There was a movement prevalent in the first half of this century called mental hygiene. One goal of this movement was to prevent mental health problems, as much as possible, via healthful living practices and anticipatory problem solving. Although the thrust of the movement changed over the decades, there were useful ideas that are applicable for the elderly. Prevention of mental health problems is relevant today because, with demographics shifting so dramatically toward older age groups, mental health workers are likely to be deluged in the coming decade and beyond.
Three common mental health problems often seen with older women (who outnumber men in the older age groups) are, if not preventable, at least modifiable. These problems are the abject poverty of women, isolation, and becoming "trapped" in their housing. There is an aspect of this discussion, however, that must be recognized as problematic. "Prevention" discussions can turn into "blame the victim" discussions. If an aspect of any situation is seen as preventable, then an easy step is to conclude that there is little communal responsibility to help the victims - "they got their just desserts." An example of this thinking is blaming the victims of lung cancer related to smoking. Mental health professionals urge concentrating on the prevention aspect rather than the blaming aspect.
In addition, prevention discussions can easily turn into simplistic notions of ways in which to address complex problems, with little recognition that complex problems need complex solutions. Prevention discussions may also delude one into thinking that "telling" is sufficient and we will "do what we know is best for us." Information alone has not eradicated lifestyle illnesses, although it has heightened awareness of outcomes of acts and of choices. It is in this latter spirit that this discussion is offered.
The American Association for Retired Persons (AARP) offers demographic data that is in many ways frightening to thoughtful readers. One of the most sobering statistics is that the vast majority of elderly women in the US live below the poverty level.1 The figures hold for all racial groups, and are a contrast to those that are more positive for men as a group. These figures certainly suggest societal imperatives, but there are also personal conclusions one should draw. The fact that vast numbers of women are currently employed does not necessarily mean these figures will be reversed.
Women need to take a proactive stance to ensure that adequate monies in the form of pensions and other sources are available as they retire. Likewise for married women, pensions transferable from spouses in cases of death, separation, etc, are also needed. Nursing as a service occupation has had lower pensions, and close attention needs to be paid to the pension levels of nurses if we are not to join our sisters below the poverty level. Perhaps this heightened awareness of all women to these statistics may help reverse the AARP figures.
The second situation that seems amendable to change is that of elderly isolation. For those who are married, widowhood is the most likely state in the later years. A profoundly devastating loss, it is nevertheless a likelihood that women will outlive their husbands. A more proactive stance is needed to assist women to recognize this likelihood, think through scenarios, read about the problems to avoid, and think through how we personally might approach such a situation.
If not married, there are other personal losses that are equally predictable and therefore some preparation can be made. Related to this is the idea of extending our networks as we age so as to compensate for the losses of friends, family, and others. Forcing ourselves in a sense to make new friends, join groups that are meaningful to us, and extend ourselves to others are habits that may serve us well when we suffer these personal losses.
Finally, one aspect of aging that many do not seem to recognize is the very real loss of energy. Energy seems to come in spurts for the well elderly, and is decreased in some incremental fashion for those with illness. As we age, the majority of us will have at least one chronic illness and therefore can expect energy losses. Planning for retirement living thus involves planning for decreased energy levels. Most people are not able to care for an entire house when they are elderly; houses often mean a large financial drain in times of decreased finances. Those who plan to travel to visit friends and others may not be able to do so if their energy is significantly decreased. Perhaps increased attention to maintaining physical fitness as we age may stave off energy losses.
In summary, several problematic situations with mental health implications, might be approached through the use of anticipatory planning. Anticipatory planning and informing oneself so as to make knowledgeable choices, maintaining awareness of the latest research and knowledge regarding such problems, and the maintaining of social ties and skills are all avenues to foster maintenance of mental health as one ages. We should also be aware that because change is one stable aspect of our existence, that these problems will undoubtedly change in form and substance, and un i magi ned aspects of these problems occur. Using these mental health principles, however, may help to meet these changes.
- 1. AARP. A Portrait of Older Minorities. Undated brochure. Washington, DC: AARP.