Healthy Aging: Managing the Hard Realities

By Arbore, Patrick; Tusscher, Tessa Ten | Aging Today, September/October 2003 | Go to article overview

Healthy Aging: Managing the Hard Realities

Arbore, Patrick, Tusscher, Tessa Ten, Aging Today

A robust-looking man of 78-we'll call him Mr. Lee-was the primary caregiver for his wife until her dementia progressed to a level where placing her in a nursing facility became the least troubling of his remaining options. On the surface, Mr. Lee seems like a model of healthy aging. He is in good health; he owns a comfortable home in a suburb of San Francisco; and his adult children, who live in another state, call him regularly and supported the decision to place their mother in a nursing home.

At a caregiver support-group meeting, however, this picture of health shifted noticeably. Speaking of his life, Mr. Lee lamented, "Although my wife is alive, she may as well be dead. She is lost to me; she doesn't know who I am and hasn't recognized me as her husband for a couple years. We've been married 50 years; I live in the house we bought when the kids were little. I'm alone and have no reason to live. My two children have their own lives and families; my wife doesn't need me. Why go on living?"

Aging and health have become a contradiction in terms for many Americans. The assumption that aging inevitably involves loss, depression and decay, that it is a prelude to death, abounds in clinical and popular literature. The recent trend toward laying a pathway to successful aging with such flagstones as good diet, exercise (often supplemented, by yoga or tai chi) and strong social contacts, has focused on being "vital." The assumption is that if-people do all the right things, they will age with health, equanimity and grace. This model of health, although it includes much worthwhile advice, misses one critical point-that aging is difficult.

Aging comes with losses, dilemmas and developmental tasks, which people seldom think about when they are younger and which usually surprise them in their later years. Mr. Lee, despite his good relationships, physical heartiness and openness to receiving help, still struggles with the extraordinarily difficult task of losing his life partner to dementia and having to move her out of their home. This reality is not something that millions of people like Mr. Lee anticipate, much less plan for, each year.


As one of the authors of this article was facilitating a discussion on grief and loss during a support-group session, he asked Mr. Lee whether he wanted to talk about his feelings. Mr. Lee politely declined the invitation and stated flatly, "My doctor says I have the health of a man half my age. What good does health do me now? I am alone." Asked whether his physician had spoken to him about mental health concerns, such as depression, he replied, "No, he thinks I have all my marbles."

Even though older adults like Mr. Lee may have their "marbles" intact, they might experience depression as a result of long-term caregiving, as well as repressed grief over making the hardest of choices. According to the Family Caregiver Alliance website (, among spousal caregivers almost a quarter of husbands and half of wives become seriously depressed.

Recognizing depression in older adults is not easy. Some professionals may even think that the life of someone such as Mr. Lee is better once his caregiving responsibilities have ended. Members of his support group expressed admiration over Mr. Lee's ability to care for his wife for so long, and some commented that now he can go on with the rest of his life. But whatever relief caregivers such as Mr. Lee may feel when their loved ones are first placed in a facility, that relief soon may be replaced by a sense of worthlessness, loneliness and hopelessness.

Fortunately for Mr. Lee, the facilitator of his large respite support group was concerned and asked if he would be interested in contacting a grief counselor. He agreed, and during grief counseling he acknowledged his loneliness and cried. Mr. Lee began to tell the story of his relationship with his wife, expressing and experiencing his complex feelings about how it feels to grow old in America. …

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