We boomers haven’t heard much about the generation gap lately, although it was a big topic, the stuff of newsweekly covers, decades back. But I’m wondering if this phenomenon — fundamentally different perspectives on goals, behavior and values, based largely on one’s age cohort — resurfaces in later life.
These musing were prompted by — what else? — a new study, this one led by Debra Moser, a cardiovascular researcher at the University of Kentucky, on the seemingly unrelated subject of how people suffering from heart failure assess their quality of life.
When a damaged heart can’t pump enough blood, the consequences may include shortness of breath, fatigue and swelling; people with heart failure may struggle to walk even short distances or climb stairs. Medication can help, especially in the early stages, but short of a heart transplant, there is no cure.
“It interferes with daily life,” Ms. Moser told me. “And it shortens life.” Average life expectancy after diagnosis is less than five years. Small wonder that patients with heart failure, also referred to as congestive heart failure, often contend with anxiety and depression.
You might expect that distress to intensify in older people, among whom heart failure is fairly common. Compared to younger patients, “they have more co-morbidities,” Ms. Moser pointed out, meaning that they have other diseases at the same time. “Their functional capacity is worse. They’re hospitalized more often.”
Yet when her team asked a national sample of 603 people who had a diagnosis of heart failure about their health-related quality of life, the younger patients (up to age 62) scored the highest — the worst — on a questionnaire measuring the negative physical, psychological and social impact of their illness. They reported significantly higher levels of depression and anxiety, too, as assessed by commonly used scales.
In this study, published in Age and Ageing, patients in the older groups, age 63 to 70 and over 70, reported better quality of life and significantly less depression and anxiety, even though older patients with heart failure are likely to be sicker and more impaired.
What?
All the age groups defined quality of life similarly in terms of happiness, relationships and the ability to perform activities. The apparent reason that people who could do less still felt they had better quality of life, Ms. Moser said, is that “older people are better able to reframe their lives.”
When the researchers interviewed a small subset of subjects (only 20), the younger patients lamented what they could no longer achieve. “I’m just a shell of my former self,” a 46-year-old man said. Their loss and disappointment sound shattering.
The elders compared themselves not with their former selves, but with the peers they saw around them; they felt grateful to be alive and able to do whatever they could do. “It could be worse” was a common theme.
Researchers have long talked about the U-shaped curve in which people say they are happiest in youth and in old age. We know that older people see things more positively, and it often pays off.
“Your ability to be flexible, to cognitively restructure challenging or threatening events, to see the positives in the situation, is almost always associated with positive outcomes,” both emotionally and physically, Ms. Moser said.
Which led me to ponder what is probably the single most common grievance that adult children express about elderly parents: their resistance to accepting assistance or permitting change, even in circumstances their caregivers see as crucial to their safety and well-being. Why won’t they hire an aide/call a cab/install grab bars/buy a hearing aid/consider assisted living? Why do they make it so hard for their well-intended families to help them?
We tend to chalk up this intransigence to fear of dependence or denial of reality, and those factors frequently do come into play. But the older heart failure patients weren’t in denial. They acknowledged their physical and social limitations; they just didn’t seem as bothered by them.
So consider: An elderly woman insists on continuing to brave the steep basement stairs to do the laundry, waving off her son or daughter’s protest that someone else should take over the task. No, no, she says. Everything’s fine, no need.
Maybe she’s not fearful of admitting decline, as we sometimes think, or unable to see the risk she is taking. Maybe she just thinks about it differently.
The child compares her mother with her younger, stronger and more capable self and wants to take action because at some point the older woman’s kind of thinking can become dangerous. And perhaps the mother compares herself with more debilitated peers and tells herself it could be worse — which is also true.
As a careful researcher, Ms. Moser doesn’t want to make claims beyond the parameters of her study. But to me, it looks as if the generation gap, a stark difference in the way two age cohorts regard the same phenomenon, has returned to bedevil us again.