The Elder in Exile: Psychotherapy with Older Adults By Tom Medlar, LMHC on 5/14/24 - 6:21 AM

A frustrated and depressed nursing home resident recently described the facility as “a place where unwanted elders can be exiled.” Through our therapy conversation in that session, he came to acknowledge that he did have problems with his memory and his health, and that his facility residence was reasonable — even though unwanted — and was not a rejection by his son. “I know he’s only doing what he thinks is right for me.”

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The Emotional Plight of the Nursing Home Resident

Many residents of nursing homes view their predicament as a rejection, or an exile, or an imprisonment. Many blame family members for the situation and try to pull the heart strings of loved ones in efforts to get them “to take me home.”

Many adult children weep as they speak with me about the conflicts they feel over the placement of their mother or father in the facility. Daily care at home with family is desired by all, yet available to only a few.

The older person living in the nursing home may feel a loss of home, family, their former roles, and too often, their sense of the value of their life. Some older people feel not only cast out by others, but inadequate due to the infirmities of their advanced age and their medical problems.

As I speak with seniors in psychotherapy at nursing homes, I discuss the specific aspects of their situation and seek to place some of their experience in a broader cultural and societal context. For example, I talk of ways that “the Elder” has traditionally been venerated in human societies.

Whether sitting around a fire in the cave, or in a small tribe, or a simple village, it has been the Elder who others looked to for history, stories, and advice. The younger members of the tribe or clan or family came to the Elder to learn the lore and lessons of their people. Others listened to and memorized the stories told by the Elder, and those stories they passed along when they, in turn, became an Elder.

The older nursing home resident might feel adrift from their family and their former life, but the value and the lessons of their life endures, and the sharing of their personal stories — whether in life-review therapy, with family, or with others at the facility, is a key part of reclaiming and affirming the value of their experience.

I encourage residents to share their stories with me and others in their life. I point out and affirm the dignity and value of the person’s journey through a long life. I speak to seniors of ways the society has changed, and how elders might not socially be held in the respect that their lives deserve and have earned.

Some people have suggested that nursing homes ought to have daycare programs attached to them, for the mutual benefit of old and young. But I think that it might be more productive, and developmentally appropriate, to have programs for troubled teens associated with nursing homes. Then, a teenager might share her problems about a relationship, her parents, school, or a career choice, and the senior might be able to understand and share suggestions, relate anecdotes, and offer guidance that might be helpful and in line with the long history of ways younger persons have been helped and guided by the wisdom of the Elder.

“Okay, but I don’t know if I really am wise, and I have all kinds of problems,” an elderly lady said as we discussed these ideas one day. I point out that throughout the long history of human life, the Elder who others looked to and venerated, likely also experienced problems with balance, and with short-term memory, and with urinary incontinence; but that did not erase the value of what they could contribute to younger generations.

It is important to share the stories of one’s life. As we age, we might become less active, and we might forget some of the recent events, but we might retain long-term recall of long past events and situations and relationships — and the sharing of those stories can enrich the understanding and the development of the younger person.

A nursing home sponsored a program a few years ago in which all the staff wore a round metal pin labeled “I’m a Future Senior Citizen.” That program enhanced the awareness of younger workers about the aging process. We each may now be, or may later be, senior citizens. Aging does not invalidate the adventures and lessons of a full life. A key task for the elderly person is to share their tales, and that is as it ever has been, and should be. And one of the most valuable tasks a therapist can undertake with the elderly is to give them the opportunity to share their story. 

File under: A Day in the Life of a Therapist, Musings and Reflections