CASE EXAMPLE

Steve is a 75-year-old Vietnam veteran. He lives in northeastern Nevada with a stepdaughter. For most of his life, Steve has viewed himself as very independent and has managed to keep a roof over his head in spite of multiple challenging personal situations. As of late, however, Steve has started to experience problems with his health. He has a 55-year cigarette smoking habit, but Steve feels that it would be too difficult to kick the habit. Recently, Steve began having trouble with his vision. His problems have worsened to the point where he cannot drive. Since he lives over 2 hours from Elko, his stepdaughter drove him into town. He met with an optometrist who told Steve that he was suffering from age-related macular degeneration (Tolman, Hill, Kleinschmidt, & Gregg, 2005) and that Steve would be blind (or nearly blind) before the end of the year. Steve is unable to drive; his stepdaughter is only intermittently helpful. Steve was substantially discouraged when he got the diagnosis and thought that the best way to deal with this was to simply stop living. He stopped eating; he began smoking at a higher rate; and he has stopped calling family and friends. His idea is that “life is no longer worth living if you are blind and have to depend on others.” His conclusion is to simply stop living and let death take over.

Analysis of Issue

Steve has taken a very negative view of his aging process and feels that he is not worthwhile because he can no longer live as independently as he is used to living. His focus is narrow, and he has allowed his change in health status and his progressive vision impairment to define his sense of worthlessness. He can’t change his declining vision status, but he can still find meaning in life and is likely still important to others around him, including his stepdaughter. Steve needs to find new sources of meaning that will allow him to regain life satisfaction even though his daily routines might need to change as he finds himself less and less able to be independent in the presence of his declining vision.

Assessment

Steve needs to identify other sources of meaning, or even sources of meaning that he no longer thought were present. A first step would be to assess potential strengths that are still present and to begin focusing on those strengths. An initial assessment of those strengths might be identified through the Meaning in Life Scale, which assesses two dimensions of meaning in life using 10 items rated on a 7-point scale from “Absolutely True” to “Absolutely Untrue” (Steger, Frazier, Oishi, & Kaler, 2006, reproduces the Meaning in Life Scale in the article appendix). The Presence of Meaning subscale measures how fully an individual feels that he or she has meaning. The Search for Meaning subscale measures how engaged and motivated a person is in finding personal meaning or understanding the role of meaning in his or her life. Search is positively related to the seeking of meaning through various resources such as religion, helping others, or finding ways to volunteer. This scale is negatively related with present rumination and present-fatalistic time perspectives such as a newly discovered chronic health condition. Presence relates positively to strategies that can enhance personal and altruistic and spiritual behaviors.

Intervention

Steve could be engaged with a counselor either through telephone or through several in-person visits. The goal of the intervention would be to identify sources of meaning that could compensate for Steve’s tendency to engage in maladaptive behaviors such as increased cigarette smoking and failure to thrive through not eating and personal isolation. A beginning step might be to help Steve identify sources of gratitude—that is, what features of his life and world are worth being grateful for. He continues to have family who cares about him. Although his vision will be declining further, he is still able to ambulate and can still enjoy activities such as listening to the radio and staying involved with others. Such a gratitude intervention could help Steve identify his existing strengths and provide new reasons for wanting to live. It could also allow him to identify reasons for rediscovering sources of life satisfactions. Altruism could play a role in aiding many people like Steve, who are struggling with this issue.

Perhaps Steve could find a renewed purpose for living by helping others like himself who are in need. In fact, it is quite possible that his efforts to find renewed life meaning could be a source of strength and hope to others as he becomes an example of someone who is older but who finds a way to cope with an age-related challenge and find life satisfaction in the process. These kinds of strategies could reengage Steve’s sense of control over his world and help Steve to identify ways that life could still be worth living even though he will ultimately need to make adjustments as he becomes less able to use his visual abilities to negotiate his day-to-day living situation. It could even be suggested that Steve himself, given his increasing impairment, might be an instrument to assist others in developing helping behaviors by working with Steve to assist him with his issues. In the past, Steve has relied on himself; by letting others help him, Steve could become a source of satisfaction and altruistic development for a younger generation who desires to help others but does not have an active way to practice or engage in helping behaviors. Steve could be the agent for other people to learn how to become better helpers.

DISCUSSION QUESTIONS

1. How can a positive aging model of health care be adapted for strength-based counseling interventions with older persons?
2. What are the unique needs facing older persons who are from historically marginalized groups (e.g., older women, older persons from ethnic minority groups, older persons with lifelong disabilities)?
3. What kinds of positive aging counseling approaches would be effective for older adults with cognitive impairments?
4. What role could a positive aging model play in addressing the needs of a patient with Alzheimer’s disease?
5. How can the SOC model of adaptation be applied to promote healthy lifestyle prevention strategies in older persons?