Non-Attachment Therapy: How to Help Parents Downsize and Embrace a Simpler Life
How does attachment to the life prior to the present-tense inhibit happiness and well-being, ie mental health and in turn physical health, for late-stage seniors between the ages of 75 and 102? Attachment for this problem would have a conceptual definition of a life lived with a specific set of material objects that is not being lived in the now or present tense.
Happiness will have a non-materialistic conceptual definition as clarified by researcher Kent Swift (2013) that meaning, purpose and creativity are essential elements for a good life; and Richins and Dawson’s 1992 Materialism Scale; Gratitude Scale GQ-6; BMPN measure of psychological needs; and SWLS life satisfaction scale (Tsang, Carpenter, Roberts, Frisch, & Carlisle, 2014).
This proposed research seeks to examine if Tsang et al.’s scales and measurements can be adapted to research happiness with late-stage seniors for a positive affect. Swift, along with other cited research in this article, has shown that material success does not increase happiness. The depression of late-stage seniors is a proven and known factor through the Geriatric Depression Scale (GDS) and other research discussed below (Mui, Kang, Chen, & Domanski, 2003).
This research will suggest that traumatization is experienced by the late-stage senior when a family member, change in health condition or other non-autonomous decision moves the late-stage senior from their mid-life stage object filled home to a Long Term Care (LTC) facility without a professional organizer with the therapeutic background to support. A Senior Living community for the elderly in the United States goes by the names Long Term Care (LTC) facility used in this research proposal, Residential Care Facilities (RCFE), adult care homes, adult foster homes and Skilled Nursing Facilities (SNF) and more(Mitchell & Kemp, 2000).
The late-stage seniors are forced to make a change in living situation without their sentimental items and become more attached by speaking about a home they do not live in, a car that they do not drive or a job that is completed. Can non-attachment to a material relationship to the world prior to the present-tense help the late-stage senior achieve happiness? Objects and unwanted items acquired throughout adulthood hold emotional, spiritual and historical significance.
When a late-stage senior says that their children sold their home it speaks to victimization and larger issues that necessitate the help of a compassionate licensed social worker.
Will historical investigation of these mid-life-stage objects help late-stage seniors process the past and re-empower the late-stage seniors to be more present?
Can non-attachment lead individuals to a happy life?
Are the non-materialistic happiness or well-being factors of purpose, gratitude, and joy in relationships available at any age?
Problem Statement
The problem concerns the person between the ages of 75 and 102 who might not be engaged in present-tense purposeful living. Current evidence that living in the past creates dissatisfaction with what is happening in the now. Possibly the late-stage senior does not feel in control of their present-tense life because of aggressive foreign factors defined below as System Theory of LTC in the retirement community.
Independent predictors of daily significance and joy, rather than material wealth, are fundamental to living with purpose (Swift, 2007). Further studies with self-reported life satisfaction, establish that materialism is associated with depression, anxiety and substance abuse and do not relate positively to many aspects of the life course (Roberts & Clement, 2007). This question of whether materialism is on the level of disease and substance abuse is a larger study than the scope of this proposed research.
The past-tense-attached late-stage senior is not only a problem to themselves because of depression outcomes but also a problem to the caregivers and family because of the state of dependency that is created. My personal observations as a professional Memory Care Director shows that cognizant, active independent living residents, once happy people, will complain about everything down to soup temperature.
Working with senior move managers and being an autonomous part of the downsizing process can help elders be more engaged in their life. Resident’s detailed notes with dates and times of service in the well-run dining room shows their need for autonomy, purpose and contribution. These monthly resident meetings where the notes are received by management are a highlight to the resident because the late-stage senior is given the microphone and heard. The note taker may have been a secretary during her working years and her actions are past-tense attached to a present-tense environment that does not receive her intention as positive or productive. In this scenario it is a qualitative approach that would inform the Long Term Care (LTC) facility of the senior’s intent (Cobb & Forbes, 2002). Pertinent information for this scenario is whether the note taker is living in the LTC facility of her own will or was she placed in the situation by a family member, a cajoling medical professional or the sales team at the LTC facility. If the choice was that of the late-stage senior is there a way to engage the note taker in a purposeful activity that assists the LTC facility or another scenario for example a middle school student with homework?
Engaging the elder with their living space as an active participant makes all the difference. Possibly this note taker would be emotionally and contextually satisfied with the engagement of a social worker in the documentation and historical investigation of her mid-life stage objects as therapy to help her process the present-tense. ReM(i) has seen elders who have done memorabilia review from boxes brought to them by their families in the living facilities.
Discussion and Relevance of Problem
An empirical study into the Myth of the Life Plan shows that imperfect training for material-wealth-as-happiness continues to be instilled in our youth (Lazcano, 2011). To be placed in a passive modality, such as a LTC facility or an assisted living, where there is no purpose and no action to be taken by the late-stage senior facilitates the decline of life skills. The Canadian Institute for Health Information reported in 2010 44% of seniors in LTC facilities have symptoms that are consistent with major depression (Fiest, Currie, Williams, & Wang, 2010). In 2005 the Centers for Disease Control and Prevention reported seniors making up 12% of the U.S. population in 2004 and accounting for 16% of suicide deaths (Berman & Furst, 2012). For any other age group the gravity of these depression statistics would necessitate a social worker’s intervention because of the integrity of the practice and profession, yet many LTC Facilities operate without one (Butler, 2002). It is the sales team and a group of movers that finalizes the transition ignoring the emotional transformation that needs to take place for the late-stage senior. LTC Quality of Life (QOL) measurements with regard to late-stage seniors have been generalized to communicate namely control over physical functions and other institutionalized needs; with over 11 different models across LTC facilities, there is no agreed upon design (Mitchell & Kemp, 2000).
Mitchell et al., includes that the LTC standard language measurements of QOL also include familial support, autonomy for the late-stage senior, with the likely negative affects of institutionalized living. QOL for late-stage seniors has been redefined at The Centre for Health Promotion (CHP) with a model of Being, Belonging and Becoming, components that relate to people regardless of age (Raphael et al., 1995).
The Being, Belonging and Becoming model speaks to this proposed research’s caring transitions and operational concept of time and the personal time-lines of late-stage seniors in relationship to past-tense attachments and present-tense wellbeing and happiness, moving towards happier people. If there is no being, late-stage seniors can remain caught in the past and exhibit dementia like symptoms. If LTC living is necessitated by a change in health condition or familial situation a social worker is necessary to elevate the pain and struggle of the late-stage senior through this transition. The magnitude of this transition, which could be a smooth transition, should include the pursuit of happiness, where the late-stage senior must move from a home that they were possibly living in for 70 years cannot be underestimated as proven through the known depression of late-stage seniors.
The research proposed with the scales of measurement for happiness such as the GQ-6 six-item measure for dispositional gratitude would be adapted for late-stage seniors with regards to their abilities in the present-tense. All future studies and research would conceptualize QOL as Being, Belonging and Becoming rather than the limitations that LTC facilities place on late-stage seniors. The LTC systems that have been operationalized out of the necessity of physical care for sometimes frail late-stage seniors may not be systems that increase happiness and enhance QOL. The change that this research proposes is engaging the late-stage senior with a social worker in the present-tense to encourage self-care emotionally through engaging in all life transition choices rather than primarily being cared for physically.
History and Empirical Conversation
Research into the age range of 75 to 102 is currently being generated for this new age subset. The group of individuals over the age of 65 in the United States (U.S.) was 8 percent in 1950 and plans to exceed 20 percent by the year 2030 as Baby Boomers reach late-stage seniority (Lee, 2014). Healthcare innovations have created a sometimes frail population that necessitates care in a different way than prior generations. Corporations and private pay institutions have met this need by building physically and materially beautiful facilities identified as Assisted or Independent Living in proximity to family.
The corporate innovation, with beautiful floor plans, and answer to the care question for late-stage seniors perpetrates and feeds into the materialism-as-successful-life misconception as defined by this research. Family members of late-stage seniors are relieved of guilt in this entire process and placated into feeling better because they have purchased an expensive, with a connotation of quality, or visually good looking form of care services for their loved one. Possibly the late-stage senior would have been healthy at home with a part-time caregiver and a schedule of outings. Many times it is the family that victimizes the late-stage senior into the move to LTC to subdue their personal worries but have not addressed the stresses associated with the move for the late-stage senior with a professional licensed social worker.
In 2017 people are living through strokes, heart attacks and cancer while the cost of living has skyrocketed. Many times it is the same family member who allows the late-stage senior to be resuscitated without direct discussion with the senior prior to the medical event. Using stroke as an example, is the psychological and spiritual life post-stroke, as related to Being, a QOL that includes happiness? What state of physical and mental wellbeing does the late-stage senior emerge from the stroke with? All three aspects of Being in the present-tense are equally as important as the physical stroke outcome (Raphael et al., 1995). Specific studies on better outcomes through Stroke Care Units are an example of the in-depth research and interventions implemented to keep people alive (Langhorne et al., 2013). Seniors are accepted for heart valve replacement and pacemakers at ages over ninety. The mean age of participants in cardiovascular studies are 74 + 3 years and one third of a study can be comprised of nonagenarians, meaning a person who is ninety to ninety-nine years old (Kahn et al., 2013).
This research begs to ask why the elder care community is making use of the curative medical model and putting so much effort into keeping late-stage seniors alive but not fully physically functioning while simultaneously ignoring their emotional and spiritual wellbeing. Medicare is suffering and the finances are being drained to the point that hospitals are being charged for readmissions (Rice, 2015). If a social worker can be employed to discuss end-of-life and what QOL late-stage seniors would like to lead possibly there would be lower states of depression, lower cost of readmission to hospitals, and better happiness outcomes through autonomy and choice. This medical curative model creates further medical issues, additional pain and suffering for the late-stage senior, frailty and in turn depression.
Frailty Assessment Tools
Frailty assessment tools are being developed by researchers for health care providers. Frailty is defined as slow walking, physical weakening, lethargy or inability to attend activities, fatigue and physical compression of the musculoskeletal system resulting in smaller stature (Afilalo et al., 2013). People now live longer than ever before, and life expectancy is still increasing. The American Association of Retired Persons (AARP) reports a 37% increase LTC communities between 1990 and 2000 to assist this newly created frail population (Mitchell et al., 2000).
Prior to 1990 the elderly lived at home or with family and passed or needed skilled nursing also known as a nursing home. The late-stage, frail or mildly-ill senior with downgraded or low QOL necessitates a larger body of research to navigate life between 75 and 102. Many times families of the late-stage senior rely on the LTC facility to navigate care. For example, a visitors sign-in book logs approximately 90% of the family members of the memory care facility visit once weekly and sometimes bi-weekly with 10% visiting multiple times in one week. The other 160 hours of the week the team of caregivers, without the assistance of a social worker, is relied upon for their expertise with QOL.
This system does not allow for the CHP’s QOL measurements of Being, Belonging and Becoming or Swift’s happiness to be achieved for these late-stage seniors. It is possible that these late-stage seniors would be better equipped to process this present-tense life stage with a social worker in the historical environment of their own home. With the assistance of a social worker to support historical documentation, sorting and processing through non-attachment and an investigation of mid-life stage objects, the process of healing and coming to terms with what end of life means for the individual late-stage senior can be engaged.
System Theory
If System Theory is applied here, as it relates to LTC, it is the curative model of the U.S. modern medical system for health that is being applied to the late-stage life of seniors and does not relate to late-stage senior needs, QOL or happiness. System Theory applied to LTC details the interconnectedness and parts of the system can only contribute successfully within the overarching function of the organization which can be viewed as separate organisms from the individuals they are serving (Massie, 1998). Emotional and physical separation are not cohesive with this research’s definitions of happiness.
The LTC facility architecture is built around levels of care and Activities of Daily Living (ADL), broken down into eating, bathing, dressing, toileting, transferring or walking and continence and do not include smiling, laughter, and number of hugs per day or initiation to include oneself in a creative program (Smith, Hogan, & Rohrer, 1987). With the sponsorship of the Asian American Federation of New York, the Geriatric Depression Scale (GDS) was adapted to measure depression among Elderly Asian American Immigrants further proving the actuality of depression among seniors with the need for multiple scales (Mui, et al., 2003). The research cited for this article shows that both the late-stage senior and the LTC caregivers are under stress making it physically impossible for the caregiver to engage in the present-tense needs of late-stage seniors in an open and loving way (McGilton, Wodchis, Hall, & Petroz, 2007). The adapted GDS for Elderly Asian American Immigrants also makes clear the necessity for multicultural competencies for social workers with each cultural group of elders being specific to the culture they have experienced over their life course (Kocareck, Talbot, Batka, & Anderson, 2001).
Europe is experimenting with Senior Co-Housing to allow seniors to live with younger people who may not necessarily be the late-stage senior’s biological family. The U.S. opened multiple communities between 2005 and 2007 for example the ElderSpirit Community of Abingdon, Virginia which is closer to the LTC model with a mean age at move-in of 70.4 (range = 63 to 84). Colorado’s Silver Sage community was built for active adults who are 50 and over, and if they do not move out, the mean age will be 70 by 2025 possibly requiring a different QOL scale (Doyle & Timonen, 2007). The New York Times is reporting that mid-life-seniors or Boomers are adopting foster children (Korkki, 2013.) It is possible that people need to be purposeful in order to remain happy; and that gratitude, or a feeling of having enough, allows a person to give and engage in a present-tense vibrant happiness that is different from their past-tense life yet utilizes a similar skill set.
A way to implement the same type of purposeful living that early-stage seniors engage in for late-stage seniors is engaging the late-stage senior in non-attachment to mid-life stage historical objects to create space in their home for co-housing rather than the severe and immediate all-or-nothing transition to LTC. The benefits of downsizing specialists is that they can make room in the current house for any of these social isolation solutions. Nesterly is available in some cities to help elders find good partners for cohousing.
The product and growth of LTC Assisted Livings are corporate entities. The System Theory as it currently relates to LTC, in addition to corporate ownership, with the above statistics on depression in late-stage seniors does not create a platform for trust in a profit driven care sector. A Wall Street Journal Article researches both the U.S. real estate market and early-stage seniors’ material attachments in relation to their inability to successfully downsize (Tergesen, 2012). In this article Esteban Calvo, an associate professor at Diego Portales University in Santiago, Chile, uses the word attachment in relation to lifestyle, and details the trend of early-stage wealthy seniors repurchasing similar or more expensive objects than they originally discarded during downsizing. If the early-stage senior’s resources are being wasted on moves that don’t save equity and are taking the action to physically reestablish their store of material possessions, the downsizing has not actually been accomplished.
With this research in place it is necessary that early-stage seniors are taught non-attachment with a skilled social worker to successfully plan ahead for realistic late-stage years that include wellbeing, happiness and all aging possibilities including frailty. If the real estate market does not support monetary savings for the senior, downsizing while staying home might be a better option and be used to benefit another person. If co-housing and respect for elders becomes an accepted part of our society many communities could possibly benefit financially, spiritually, intellectually and academically from the late-stage senior. A change to the System Theory medical model of LTC facilities with ADLs could upset those in corporate and medical communities as financial beneficiaries. This change from LTC to co-housing is assuming that the perception of late-stage life abilities will change on the part of the senior and non-senior communities as well as on the part of the medical and corporate institutions who are benefiting financially. Increased numbers of late-stage seniors in a home environment would necessitate additional doctors, nurses and caregivers undertaking home visits with some returning to general practitioners.
Preliminary Method of Data Collection
A quantitative study conducted with college students on gratitude could be used with the same measurements of happiness and adapted for time of life, i.e. past and present-tense and for late-stage seniors between the ages of 75 and 102. Possibly the use of the same investigated scales and adapted questions would work with late-stage seniors: Richins and Dawson’s 1992 Materialism Scale; Gratitude Scale GQ-6; BMPN measure of psychological needs; and SWLS life satisfaction scale utilizing The Centre for Health Promotion (CHP) QOL definitions of Being, Belonging and Becoming (Raphael et al., 1995).
Well-being is a valid and measurable form of happiness and contentment. Kent Swift breaks the terms down into PWB (psychological well being) and SWB (subjective well being) in relation to empirical studies and economics. Swift’s article published in the Journal of Business Ethics literally restates that adage that money cannot buy happiness. Private pay LTC communities back up this statement without meaning to by creating geriatric depression scores of late-stage seniors residing in these luxurious wealthy communities. Lazcano’s empirical study shows that it is actually engagement with life and loved ones that increase happiness (2011).
Possibly an empirical study like PO Bronson’s What should I do with my life? could be adapted with the word “now” (Bronson, 2005.) In Bronson’s book he interviews individuals in the early-stages of life who changed the trajectory of their life course in order to achieve inner peace and happiness. This research proposes that late-stage seniors can also break with medical model of social aging patterns in order to create present-tense happiness for themselves with the assistance of a social worker.
Depression among seniors in LTC is the known factor. The above Gratitude Scales adapted for seniors and a good sample would conclude if re-empowerment and present-tense autonomy are the methods for true happiness and life satisfaction. It is the present-tense ability to engage the idea of one’s own mortality that allows for the current life to be lived. It is the moral obligation of social workers to address the known depression of late-stage seniors by alternative methods that engage the late-stage senior in autonomous present-tense action.
In conclusion, the research question remains the same:
Can late-stage seniors learn to live in the present-tense with purpose?
Will this purpose increase happiness? Is it attachment to the past and not being present that creates distress and unhappiness?
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