The psychological tolls of ageing

We live in a youth-obsessed society. One of denial and the widespread devaluing of the old.

While some dabble with  cosmetic procedures, youthful haircuts or trendy clothes, others proclaim the virtues of lifting their own bodyweight in the gym, running marathons, and make various other sacrifices on the alter of staying young.

But its not just  youthful appearances that we value over wrinkles. We live in a society where we also value independence and vigour, and devalue human vulnerability and neediness. Perhaps by erasing our wrinkles, we take away the perception of our vulnerability.

But human vulnerability and neediness comes to us all.

As the old begin to outnumber the young in societies around the world, we should be talking about the culture of ageing. As Amy Schaffer so poignantly illustrates in her book, Blooming in December:

For all the pride of youth, ultimately there are only the old, and the not-yet old.

Summary of the book, Blooming in December by Amy Schaffer

Amy explains that the experience of ageing often starts for many of us, long before we are ourselves old.

Ask any caregiver, and they’d tell you that caring for ageing parents or grandparents can feel overwhelming. The practical demands—juggling medical appointments, managing physical decline, coping with mood changes, and facing financial pressures—are real and daunting.

As Amy describes,

 “To put yourself in a position to look after the elderly is to live with the painful reality of how little you can do. You cannot relieve arthritic pain, or the agony of losing a spouse. You cannot cure cancer or fend off death. .Yet, if you can tolerate these limitations, loving and caring for this age group can be deeply transformative. It not only relieves suffering, but it can also lead to significant growth. And it can bring fulfilment and meaning to both adult child and elderly parent.”

But before we wade into growth and meaning, its important to deepen our understanding of the day to day challenges. As previously-young people often unexpectedly find, ageing brings a cascade of changes, each with its own psychological impact. Understanding these changes can be key to bridging the divide between old and young.

Physical Changes: Suddenly you can’t hear your children as they attempt to roast you good humouredly at the dining table, and reading becomes harder and harder. Visiting them becomes challenging because all the stairs that lead to their walk up apartment are killer on your knees. Like losing your hearing, mobility issues and chronic pain soon also mean frustration and exclusion from previously valued activities.

Mental Changes: Memory lapses and slower thinking can be frightening and isolating. First you hide it, then you start wondering if other people notice. Eventually you start to worry and wonder if you’ll be able to take care of yourself.

Relational Changes : Relational losses include the loss of loved ones such as watching a spouse die of cancer. It also means a loss of long-standing roles - going from family breadwinner and authority figure to the dependent can be a hard pill to swallow.

Identity Changes: Another loss is that of identity. How does one come to terms with going from esteemed professor, to an old man with incontinence? Like so many elderly clients have explained, hearing difficulties open the door to being spoken to like you are mentally deficient.

Financial: No longer earning in retirement, daily expenses and inflation eating up what’s been hard won and accumulated and creates great anxiety and insecurity. Financial struggles in our younger years through illness, divorce and financial loss have real implications in one’s later years.

Existential/Emotional: Late-onset trauma (perhaps from watching a loved one die), death anxiety around a fear of the unknown, not having time to correct mistakes such as financial errors, or not having time to start new relationships if the old ones end badly. Along with regrets, existential questions include questions about whether one’s life had value, and “Did I achieve enough.”.

The Resurgence of Childhood Memories and Trauma: Many elders find that, as their bodies become frail, memories from childhood—especially traumatic ones—resurface. Sensory experiences in old age can act as triggers. For example, being unable to get out of bed may remind someone on the cusp of dementia of being locked in a room as a child, or of neglect by an overworked parent. These memories can be as vivid and distressing as the original events, adding a new layer of psychological suffering in later life.

Late-Onset Trauma : Traumatic events in old age can be just as impactful as those experienced in youth. Schaffer shares the story of a patient who fell, broke her hip, and lay in pain on her kitchen floor for three days before help arrived. Another suffered a heart attack on a New York subway, fearing for her life and her belongings. A third experienced a stroke, resulting in sudden incontinence and immobility. These incidents are not just physical crises—they are psychological traumas that can lead to anxiety, depression, and a profound sense of vulnerability.

Anger as an Expression of Loss: Loss of autonomy can manifest as anger. One example is an 80-year-old man, accomplished in his career, who becomes irritable whenever someone tries to help him. His anger is not just about the immediate situation; it’s a response to the loss of control and independence that once defined his identity. The challenge for him—and for many elders—is to find a way to retain dignity and equanimity in the face of increasing dependence.

When Simple Needs Become Big Asks : Asking for help with basic tasks can become a source of anxiety and shame. Sadie, a 68-year-old widow, struggles to ask her doorman to open a stuck window. She worries about whether to tip him, how much to tip, and whether sharing the struggle will make her seem burdensome to her family. This internal struggle highlights how even minor needs can feel overwhelming, reinforcing feelings of helplessness and isolation.

Alien Experiences with Alienating Effects: Social interventions, even when well-intentioned, can feel alienating. Rose, recently widowed, is urged by her daughter to join a senior citizen center to combat loneliness. But for Rose, the suggestion feels hollow—no casual conversation with strangers can replace the intimacy she shared with her late husband. Moreover, the reversal of roles—her daughter now caring for her—feels uncomfortable and underscores her loss of purpose.

Despite this depressing list of challenges, Amy reiterates that ageing can also bring unexpected gifts. As Samuel Johnson famously said, “When a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.” The awareness of mortality can foster psychological and spiritual growth, encouraging us to focus on what truly matters and to find meaning even in suffering.

Preparing for Our Own Ageing

Against the backdrop of these challenges perhaps is the hope tht we can ourseleves prepare for this stage a little bit better. In my experience with geriatric clients, maintaining good mental health in old age requires ongoing physical, psychological and spiritual work. Alongside a commitment to exercise, healthy eating and socialisation, the following are some factors that separate clients who age well, from those plagued by anxiety and depression.

Acceptance: Learning to accept our changing body and changing mind.

Finding Meaning:  Finding purpose in these changes and meaning even in difficult experiences, such as leaving home and moving to a rest home. Finding meaning in suffering for example, allows us to accept it more peacefully and this is often easier for people with a spiritual bent.

Non-Attachment: This means not interfering with children and grandchildren and exerting your will around how they live their lives. It means stepping back and finding your own purpose outside of the family. Letting go of the need to control. Letting go of a desire for life to be a certain way.

Building Resilience Early: Learning to embrace “what is” is not something we can start learning in our 80s - It is a muscle that has to be built earlier in life.

Conclusion
In looking for a resource to help elderly clients, I found Amy Schaeffer’s book to be the most profoundly relatable and eye-opening. I encourage you to read it too. The book taught me that ageing is not simply a medical or logistical challenge—it is a profound psychological journey, marked by loss, adaptation, and, potentially, transformation. In a future blog post, I will talk more about the psychological growth and equanimity that can accompanies ageing.

Feel free to contact me at DrAmrit.sg@gmail.com if you or a loved one are struggling with ageing or with caring for a loved-one.