How Agers Make Decisions

How Agers make decisions is complicated. When I was a little guy between the ages of eight and ten I used to ask “why?” all the time. Most adults tried to answer my questions. One Uncle didn’t. His favorite response was “So you could ask why.” “Why do you keep your tools in there? “So you could ask why?” “Why do you hang the rake on the wall?” “So you can ask why?” “Why can’t I swim?” “So you can ask why?”

My Uncle and Aunt were up every day before dawn to hit the road to sell clothes all over Los Angeles county. My Uncle ran a clean, quiet, and orderly household. Their kids had to behave and always kept things neat and orderly. If you got out of line my Uncle would yell at you.

Goating The Decision Maker

For some reason I found it amusing to “get his goat.” My Uncle liked quiet time, and demanded it. He liked to read the newspaper and would sit in his favorite lounge chair, holding the newspaper spread open in front of him. To me it looked like the walls of Babylon. I’d sneak up and punch the newspaper and run. My Uncle would scream.

We also had certain family events at my Uncle and Aunts. They were long events, especially for a kid. They often involved lots of readings from religious texts. And he never skipped any passages. I got bored and liked to sneak under the table and tie his shoelaces together.

Believe it or not, we were communicating. Not very effectively, but nonetheless communicating.

Communication Can Evolve

Years later, when my Uncle had grandchildren things changed. The house was messier, quiet time didn’t exist, and pre-dinner family events went from hours to twenty minutes. My Uncle had mellowed, and I would joke with my cousins that I had broken him in.

Our last communication occurred shortly after his death. I was upside down in my car in a river drowning. I saw my Uncle and he said to me “Not your time.” I was able to unlock my seat belt, flip from my upside-down position, and kick out the window. This allowed me to get above the running river water. It was our most effective communication, and he was dead.

I share this story to emphasize how communication, decisions, and actions can be strangely connected. A kid in his early developmental stages may be deeply connected to his emergence within his quickly growing world, and relationship to that world. A middle-aged man may be equally embedded in his world. Comfortable with his family, happy with family traditions, and desirous of tranquility. Their ability to communicate may have been minimal at the time. But they both were making decisions that impacted one another.

Born to Choose: Autonomy & Dissonance

I think, therefore I am.
Decartes

Americans are trained at birth to accept as fact their free will and right to self-determination. It’s in our constitution, our western philosophies, our religion and everyday law. Many assert that it’s in our biology. The understanding that one can exert control over their environment to produce desired results is integral to a person’s health: to their sense of wellbeing; and a goal of society.

Most Americans shudder at the idea of arranged marriages, where they can’t meet their respective spouse until their wedding day. Imagine a dating site where you don’t get to see or know anything about your date. How about a world where a random stranger picks out the names of your kids, what you’re doing over the weekend, and where you’re going on vacation. Or a world where your right to vote is taken away and given to someone the Government thinks is more competent than you: a popular actor, or singer, or a social network influencer.

One of the most common areas of contention Carmen and I hear is when an Ager tries to explain to their child or children why they can still drive and live in their own home.

I Can Still Drive

We’ve heard lots of stories like the following:

Two of our three kids came to Thanksgiving at our home in upstate New York and announced that their father shouldn’t drive. That his last accident was an indication of his incompetence. It wasn’t even his fault. Then they said we need to consider assisted living. They said my sister had moved into assisted living and she was younger than me. My husband and I both go to exercise class three times a week and spend three days a week volunteering at Church. We’re the ones that deliver food to the old folks and take them to their Doctor appointments. We thanked our kids for their concern and after dinner, hugged and kissed them goodbye. We told them we look forward to seeing them next year and discussing their concerns in more detail.

Autonomy

The number one concept Carmen and I want to share with you involving family communication is autonomy. The capacity to make an informed and uncoerced decision. The word itself comes from Greek roots meaning “self” and “law.” Think of it in terms of you having the right to make your own choices.

Scientists have postulated that autonomy is required for survival. The theory suggests that if people don’t believe they can successfully produce desired results, there is no incentive to address challenges. Said another way, if I don’t control my world, why should I try.

Autonomy & Survival

From here, scientists postulate that survival, the perpetuation of the species, requires autonomy. In everyday life, think of this sequence. I study hard, go to college or a vocation school, get a good job, and raise a family. If I believed that no matter how hard I worked, or what I did, the outcomes were random, why would I try?

This autonomy often is colloquially referred to as control. If you’ve ever interacted with an Ager around the use of a car, you’ve heard them express that the loss of the car would take away their control. Autonomy is important because as Agers, we don’t want to give up our control.

As Agers, we’re just old, not dead. We’ve been doing just fine, why would we give up driving, leave our home or move away from our friends? Yet that’s exactly what we’re often asked to do by our loved ones. Children come to us and say you can’t drive, or you need to leave your home. Of course we don’t agree. Why would we?

Carmen and I will talk about how to have conversations as an Ager, or as the children of Agers below. For now, keep in mind how important our autonomy is to us no matter our age.

How Children Deal With A Parents Need For Autonomy

Before we leave autonomy, let’s look at the point of view of a child concerned with their parent. Let’s say as a child, you believe that you have a legitimate concern about your parent’s ability to drive or manage themselves in their own home. You explain to your parent that they should not be driving and that they need assistance either in their own home or in an assisted living residential facility. They say, “No.”

How do you feel? Certainly, you didn’t make your statement lightly. You reviewed the facts. Perhaps they included multiple car accidents, misuse of medications, falls in the home, and multiple hospitalizations. How is your autonomy (control) feeling? You want to control your world, and that world includes the safety of your parents. But they won’t listen.

When it comes to staying in your own home, see our Section on Housing. Often times, the parent – child home discussion is contentious because the participants don’t understand the issues, and the proper framework that identifies these issues. Below Carmen and I will talk about how to talk with your parents about when to make changes. For now, keep in mind that autonomy is important to all of us.

Will to Live – Life Force

Carmen and I came face-to-face with the tremendous power of the life force as we visited nursing homes. I, like many others, have an aversion to nursing homes. I have problems with the smell, the energy of the residents, the lack of awareness many residents exhibit and the difficulty getting things done that I thought should be done quickly (changing sheets, quicker support for ADLs, etc.).

Carmen had the opposite view, she relished visits. She’d prance down the halls, pop her head into peoples’ rooms and say hello to residents, hug people who were in the halls and spend hours chatting with residents. Mealtimes were also great. It was like she was at a child’s imaginary tea party. She’d act as a gracious host asking how everyone was, and encouraging the people around the table to share stories. She’d fill in gaps when needed. Where Carmen clearly saw people to interact with, I tended to see things more related to death.

Despite Circumstances, The Will To Live Prevails

If you paid close attention in the home you’d hear lots of resident’s comments related to sustenance, “When’s dinner?” “We’re having meatloaf tonight.” There were also lots of comments about things gone missing, “Someone took my sweater,” “Who stole my wallet.” There were also lots of comments related to services, “Are you having your hair done today, Margret?” “Your hair looks nice Mrs. Jones,” “How do you like being a blonde Ms. Debra?” There were also a substantive percentage of residents who were bedridden or sitting in wheelchairs with limited ability to respond. There were also residents who would scream, either in pain or fear, or combinations.

No Talk Of Death

What you didn’t see or hear were things related to death. No daggers, scythes, or skulls. We never heard the word kill, and seldom heard the word death. People passed, people left to a better place, but we rarely heard the word death, or died. Very few residents or workers wore black. Almost every resident had pictures of family members. For all the times Carmen and I heard people in their sixties say, “kill me if I’m ever put in a nursing home,” we never heard a resident ask us to do them in. People wanted to live, or at the very least, were not trying to hasten death.

If you think this behavior of extolling life is common you haven’t been to a large public high school. In every large public high school I’ve been to the kids are wearing shirts with skulls and scythes. Black is often the most common color worn by the boys, and not uncommon among the girls. Conversations often use the words “kill” and “death” or equivalent euphemisms. You hear words and phrases like “bite it,” “kill-it,” “Hara-kiri,” and “cap.” Teenagers are doing all sorts of crazy and dangerous things that bring death closer. And when it comes to doing oneself in, percentage wise they crash their cars and commit suicide at higher rates than any other age group.

Agers Don’t Commit Suicide

As people age, suicide as a cause of death is barely measurable. This is remarkable for anyone that has spent time asking people in their sixties what their plans are for when they get old and can no longer care for themselves. At least 10% of the people Carmen and I have talked to in this age range say, “When I get old and can’t care for myself, just kill me.” When these people get there, they want to live. What’s happening?

When we’re in our fifties and early sixties, we often associate a good life with being healthy, being mobile, and being able to pursue our passions. But studies show that these don’t matter toward the end of our lives. General health is not that important. Mobility is not that important. Continence is not that important. Studies of Agers demonstrate older people want to live. Studies even show that as we get older, we want to live longer.

If you’ve ever tried to swat a fly in your house, or catch it so you could move it outside, you’ve seen the will to live in action. Self-preservation at the biological level is innate to all species: from the smallest organism to human beings.

As humans, we avoid things that harm us like pain. If I move your hand over a flame, you’ll move it away. If I place you in a dangerous situation like dropping you in a war zone, your body will react at an unconscious level in a very specific way. Your central nervous system is programmed to release adrenaline to boost performance. Adrenaline stokes the heart and increases blood flow to the muscles and increases brain alertness. It also heightens our senses of hearing, smell and sight.

A Desire To Hasten Death Is Rare

By studying people of advanced age or as they face serious chronic illnesses, social scientists are able to investigate what Agers are most concerned about. The studies then look at those that appear to be losing their will to live by measuring identifiable characteristics across psychological, physical and emotional domains. When they stop wanting to live there are specific psychological factors that contribute to this desire to hasten death. These include:

Physical factors correlated to the desire to hasten death:

• Dyspnea
• Constant pain
• Nausea & vomiting

Psychological factors correlated to the desire to hasten death:

• Depression
• Meaning and purpose
• Distress and coping ability
• Perceived control
• Self-worth

Relationship with other factors correlated to the desire to hasten death:

• Burden on others
• Control time of death

Circumstances When Seniors Want To Hasten Death

The science shows that the average Ager wants to live unless they are tortured and thrown in jail. Think about that for a moment. From a physical point of view, the kinds of things we associate with torture make the list. How many movies have we seen where someone tortures someone by holding their head underwater or pouring water into their mouth? How many times have we seen a movie where someone tortures someone by causing them extreme physical pain?

It’s not torture if you can walk away. So along with torture comes imprisonment. Once trapped, our autonomy diminishes. If the entrapment starts to look permanent, a prison sentence, what happens? Depression, meaninglessness, loss of coping ability, and no self-worth. These are all the psychological factors correlated with wanting to hasten death.

Agers Live Long

Why is this Life Force relevant? Here’s one of the most common and tragic scenarios Carmen and I commonly hear about.

Mom (or Dad) is in the hospital again. They’re in their eighties. They’re trying to live independently but have had a series of issues. They have a couple of chronic illnesses like heart failure and diabetes. They’ve broken an arm or hip or have serious pain in their knees. They manage their medications, but the list of their medications is very long. It includes over fifteen medications. Some of them are very powerful and regulated as Class Two narcotics.

In the scenario above, Agers can live for many more years, even if they prefer not to. They live because a visit to an emergency room can address most of the things that would end their life: dehydration, infection, heart problems, and breathing problems. Their life force motivates them to stay alive.

Super Agers appear to understand this life force. If they have made the decision that they don’t want to live under certain conditions they place clear directions into their advance medical directives. They generally center around the notion that upon reaching certain criteria, they don’t want to be rushed to the hospital, resuscitated, or hospitalized. They know that these interventions will allow them to live long after they’ve reached a place where they’re ready to pass.

Dissonance & Resonance

Dissonance is a lack of harmony. Discordant sounds. Resonance is harmony. Reverberate sounds. If you’ve ever sung along to a tune on the radio, or internet, your practicing a kind of resonance.

The same is true if you’ve been to a sporting event and rooted along with the crowd. Resonance is powerful. Think about a political rally where attendees are encouraged to chant a slogan. As more and more people join the chanting, it gets harder and harder for people not to join the chant. There’s a name for the inability to go against the crowd: it’s called cognitive dissonance.

Cognitive dissonance is one of the most persistent sociological theories. The theory postulates that individuals seek consistency among their beliefs and opinions. There is dissonance when there is an inconsistency, and something must change to eliminate the dissonance. There are two factors that affect the strength of the dissonance: the number of dissonant beliefs, and the importance attached to each belief. Dissonance can be eliminated in three ways: (1) reduce the importance of the dissonant beliefs, (2) add more resonant beliefs to outweigh dissonant beliefs, or (3) change the dissonant beliefs so that they are no longer inconsistent.

Experiments Demonstrating Dissonance

Cognitive dissonance is demonstrated in experiments structured as follows. First, the participant is asked their opinion about something or tested on their ability to identify a fact, like the length of stick several feet away. Next, this participant is exposed to something opposite. In the case of opinions, the participant might be asked to prepare a speech taking the opposite side of a position they hold. In the case of the ability to gauge the length of a stick, the participant is placed in a room with actors who all say the stick is 12 inches, when it is actually 8 inches long. In both cases, the participant sides with the opposing view. In the opinion scenario, because they made the effort to write a speech expressing a view, they had to literally change their view. In the stick case, because every other person said the stick was a certain length, they fell in line and sad the same. In both cases, it was easier to be resonant than dissonant.

Dissonance and resonance will ultimately be good for aging issues. When American culture understands the impact of declining cognitive and physical abilities of Agers, as a culture we will all understand the best actions to take. In other words, there will be a ubiquitous understanding that Agers reach a point when driving and independent living makes no sense. Agers will simply stop driving and live with assistance. The resonance will simply be too great to resist. Today that is not the case. The opposite is true. Driving and staying in one’s home are what’s considered normal. Staying independent at almost all costs is what aging Americans want.

Children Trying To Persuade Their Parents Can Use Dissonance

Carmen and I bring up cognitive dissonance to explain why children don’t get far when trying to convince their parents to stop driving or leave their home. However, remembering the theory of cognitive dissonance can help you understand how we as Agers, or our children, can help get us on a path where we can make the right changes, at the right time. Carmen and I noticed that Super Agers did something unique when it came to housing. They had, as their point of view, some objective criteria to measure their abilities. These abilities could be used to determine the best environments for them.

For example, one Super Ager couple we met agreed that when they were unable to walk comfortably from one end of their farm to the other, they would leave their farm for a home close to one of their children. Comfortable meant no stopping or falling. Super Agers have little or no cognitive dissonance about moving to a different home. It was already part of their thought process. They recognized that independent living requires independent capabilities. When independence is lost, so is independent living. In other words, they eliminated the dissonance by agreeing to a course of action in the future.

Echo Chambers

An echo chamber is a metaphor for a situation where ideas, beliefs and data points are reinforced through repetition inside a closed system. In a recent election, supporters of the President of the United States heard a set of messages and beliefs from conservative talk radio and cable networks that echoes the President’s claims that the country was in danger because of bad trade policy, poorly thought out immigration policy, and a government run by corrupt bureaucrats. He suggested that anyone not an elite was not benefiting from the liberal policies of the prior president. On non-conservative cable and network news the messages were very different. On these channels, the messages were that the President was racist, ignorant of trade policy and corrupt. These messages were reinforced in most newspapers, and on liberal news and radio stations.

The messages were so different that both sides took on tactics to invalidate the other side. Conservatives suggested that the liberals were so upset with their loss that they would try and invalidate the election. Non-conservatives claimed that the election was invalid. That the popular vote clearly dictated a victory for their side and the conservatives would not have won without the help of foreign government intervention. The point of echo chambers is that they reinforce people’s positions.

Echo Chambers & Little League

If politics are not your thing, just think about the last time you went to your child’s baseball game. Did you root for the other team? When your child was at bat, did you root for the pitcher to strike him or her out? What if your child smacked the ball into the outfield? Did you tell him or her to slow down because the other team would be upset if he scored? Parents root for their kid’s team. This is a kind of echo chamber. The louder and more boisterous the parents get, the more likely it is that the other team parents join.

This pattern repeats in college and professional sports. How many people from Boston root for the Los Angeles Lakers? How many people from Los Angeles root the Boston Celtics? You don’t see many Oklahoma City or Tulsa college football fans rooting for Texas teams. And there are fewer Texas college football fans rooting for Oklahoma teams. This is true even in the same State. You can’t find many Alabama Crimson Tide fans that root for the Auburn Tigers or vice versa.

If you’re old enough to remember, or fortunate to have in your neighborhood today, an ice cream truck, you’ve seen the effect of the music. But more effective than the music is the screaming of children. “I scream, you scream, we all scream for ice cream,” is a cultural artifact form a 1927 hit song. But there’s no better echo chamber than actual kids screaming for ice cream.

Agers Live In Echo Chambers Of Their Own Making

Carmen and I bring this up because it creates a conundrum for us as Agers. As Agers we’re not eager to give up our beliefs and lifestyle. We even reinforce our beliefs by surrounding ourselves with people that think the same way. This means it’s really hard to hear people who have a different point of view. As we decline cognitively and physically, our point of view will not change. We often get more adamant. The very thought of change becomes paralyzing.

Carmen and I noticed that Super Agers did something unique. They already considered the implication of declining abilities and how this affected their ability to live in a home. They set criteria that would trigger the need to make changes. By doing this they were able to step outside the echo chamber.

Any of us that live long enough will need the assistance of other people — most likely family. Carmen and I have learned from Super Agers that aging brings physical and cognitive challenges. They have clear metrics that they use to make decisions.

Other Resources On Senior Decision Making

Interesting articles on seniors and decision-making here.

Make sure to see our other sections, especially, Getting Things Done here, and Best Practices: Tips and Techniques, here.