Positive Ageing and Meaningful Life – Dr Chris Poulos

There is opportunity to extract the most out of life

12 MINUTE READ

from Luke’s Journal 2020 | Ageing Gracefully | Vol.25 No.3

Aged couple riding bicycles along a country path

“Even to your old age and grey hairs
I am He, I am He who will sustain you.
I have made you and I will carry you;
I will sustain you and I will rescue you.”
Isaiah 46:4 NIV

To do the subject of ‘Positive ageing and meaningful life’ justice in only a few pages is an impossible task. We can only scratch the surface of this important topic. However, I will attempt to provide a framework in this article, divided into three sections.

  • The first is a clinical approach to positive ageing, which focuses on functional ability as well as having purpose and meaning in life.
  • The second section discusses how purpose and meaning is strengthened by a Christian worldview. 
  • The third draws both together. 

The focus of the article is on someone who may be just entering, or is well into, older age (let’s say late-50s – either fully retired, or retirement is on the horizon). One caveat – even though many of the principles still apply, I don’t claim to cover some of the more complex needs of older people requiring high levels of supportive care, such as those with extreme frailty, or the more specialised needs of people living with dementia or those who are receiving palliative care. 

Positive Ageing and Meaningful Life – a clinical approach

What is positive ageing?
A number of terms (such as healthy, active, productive, successful) have been used to describe what ‘ideal’ ageing might look like. While it’s helpful to describe an ideal picture of older age, and to study the epidemiological determinants of ageing well (and hopefully raise the bar for all in the future) by identifying an ideal picture of older age, it is not particularly helpful for people who are already there.

The ideal ageing journey usually requires a life-course approach, and many of the determinants of the ideal are out of a person’s control – either because of genetics, or the environment in which they were raised, or because they have made poor decisions in the past that cannot be undone.

I prefer the term positive ageing, not necessarily confining its meaning to the realm of positive psychology. I use it in a more ‘off-label’ sense, such as: there is usually something positive a person can do to improve their ageing journey. This approach is more helpful to people who may not have aged particularly successfully, healthily, productively or actively.

“Having meaning and purpose in life is also integral to positive ageing.”

Functional ability
Because I am a rehabilitation physician, I tend to view a patient in terms of their ability to function. People seek medical attention for many reasons, but declining function resulting in activity limitations is certainly one of the main ones. Activity limitations lead to a reduced ability for people to participate in life pursuits that are meaningful to them. 

The World Health Organisation, in its 2015 World Report on Ageing and Health1, introduced the term intrinsic capacity. Intrinsic capacity is defined as the “the composite of all the physical and mental capacities of an individual”. A person’s intrinsic capacity, along with the environment, is what determines their functional ability

The environment, in this context, consists of all the extrinsic factors that can influence function, such as the use of assistive technologies, the physical environment, social policy, or the formal and informal support available to the person.

The life-course view
Over the life-course, the aim is to maximise a person’s intrinsic capacity, thereby creating a buffer, or reserve, against functional decline. The WHO Report provides a public health framework in which this can occur. From early in the life-course, the aim is to promote capacity enhancing behaviours. This is done by education, as well as public health and societal strategies (for example, minimising tobacco use through taxation and restrictions on supply, or creating environments which help promote physical activity). The health system also plays a role in helping people to build and maintain intrinsic capacity (for example, through identifying and managing risk factors for chronic disease). 

An inevitable consequence of ageing is a decline in intrinsic capacity. The aim should be to slow the decline wherever possible, as well as take opportunities to reverse any declining capacity that occurs following illness or injury. Once again, the health system plays a large role in disease management, secondary prevention, and the provision of rehabilitation (and other restorative strategies). However, the environment surrounding the individual also plays a role and can help people maintain or maximise their functional ability by compensating for loss of capacity (for example, through the use of assistive technology and removing environmental barriers to participation).

The individual view
In a positive ageing approach, the same public health framework can be used at the individual patient level. A very truncated version of this approach follows2

The starting point is to explore ways to maximise a person’s intrinsic capacity through optimal disease management, including the management of pain, if present. Allied health therapies, especially exercise in its various forms (aerobic, strengthening and balance training), can also help a person maximise intrinsic capacity. Overcoming internal ageist attitudes about the benefits of exercise, and promoting self-efficacy is key. In the case of exercise, self-efficacy is a belief by the person that by exercising they can make a difference to their ability to function. Allied health practitioners are also very effective in looking at how the environment impacts function and they will be able to advise on assistive technologies as well as modifications to the environment. 

If functional deficits remain, then further ‘environmental’ modifications in the form of community services are fortunately readily available in Australia. Providing supportive care might not seem to be a way of promoting functional ability, but it can do this when it allows someone to continue to undertake meaningful activities (for example, assistance with meals and cleaning to allow someone to live in their own home, or assistance with transport to allow continuation of shopping). Assistance with a task itself in the form of ‘doing with’, and not ‘doing for’, can also serve to promote the retention of functional ability. 

Informal support through family carers is also very important, as is supporting those people in their caring role.

Ultimately, however, a change in accommodation, including to supported accommodation such as nursing home care, may be required. However, this too can positively impact a person’s ability to continue to do some of the tasks that are meaningful to them.

Meaning and purpose as factors in positive ageing
Having meaning and purpose in life is also integral to positive ageing. Eudaimonia is a term for happiness or well-being. According to academic and psychologist, Carol Ryff3, psychological well-being includes the following constructs: self-acceptance; positive relationships with others; autonomy; environmental mastery; purpose in life; and personal growth

Having purpose includes having goals and a belief that life has a purpose. 

Within HammondCare we run a program called Arts on Prescription, in which older people with unmet health and wellness needs work with professional artists to explore their own creativity in small group settings. An evaluation of the program suggests that this type of pursuit was able to create meaning and purpose and improve mental well-being.4 (Note that eudaimonia can be contrasted with hedonia, which is happiness from short-term gratification and pleasure. Hedonistic pursuits are unlikely to create purpose and meaning – your football team may not always win!).

Volunteering is another pursuit that has been shown to promote positive ageing.5 Volunteering and participatory arts both help to create purpose, connect people with others, develop new skills, and build confidence, all of which can lead to improved mental well-being. They can also be a means by which people increase their physical activity. 

Meaningful life and the Christian worldview

Meaning and purpose
There are numerous self-help books that aim to help people age positively. Generally, they contain sensible suggestions that most people would agree with. 

For example, in his book Seven Strategies for Positive Ageing6, psychologist Robert Hill lists: 

1. Finding meaning; 

2. You’re never too old to learn; 

3. Using the past to cultivate wisdom; 

4. Maintaining and enhancing meaningful relationships in older age; 

5. The importance of giving (and receiving gratefully); 

6. The power of forgiveness; and, 

7. Having a grateful attitude. 

While Hill’s book is secular in nature, it does include a part of one Bible reference at the beginning of his chapter on forgiveness:

“Be kind and compassionate to one another, forgiving each other” Ephesians 4:32

He then goes on to talk about the psychological, and some physical, benefits of forgiveness. There are clearly similarities between Hill’s Seven Strategies and the work of Ryff and others.

Meaning and purpose are Biblical precepts
We should expect that a secular view of positive ageing and the things that create meaning and purpose would be similar for both the Christian and non-Christian, because we all share the same Creator God. In fact, we can find Biblical precepts behind Hill’s Seven Strategies:

  1. Our lives have meaning:
    “I praise you because I am fearfully and wonderfully made;” Psalm 139:14
  2. God wants us to grow, especially within the Christian faith:
    “For this very reason, make every effort to add to your faith goodness; and to goodness, knowledge; and to knowledge, self-control; and to self-control, perseverance; and to perseverance, godliness; and to godliness, mutual affection; and to mutual affection, love. For if you possess these qualities in increasing measure, they will keep you from being ineffective and unproductive in your knowledge of our Lord Jesus Christ.” 2 Peter 1:5-8
  3. We develop wisdom as we age:
    “Is not wisdom found among the aged? Does not long life bring understanding?” Job 12:12
  4. God intended for us to value relationships:
    “A new command I give you: Love one another. As I have loved you, so you must love one another.” John 13:34
  5. We should be generous:
    “In everything I did, I showed you that by this kind of hard work we must help the weak, remembering the words the Lord Jesus himself said: ‘It is more blessed to give than to receive.’ ” Acts 20:35
  6. We should be forgiving:
    “Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with compassion, kindness, humility, gentleness and patience. Bear with each other and forgive one another if any of you has a grievance against someone. Forgive as the Lord forgave you.” Colossians 3:12-13
  7. We are to be grateful and give thanks:
    Make sure that nobody pays back wrong for wrong, but always strive to do what is good for each other and for everyone else. Rejoice always, pray continually, give thanks in all circumstances; for this is God’s will for you in Christ Jesus.” 1 Thessalonians 5:15–18

The added dimension
Within a Christian worldview, the things that create meaning and purpose in this life have an added dimension and greater depth: 

We value relationships not only because strong relationships are inherently good, but because we are in relationship with God, and He with us:

“But when the set time had fully come, God sent his Son, born of a woman, born under the law, to redeem those under the law, that we might receive adoption to sonship. Because you are his sons, God sent the Spirit of his Son into our hearts, the Spirit who calls out, ‘Abba, Father.’ So, you are no longer a slave, but God’s child; and since you are his child, God has made you also an heir.” Galatians 4:4-7

We can use our experiences as we age, including through suffering, to grow spiritually:

“Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope.”
Romans 5:3-4

Ageing, with God’s help, allows us to develop wisdom (i.e. a greater ability to discern, choose and encourage, see Proverbs 1 through 7). We are generous to others because God is generous to us. We are forgiving to others because, through Jesus, God has forgiven us. We are grateful to God for rescuing us. 

And we have a future hope to help us through times of trouble – because, let’s face it, ageing isn’t always fun.

Positive ageing within a Christian worldview

When I contrast some of the Christian books written to provide practical advice about ageing, with the ‘self-help’ style secular books, I find that the former often take on a more contemplative approach, with a greater focus on dealing with loss, in its many facets: loss of loved ones; loss of status and meaning derived from work; loss of financial means; and loss of function – to name just a few. 

While ‘loss’ is a theme that is especially prevalent in older age, given that our earthly life is fallen, fragile and fleeting, the Christian should be better placed to deal with loss, and able to maintain an eternal perspective. But I also wonder if some of these Christian books are written with these in focus so as to counterbalance the anti-ageing, “Let’s not talk about death,” mindset that is so pervasive in Western society today?

Christians who are ageing can still embrace life
There is every reason why the Christian should embrace older age to the extent that they are able. It is good to seek to maintain an active, meaningful life into older age, and it’s good to look for ways to improve functional ability when declining function interferes with the ability to do so. Not to do this is both ageist and, I believe, not the view of ageing presented in the Bible. 

Older age also presents many opportunities to strengthen one’s faith and continue to play a role in advancing God’s kingdom and imparting that faith to generations to come – particularly to grandchildren.

Within Australia there are a range of government-funded programs, including allied health services, to help people address functional decline.2 There are also many opportunities for undertaking purposeful activities, such as volunteering. There are resources available now that were not available to previous generations that can assist older people to maintain an active faith life, despite functional loss. 

  • Audiobooks, podcasts and online sermons have opened up new opportunities for people who are visually impaired or otherwise isolated. David Suchet’s complete reading of the Bible (NIV) is an excellent resource. 
  • The COVID-19 pandemic has fast-tracked the adoption of technology by many churches to bring church into the homes of people, including the unchurched and people who are isolated and who may not have been able to attend in person, even before the current pandemic. 
  • Videoconferencing apps allow people to connect within home groups. Tablet devices allow visually impaired people much greater access to the written word. Within Australia, the purchase of these devices can even be done through home care package funds if it is deemed that the purchase improves the well-being of the person, and they cannot otherwise afford them.

Ageism
Finally, a word on ageism. Ageism can be both external (i.e. how society views older people, or how one person views another) and internal (i.e., how someone views themselves). Ageism is the enemy of positive ageing and living a meaningful life. Churches have an important role to play in combatting ageist attitudes (but this is a topic for another day).

A future hope
Inevitably there will come a time when ageing and functional decline does beat us. Until that time comes, there is opportunity to extract the most out of life. However, when the inevitable comes, the Christian has the comforting words of Isaiah 46:4 to rest on: 

“Even to your old age and grey hairs
I am he, I am he who will sustain you.
I have made you and I will carry you;
I will sustain you and I will rescue you.”


 
Dr Chris Poulos  
Dr Chris Poulos is a rehabilitation physician and head of Research and Aged Care Clinical Services for independent Christian charity HammondCare. He is also a conjoint professor in the Medical Faculty at the University of NSW. Chris attends St Phillip’s Anglican Church in Caringbah, Sydney. 


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References

  1. World Health Organization. World report on ageing and health. Geneva; 2015.
  2. Poulos CJ, Poulos RG. A function-focused approach in primary care for older people with functional decline. Making the most of reablement and restorative care. Aust J General Practice. 2019;48(7):434 – 9.
  3. Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology. 1989;57(6):1069–81.
  4. Poulos RG, Marwood S, Harkin D, Opher S, Clift S, Cole AMD, Rhee J, Beilharz K, Poulos CJ. Arts on prescription for community-dwelling older people with a range of health and wellness needs. Health Soc Care Community. 2019;27(2):483-92.
  5. Lum TY, Lightfoot E. The Effects of Volunteering on the Physical and Mental Health of Older People. Research on Aging. 2005;27(1):31-55.
  6. Hill RD. Seven Strategies for Positive Ageing. New York: W. W. Norton & Company; 2008.

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