Couples Counseling for Older Adults

A recent article called “Don’t Give Up on Marital Therapy” from the New Old Age blog of the New York Times speaks to the importance of couples counseling for older individuals.

“Marital therapy for individuals over 65 years of age is difficult, since habits of a lifetime are deeply ingrained,” stated a study in The Canadian Journal of Medicine, one of the few in the medical literature about marital therapy among older people.

“Yet, in a sense, marital therapy is more crucial for the elderly than for younger patients,” the study continued. “At a time when they are least adaptable and most vulnerable to stress and are entering perhaps the most difficult period of their lives, the elderly must learn new methods of relating and coping”.

‘Aging in the 21st Century: A Celebration and A Challenge’

In ancient times, open-minded map makers labeled unknown territories simply as “Terra Incognita”, meaning “land unknown”. More fearful cartographers literally marked those territories: “Here be dragons”.

In America, with our youth-oriented culture and associated denial and dread of growing older, there appears to exist a comparable fear of the unknown territory of… aging. “Here be dragons!” seems to be the underlying message of the anti-aging products and ageist stereotypes that flood our media.

Interestingly enough, at the same time,  there is a huge global, aging population swell happening.

The United Nations Population Fund (UNFPA) and HelpAge International, London just published the results of their 2012 study called “Ageing in the Twenty-First Century: A Celebration and A Challenge”.

Here are just a few of the mind-boggling statistics from this report:

1. Around the world, two persons celebrate their sixtieth birthday every second – an annual total of almost 58 million sixtieth birthdays.
2. By 2050 for the first time there will be more older people than children under 15. In 2000, there were already more people aged 60 or over than children under 5.
3. In 2012, 810 million people were aged 60 or over, accounting for 11.5 per cent of the global population. The number is projected to reach 1 billion in less than 10 years and more than double by 2050, reaching2 billion and accounting for 22 per cent of the global population.
4. In the past decade, the number of people aged 60 or over has risen by 178 million – equivalent to nearly the entire population of Pakistan, the sixth most populous country in the world.
5. Japan is only country in the world with more than 30 percent of its population aged 60 or over.By 2050, there will be 64 countries where older people make up more than 30 per cent of their population.
6. The number of centenarians will increase globally from 316,600 in 2011 to 3.2 million in 2050.

As you can see, the numbers of us in older age are growing dramatically – not just here in Marin, but around the world. Here in Marin County, our population’s fastest growing age sector is 85+ years old. And of that 85+ group, the fastest growing segment are the centenarians! This aging population wave has often been referred to as the “silver tsunami”.

Extraordinary advances in medicine and sanitation, education about nutrition, declines in some types of unhealthy behavior, such as smoking, are contributing to rising life expectancies. The average life expectancy in the United States in 1900 was 49 years, now it’s about 80 years.

All of this is to say, not only is growing older uncharted terrain because each of us is experiencing it for the first time, but there are so many more of us experiencing it for the first time… ever. Human beings, in general, have never lived this long and there have never been so many of us experiencing it together!

More and more guides for how to age well will be sought. Books written, interviews conducted, studies done, opinions opined. Rest assured, growing older will become more visible just through the sheer numbers of us. Hopefully this will result in more awareness of the opportunities, the challenges and the needs of older people – and we will come up with many new, creative alternatives and solutions for for taking care of ourselves and each other as we age.

NORC’s are “Naturally Occurring Retirement Communities”. The term was originally coined in 1984 by Professor Michael Hunt of the School of Architecture and Urban Planning at the University of Wisconsin. He had noticed that a large apartment building in downtown Madison housed mainly older people who had migrated there for convenience – they could walk to stores, parks, theaters and doctors’ offices. He called this “naturally occurring retirement community” an example of “in-migration”.

Other types of NORC’s occur where there are already stable longtime communities of residents who are apt to stay in their locations and age in place together – this is called “aging in”.  I think what we are seeing in Marin is an example of “aging in”. Residents tend to love living here – the climate is fantastic, the mountain and views are hard to beat anywhere, the air is clean, the services are high quality, the arts are in evidence. Why go anywhere else if we can afford to stay here?

The third type of NORC’s have been defined as being examples of “out migration”. These cases happen often in rural communities where younger working people move, leaving the older folks behind. From what I’ve observed over the years, we have a bit of “out migration’ happening in Marin as well. Many aging parents tell me that their adult children cannot afford to live here in Marin or can’t find jobs here, so they have moved north, to the East Bay or out of state. Thus many older people here have no local family to care for them as they age.

NORC’s really got going originally in New York. The pioneer activist in the movement is Fredda Vladeck, a geriatric social worker who worked with the state and city of New York to garner matching funds from private agencies. The first NORC was born in a housing development called Penn South, in 1986. Penn South housed 5000 older people (of its 6200 residents) – most of whom were lifelong union organizers who had never married or, if they had married, never had children. So, they did not have the traditional circles of support.

At Penn South, the residents also did not trust social workers. They feared that the social workers would try to get them to move into nursing homes. After years of working to build trust, the community was thriving – full of renewed arts programs, activities, intergenerational bonding and mutual care. Members were all contributing their volunteer services. Further, the state and city funding paid for a variety of health services to be offered on-site. Visits to ER’s dropped dramatically as overall physical and emotional health and wellness increased. Isolation and depression decreased.

This “vertical NORC” model (in a high-rise) spread throughout New York and morphed to includeNORC WOW’s (NORC Without Walls). These NORC’s exist in demographic-based communities where members live in their own homes. Hundreds of NORC’s exist across the US now – there are many different iterations depending on the culture of each community and the members.

For example, here’s information on one thriving NORC Without Walls in St Louis:

Productively Aging: St. Louis’s Naturally Occurring Retirement Community

For more information about the history of NORC’s read this fascinating interview inDesigner/Builder magazine with Fredda Vladeck:

 NORC Blueprint: A Guide to Community Action .

Here’s a quote from Fredda:

“What we’ve accomplished is about changing the discussion from long-term care to long-term living. It’s moving the mindset and recognizing that older adults, as old and as frail and as fragile as they are, have roles to fill in their community. It’s up to us to find those appropriate roles and recognize that it’s not just about putting in a service: it’s about addressing the quality of life of older adults.

 

There’s a major push right now among public policy folks in the aging and long term care world to do what’s called community-based care. I’m not sure exactly what that means. I think the larger question here is we need to be thinking about the role of older adults in communities and how they can continue to be valued contributors. At Penn South we told people in wheelchairs, who ordinarily would have been stuck in their apartments, that there was stuff they could do here to help this community and this program. We told them, bring your home care worker too. That’s fine. You have a role in this community and in this society, and our job is to help you realize your potential.”

 

 

In Marin, we have naturally occurring retirement communities happening whether they are officially affiliated with the NORC movement or not. Alternative housing arrangements for seniors are cropping up all over, including here. They may include housing complexes with NORC’s, NORC’s Without Walls in neighborhoods, Villages (another neighbor helping neighbor model), or even CCRC’s Without Walls (Continuing Care Retirement Communities Without Walls). It is good to see a variety of choices. (See this recent article about CCRC’s Without Wall in the NY Times: A Choice of Community Care, in Your Own Home.)

With all of the creative energy in Marin and in the Bay area, I’m sure there will be many more community models emerging as we boomers continue to age. If you know of more examples in our area, please feel free to email me or post a comment. Thanks!

– Nancy Rhine, MS, LMFT is a licensed marriage and family therapist who specializes in working with midlife and older individuals, couples and families. She is Mill Valley’s former Commissioner on the Marin County Commission on Aging and a passionate advocate for older members of our communities. You can reach her at nancyrhine@aol.com.