If the welfare of each person depended upon him or her alone, then life would be a simple matter. But that is not the case. Each individual is part of a community, and the life of each person is interwoven with the lives of others. People want many different things, and in order to satisfy those wants, the members of a community must work together to get them. To satisfy their thirst for knowledge, they build schools. To satisfy their spiritual needs, they built churches and worship together. To satisfy their need for shelter, they build houses and created towns. To satisfy their needs for objects that they desire ranging from clothes, foods, shelter, and many other things, they create occupations, businesses, and trading systems. To satisfy their need for managing grief, they create rituals, support systems, and ways of taking care of the dead. In all of the activities of any community, each person contributes a part and abides by the result. Each individual makes his or her community life themselves. It one is strong in support of reading, education, and knowledge, he or she will work to improve the schools. If one is strong in plants, he or she will plant flowers, trees, bushes, and other flora and fauna. Yet, in spite of the seeming order, grief is not so easily satisfied. For the old old, who may have spent the majority of their life with their spouse, community support seems fleeting or even non-existent. Communities are challenged to provide support for the oldest members of our society when they are grieving.
With the physical, psychological, social, and spiritual challenges that come with aging, also come the problem of having friends, family members, and ultimately, one’s spouse die. Those confined to assisted living or other community situations may or may not have community support. Even in extended care and group homes that have planned social activities, many are confined to a room or small apartment. Many will experience an extreme sense of loneliness and isolation while living among many people. While some may relish the solitude for spiritual purposes, others may become bitter thinking that no one cares. Some of the old old respond well to large gatherings while others are more responsive to smaller group settings. It is important to offer both to those in institutional settings. Some may be too frail, bed-bound, or have dementia and not be able to participate in group activities. For them, one on one care, rituals, and support must be given. One can certainly invite other residents to join the bed-bound or others who cannot join large groups. Even the very much alone person can benefit from a sense of community that would come from having other residents, friends and family, and staff take part in rituals in their room.
Those who are confined to extended care and group homes often have lost their sense of who they are. They no longer contribute to society through work, owning a home, shopping, traveling, buying and selling, driving themselves, and perhaps even such activities as bathing, dressing, monitoring their medications, and cleaning their room is no longer something that they can do for themselves. Some may experience hearing loss which further separates them from the world around them. Vision loss also is a challenge to one’s sense of well-being. Many are forced to use canes, crutches, wheel chairs, and walkers to go anywhere. Long walks become a major challenge or even an impossibility for many. The loss of physical contact is also a challenge to many. Particularly those who have lost their spouse of many years, often miss human touch. Much has been written on helping the newly widowed, grieving children, loss by suicide, and so forth, but little has been written on helping the old old with their grief especially those in extended care and group homes.
Extended care and group homes are by definition, communities. In most such institutions, the staff is often over-worked, poorly paid, and stressed by the many tasks that are assigned to them. Fortunately, many are beginning to look for ways to aid the grieving members of their community. Residents are looking for ways to help their new acquaintances and sometimes old friends in the group living situations. Pastoral care providers are spending more time developing programs to aid the old old in their grieving. Sacraments, rituals, liturgical rites, prayers, readings, hymns, music, and dance can all be expressions of spiritual, social, and psychological well-being. Even those with dementia tend to respond well to music, dance, and traditional prayers from their youth. Engaging in the familiar will often lead to the expression of feelings and emotions that would otherwise be kept bottled up. Those who are in group institutions often feel that they are all alone. Rituals, music, dance, and so forth let them know that others are with them and that they care. Creative leaders can develop rituals and prayers that focus upon old learning and familiar experiences. For Catholics incorporating into your rituals, familiar symbols such as crucifixes, rosaries, candles, prayer books, statues, icons, liturgical colors and clergy vestments, and religious pictures will encourage them to respond and provide focus for a diminishing attention span. For the old old Jewish resident, one can bring prayer shawls, candles, stones rather than flowers, though for those who are not mourning, roses are traditional. Regardless of the religion or spiritual orientation, it is vitally important to bring the familiar into the room for the resident who has need for something to bring back the sense of community. In many ways, working with the old old is a ministry of memory. One can use many ways, rituals, and prayers that touch their past and bring them home even if only for a little while. For those who are isolated, invite family, other residents, and staff to join in the rituals and prayers. Storytelling is also productive, particularly if you can get the resident to tell stories. For those who had a musical background, having a piano or whatever instrument they played placed in front of them may trigger past abilities and joy. Dance, art, and other forms of expression will also be vitally important to reach into their past and inner needs. One last point is that it is important to keep the prayer service or other ritual lively enough to raise the spirits and energy of the participants and to hold their attention and to keep them relaxed enough to invite participation.
The old old, particularly those who are in extended care and group settings deserve our full attention and care. Their needs are as important as those of any other age.
About the Author
Gerry R. Cox is a professor emeritus of sociology at University of Wisconsin–La Crosse. He served as the director of the Center for Death Education & Bioethics. He has over one hundred publications including books. He has served as editor of Illness, Crisis & Loss and for The Midwest Sociologist. He is a member of the International Work Group on Dying, Death, and Bereavement; the Midwest Sociological Society; the American Sociological Association; The International Sociological Association; Phi Kappa Phi; and the Great Plains Sociological Society.