https://www.straitstimes.com/opinion/can-dementia-or-stroke-patients-age-well-yes-if-mindsets-change
2025-01-14
By -- Philip Yap is the chairman of Dementia Singapore.
The recent suicide of acclaimed Chinese novelist Chiung Yao sparked an outpouring of grief, as well as discussions on the care that older people receive. Still looking hale and hearty at the time of her demise, she chose death to take control of her life, as she did not want to endure a slow decline and the prospect of becoming frail and dependent.
Some supported her choice to take matters into her own hands while others bemoaned her decision and regretted that she had seemingly failed to consider the sentiments of those who loved her. One might also speculate on whether she suffered from untreated depression after her husband’s death, possibly impairing her judgment and mental clarity as she took that fateful decision.
Amid the buzz around successful and active ageing today, would one consider Chiung Yao to have aged successfully? She was, after all, poised and spritely at 86 and ultimately remained in control of her life even unto death. One could equally hold the other view that ageing well should encompass the ability to adapt positively and roll with the punches that accompany ageing. Clearly, it would be contentious to portray her as a role model for other seniors, lest they entertain thoughts of taking their own lives too. It is concerning that in some parts of the world, some people are documenting in their advance care plans the desire for euthanasia should they succumb to a particular state of dementia, frailty or dependency in the future.
Given the hackneyed negative stereotypes surrounding ageing, it would be pertinent to reframe ageing more positively. The idea of successful and active ageing was conceived to depict seniors harnessing their inherent value for their own good and the good of society at large. That said, successful ageing can also be construed as an oxymoron because ageing is predictably accompanied by decline and eventual death. Although personal responsibility has a part to play in determining how we age, many suffer from age-related diseases due to factors beyond their control. Is successful ageing then beyond the reach of those stricken by chronic disabling illnesses such as dementia, stroke or organ failure?
There is no denying the importance of ageing actively with the goals of avoiding or minimising disease, and maximising physical, mental and social engagement. However, the relentless pursuit of successful ageing may inadvertently engender a cultish mindset that adores the traits that convey wellness and vitality, and values seniors merely by their instrumental worth. Herein lies the slippery slope that could lead us from seeking active ageing to being anti-ageing, eschewing ageing as if it were a bane, with attempts to forestall or reverse it.
Embracing the decline
We would do well to rethink the concept of successful ageing. It needs to embrace decline and appreciate the worth of seniors beyond utility and material value. Seniors are worth much more than their personal attributes. As enunciated by William Thomas, a thought leader in eldercare, “elders are the glue that bind us together”. This holds true even if seniors become frail and lose their utilitarian worth, as can be seen in patriarchal figures in families and the society at large.
Ageing comes with certain losses and we have to accept that. Seniors who fight the inevitable consequences of ageing may find ultimately themselves at the losing end and become despondent. Conversely, those who are able to transcend the losses through acceptance, lowered self-expectations and finding new meaning, gain integrity.
Instead of fostering paradigms of active ageing in physical, economic or social terms, ageing with a greater sense of coherence involves seniors looking back on their life and gaining fresh insights from the past to make sense of the present, and finding hope for the future. Such resilient seniors can maintain their sense of well-being despite the ravages of ageing.
A concrete way to help seniors find closure and completeness in their lives is to initiate life-story reminiscence groups, possibly in active ageing or daycare centres, community clubs or religious settings. Here I would commend a particular form of telling a life story with emphasis on meaning, known as spiritual reminiscence.
Spiritual reminiscence can identify meaning associated with joy, sadness, anger, guilt, or regret. Exploring these issues helps seniors find new meaning, purpose and hope by reframing life experiences, coming to a new understanding, acceptance and transcendence. A study of a six-week spiritual reminiscence intervention in Hong Kong provided evidence of positive outcomes among seniors, in terms of hope, life satisfaction and well-being, even as they suffered from dementia.
Dignity therapy is another well-established intervention to uphold a person’s dignity by helping them record the meaningful aspects of their lives to leave a lasting legacy that can benefit their loved ones and others in the future. It can bring about inner fulfilment and engender new optimism in transcending personal needs by promoting the interests and welfare of subsequent generations. Dignity therapy as well as spiritual reminiscence can conceivably be implemented on a more systemic level through health and social care agencies, as well as organisations that promote positive ageing such as the Centre for Seniors and Council for Third Age.
Dignity despite dementia
For seniors stricken by dementia, as the illness progressively impairs cognitive faculties and threatens the attributes that define their identities as people, maintaining integrity needs to draw on the relational. This experiential dimension subsists in relationships expressed in human bonding and connectedness, transcending the material world. Author Christine Bryden, a public figure living with dementia, once famously said, “A person is a person through others… we know the feeling but don’t know the plot. Your smile, your laugh and your touch are what we will connect with… We’re still in here, in emotion and spirit, if only you could find us”.
Seniors with advanced cognitive deficits may no longer be able to form critical interests – things that provide meaning and purpose, which are engendered by a rational mind. However, they can continue to have experiential interests that are sensory-focused. Therefore, unlike active ageing which is beyond the reach of the physically and cognitively frail, a more expansive notion of ageing well embraces the whole person, inclusive of both critical and experiential interests. It is premised on the ethos that humans are embodied beings and hence vulnerable, yet remain relational and experiential, and thereby retain integrity through interconnectedness. To rate critical aspects above experiential interests implies we hold the belief that some lives are lesser than others because of their diminished mental faculties. How could we then call ourselves a caring society?
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Chiung Yao, known for her public endorsement of euthanasia, had her supporters echoing “your life is your own decision”. The choice to live and die on one’s wishes is emblematic of a certain hubris. It echoes expressive individualism in which one is who one chooses to be. Modern freedom, which espouses doing whatever one wishes, is at odds with the traditional notion of freedom – doing what one ought to do. When faced with frail and vulnerable seniors, would not the objective good be to care with love and kindness than to bless euthanasia, which is implicitly underpinned by egotism and unbridled individualism?
As a novelist who often concluded her stories with romanticised sentimentality, Chiung Yao chose to write the final chapter of her life on her own terms. In contrast, one might express freedom in the choice to surrender one’s will, acknowledging that some things are beyond our control. Spiritual writer Ronald Rolheiser writes: “In this life, all symphonies remain unfinished. Our deep longings are never really satisfied.” By this, he intuits a transcendent order beyond this life that can finally satiate our human desire for meaning, justice and love.
Perhaps, it is in this higher order and frame of reference that we can hope to understand the meaning behind the seemingly senseless pain and suffering that accompany ageing, illness and loss.
We might do well to age with courage and patience in that hope.
Philip Yap is the chairman of Dementia Singapore.
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