Jan 26, 2012

Aging Well with Dr. Dan Blazer, Part 5: Social Supports & Storytelling

Part 1, Part 2, Part 3, Part 4

Stories help us make sense of the world. True stories told by our elderly relatives help us understand ourselves, and the telling also helps the storytellers make sense of their lives, says Laity Leadership Institute Senior Fellow Dan Blazer, M.D.

“One of the most critical things a family can do is to try to recognize the value of an older person, and one of the best ways to do that is to get the older person to talk about himself or herself, or maybe write about himself or herself. Then actually pay attention to what they write,” Blazer said when The High Calling talked to him recently.

He mentioned the work of the late psychologist, Erik Erickson, who developed a metric called the Eight Stages of Man. The idea was that particular psychological tasks need to be completed at each of the eight stages of life or else there will be difficulties in development.

For example, the first stage is “trust versus mistrust.”

“Babies are in a totally dependent situation. Therefore, they must learn to trust, and if they can trust that their parents will be there and do things for them, that builds a sense of basic trust in the child. This sense of trust will stick with that individual throughout life. If it doesn’t happen, then that person may have difficulty with trust for the rest of their life,” Blazer explained.

The last stage is “integrity versus despair,” where integrity refers to “the ability to tell a story of one's life that makes sense in the bigger picture.”

When we listen to our elderly loved ones’ stories and help them grapple with those stories, we assist them in successfully moving through the final stage of life.

“If they can’t make sense out of their lives---if it just seems like a mishmash that has no theme---then they’re going to get depressed about that,” Blazer said.

Affirming senior citizens’ stories also reinforces “social capital.”

In The Age of Melancholy: Major Depression and Its Social Origins, Blazer described “social capital” as capital that is accumulated through positive communal interactions, such as sharing stories across generations.

Conversely, in Depression in Late Life, he said, “The prime social contributor to chronic disease, such as late life depression, has been hypothesized to be stress.”

This may be true in part because “the elderly experience predictable stressful events that force them into a preconceived cultural definition as dependent, querulous, forgetful, fretful, and irritable.”  

But “activity and the persistence of a socially engaged lifestyle are the most adaptable means of achieving life satisfaction in later years,” he said.

Blazer outlined the elements of social support as follows:

  1. social network: spouse, children, group memberships
  2. social interactions: frequency of interaction with social network
  3. perceived social support: an individual’s subjective evaluation of his or her sense of having a dependable network, ease of interaction with it, a sense of belonging to it, and a sense of intimacy with network members.
  4. Instrumental support: concrete and observable services provided by network.


Successful social supports provide feedback, information, and guidance to the elderly, he said. They also give senior citizens a sense of attachment and bonding, provide physical and task-oriented assistance, and can deflect disease-inducing stress from them.

Not all social support is beneficial, though. Dissatisfying and conflictual interactions may affect older adults more adversely than no interactions at all, Blazer said. Excessive support, too, even if welcomed, can lead to loss of autonomy and self-reliance. Thus, senior citizens who have a small core of supportive intimates may be better able to buffer themselves against stressful events than those with wider, but less intimate social networks.

A major source of support for many older adults, especially those who are geographically separated from their families, is their faith community, Blazer told The High Calling. Churches that seek to minister to older adults can do no better than to provide a sense that these elders are included and valued within their fellowships.

Every time we stop what we’re doing, pull a chair up close to an aging relative, friend, or congregant and say, “Tell me a story about your life,” we’re not only helping them and ourselves make sense of life; we’re letting them know that we’ll be there when they really need us.

 

Image by Leo Grübler. Used with permission. Sourced via Flickr. Post by Christine A. Scheller.

Laity Leadership Institute senior fellow Dan Blazer, M.D., PhD. is vice chair of faculty in the Department of Psychiatry and Behavioral Sciences and Vice Chair of academic development at Duke University Medical Center in Durham, North Carolina. Dr. Blazer is a geriatric psychiatrist and an epidemiologist, and is the author of numerous books. He is also co-editor of Essentials of Geriatric Psychiatry, which is scheduled for release in 2012.
 

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