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PASTORAL PERSPECTIVES ON AGING
Dr. Fr. C.M. Joseph Cherukunnel SDB

Pastoral Aspects of Aging
Old Age Bible speaks on Aging Beatitudes of Aging Spirituality of Aging Pastoral care of the aged

Old Age Old age also has been divided into three stages:
young-old (65-74 years), old-old (75-84 years) and oldest-old (85 years ff).

AGING Aging is a process of gradual maturation

OLD AGE Positive components of old age
Increased wisdom Experience Expertise. Negative component of old age - Decline

CHANGES IN OLD AGE Those that result from aging itself
Those that result from diseases, life style.

CAUSES FOR GROWTH OF ELDERLY PEOPLE
Decrease in the birth rate during the past 25 years Improved sanitation and nutrition Effective control of infectious diseases

Old Age It is predicted that by 2033 there will be a 50% increase in the number of old people .

Old Age Living longer brings with it possibilities of enhanced health, happiness and productivity but also increasing frailty, chronic illness and diseases of older age such as dementia, diabetes and heart disease.

Old Age Theories of aging.
The Developmental Theory of aging, begins at birth, then childhood, school years, teenage years, work/professional years, adult years of vocation/life choice (single, married, religious, priest/brother), retirement/elder years, and from there to death. In this theory, the developmental tasks of each period in one’s life is negotiated.

Theories of aging. Old Age
The Activity Theory, as it connotes, is staying active with one’s familiar ways of doing as long as it is possible.

Theories of aging. Old Age
The Wear and Tear Theory postulates that one’s body wears out with stress and living.

The Bible Speaks on Aging
1.Old age may be the fruit of a moral life and an indication of God’s favor. 2.Old age is a general part of God’s purpose for a normal life. 3. Old age may be a reward for those who honour their parents.

4. Characteristics of old age. Wisdom is an attribute of the aged who depend upon God. Wise counsel to the younger is a duty of the aged. The aged have continuing moral responsibilities.

5. Resources for the aged. God has promised his abiding presence. God gives strength to endure suffering and infirmity. God gives deliverance from the fear of death.

1. Old age may be the fruit of a moral life and an indication of God’s favor. “Follow the whole instruction the Lord your God has commanded you, so that you may live, prosper, and have a long life in the land you will possess” (Deuteronomy 5:33).

2. Old age is a general part of God’s purpose for a normal life. “He took his last breath and died at a ripe old age, old and contented, and he was gathered to his people” (Genesis 25:8).

1 “David son of Jesse… died at a good old age, full of days, riches, and honor…” (1 Chronicles 29:26, 28). “Then Job died, old and full of days” (Job 42:17).

3. Old age may be a reward for those who honor their parents. “Honor your father and your mother so that you may have a long life in the land that the Lord your God is giving you” (Exodus 20:12).

“Children, obey your parents in the Lord, because this is right. Honour your father and mother—which is the first commandment with a promise—that it may go well with you and that you may have a long life in the land” (Ephesians 6:1).

“If you walk in my ways and keep my statutes and commandments just as your father David did, I will give you a long life” (1 Kings 3:14). “Gray hair is a glorious crown; it is found in the way of righteousness” (Proverbs 16:31).

Characteristics of Old Age In the Bible, the aged are perceived as resourceful people with valuable gifts to share for the good of everyone.

1. Wisdom is an attribute of the aged who depend upon God. “Happy is a man who finds wisdom and who acquires understanding… She is more precious than jewels; nothing you desire compares with her. Long life is in her right hand; in her left, riches and honor” (Proverbs 3:13, 15-16).

“The fear of the Lord is the beginning of wisdom, and the knowledge of the Holy One is understanding. For by Wisdom your days will be many, and years will be added to your life” (Proverbs 9:10-11).

2. Wise counsel to the younger is a duty of the aged. “Hear this, you elders; listen, all you inhabitants of the land. Has anything like this ever happened in your days or in the days of your ancestors? Tell your children about it, and let your children tell their children, and their children the next generation” (Joel 1:2-3).

“Remember the days of old; consider the years long past. Ask your father, and he will tell you, ask your elders, and they will teach you” (Deuteronomy 32:7).

“In the same way, older women are to be reverent in behavior, not slanderers, not addicted to much wine. They are to teach what is good, so that they may encourage the young women to love their husbands and children, to be sensible, pure, good homemakers, and submissive to their husbands, so that God’s message will not be slandered” (Titus 2:3-5).

3. The aged have continuing moral responsibilities. “Older men are to be self-controlled, worthy of respect, sensible, and sound in faith, love, and endurance. In the same way, older women are to be reverent in behavior, not slanderers, not addicted to much wine. They are to teach what is good” (Titus 2:2-3).

Resources for the Aged Numerous problems—economic, physical, mental, and spiritual—confront the aged. Resources for meeting these problems are set forth in the Bible.

1. God has promised His abiding presence. “Listen to Me, house of Jacob, all the remnant of the house of Israel, who have been sustained from the womb, carried along since birth. I will be the same until your old age, and I will bear you up when you turn gray. I have made you and I will carry you; I will bear and save you” (Isaiah 46:3-4).

2. God gives strength to endure suffering and infirmity. “Therefore, since Christ suffered in the flesh, arm yourselves also with the same resolve—because the One who suffered in the flesh has finished with sin—in order to live the remaining time in the flesh, no longer for human desires, but for God’s will” (1 Peter 4:1-2).

“Now I rejoice in my sufferings for you, and I am completing in my flesh what is lacking in Christ’s afflictions for His body, that is, the church” (Colossians 1:24). “So those who suffer according to God’s will should, in doing good, entrust themselves to a faithful Creator” (1 Peter 4:19).

3. God gives deliverance from the fear of death. “For I am persuaded that neither death nor life, nor angels nor rulers, nor things present, nor things to come, nor powers, nor height, nor depth, nor any other created thing will have the power to separate us from the love of God that is in Christ Jesus our Lord!” (Romans 8:38-39).

“…Look! God’s dwelling is with men, and He will live with them. They will be His people, and God Himself will be with them and be their God. He will wipe away every tear from their eyes. Death will exist no longer; grief, crying, and pain will exist no longer, because the previous things have passed away” (Revelation 21:3-4).

“Now when this corruptible is clothed with incorruptibility, and this mortal is clothed with immortality, then the saying that is written will take place: Death has been swallowed up in victory. O Death, where is your victory? O Death, where is your sting? Now the sting of death is sin, and the power of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ!” (1 Corinthians 15:54-57).

In the Bible, old age is considered the positive and good fulfillment of a life devoted to God. Both the blessings and responsibilities of aging are to be accepted with gratitude and in a sense of stewardship, “For God has not given us a spirit of fearfulness, but one of power, love, and sound judgment” (2 Timothy 1:7).

Blessed are they who understand my faltering steps and palsied hand.
Beatitudes for Aging Blessed are they who understand my faltering steps and palsied hand. Blessed are they who know my ears today must strain to catch the words they say.

Beatitudes for Aging Blessed are they who see that my eyes are dim and my wits are slow. Blessed are they who looked away when I spilt my cup of tea today.

Blessed are they who never say, "You've told that story twice today."
Beatitudes for Aging Blessed are they with a cherry smile who stop to chat for a little while. Blessed are they who never say, "You've told that story twice today."

Beatitudes for Aging Blessed are they who know the ways to bring back memories of yesterdays. Blessed are they who make it known that I'm loved, respected and not alone.

Blessed are they who ease the days on my journey Home in loving ways.
Beatitudes for Aging Blessed are they who know I'm at a loss to find the strength to carry my cross. Blessed are they who ease the days on my journey Home in loving ways.

Aging is a journey which includes a spiritual dimension
Spirituality of Aging Aging is a journey which includes a spiritual dimension

Spirituality of Aging The spiritual dimension focuses on meaning of life, hope and purpose, explored through relationships with others, with the natural world and with the transcendent.

Spirituality of Aging The evidence base suggests that genuine and intentional accompaniment of people on their aging journey; giving time, presence and listening are the core of good spiritual practice.

Spirituality of Aging The evidence base suggests that genuine and intentional accompaniment of people on their aging journey; giving time, presence and listening are the core of good spiritual practice

Spirituality of Aging Reminiscence, life story, creative activities and meaningful rituals all help the process of coming to terms with aging and change.

Spirituality of Aging Focusing on the spiritual care of older people is one of the ways in which person-centred care can be achieved. (Coleman, 2011; Nolan, 2012).

Spirituality of Aging Spirituality as part of a religious belief: A particular spirituality is a specific system, or schema of beliefs, virtues, ideals and principles which form a particular way to approach God, and therefore, all life in general. (Franciscan spirituality).

Spirituality as a secular concept:
Spirituality of Aging Spirituality as a secular concept: Spiritualty includes ideas, practices and commitments that nurture, sustain and shape the fabric of human lives, whether as individuals or communities. (King, 2011)

Spirituality of Aging Spirituality as a search for meaning with or without God: Spirituality recognises the human need for ultimate meaning in life, whether this is fulfilled through a relationship with God or some sense of another, or whether some other sense of meaning becomes the guiding force within the individual's life. Human spirituality can also involve relationships with other people..

Spirituality of Aging 'Spirituality encompasses wide ranging attitudes and practices which focus on the search for meaning in human lives, particularly in terms of relationships, values and the arts. It is concerned with quality of life, especially in areas that have not been closed off by technology and science. Spirituality may, or may not, be open to ideas of transcendence and to the possibility of the divine' (Ferguson, 2011)

Spirituality of Aging The contemporary use of the word 'spirituality': Spirituality refers to the deepest values and meanings by which people seek to live… it implies some kind of vision of the human spirit and of what will assist it to achieve full potential. (Sheldrake, 2007).

The theoretical basis for research on spirituality and aging
Spirituality of Aging The theoretical basis for research on spirituality and aging Research into aging and spirituality is based on assumptions of aging as a journey, as a search for meaning, balance, integration and reconciliation. (Mowat, 2004).

Spirituality of Aging There are a number of key theorists who have influenced those looking for a theory of aging and spirituality. These theorists do not directly associate the search for meaning with spirituality; their work has been used by others to build a foundation for particular understandings of spirituality.

Spirituality of Aging Victor Frankl (1984) posits man's search for meaning as a dominant conscious and unconscious driver. His incarceration in Auschwitz concentration camp during the second world war offered him the opportunity to develop his theories as part of his own survival strategy. His very powerful ideas of the capacity of man to be stripped of all the 'trappings' of life and to still find ultimate meaning underpins much of the work subsequently produced on aging and spirituality. (Kimble, 2000; Mackinlay, 2001).

The idea of journey and progression is built into this theory.
Spirituality of Aging Erik and Joan Erikson (1997) theorised stages of life. In each stage, the individual tries to achieve balance between two 'states' with associated virtues. In the later part of life, the balance to be struck is between integration and despair, and the virtue attached to this is wisdom (Capps, 2008). The idea of journey and progression is built into this theory.

Spirituality of Aging Carl Jung (1960) was particularly interested in the second half of life and the importance of life review to find meaning. He wrote: 'one cannot live the afternoon of life according to the program of life's morning: for what was great in the morning will be of little importance in the evening, and what in the morning was true will at evening have become a lie' (Jung, 1970).

Spirituality of Aging Antonovsky (1987) was interested in what psychological processes allow people to maintain themselves in a state of good health. His work on a sense of coherence develops a model and an empirically validated questionnaire which provides clinicians with a tool by which to assess a sense of coherence. A strong sense of internal coherence helps support good health. The work on spirituality and aging is multidisciplinary, offering fact-based opinion, empirically based research, theory building and philosophical insights.

Spirituality of Aging Koenig (1994) identified 14 spiritual needs of older people based on prior research both at a theoretical and empirical level..

Spirituality of Aging Need for support in dealing with loss
Need to transcend circumstances Need to be forgiven and to forgive Need to find meaning, purpose and hope

Spirituality of Aging Need to love and serve others
Need for unconditional love Need to feel that God is on their side

Spirituality of Aging Need to be thankful
Need to prepare for death and dying Need for continuity Need for validation and support of religious behaviours

Spirituality of Aging Need to engage in religious behaviours
Need for personal dignity and sense of worthiness Need to express anger and doubt

Spirituality of Aging Spirituality, although a contested concept, is evolving and developing and can be defined as a search for meaning with or without religious adherence.

Person-centred care involves:
Spirituality of Aging Person-centred care involves: spiritual care – the time, attention and listening to support individuals to find meaning and purpose in their lives.

Spirituality of Aging It has been established that there are a range of activities and practices which can support dimensions of spiritual care.

(Atchley, ‘Spirituality and Aging’)
Spirituality of Aging There is evidence that as people become older, spiritual concerns become more important to them. (Atchley, ‘Spirituality and Aging’)

Spirituality expresses itself in a variety of ways :
Spirituality of Aging Spirituality expresses itself in a variety of ways : An inner resource that drives and motivates a person and a deep longing for fulfillment. People’s health and well being; transcendence of self. Relationships with people and with the world around: a sense of belonging.

Spirituality of Aging Love, compassion, patience, tolerance, forgiveness, contentment, a sense of responsibility, a sense of harmony which brings happiness to both self and others; sometimes support for global issues such as human rights, justice, peace and care for creation.

Spirituality of Aging A reaching out towards a mystery which is outside human control. Meaning and purpose, belief and hope or ideals; people’s future and destiny. A way of coping with losses, challenges and death.

Spirituality of Aging Aging is a spiritual journey, reflects our core belief that spirituality is the essential piece of every person’s aging process.

Spirituality of Aging Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred.

Spirituality of Aging Spirituality is about life -- the fullness of life promised by Jesus. A spirituality of aging focuses in on the aging process itself as the ordinary human process that God uses to bring us to God. Spirituality fills "all this unused life that we carry about." Spirituality is the environment for wholeness.

Spirituality of Aging Spiritual practices tend to improve coping skills and social support, foster feelings of optimism and hope, promote healthy behavior, reduce feelings of depression and anxiety, and encourage a sense of relaxation.

Spirituality of Aging Qualities like faith, hope, and forgiveness, and the use of social support and prayer seem to have a noticeable effect on health and healing..

(seeing one’s situation from a more positive perspective)
Spirituality of Aging Researchers found three factors that reliably increase happiness as we grow older -- gratitude, generosity and reframing. (seeing one’s situation from a more positive perspective)

Pastoral Care for the Aged
Different models of caring Home Care with paid nurse/ staff Palliative care centres Hospice Home for the Aged Charitable Homes Assisted Living centres Senior citizen’s colony Day care centres New Model

PROBLEMS OF THE AGED Problem due to aging process
Problem associated with long term illness Psychological problems Social problems Spiritual problems

THE DISABILITY The disability statistics shows 50% of the people above 65 years have some kind of disability

CAUSES OF DEATH Congestive heart failure Chronic lung disease Cancer
Stroke

PALLIATIVE CARE The World Health Organization’s (WHO) definition is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other physical, psychosocial and spiritual problems (WHO, 2005).

HOSPICE “Hospice care is a compassionate method of caring for terminally ill people. Hospice is a medically directed, interdisciplinary team-managed program of services that focuses on the patient/family as the unit of care. Hospice care is palliative rather than curative, with an emphasis on pain and symptom control, so that a person may live the last days of life fully, with dignity and comfort, at home or in a home-like setting”. (National Hospice and Palliative Care Organization)

Society has a moral responsibility to care for its aging members. Christians are to be especially sensitive to the needs of the aged and active in ministries to them.

The aging population requires person-centred care and developmental support in order to maximise its chances of aging well.

The Bible speaks The aged deserve kindness and respect. Families have an obligation to provide for their aged members. Churches have special responsibilities for the aged.

1. The aged deserve kindness and respect. “Do not rebuke an older man, but exhort him as a father, younger men as brothers, older women as mothers, and with all propriety…” (1 Timothy 5:1-2).

“You are to rise in the presence of the elderly and honor the old… I am the Lord” (Leviticus 19:32). “Listen to your father who gave you life, and don’t despise your mother when she is old” (Proverbs 23:22).

2. Families have an obligation to provide for their aged members. “Now if anyone does not provide for his own relatives, and especially for his household, he has denied the faith and is worse than an unbeliever” (1 Timothy 5:8).

3. Churches have special responsibilities for the aged. “If any believing woman has widows, she should help them, and the church should not be burdened, so that it can help those who are genuinely widows” (1 Timothy 5:16).

Proposed model for Parish (Fr. Joseph Pampara, Old age – a Golden period, 2002) Unit / Ward committee Central committee Service Team

Proposed model Unit / Ward committee Identify the elderly in need Evaluate their situation Organise routine services Coordinate with central committee

Proposed model Central committee Representatives from units/wards Representatives from Religious Nominated members Executive - Administrator Coordinates units/wards Budget & Raise funds Evaluation

Proposed model Service Team Physical health care Mental health care Spiritual care

Proposed model Physical health care Nurse Helpers Physiotherapists

Proposed model Mental health care Councillors Social worker

Proposed model Spiritual care Parish Priest Sisters Lay volunteers

Proposed model Service Those who are independent Those who are bed ridden

Proposed model Service Those independent – Boring at home Take them to their friends Facilitate friends to visit them Take them for prayer meetings, Church services & celebrations Organise programmes

Proposed model Service – Day Care Centre Facilities for recreation, rest Medical care Exercises Food Transport

Proposed model Service - Volunteers Children Youth Mothers’ organsation Vincent De Paul Prayer Groups

Proposed model Service - Bed ridden Nurses Helpers – Bathing, Cleaning Counsellors Spiritual care – Priests, Sisters, Lay people Independent - Together in a home

Proposed model Advantages Christian Love Live in their home atmosphere

Saying the “Five Things” “Please forgive me”; “I forgive you”; “Thank you”; “I love you”; “Goodbye”

Tell Me and I Will Forget. Show Me and I Will Remember. Involve Me and I will Understand. (David Kolb quoting Confucius)

“As for old age, embrace and love it. It abounds with pleasure if you know how to use it. The gradually declining years are among the sweetest in a person’s life”. (Seneca)

“The best classroom is at the feet of an elderly person.” (Andy Rooney)

Listen to the aged……… For they will tell you about living and dying. For they will enlighten you about problem-solving, sexuality, grief, sensory deprivation, and survival. For they will teach you how to be courageous, loving and generous. ( Irene Burnside, 1975)

In Conclusion “We need to meet all kinds of people so that we can find ourselves. Young people need older people just as older people need young people in order to become more themselves and more human. That humanizing process will teach us that there is a child behind the mask of each older face, just as there is already an older person behind the mask of each young face.” (Missinne, 1990)

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