WHY AM I STILL HERE?

It's a phrase I hear almost every day in my work as a Clinical Psychologist treating patients in Skilled Nursing Facilities, Assisted Living, Independent Living communities and hospital. Whether these people have acute medical conditions or are relatively medically stable, I often hear the same question.

People living into their 90s and beyond sometimes lack the will to live and struggle to find meaning and purpose in their lives. Often, they have relocated from homes and communities where they were well-established among friends and within community. They moved to be closer to family, making the transition into a senior living community.

And while all the reasons for moving into these new locations are reasonable and rational, the value of the community they lived in for decades and left behind can be a significant loss for them.

I often hear; “I’ve lived a good life. I’ve done everything I wanted to do, and I’m simply done living this life. I want out. I want it to be over.” Some express these thoughts with despondence and others seem to have no feelings associated

with being depressed. They are content in their analysis of their lives and simply don’t want to live any longer. They start asking questions like “I don’t know why I’m still alive. I’m 96 and I’ve lived a full life. How much more do I have to do?” These sentiments are accompanied by multiple chronic medical conditions which keep them from doing the things that gave them meaning and purpose and they don’t see hope for the future due to their limitations, real and perceived.

Medical professionals sometimes suggest antidepressant medications, hoping this approach improves their outlook on life. Medications are worth trying to see if it makes a difference. However, medications are not designed to address their existential issues.

It must be terribly difficult to start over and find a meaningful life when you are in the later stages of life. When I hear these types of comments, I feel grateful that they trust me enough to disclose these thoughts.

As an example, one patient I recently interviewed described having a meaningful life through service at her church. As she got older, she couldn’t be as active, so she created a “Card Ministry” where she mailed get well and condolence cards to parishioners. She loved doing this and insisted on finding the right cards for each person.

This service gave her a feeling of purpose. She was happy. When she and her husband moved to an Assisted Living facility far away from their community to live closer to family, they left behind many of the things that gave them meaning and purpose.

The most significant challenge to finding purpose in live at an older age is the loss of a life partner of 50 plus years. How do they go on without them? Another significant challenge can be their declining health and cognitive abilities. The world is more complicated, confusing, and challenging in so many more ways than it used to be. Suddenly facing it alone is the worst scenario of all.

I empathize with these people and help them find new activities to be involved with. This might involve a new church, mosque, or synagogue community to engage in. Or our conversation might prompt something from their past that gives a clue about how to help them get engaged in their new life.

After our discussions, many of these people find a way to get re-engaged in a meaningful life. Sadly, others do not. It can be a slow insidious process that gets them to the state of wanting to give up.

Maybe it’s the brave ones who have enough insight to talk about their lack of will to live their new lives. It’s almost always a difficult transition and, in time, most seem to make it successfully…especially if family is a positive support system and are engaged in their lives.

Visiting with grandchildren and great-grandchildren often fills them with a renewed feeling of purpose. However, if there are unresolved family conflicts, these seniors are again robbed of another important source of meaning.

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David Tweedy, Ph.D., MHA, is Vice President of Senior Medical Associates, Licensed Clinical Psychologist, and a specialist in Patient Care Excellence. You can reach him at dt@seniormedicalassociates.com.