Getting to Know the Oldest Old

Beverly Sanborn remembers sharing a bedroom with her great-grandmother when she was 9. “I would be spellbound listening to her tell about her life. Before bedtime she would sometimes say, ‘Oh, Bevy, it was such fun talking, but I hope tonight’s my very last night and I’ll go to heaven,’ recalls Sanborn, who is director of Alzheimer services for a San Diego-based health-care group.

“She was in pretty good health, and I would ask her why she would say something like that. And she would reply something like: ‘I love being alive, but I have lived a whole lifetime. All the people I knew are gone, and I want to join them.’ ”

According to Sanborn, such peaceful candor is typical of the elderly, particularly those who have lived to be 85 and older. It is one aspect of this fastest-growing age group, which she and two other authors spent three years researching for their new book, “Eighty-Five Plus--The Oldest Old” (Wadsworth Publishing: $16).

Myth Dispelled

One outcome of the research for the book, Sanborn said, has been to lay to rest the myth that adults in American families no longer wish to take care of their elderly.

“Estimates now are that about 80% of the aged are cared for by family members,” she said in an interview. “A lot of the remaining 20% have nobody left--they have outlived their spouses, siblings, friends and, in some cases, their own children.”

This, Sanborn said, can be particularly true of the very old.

“About 70% of these oldest old are women,” Sanborn said. “And when the caregiver is an offspring, that person often is a grandmother who may herself have infirmities.”

Nonetheless, she continued, regardless of how far along the aged ones are, “care of them within the family is becoming more typical, not less so.” She adds that “this isn’t any change in family attitudes--it has been part of the American culture a long time. It’s just that, 40 years ago, not that many people were living to the point where they needed care.”

They are now. In fact, according to the Social Security Administration, in 1950 the oldest old (85 and older) comprised less than 5% of the population of those 65 and older; by 2000, that percentage is predicted to be more than 14%.

As for numbers, in 1980 those 85 and older totaled about 2.4 million, a figure that by the turn of the century is expected to soar to 5.2 million.

That this age segment is the fastest growing in the industrialized world was another reason for doing the book. Sanborn’s coauthors in the endeavor are Sally Bould, associate professor of sociology at the University of Delaware, and Laura Reif, director of the graduate program in gerontological nursing at the University of California, San Francisco.

As Bould points out in the book’s preface, “there are as many years between 60 and 90 as there are between 20 and 50. For many of our parents . . . there may be an extra decade of life (they) have not planned on.”

Interdependence Valued

What the authors discovered as they probed and interviewed is that interdependence is more important to the most senior of seniors than independence is.

“An interdependent life style often involves friends and neighbors as well as family,” Sanborn said. “It can mean reciprocal helping. In the case of the family, a daughter, for instance, may help during a sickness, and the mother in turn may be able to do the shopping for her busy child.”

The book, which references a multitude of studies other than the authors’, sheds some light on the relatively little-studied and rapidly growing age group comprising mid-octogenerians and older:

* According to a study, 54% of them need the help of another person to manage their daily lives. For those 75 to 84, that percentage is only 22%. And for those between 65 and 74, the figure drops to about 8%.

* More than 54% of the oldest old are concentrated in California, New York, Pennsylvania, Florida, Illinois, Texas, Ohio, Michigan, Massachusetts and New Jersey. California has the highest percentage: 9.7%.

* According to “The Extreme Aged in America” by Ira Rosenwaike, it is the oldest old--not the young old--who are most likely to have changed their residence in the past five years. The changes are likely to have been prompted by widowhood, disability and institutionalization.

* But the incidence of the very elderly living in the same home with adult children is sharply declining. For example, in 1950 a total of 32% of men 85 and older who lived in the community were living in an adult child’s household. By 1980, the proportion was only 9%. The tendency for such people to live alone may account for the myth that adult children don’t take care of their aged parents, but the authors feel the current living arrangements reflect the preferences of both parties.

* Among the oldest old, 48% of the men are married, but an oldest old woman’s chance of having a spouse is only 8%.

The author said she thinks young people sometimes miss out on a great opportunity--getting to know that very old member of the family.

Little Fear of Death

Sanborn said one thing that fascinated her while researching this age group was discovering that, “on the whole, they aren’t afraid of death.”

“Our culture is petrified at the thought of death. But not these people. They talk openly and often about it. They seem to have a real sense of moving on to something else, that they are at the last stage of life and that their journey on Earth is coming to an end.

“It isn’t at all ghoulish. The oldest old do it with a sense of acceptance. You hear them say things such as ‘I’ll see you tomorrow, if I’m alive.’

“The oldest old somehow seem to know something we don’t,” Sanborn added. “They are closer to something. Maybe they are closer to a life truth. That, I think, explains our awe of the very old.”

More prevalent than the fear of death, she said, is the fear of becoming helpless.

The author also said that while interdependence ranks high with these seniors, this doesn’t mean that independence isn’t cherished.

“They want to feel that they aren’t a burden. They want to maintain some sense of self. After all, in addition to having possibly lost their spouses, siblings and friends, they have probably also lost their bodies (as they were at a younger age).

“One reason very old people don’t like to move is that they feel a need to be surrounded by (familiar) objects and ways of life. . . .

“When we are younger, we have social networks, and they do a lot to tell us who we are. The oldest old don’t have that support network--they must rely on internal means, such as remembering their lives. It is the reason they talk a lot about their pasts. They don’t have external sources to remind them of who they are.”

Limits of Caregiving

Regarding what Sanborn found to be a sincere effort by most American families to look after their aged ones, she cautioned that all should be aware of their limits as caregivers.

“Sometimes people personally take care of someone too long, to the point of jeopardizing their own health. Caregiving can at times be so emotionally and physically draining that the person is pushed beyond the limit. You really see this in instances of Alzheimer’s patients.”

Sanborn, who currently is setting up assisted living for Alzheimer’s residents at Rancho Encinitas in San Diego County, said that when the point is reached at which a caregiver is stretched to the limit, there is nothing wrong with seeking options such as placement in a nursing home.

“And friends should support any such decision,” she added. “They should honor those who are able to stay with the caregiving, but at the same time recognize that the time sometimes comes when a change has to be made.”