Integration: The final developmental challenge of older adults

According to Erik Erikson, a person’s last developmental task in life is to overcome the psychosocial task of “integration and despair.” Either you integrate your life experiences and rise above them or become desperate for failing to meet the challenge.

I have read Erikson’s writings about the psychosocial task of old age. I have even discussed his perspectives in an assignment for a master’s course I took. But do I really know what integration means?

Does it mean making meaning out of one’s entire life experience? Does integration require us to determine what achievements we have made in our long life? Or to accept the fact that we really are small beings and have led ordinary lives? Does it involve finding out which relationships still bother us and settling all grudges with those we dislike? If that is not possible, does it mean we accept that we will never be able to make peace with those people we can no longer reach, to let it go and not let it bother us again? Or is it about forgiving ourselves for being silly, cruel, vain and stupid at various times in our lives?

What is integration, really? Is it possible? How do you forgive yourself for the tempers you have thrown and the cruel things you have said or done to people? How do you integrate odd and unsettling experiences that, over the years, you purposely have tried to forget? How can things be put into perspective when you cannot make sense out of these weird experiences?

Can integration occur if, after long introspection, you don’t like who you are or have far too many regrets? Can it happen only when you can see yourself in a positive light?

How, in old age, do we integrate all the things that have happened to us over a lifetime? As a gerontologist and a person, I am intrigued. I realize that I don’t really know.

Older people have a lot of work to do in meeting this developmental challenge. And only they can provide firsthand knowledge.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

“All older people are vulnerable.”

The above statement is from the lecture notes of an established global nurse leader at a conference on institutional care of older people, which I attended recently. The statement caught me by surprise. No offense intended, but I could not disagree more.

First, it’s patronizing. I don’t think all older people hold similar beliefs about themselves. I think health professionals should be caring and empathic, but certainly not patronizing. We do not always know what is best for others. We would like to think we do, but we don’t, at least not always.

Second, the message seems to imply that people can be categorized purely on the basis of age, according to whether they are fully capable of looking after their own affairs or not. In our society, we generally agree that children and disabled people are vulnerable and require protection, but if we follow the conference speaker’s logic, it would mean that only those in the well adult population are fully capable beings. So where does that leave us? Should we allow only well adults to lead the world?

Vulnerability should be perceived as a multi-dimensional concept when applied to humanity and should be not used as a descriptive label. A disabled person can be physically handicapped and, therefore, vulnerable to environmental barriers they come across in their daily life. A physically frail person can be vulnerable, in that he or she easily falls ill. A terminally ill person may be vulnerable to “assaults” on his or her humanity when the need for analgesics is ignored. A cognitively impaired older person may be vulnerablebecause his or her power of discretion is compromised.

But not all older people are vulnerable. They should not be. An elder with no loss of mental faculties, even though physically frail, can adequately manage his or her own affairs. Whenever we refer to the vulnerability of older adults, qualifying statements are required so that we are not disempowering our older clients.

The first baby boomers reached 65 in 2006. Let us not forget that future cohorts of older people are better educated and economically more secure than their predecessors. They certainly are in a much better position to manage their own affairs, and we should respect that.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.