Healthy Aging

Healthy Aging

“Selective Optimization with Compensation”

“All is good in the end.
If it is not good,
It is not the end.”

The “Oldest-Old”, those 80 and above, are the fastest-growing demographic subpopulation in the United States. It is estimated that this age group will more than triple its size from 5.7 million in 2010 to over 19 million by 2050. A colleague defines the central transitional task of this life cycle stage as loss and reinvestment – the longer one lives the more losses one experiences. Erickson described the major dialectic of this Eighth Stage of his Psychosocial Development construct as Integrity Versus Despair. His epistemological construct defines success at this stage as resulting in feelings of wisdom while failure to successfully complete the task results in feelings of regret, bitterness, and despair.

A family unit also has developmental tasks and normative second-order transitions in this later life stage of its life cycle, succinctly summarized by Carter & McGoldrick as “accepting the shifting of generational roles.” Family reorganization is largely determined by the boundaries of retirement and financial concerns, grandparenthood, chronic illness and caregiving, and multiple deaths and other losses. Changes in familial and social roles include a more central role for the middle generation with ongoing opportunity for healing and growth, resolving conflicts and repairing cut-offs.

A Resiliency-based approach which acknowledges the wisdom and experience of the older generation;

  1. Engages elders collaboratively in active problem-solving

  2. Affirms strengths and personhood while redefining self

  3. Encourages optimal functioning, personal control and self-efficacy

  4. Builds social capital with direct involvement of significant family members

Life review and integration will hopefully lead to a sense of fulfillment, acceptance of one’s experiences and acknowledgement of Ronald B. Cohen MD of discusses the growing senior generation and how they can continue aging in a healthy way. approaching death. Renegotiations of the couple relationship address changes in role expectation and relationship time. Transitional living arrangements necessitate reorganization and transformation of family relationships, roles and rules. In reflecting on one’s life journey consideration of the legacy for future generations is paramount for most seniors.

Older adults appear more adept at managing negative effect, difficult emotions and stress tolerance. Healthy aging is enhanced by including the perceptions and beliefs of all family members who are central to the resolution of conflict and disagreement.

Beyond living longer and avoiding disability, successful aging depends on connection and attachment. Being part of a mutually supportive family reduces loneliness and social isolation while encouraging flexibility in managing the transitions of this life cycle stage.

A colleague says life is “loss and reinvestment”, so reinvest with gusto and as they say in Nawlinz at Mardi Gras, laissez le bon temps rouler!

Please share your experiences with the senior generations of your family in the “Leave a Reply” box below. To request more information and/or schedule an initial consultation, click here . If you found this post helpful, please don’t keep it a secret. You are encouraged to click on the buttons in the second to the right hand column at the bottom of the page and share this article with your own networks.

Ronald B Cohen, MD, PC Ronald B. Cohen, MD
Bowen Family Systems Coach
1 Barstow Road, Suite P-10
Great Neck, NY 11021
(516) 466-7530

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  1. Jillian Beverstock, MS, LMFT on June 6, 2013 at 5:26 pm said:

    Thank you Dr. Cohen for this important article. I am saddened at the way the elderly are treated in this country for the most part.
    It is important to make it known that we will all eventually get there and that it should be with respect and gratitude.

    • Ronald B Cohen, MD on June 6, 2013 at 8:01 pm said:

      Hi Jillian,

      Thank you for your comment. I wholeheartedly agree and would add that attending to the ongoing cycle of loss and reinvestment including resolving conflicts and repairing cut-offs provides ongoing opportunity for growth and development, redefinition and self-differentiation. Life review and reflection coupled with acceptance and a sense of fulfillment helps smooth the transitions.



  2. Susan Shuman on June 6, 2013 at 10:21 pm said:

    “…– the longer one lives the more losses one experiences.” That is exactly what I am having a hard time dealing with. It seems as though I know more dead people than I do living ones. I am to the point of keeping people at arm’s length for fear they will die before me.

    You craft a great article, by the way :-).


    • Ronald B Cohen, MD on June 7, 2013 at 9:38 am said:

      Hi Susan,

      Thank you for your compliment. Ongoing loss is inevitable and cumulative. A colleague defines life as “Loss and Reinvestment”. In a previous blog on Family Resilience I discuss how best to “help families and communities heal from trauma and loss as they respond to persistent life challenges and adversity”. A resilience-based approach affirms the ever-present opportunity for emotional growth and reinvestment in other relationships and life goals.



  3. Ed Mc Hale, PhD on June 7, 2013 at 5:19 am said:

    As a 69 year old grandfather I fully endorse the content of this article. Forgiveness and understanding comes easier and the benefits of a close mutually supportive family and social network become more obvious and rewarding.
    My only misgiving about this article is the loss of an opportunity to include the voice of those who are part of the eighth stage rather than describe them as another external group. I am sure it would be possible to find some informed voices as the article proclaims.

    • Ronald B Cohen, MD on June 7, 2013 at 9:26 am said:

      Hi Ed,

      Thank you for your insightful comment. It was surely not my intent to either marginalize or minimize the voices of the senior generations. Nor was I endorsing Erickson’s schema. Rather I was presenting it as one man’s observations on the theme. I have not yet reached the life cycle stage of grandparenthood and consequently can only speak as a concerned, involved but nonetheless clearly outside observer. As you are one of the informed, knowledgeable and articulate voices, I look forward to more of your insights and elucidations.



  4. Ica Iova on June 7, 2013 at 11:31 pm said:

    Great article as usual Ron. Being supportive towards our aging parents, not only reduces their feelings of loneliness and social isolation, but it teaches the younger generation compassion and family values. Here is a joke that could very well be real life – I hope that makes sense because it’s translated from another language, it goes like this: A couple takes in the wife’s elderly father. After a while of being annoyed with the way the old man was slurping and spilling his soup, they don’t allow him to sit at the dinner table with them, and instead they place him behind the door and serve his soup in a salad bowl thinking that will prevent the spill. A few days later, the couple see their young son carving something from a piece of wood. The father asks his son what is he carving. The son responds – “A big enough bowl for when you and mom will get old, so I can feed you”

    • Ronald B Cohen, MD on June 9, 2013 at 8:31 am said:

      Hi Ica,

      How true it is. The life we live creates the legacy we leave. Thank you for the story.



  5. Melissa Killeen on June 12, 2013 at 8:25 pm said:

    Ron, excellent article. My mother is 84. Your article gave me the insight to see her from the inside AND to set aside my mother issues. Thank you!

    • Ronald B Cohen, MD on June 13, 2013 at 8:37 am said:

      Hi Melissa,

      In her book You Can Go Home Again – Reconnecting With Your Family, Monica McGoldrick wrote:

      If you want to understand your mother as more than the dragon lady whose domineering intrusiveness overwhelms you even at the age of 40, you need to get a picture of her as a daughter, a niece, a sister, a friend, a co-worker, a granddaughter, a lover and a cousin. Then you will also want to learn about your mother’s mother in the same kind of way. You might want to ask, “Mom, how did our father react when his father stopped talking to him? How did Uncle Al take it? What about Aunt Martha? Who was actually there when the fight occurred and how did they handle holidays and family gatherings after that?

      Best of luck on this unfolding journey of a lifetime.



  6. Jacquie Ye on June 13, 2013 at 9:53 am said:

    Thank you Ron, for this very well needed but often neglected discussion. As I am reading, my heart was very touched and my mind goes to several of my close friends, in their 70s, and I can see how they evolve beautifully and grapple with issues consistent with your description. I shall forward this article to them. It is so important for older individuals to continue value their energy, wisdom, and their ability to contribute.

    • Ronald B Cohen, MD on June 14, 2013 at 8:35 am said:

      Hi Jacquie,

      Thank you for your positive and supportive comment. The wisdom of the ages is a wonderful thing. Attending to the ongoing cycle of loss and reinvestment including resolving conflicts and repairing cut-offs provides ongoing opportunity for growth and development, redefinition and self-differentiation. Life review and reflection coupled with acceptance and a sense of fulfillment helps smooth the transitions. A resilience-based approach affirms the ever-present opportunity for emotional growth and reinvestment in other relationships and life goals.



  7. Allen Cardwell on June 13, 2013 at 2:39 pm said:

    Your article struck me in two ways. One as the son of a very proud and competent 94 yr. old dad who passed in ’09, and as a then Assistant Case mgr. in mental health (a peer) who worked with an elderly couple doing tasks like shopping in the mid ’90s. My dad took on a very supportive attitude after my diagnosis and hospitalization. Prior, he seemed antagonistic while I was acutely ill. I appreciated his understanding and interest in my whole health along with our mutual rededication to the quality of our relationship. What is odd is that while assisting the couple I was also under time constraints to do other assignments in my limited part time “ACM” job. I rushed to meet my goals (I had another part time job too) and the lady was gracious despite my anxiety. We talked about it often, however I didn’t get relief from my competing demands. Helping professions may intend to make life better or easier for people but in the end it comes down to whether people get their basic needs met. It hurt to see what the couple needed on a personal level and not provide it. Peer Support work is much more person centered and accommodating in my experience. My dad did what he could to work with my sisters and I, like the elderly couple I assisted, and I have that and several other stories of the grace and wisdom of the elderly. Thanks for shedding light on getting older Ron.

    • Ronald B Cohen, MD on June 13, 2013 at 5:55 pm said:

      Hi Allen,

      Thank you for sharing your intensely personal and uplifting story. Helping “people get their basic needs met” is fundamental to all caring communities. It is a true honor and privilege to hear of the reconciliation with your father before his death. With chronic disorders an overarching family goal is to deal with the developmental demands of the illness without family members sacrificing their own or the family’s development as a system over time. Working to resolve relationship problems can be both healing and protective of future generations. Best of luck in all your future endeavors.



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