Loss of connections, associations, and skills, that at one time were easy, seems to exacerbate cognitive decline in older elders because many are aware of what is happening.
I’ve now closely observed five elderly family members move through late-in-life years, four of them having lived into their 90s with two of them still living. Four of these older elders had minimal memory problems until around age 90. And yet in a short time when the decline began to overtake them — a period of a couple of years — three of our older adults moved from days filled with working on committees, playing bridge, church, singing in choirs and attending book clubs into a time when they were unable to do many of the activities they cared most about.
Despite memory challenges, all five of our family members knew exactly what was happening. At one time or another two of them commented that it seemed like they were watching a movie or reading a novel about the end of their lives. Another one stated pithily, “It’s like I am watching myself sunset.”
The first inkling that the rich context of their lives was weakening occurred when our family members stopped driving at night, and three of them made this decision without much prodding. This single change erased a range of activities from their lives, things they still wanted to do. Yes, friends helped with rides and churches often offered volunteers who assisted, but there was no way to accomplish everything that was possible before night-time driving ceased — even though they still wanted to do them.
“My mother lost her sense of sharpness when she could not get to the night activities she loved,” one adult son told me.
Of course, the biggest loss came when it was time to give up the car, which meant that almost all activities away from home were no longer possible. None of our family members — had access to good quality public transportation or a caregiver who was around most of the time. Good friends helped out, but even the most mundane activities of daily life were not possible — going to the pharmacy, the dry cleaners, the grocery store. More significantly, the time spent socializing with friends who did not live in their retirement community came to a halt.
But the movie about loss in elder life continued to play as they watched.
For some of my family members, the next loss had to do with their computer skills as the mechanics of using their machines became increasingly difficult. Our older elders knew what was happening, and were frustrated as they watched themselves unlearn. Their troubles had to do with certain more complicated sites, bill paying, and those always-challenging passwords. Gradually, it became harder and harder to remember how to log on to most sites and finally onto the computer. Emails decreased from hundreds a week down to just a few. Communicating with a lifetime’s worth of friends and family on email and, more recently on Facebook, was impossible without enormous assistance — which we often tried to give, usually over the phone.
The elder adults in my family clearly articulated how much they missed connecting with distant friends and family, but their connection skills were just too weak to continue. For a while letter writing, cards, and notes sufficed, but here, too, the mechanics grew to be challenging. My mom commented, “I can’t even find out who is sick or who has died.”
Then there was the phone. For our family members the ability to answer the landline phone longest-lasting technical skill. But using voicemail, dealing with the passwords, and eventually, making calls gradually became too confusing. People would leave messages that were not retrieved.
Even for older elders, even individuals with great strength and fortitude, observing the losses and knowing what is happening must create a profound sense of grief and isolation that contributes mightily to greater cognitive decline. If an aging adult is fortunate enough to have family members living nearby — and some of our family members benefitted from this — the sense of loss and helplessness diminishes a bit. When an elder lives in a warm and supportive assisted living community where new relationships can form and independence are encouraged the sense of loss is somewhat ameliorated, but it does not seem to go away.
Losing so much is probably one of the most difficult challenges of outliving an active and rich activity-filled life. We cannot forget, even when all the aging support guidelines are in order — a lovely community, plenty of retirement activities, field trips, new friends, awesome caregivers — that feelings of loss about a rich past life are still there in their memories reminding them of what they no longer have.
As one adult child friend joylessly commented to me recently, “It was almost a relief when my mother stopped remembering so many of the most significant things.”