Being older today is not easy. We are surrounded by a negative stereotype that wants to undermine us. How do we cope?
As we age we are faced with a continuous stream of challenges. Our bodies start to fail. We may well lose one of our senses. We will have to cope with one or more chronic disease. We can wear glasses or hearing aids. Modern medicines can at least reduce symptoms. But what do we do about the plethora of negative ageist stereotypes that swirl around us? What do we do about a world still dominated by a “youth culture”? Despite this the vast majority of older people maintain a positive sense of self.
A Sense of Control
Many years ago there was study of life expectancy in care homes. It was plain that there were two groups of people that entered such homes at the end of their lives. One had a short life expectancy in the home, the other much longer. The difference did not seem to depend on known medical issues. In the end the best predictor was the nature of the decision. Individuals who chose themselves to enter a home lived longer. Those that were “put” there died sooner.
In a cardiac intensive care unit the processes were modified for a group of patients. They were allowed to make simple decisions. They could decide for themselves whether they had visitors. They could even trigger an ECG if they felt symptoms. The patients given simple decisions to make, on average left intensive care days quicker. They also adapted to life on a traditional ward more easily.
These are examples of the power of control. We have an underlying need to feel in control. We all sense it when having checked in for a flight, we are isolated at the gate. There is a delay but we are given no information. Control is a key determinant of our sense of being crowded. There is a difference between “people density” and crowding. The difference is whether we feel in control. A disco full of people is stimulating. If the fire alarms go off it is “crowded” and we show stress symptoms.
Changes in Control during the Life Course
Control is a key part of how older people cope. There are two dimensions to our desire to gain control of our interchanges with the environment. The primary dimension is to achieve decisional control. We get what we want. We mold the environment to our desires. Long ago I showed that the reason that we use automatic teller machines is that they give us control. We are not dependent on the whims of a teller. Secondary control is about gaining perceived control. If the “world” is predictable then we feel in control. We may have no direct influence. Because we know what is going to happen it feels like we are still in control.
Primary control first increases as we grow up. As a child we may want to do it “our way” but we may not be able to influence parental plans. As a young adult we can seize control. At some point in todays world our influence declines with age. We have less agency. Secondary control seems to become more important in later life.
Managing Subjective Age with Control
According to the “Control Theory of Ageing” we can maintain our subjective age by shifting from primary to secondary control. We shift our goals. We recognize that we may not be able to achieve primary control over the environment. We are no longer fit enough to run for the bus and need to leave more time. It could be that our hearing means we avoid noisy restaurants. It could be that the ageing stereotype stops us from taking a leadership role.
Instead we focus on creating a world that is more predictable to us. We may reduce our range of activities. We may prefer to go to familiar places with familiar people. We may not be so experimental. If we want to be adventurous we will chose a safer way of doing it. Instead of back-packing in strange countries we may prefer to visit them from the predictability of a cruise ship. All of these allow us to maintain a sense of predictable secondary control.
Being Told To Stop Driving
Some commentators accuse the “Control Theory of Ageing” of being ageist. By accepting part of the ageing stereotype is it ageist. It does assume that some mental and physical changes happen with age. It does assume decline. It does assume that age brings with it a loss of agency and influence. Yet it does leave the decision of a switch from primary to secondary control to the individual. The fear is that the internal stereotype that drives that decision is pessimistic. Is the “enemy within” more negative than reality?
The theory does allow us to understand how to help older people cope with events towards the end of their life course. Losing the ability to drive becomes a major issue when we look at it from a control perspective. We all remember that sense of freedom when we passed our driving test. We were no longer dependent on others to shuttle us around. Losing that ability clearly impinges directly on primary control. Shopping can be a major source of the sense of control. We can shop when we want and chose what we want. Without the ability to drive that is taken away. Our predictable world could be rooted in mobility. Our visits to friends, restaurants, and bars all depend on it. It is far better that we decide to stop driving if at all possible. It is certainly important that there is a plan of how the future will unfold without a car.
The realistic acceptance of ageing is a tightrope walk. If we deny ageing too much we will come up against the hard reality of our growing limitations. If we are too pessimistic we are letting the “enemy within” win. We are missing the opportunities we still have. Maintaining a sense of control is one way to cope with the ambiguity.