Aging with Purpose

Near the end of my clinical career as a psychiatrist, I, like so many other psychiatrists, was required to do more in less time. In order to use that precious time as best as possible, I wondered if there was anything else I could do to offset that limitation. Soon, I recalled the landmark book by the psychiatrist Viktor Frankl – Man’s Search For Meaning – which describes how even those in concentration camps were better able to cope if they had a sense of meaning in their lives there.

I then decided to ask each of my patients what gave them the most meaning in their lives. That way, I hoped, I might quickly know what was most important to them, then also be able to connect how the treatment could help them achieve those goals.

Usually, the answers were quite helpful. Often, the most meaning resided in important relationships, religious quests, or work success. Of course, almost all felt that getting better mentally would help them to fulfill their goals or, if not, they at least wanted to find some meaning in their suffering. Occasionally, an answer needed much more discussion, such as “to get high”.

Once in a while, my patient could not come up with an answer. That required a suicide assessment. If that seemed negative, we spent time trying to find a purpose in their life.

While I found this focus to be invaluable clinically, what I didn’t realize at the time is that it might also add years and health to their lives. Recently, new research that I have been reading pointed out that likelihood.

The most recent research by Hill and Turiano from the University of Rochester Medical Center reported in a 2014 articlePurpose in Life as a Predictor of Mortality Across Adulthood – suggests that you can live longer the longer you have a purpose in life. The longer and more sustained that purpose, or purposes, is, the better.

Earlier in 2012, as part of ongoing studies of healthy aging by Boyle and others at Rush University Medical Center in Chicago, retirement-age women and men were given questionnaires to rate their sense of purpose in life. The results were published in May 2012 in the articleEffect of Purpose in Life on the Relation between Alzheimer Disease Pathologic Changes on Cognitive Function in Advance Age. Those with the highest sense of purpose were half as likely to develop Alzheimer Disease after 7 years.

Remarkably enough, those who scored high were just as likely to have plaques and tangles in their autopsied brains. However, despite the similar physical findings, those with a strong sense of purpose in life tended to score higher on testing of memory and thinking.

Unfortunately, earlier research by Boyle and colleagues indicated that adults tend to feel less and less purpose in life as they age. Especially in Western society, the elderly tend to feel less valued as they retire from work and children leave home.

Given all the costs – psychological, social, and economic – of Alzheimer Disease and other illness, continuing to find a purpose in life after the age 65 can have multiple benefits. Working on the goals of this website is, of course, one example. That can include writing a blog, commenting on the blog, and working on the challenges the posts discuss. Other more general protective factors seem to be continued employment in a valued job, a sound marriage, frequent contact with family, learning new things, and in particular, volunteering.

Not helpful in this regard are hedonistic activities just done for one’s pleasure, sort of like the answer “to get high” that an adolescent patient of mine answered to what gave him meaning in life. That meant that my own earlier fantasy of just lying around listening to my beloved jazz records in retirement would not serve as good a purpose as doing whatever I could for my more beloved wife.

Asking about purpose in life is something we can all do, including geriatric physicians with their patients in an outpatient setting or hospice. No wonder the book by the pastor Rick Warren – The Purpose Driven Life – is so popular. Given this new research, perhaps the purpose of aging is to age with a purpose!

H. Steve Moffic, M.D., 67, retired from clinical practice at 66. He was fondly deemed a “psychiatric gadfly” by the Chair of the Department of Psychiatry where he first trained. His book The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare, published in 1997, was the first extended discussion of the ethics of managed mental health care.

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