Wednesday, May 24th, 2017

Potential Religious Opportunities and Challenges for Old Age by Gidon Rothstein

February 22, 2011 by  
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Preliminary Thoughts From Less of a Distance Than Once Upon a Time

Old age, what is it good for? When the Temptations and then Edwin Starr asked that question about war in the early 1970s, they opened us up to remembering that there are aspects of life we take for granted that might bear further inspection.  I don’t have to accept their answer about war (absolutely nothing) to appreciate their reminder that just because this is how it has been doesn’t mean this is how it must be.  I want to apply that kind of consideration here to the question of old age.

In the early years of life, old age is so distant from us, that perhaps we do not think about it at all. It is what our grandparents experience, or the people next door, and we may do all we can to help those others, but is not something we truly expect to happen to us.

My father, a”h, passed away before he reached old age, so that even as I reached my own middle age, I had and have none of his modeling to build from, as I do in so much of the rest of my life.  I have relatives, friends, and friends’ parents and grandparents, and they have set me to pondering what would constitute a good old age, how we might best maximize the later years of our lives. I hope my thoughts here start a conversational ball that will roll in the direction of helping all of us think clearly and carefully about how we can best utilize all the years God grants us, in good health or ill.

Think of a man or woman, looking in the mirror every morning.  In her teens, the woman may be checking for acne or other imperfections, worried about the impression she will make on friends or members of the opposite gender.  As she ages, she may check for wrinkles, anxious to stave off the physical effects of creeping years.  And so for a man.

At some point, that man or woman looks in the mirror to see an old person staring back.    Where that point arrives perhaps changes over historical eras and from person to person.  The Mishnah in Avot 5;21 that lays out one vision of the rhythms of life suggests that sixty is old age, seventy advanced old age, and eighty remarkable, heroic old age.  With advances in medicine, we might push those numbers off by a decade or two but at some point, people get old.  It is as a separate stage of life that I’d like to think about old age, from within a Torah perspective.

Rage Against the Dying of the Light

Many seem to assume that we should push old age away, to ignore it as much as possible, try our best to continue living exactly as before.  These are people who never retire from their jobs or occupations, whose day to day activities in their 70s and 80s are, to the extent possible, just about the same as they were in their 50s and 60s.  They may work slightly less, shorter hours, as an accommodation to the creeping physical decline but, largely, life continues as it always has.

For an example from the world of Torah, the Rov and his brother R. Aharon Soloveitchik, zt”l, were models of fighting against any limitations their physical infirmities placed upon them.  Each continued flying in to New York weekly to deliver shiurim at Yeshiva University long beyond where everyone would have understood if they said it was too taxing, that they were simply too infirm to make the trip.

Beyond the resistance to physical old age, in the hespedim, the eulogies delivered on the Rov’s passing, I remember one speaker recounting studying Baba Kama when the Rov was in his 60s.  When this student mentioned that to someone in the more yeshivish world, the reaction was surprise, since—in that world— the deep analysis of such a difficult tractate was usually undertaken by younger men.

Similarly in other occupations, I know more than a few men of advanced old age still maintaining a busy business schedule. There are men in their 90s still going in to their office every day; I once met a doctor who admitted he was 88, but asked me not to tell, because he was afraid patients would stop coming to him if they knew how old he was!

There is heroism to this approach that I want to pause and admire before I note where I think it can be excessive.  Some of these people are enjoying a robust old age, with few health problems, so that the challenge of maintaining their schedules is not significantly more difficult than it had been before. But many of them are, in fact, aging in visible and demonstrable ways, and yet push themselves to resist giving in or giving up, resist fading away into an aimless, rootless existence.  And we should admire those efforts, respect their (absolutely correct, it seems to me) awareness that life is meant to be lived, that every moment should be taken advantage of.

I have long been struck by a comment cited in the name of R. Yosef Eliyahu Henkin zt”l, who was, I believe, blind and almost totally deaf by the end of his life.  While I forget the exact Yiddish—which makes it sound even more powerful– it went something like, “azoy a Yid lebt, er mussen willen leben”, as long as a Jew is alive, he must want to live.  People who struggle to do that which they always have, to maintain their routines with few concessions to frailty, are living examples of recognizing the gift God gives us daily, and making the best use of it possible.

Even the Good Can Become a Trap

Where this approach can go wrong, it seems to me, is captured in a story I heard about the Rov’s encounter with former President Carter (that the two met is a matter of public record; the interaction as I heard it is less certain, but the story is instructive).  Carter, a Bible student, asked the Rov about the verse in Tehillim that readsואם בגבורות שמונים שנה, and if with heroism, eighty years.  Carter asked the Rov to explain the גבורה, the heroism, of being eighty.  And the Rov responded, to know that you are no longer fifty.

The comment issues a new challenge to us as we age: aside from not giving up on life, not allowing ourselves, at any point, to assume that all we have left is to loll around playing cards, the Rov seems to be saying that we should also not think that life is all of a piece.  From our early to middle years, we instinctively know this: there is the time of being a student, learning how to function in the world, the time of building– a family, a career, a legacy.  As that Mishnah in Avot captures it, there are the years of study, of running, of attaining full strength, of attaining insight, of giving advice.

But then what? When we reach the time of old age, if we are to take the Rov’s advice to heart, what does it mean to, at 80, understand that we are no longer fifty?  I don’t pretend to have an ironclad answer, but I think I can lay out some basic approaches by borrowing a valuable distinction Dr. Muriel Gillick makes in her The Denial of Aging.

Robust, Frail, and Demented Elderly

Dr. Gillick introduces her three-fold view of the elderly to promote the idea that medical care should vary according to how a patient is aging.  The robust elderly, she notes, are largely indistinguishable from the young and middle-aged, except that they have lived a few more years, might be a step or two slower, have a bit less energy. 

In medical terms, she notes, such people’s care will also be very similar to younger people’s.  A robust ninety-year-old diagnosed with cancer might choose the same aggressive chemotherapy as a younger person, since the experience of the side effects and the lure of extra years of active, vibrant life are largely the same.

The frail, in her model, are often best served by other choices.  While the usual treatment might be the best way to avoid certain complications or death, for some frail elderly, the side effects of treatment (like the confusion that comes to many from being hospitalized) are serious enough, and their medical condition tenuous enough, to suggest that a more moderate course would, on balance, be a better choice.

I have no medical expertise, and no insight on her medical ideas.  But her model transfers well to the question of how to maximize the years God gives us on earth.

Robust Old Age in the Service of God

The robust elderly might be those most likely to act as I mentioned above, continuing their patterns for as long and as fully as they are able.  Two caveats bear raising: First, is what that person has always done worth continuing, and, second, are there other valuable endeavors the person has neglected until then but might now choose to make time for?

For the first, I recall meeting a man who was 97 years old, and still going into his accounting practice every day.  This man was also extraordinarily charitable, so it was perhaps true that he saw his continued business involvement as a way to be able to continue giving.  But it seems to me equally possible that he had just gotten so used to that routine that he had allowed himself to get stuck in it.

The job we have always held might be one we see as so continuingly valuable that we would want to do it forever.  If an accountant finds his contribution to insuring the health of the economy a sacred task, he may wake up with a burning desire to go to the office every day, and more power to him.  If it is only because that is the routine in which he has become enmeshed, old age may be a time to consider other possibilities.

Which leads us to that second question, are there other valuable endeavors crowded out until now?  A poignant example to me was the shiva call I paid to a man in his 80s, whose wife had passed away.  He commented that these were supposed to be the years in which they would travel and enjoy each other’s company.  I asked whether they had gotten a chance to do any traveling before she had become ill, and he said that, no, he had been busy with work.  I asked him how many days a week he worked, and he said, six.

It is possible that he saw work as so important that he, in his 80s, still needed to be there six days a week.  But I suspect he had allowed routine to crowd out other important activities, that the pressures of raising children and grandchildren, of having funds to give to charity, of being deeply active in building the world, had helped him lose sight of other endeavors.  It would not require retreating into irrelevance to suggest that as we age, perhaps especially for those fortunate enough to do so robustly, we remember to make time for that which we have pushed off.

In the same vein, the story is told of R. Samson Raphael Hirsch traveling to Switzerland in his old age; when asked why, he said he wanted to see the Alps, that he feared getting to Heaven to have God ask him “Has du mein schone Alps gesehen (have you seen my beautiful Alps)? 

Clearly, R. Hirsch did not mean that he was going to now travel the world to see all its beauty; he meant that, as part of his old age, he was going to incorporate some more involvement in appreciating God’s world, until then pushed aside by other involvements.

Nor am I pushing travel per se; I am suggesting that adjusting our sights, broadening our scope, to see what we may have failed to do as servants of God.  Many find more time for Torah study, which is wonderful but again reminds us of the heroism of eighty, knowing that we are not fifty, and therefore undertaking study projects we can still meaningfully accomplish.  Instead of sitting fruitlessly over a text we can longer conquer, the heroism of old age might be to take on that which is within our reach.

Similarly, while those of us not in education might see our Torah study as primarily an exercise in self-growth, in old age, we might reasonably convert that into insuring it is transmitted to others, making time to study with our grandchildren, perhaps, or volunteering to teach whatever Torah we can to others, and so on.

What is true for Torah study is true for service of God generally.  Whether a person continues his or her professional life, reduces those hours, or leaves formal work entirely, the exciting aspect of robust old age is how to use these years, relieved of many other burdens, maximally, how to channel them into a time of expanding personal horizons, of finding the best ways to contribute to the perfection of the world in the recognition of the Kingdom of God.

I have several times suggested to men in their late 50s and early 60s—financially secure and bored with their work life—that instead of retiring, they consider moving in to the nonprofit world, taking their executive and administrative skills and applying them, without the pressure of financial privation, to causes in which they believe.  None have taken me up on it, but I still see it as a piece of aging that can be neglected, the ability to give in ways we would not have been able until now.

The Gevurah of Frailty

Some of us are not blessed with a robust old age or, I should perhaps say, are given a different set of challenges with which to cope.  The word “frail” can encompass a range of infirmities (physical or intellectual), from something as relatively minor as needing a cane to being largely wheelchair bound and prone to disorientation by minimal changes in surroundings or routine. 

Broad as the term is, we should not expect a simple prescription for how a well-lived old age would look.  Without pretending I can prescribe, I do note that the experience of frailty can lead some elderly to despair of being active players in the world.  For all the frail aged who still manage to get around and partake of events outside their homes, there are others who allow the difficulties of life to overwhelm them.  And yet, it seems to me, even fairly frail people can find ways to continue to make their mark.

First, the evaluation of frailty has both an objective and a subjective component.  A man who can no longer walk without a walker—but could, with effort and practice, get around fairly well with it—has a choice to make about how assiduously he will work to maintain that function (with repercussions for how often/easily he can get out of the house, attend worthwhile events, and so on).  Similarly with those who choose to stay home rather than be seen in public in a wheelchair.

Second, though, whatever the level of physical frailty a person experiences, it seems to me crucial that we remind ourselves that the capabilities still left are ones to try to use in productive, God-focused ways.  I already mentioned the Rov and R. Aharon Soloveitchik’s insistence on coming to New York despite their ailments; some Holocaust survivors tour the country in even more frail conditions, determined to get their story out before they pass away. 

That same commitment might help others also find a cause, a passion, a commitment that would drive them forward through those physically difficult years as well.  That is not a call to ignore ailments, or to act in medically contraindicated ways.  But I hope it reminds us that if every moment of life is precious, it is precious because of the opportunities it offers us for service of God; that service might be restricted to using the phone or Internet to connect with others, or with using a wheelchair to get out and do so, but the value of the moments resides in using them as best possible.

I stress that I don’t mean these comments as a judgment on anyone; I do not know whether a person can really only get out of bed at eleven, or could, with effort, have been up and out at minyan by 7:45.  I do not know who could volunteer for a local organization and who could not, who could study with a less knowledgeable Jew, who could still have guests over at their home (even if it would involve catered food and hired help) to share their lives and experiences.

I write not because I think I have the answer, but because I think I have the form of a question that is not yet as commonly asked as would seem valuable.  I write because, in my experience, people too often go to one extreme or other, seeing old age as just more of the same or, when choice or necessity force it to differ, retreating into a retirement that completely ceases productive activity.  And I believe both have truth, but both miss vital points. I write in the hope that we learn to ask ourselves, from age 13 until God takes us from this world, what is the best way I can, at this point in my life, with whatever God has given me, serve God, contribute to making this world the best it can be?

The Demented

This becomes even more challenging when we consider those no longer mentally capable of grappling with any of these issues.  It is one thing to imply that even the most frail might still find ways to construct their days to serve God; it would be quite another to extend those expectations to those who are, literally, no longer in their right mind.

And, often, the problem is not diagnosed early enough to allow for consideration of how to cope with it.  I once eagerly bought a book written by a man in the early stages of Alzheimer’s, in the hopes of being edified about the course and impact of this awful condition.  Sadly, while his motives for writing the book were laudable, and his struggles with his encroaching dementia admirable, the book showed that his capacity for meaningful reflection had already largely left him.

That would seem all the more true for the service of God; early stage dementia might allow for continuing old routines, especially the relatively passive ones of attending minyan or shiurim, of treating people politely, but it is hard to imagine a person in this condition able to adjust his or her service of God as appropriate to the medical reality.

Dementia, it seems, might be a case where the patient’s constructive role in God’s world really has come to an end.  Are we to see such people as just waiting around for death to take them?  Aside from all the end of life issues that viewpoint would raise, does it mean we no longer look at that person as a servant of God?  And, if not, do we see anything to that person other than a leftover body waiting to be taken from this world?
I think we might answer partially in the affirmative and yet recognize an important role these people play in other’s lives.  First, let me stress that I am speaking of those people whose minds have stopped working so extensively that we can no longer imagine God holding them responsible for anything they do, good or bad.  It would seem odd to think that God expects such people to pray when they cannot, to study Torah when they cannot, to act nicely towards others when they do not have—and will never again have– any realization or understanding of what they are doing.

If so, however, why does God leave such people in the world? I think Franz Kafka’s Metamorphosis suggests an answer.

The Metamorphosis and the Function of the Demented Elderly at the Present Time

I came to the novella with only the knowledge that it was the story of a man who wakes one morning to find that he has turned into a grasshopper (or, I think, cockroach, depending on the translation).  While it has been many years since I read it, I vividly remember my shock at realizing that that description missed the point.  It was, as far as I understood it, not about the title character at all; it was, instead, about how his change forced a metamorphosis in those around him. Before the event, the other family members had been stagnant, relying on him to carry their load in addition to his. With him no longer functional, they were forced to take action for themselves.

I wonder whether the same might be true of the profoundly demented elderly—and, on a sliding scale, of those whose limitations, physical or intellectual, reduce their ability and responsibility to fully partake of the world.  In the areas where such people can no longer function, I cannot imagine they are being judged, or that they are expected to grow, develop, or contribute.

But they challenge the rest of us every moment of every day of their lives, with a myriad of questions and choices: how will we handle that person’s care? With what level of personal involvement? With what level of cheer and sympathy for the inconveniences the person faces, the discomfort that person may be feeling?

There may come a time, I am suggesting, when the person’s self-awareness and consciousness are so limited that it is hard to imagine God expecting or judging him or her for anything that occurs (for whether s/he eats pork, violates Shabbat, or almost anything). But such people present the rest of us with opportunities we would be well-advised to meet.

Old Age: A Stage of Life, Not a Decline Into Death

To summarize, then, I write here to propose that we today too often give up on ourselves too soon.  If, as the Gemara tells us, people can acquire their share in the World to Come in a moment, they certainly can do so, in many cases, in the decades of physical decline we call old age.  If old age means a person no longer wants or is able to work at an ordinary job, or can only put in twenty productive hours a week instead of forty, I write in the hope that we will remember to find ways to channel those twenty as well as we used to with the forty.  To be sure that if we choose to travel, we do so in search of a greater relationship with our Creator. To fill our later years even more with that which we often had too little time for when we were more vigorous, not less.

Those who reach the age of 65 today can expect two more decades of life, time enough to reshape who we have been, to refine whatever rough edges we still have left, to repair where we have done wrong, and so on. The first two decades of life grow a baby from being almost completely nonfunctional into a young adult, responsible in God’s eyes for his or her own actions.  The next two take that young adult, usually, through marriage, developing a career, bearing and raising children.  Twenty years at the end of life, I believe, can be as formative and as productive, and have us meet our Maker more ready than had our lives stopped earlier.  As long as we try.

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