to your advantage. Small gestures convey a lot. Consider an encouraging word before a doctor’s appointment or a thumbs up when someone has good news. You can use this to reconnect with an old friend or signal your support of a potential new friend.
Share what you admire. We tend to like those whom we feel like us. You don’t want to be gushing, but a sincere moment now and then to let someone know what you appreciate about them can go a long way toward building a friendship.
If your relative is lonely or isolated You can bring a horse to water, as they say, but you can’t make them drink. Still, there are things you can do to help the person you care for feel more comfortable getting socially engaged.
Facilitate transportation. If your loved one no longer drives or no longer drives at night, see what you can do to help them get where they need to go.
Support good hearing. Many older adults feel uncomfortable in social situations because they can’t hear well. Many older adults don’t want to wear hearing aids either. But if you can encourage them to get their hearing checked and to wear their hearing aids, they may find it easier to connect with others. (Along similar lines, suggest meeting in venues where it is not noisy: In a park rather than in a crowded restaurant, for instance.)
Suggest rekindling an old friendship. It’s easier to strike up again with someone you know you liked in the past than it is to cultivate those fifty hours needed to make a new friend.
Look for enrichment activities. Senior centers offer day trips to interesting locations and fun activities. Or consider private one-on-one activities that may be offered locally by care managers.
Not a “normal part of aging”
Too many people think depression is “normal” when you get to a certain age. Not so!
Depression is a very real and generally treatable biological condition. If you are depressed, rest assured that you don’t have to settle for being sad.
Signs of depression
Depression is more than a passing mood. Depression is actually a biochemical imbalance in the brain. It’s not something you can just “snap out of.” It requires treatment.
If a person experiences several of these symptoms most every day over a two-week period, ask the doctor to do an evaluation for depression:
Feelings of sadness, anxiety, or even numbness (no mood at all)
Hopelessness, guilt, worthlessness, or helplessness
Loss of interest in once-pleasurable activities (including sex)
Irritability, angry outbursts, frustration
Anxiety, agitation, restlessness
Physical aches or pain that are not easily diagnosed
Decreased energy or fatigue
Moving or talking more slowly
Difficulty concentrating, remembering, or making decisions
Social withdrawal, preferring to stay at home rather than go out
Sleep changes (sleeping too much or too little)
Eating more than usual or less than usual, with unplanned weight gain or loss
Thoughts of death or suicide
A big reason depression goes unrecognized is that many of the symptoms seem common in older adults. Fatigue, for example, or insomnia may be wrongly considered “normal” side effects of age. Or they may be a symptom of another medical condition or a side effect of treatment.
(Depression is also very common in family caregivers, so if any of this rings a bell for you as a family member, by all means talk to your doctor!)
Treatments for depression Common forms of treatment include the following:
Talk therapy. Working with a trained counselor, you can learn how your thoughts, feelings, and behaviors trigger your depression and identify strategies to interrupt these triggers.
Medication. Depression involves a chemical imbalance in the body. Antidepressants help restore that balance. You may need to try several different kinds before you find the one that is the best fit for you (least side effects for greatest relief of symptoms). It usually takes a few weeks to begin feeling the effects.
Brain stimulation therapies. These activate or suppress different parts of the brain and tend to reset the brain network back to a more normal pattern. One example is electroconvulsive therapy (ECT). Another is repetitive transcranial magnetic stimulation (rTMS). They are not usually applied unless depression is moderate to severe and medication and talk therapy have been tried and not found to be effective enough. (Most practitioners encourage continuing with medication and talk therapy before, during, and after a treatment regimen.) Brain stimulation is applied by trained medical professionals.
Depression can be miserable. And it’s a self-perpetuating process that tends to zap initiative, making it difficult to take steps for a remedy. Plus, if left untreated, depression can progress to feelings of hopelessness and even suicide. (If you are concerned that suicide is a possibility, call the 24/7 suicide hotline at 988.)
Ways to prevent or reduce depression (or a relapse) In addition to treatment, lifestyle strategies can support better mental health.
Exercise. Physical activity has long been recognized as a way to jumpstart the metabolism, including one’s mood. Walking is the easiest, but whatever you enjoy doing and will keep doing is the activity that is best.
Get enough sleep. Insomnia and depression go together so often that it seems one can cause the other, and vice versa. If you struggle to get enough sleep, address this actively with your doctor. They can help you with techniques to improve both the quality and quantity of your shut-eye.
Simplify. A common feeling with depression is “overwhelm.” Life just seems to demand too much. Look for ways to make certain activities routine so you aren’t having to make extra decisions each day. (For instance, find a breakfast or lunch that is well balanced and easy to prepare ahead of time for multiple days so you can just grab and go.) Decision fatigue is very real. Routine can be your friend.
Cultivate social relationships. In person is best. People who are isolated have a much greater risk of becoming depressed. Online “friends” don’t count.
Reduce social media use. Social media is addictive. It’s too easy to get sucked into “doom-scrolling” or comparing oneself to others. Keep your social media use to a minimum (use timers, turn notifications off). Real life may be not as easy, but cyberspace is not truly grounding.
Avoid toxic people. If there are people in your life who put you down or somehow make you feel “less than” after spending time with them, do yourself a favor and spend time with people who are uplifting instead. Life is too short to fill your time with negativity.
Cut down on alcohol and recreational drugs. Again, these are not really your friends. They distort your perception and keep your mind from clear thinking.
If you think you are depressed or care for someone who may be, talk to a doctor. Life doesn’t have to be this dreary. Take a stand for good mental health.
