Inexorable. The word just seemed to pop up with unusual regularity in my reading of late. Then one particular essay stopped me in my tracks. It was discussing the challenges of ageing which is particularly pertinent at this time of year when we think more about the many vulnerable groups among us. Also, from a personal viewpoint, old age doesn't seem quite as distant as it did even yesterday.
There are aspects of ageing that are indeed inexorable – diminished vision and hearing, reduced sense of taste and erosion of erogenous sensitivity for example. These effects can result in increased isolation, boredom, frustration and depression.
However, by shifting perspective from the person to the physical and social environment we can think of two types of ageing; the inexorable march of biological processes that characterise the ageing of the organism and the impact of the evolving environment within which we function that characterises the ageing of the person. Little can be done to change the former, but the latter may be influenced substantially. Simple examples of environmental interventions include the wearing of lenses to correct visual defects and the use of hearing aids. The late behavioural psychologist BF Skinner argued that we need to create a “prosthetic environment in which, in spite of reduced biological capacities, behaviour will be relatively free of aversive consequences and abundantly reinforced”.
The concepts of reinforcing and of aversive consequences were central to Skinner’s view of the world. Behaviours that are reinforced increase in frequency, while behaviours that are followed by aversive consequences decrease in frequency. An older person who is listened to and who is genuinely included in conversation will seek out such experiences and will feel better as a consequence.
An older person who is excluded from conversation or who is "tolerated" in social gatherings will tend to avoid this experience and will feel rejected as a consequence. These rules apply of course to people of all ages, but such aversive experiences tend to increase with ageing.
Positive feelings
Skinner argued that it is a mistake to say that we suffer from feelings such as depression, loneliness, sadness and so on. We suffer rather from the defective contingencies of reinforcement responsible for the feelings.
This is a useful distinction and suggests that in order to better serve older people we should take a careful look at the environments we create around them. If we modify these appropriately, positive feelings are far more likely to ensue. This viewpoint implies a responsibility on those around the older person to act constructively, rather than locating the problem within the person and in need of a fix – often via medication. I am not suggesting that medication is invariably a bad thing. For example, severe depression may be a problem for a proportion of older people and may be mistakenly seen as an integral part of ageing, whereas the appropriate medical treatment may well speedily resolve the issue.
Much has been recommended to improve the quality of life of older citizens. For instance, The cornerstones of positive ageing is a report outlining the content of a series of seminars that took place in University College Cork in 2009 that outlines the benefits of proper diet, regular physical activity, enhanced social networks and the avoidance of detrimental behaviours; all environmental factors we can positively influence.
Skinner quoted Cicero as saying old age is honoured only on condition that it defends itself, maintains its rights, is subservient to no one and to its last breath rules over its domain. There are significant elements of truth here and it behoves us to create environments within which the elderly can express themselves freely and receive positive feedback in doing so.
Retirement, dependence on welfare and even affluence, can all destroy our much-needed sources of reinforcement, but they need not do so. To the extent that we understand the potential impact of both positive and negative environmental factors on behaviour, and consequently on feelings and general wellbeing, we can improve the lot of older people to the benefit of everybody.
From an individual viewpoint, if we are fortunate enough to survive into old age, we will live far more fulfilled lives if we remain actively engaged. The skills necessary to achieve this are best attended to much earlier in the life cycle.
Paul O'Donoghue is a clinical psychologist and founder member of the Irish Skeptics Society, contact@irishskeptics.org