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Journeying with the
frail  Elderly

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To commemorate the 20th anniversary of the Encyclical letter of
PopePaul VI, Humanae Vitae, sponsored the “Families of Australia Foundation”at an Internationl Congress in Sydney in 1988.The following Address was given by Sr Rose Mary Turner lsp.
It remains very relevant for our time.

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I have been asked to speak today because I am a Little Sister of the Poor– and
for those of you who do not know the Little Sisters, we are aCongregation within
the Church, dedicated to the service of theElderly. Our Foundress, St Jeanne
Jugan, took the initial step towards founding this work that we do, when, in
1839, she carried an elderly blind lady from the street to her home, and began
to care for her.  Today, each sister takes a fourth vow of “Hospitality” and our
hospitaller mission is lived out in a family spirit with the elderly.
We live in community with them, share our lives with them, and seek to rejoice and console them in their living, and keep constant prayerful vigil with them in their dying.
In modern society, even the fundamental values of human life are often called into question and people can experience anxieties about the meaning of advanced old age and death. Most vulnerable are the frail elderly, who, for one reason or another, are dependent on others. The elderly can teach the young that it is important to value life for itself, and in itself. Life is God’s special gift to them and becomes their gift in return to Him.  If frailty and dependence comes, and they come to some of the elderly, especially those who live to be very old, then it is a precious time for both the individual concerned and for those concerned for the individual.  It is a time of fulfilment and completion.  Pope Pius XII once said to a group of nurses that Christ was present twice over at the bedside of a very sick person – the suffering Christ in the person needing care, and the healing, caring Christ in the person of the attendant.
Death itself needs to be understood in its full Christian dimension, for it is only then that the questions of life can be answered rightly. We will look at death in the broader context that necessarily includes the sometimes long period of preparation that precedes it in the life of the frail elderly person.  For who can say when terminal care begins with the frail elderly? For the Christian, this period of life is a time of waiting on the Lord.  It is a time to say an unconditional ‘YES’ to God in faith and trust.  It is a time when perhaps even beyond words, existence itself can be an act of faith.
OLD AGE
Old age, even extreme old age, is an experience in the journey of life that can come to each of us personally or to those whom we love.
It is a time when the soul can dilate in spite of the limitations that old age and infirmity impose upon the body.  The Elderly, like any other group, are not a homogeneous group.  Each person is different and individual; but all, sick and well, have a primary and essential value just by “BEING” by providing a balance in our society, by adding their own and beautiful dimension – a dimension that does not have its basis centered on achievement.  Old age, even in its frailest form, enriches the world and the Church.
Ageing is the process of growing old and begins for each of us at the moment of conception.  It is not a disease, but a pattern of changes accompanied by necessary adjustments, and unless there is  accompanying pathology i.e. illness or disease, these changes are normal and gradual and do not of themselves cause unhappiness.  As one advances in age, however, there is an inevitable slowing down when the non-essential is allowed to drop aside, and the energies are concentrated on the enduring.
Longevity permits the human being, little by little, to withdraw from direct contact with the world and to approach it in a new relationship.  There is a new attitude to time in which one can appreciate beauty and the small ordinary things of everyday life such as human companionship and solidarity.  There are new possibilities of contemplative prayer, for reconciliation with God and man;  new opportunities of being peace and love to others.  A time to be present to others, a time to give as well as to receive.  It can also be a time of loneliness, particularly if one has lost one’s life partner, and the frail elderly need our love and presence. In his talks to the Elderly, Pope John Paul II frequently reminds them of their value of their prayer and sufferings, love to the world. To elderly priests he says… “Keep on bringing the needs of the Church before God through your priestly service of prayer.”(1)
Those of us who care for the frail elderly have the task of respectfully facilitating their fulfilment of the roles that are proper to them in this phase of their lives.
In caring for those in their late nineties and even into the hundreds, I have found that they live at an incredible level of dignified serenity and peace. There is a developing closeness to the Sacred.
Stereotyping the elderly as bedridden, disabled and demented, is quite inappropriate to the majority of them. It does great harm to their image, influencing the way others see them (particularly the young) and sometimes the way they see themselves. It creates a fear in people of growing old. In a society dominated by stereotypes of youth and vitality, the elderly can be devalued. Most vulnerable are the frail elderly whose lives are perceived as unproductive and meaningless, and even a drain on the economy. The truth is, as a recent report by Kendig and McCallum (1986) demonstrates, the majority of the elderly live independently in the community and are likely to contribute more than they receive. However, there are those who, because of extreme old age, debility, illness or mental impairment, have reached a stage of dependency on others in one way or another.
This dependency is what many people fear about old age – they fear the loss of control over their lives and themselves. They fear that those who know and love them will see them as unlovable in this ‘humiliating’ state of decline. They fear being a nuisance, a burden, an object of pity or shame. The media can sometimes foster this type of thinking.
Those who favour Euthanasia often think along these lines – for them, death would be preferable – dependency in old age is to be avoided, it is degrading to the human person. As Christians, we know that this is not so. Cecily Saunders, the acknowledged foundress of the modern hospice movement in Britain, wrote that ‘The existence of a legal option for a quick way to death implies that there is little value in the person who is dying, and the journey he or she is making. Those of us who are close to the dying know how much he or she and the family would miss’.(2)
When a frail elderly person is dependent on others, unconditional love, acceptance and genuine respect are as therapeutic as any medication or treatment.
There is no such thing as professional distance in this type of nursing.  Warmth, humanity and empathy are essential to enable us to “Care about” as well as to “Care for” the person.  We must be willing to give time and to give it peacefully and graciously.  Of course this type of caring can be draining on the health and resources of the caregiver. In a family situation of care, there must be a realistic acknowledgment that there is need for the carer to have planned and adequate periods of rest and relaxation.  There must be laughter and joy as well as sorrow and pain, not only for the caregiver, but for the frail elderly person too.  Our Foundress, St Jeanne Jugan, used to say that we owe it to the old people to be happy. ‘They do not deserve sad faces’.
The adulthood and dignity of those who are dependent and weak are essential values to them.  It is diminishing to their personhood to treat them as children or babies.  They need privacy as well as companionship; they need deference as well as friendship.  To be too managing, too intrusive or patronizing is to diminish them. Nothing that we do or neglect to do should ever chip their sometimes fragile self-esteem. 
“True compassion does not stoop down nor act charitably towards another – it is to forget  oneself – to be attentive only to the other - to suffer with, to see and accept the other just as he/she is, to be open, ready to help, to share unselfishly, to relieve his/her burden by taking it upon ourselves” (3) (Sayings of Jeanne Jugan)
Frail elderly persons, even dying frail elderly persons, need as much initiative as possible in their lives.  This may at times require us to relinquish some of our power and efficiency.  They need to be consulted in their daily programme of care in order to achieve their optimal level of well-being.  Total care includes all the interlocking dimensions of their being – physical, spiritual, cultural and psychosocial.  And whilst helping them to find peace and happiness, we need the sensitivity to respect their personality and individuality and to allow them to set the pace and to find a level where they feel comfortable and where they feel they can cope.
DEMENTIA
If dependency is feared, loss or impairment of our mental faculties is even more feared.  Yet it is not an inevitable consequence of Ageing.  It is difficult to obtain accurate figures, but the latest pamphlet circulated by the Alzheimer’s Disease and Related Disorders Society, states that some 5% - 12% of persons over 65 years of age develop dementia in some form, and of this, up to 20% could be reversible with correct diagnosis and treatment.
“To face the increasing dementia of one much loved, often over years, is one of the hardest ways of facing their death.  The carer may be exhausted, depressed, anxious, even ashamed.  What support and love is needed! As also the one who feels that he/she is losing control.” (Cecily Saunders)
In some cases, the elderly person who has dementia may cause great sadness to a spouse or family by appearing to reject them or by anti-social behaviour.  It is not easy when roles in a close relationship change.  It tests your love, courage and faith - it is a painful encounter with the Cross of Christ, and there are all sorts of feelings that one may have to come to terms with. Good professional counselling can help with coping and your dear one continues to need your strong love. There is no failure in love when a family can no longer cope at home, and places their loved one in a nursing  home. Families can still reach out in love, although the experience may be painful for them, and they will need time to find their own level of peace and acceptance. Total care of the older person includes care and concern for the family.
A mentally impaired person is still capable of experiencing joy, happiness, affection and friendship.  They can still be hurt by attitudes, the tone of our voice and our words.  They need a smile. They need our love.  Very frequently they still appreciate aspects of their religion, particularly if they have been devout during their lifetime.  They can still pray efficaciously.
In their CARE a regular routine in familiar surroundings with people whom they come to know and recognize can help prevent further deterioration in so far as possible.  Attention to appearance and dress is very important - it not only enhances their own self-image but helps to portray their dignity as a person in a way that is perceivable to all those whom they encounter.
If we, as Christians, have to witness to the value of human life, we must do more than talk about it, we must strive to bring happiness and dignity into the lives of those persons most at risk of being devalued.  “As the pattern of life changes, there comes a time when medical evidence points to the proximity of death, and the person turns as peacefully as possible with the little strength remaining to him/her, towards those who he or she is leaving and towards God who is coming to meet him/her.  It is in this radical moment of final dispossession, and the following of Christ by a life totally given, that a Christian can and must make of his life an act of love right to the end in the hope of the Resurrection”.  (5) (Bishop Roger Heckel)
THE CHRISTIAN DEATHBED
If medical science can do no more, there is never a point reached where there is no more need of caring.  If anything, it becomes more intense.  We consider it the crown of our hospitaller work to see the happy death of the elderly for whom we care.  When it becomes obvious that death will occur soon, we never leave the dying person alone.  With prayers and attentive presence, perhaps holding their hand, we accompany them to the threshold of eternity.  The Chaplain also comes to give the last Sacraments and a last Blessing and the family and other elderly residents come to surround the dying person with love and prayer.  It is a peaceful and sacred moment. This is a Christian death - the new birth for which the older person, fortified by the Sacraments and in a spirit of faith, has been preparing for a long time.  Pope John Paul II puts it beautifully ‘…In this one sublime hour of our life we allow ourselves to fall into His love without any other security than just this love of His.’ (6)  This is what it means to wait upon the Lord – to be faithful to the end, confident in His promise that He has gone ahead to prepare a place for us, and that, where He is, we also shall be.
GRIEF
Of course, there is grief for the family – particularly for a spouse, for grief is the price of love, but there is also peace and consolation and they have had time in the long period preceding death to show their love for the loved one.  The older person who had died has had a peaceful death, and the family and friends know, even if they do not understand, that his/her faith will be rewarded.  It is a life fulfilled and completed.
The following is a short extract from the homily of a priest written for the Requiem Mass for his mother:
“We are all God’s children. I used to think of this truth when I was alone with mum – weak, frail, unable to move, unable to speak, her mind no longer capable of recognition, dependent on the love and care of others for everything. Yet God loved her – her very helplessness made her His special child. I used to say to her: ‘Mum, God loves you. He loves you with an everlasting love. You are His special child and when you get to Heaven what a reward you will receive. And what a surprise you are going to get when you see how much good you have done for God simply by lying in this bed with the discomfort and pain that are part of your helplessness.’ It is the mystery of God’s love… the Elderly, the infirm, the most helpless.  These are the ones that I and perhaps others tend to think: ‘What is the point in spending time with them?  they do not even know we are there.’
I realize that Jesus would have us think differently…  These are the ones in whom His Presence and Power are most active because of their very weakness.  These are the ones He identifies with most readily because of their very helplessness.
CONCLUSION
Perhaps you will think that I have overlooked the suffering, loneliness and humiliation of the frail elderly, of this vulnerable group of adult people.  I can only speak of life and death as I know it in my daily work.  This does not mean that I am unaware of the helplessness and pain of many frail elderly in the world, or for that matter, the pain of their families who may perceive only the change in them - the weakness.  The Christian family can and must give witness to an appreciation of the frail elderly and the value of their lives.  St Jeanne Jugan used to say to the novices:  ‘Love the aged poor very much, they are Our Lord.  It is Jesus whom you care for in them’.When you see a frail older
person, one whose life is drawing to a close, see beyond the mask, for it is an encounterwith Christ, and the world needs this encounter with the suffering Christ and the opportunity to bear witness to His compassionate love and tenderness.
  1. Texts of Pope John Paul II to the Elderly (l’Osservatore Romano English Edition 1980-1986)

  2. (4)  St Christopher’s Annual Report 1984-1985 – London

  3. Sayings of Jeanne Jugan

  4. Bishop Roger Heckel – “Respect for Man in His Life and Death” - 1982