TIME
AND THE EXPERIENCE OF AGING
Neville .E. Strumpf

The Humanities Forum at the University of Pennsylvania

From a conversation on
 Time's Potential: The Past, Present and Future of Aging


Twenty years ago, I completed a doctoral dissertation concerning the meaning of time for older women, and I reread it over the weekend, confronting anew my journey in time and the meaning of the personal, clinical, and spiritual needs of older people. With this study in mind, I will reflect on what has been said today about health care, science, and the arts.

Essentially time is experienced in three ways: a) time perspective: the conception of a past, present, and future; b) time calculation and estimation: the determination, respectively, of clock time and of durations or intervals; and c) time awareness: the subjective impression that time is moving rapidly or slowly, is standing still, or is not existing at all (Fraser, 1966, 1975, 1978). Since "time immemorial," many have struggled to explain time, starting with Aristotle who asked, "For what is time? Who is able easily and briefly to explain that? Who is able so much as to express himself concerning it? And yet what in our usual discourse do we more knowingly make mention of than time?" William James, in the late 19th century, tried to grasp the meaning of time and aging, "The same space of time seems shorter as we grow older--that is, the days, the months, and the years do so; whether the hours do so is doubtful, and the minutes and seconds to all appearance remain about the same."

At the time that I wrote my dissertation, I concluded what I still believe holds true, namely, that no single theoretical perspective organizes the existing research on time and aging. I did, however, assume that life satisfaction and self-concept are closely linked to personal meanings of time. In interviews with 86 older women, I tried to capture their own sense of life, self, and time using a battery of tools that were then frequently used to evaluate "successful aging." I marvel now at the study's limitations concerning real life experience, but nevertheless, found instructive these observations buried in the interviews: the future, however defined, was important; "thinking young" was critical to one's self-esteem; and staying in tune with the present was crucial, although the past was usually seen as the happiest time. Time itself was clearly understood as "passing rapidly," but not yet "running out." Frequently chosen metaphors for time experience included phrases which implied a spiritual calmness and satisfaction, suggesting perhaps that well-being among the elderly is associated with a sense of timelessness.

In the conclusions to my dissertation, I speculated on the research implications of what I'd learned from these older women, identifying the need to explore factors which preserve a dignified life and a sense of self, even in the face of devastating physical and psychological losses; to understand the role of activities and spaces of one's choice on health and well-being; and to examine new cohorts of aging persons, with their unique personal histories (including the current generation of "baby boomers"), whose experience of time and aging will differ markedly from those who have gone before us. This early work continues to underscore for me the need to educate clinicians and others to see beyond the immediate chronic illnesses of older people; to consider the impact of environment, whether hospital, home or nursing home; and to listen always to the voices, in John Updike's phrase, of "our forward scouts in the wilderness of time."

I went on to very different lines of inquiry post-dissertation, focusing on the clinical problems of frail vulnerable elders in hospitals and nursing homes, but I see more clearly today than I once did, just how great the influence of time and aging was on my thinking and my work. The most influential study was one debunking the myths associated with physically restraining patients who were at risk of falling, might interfere with various treatments, or demonstrated such troubling behaviors as restlessness, wandering, or shouting. In a much cited clinical trial funded by the NIH, my colleague, Lois Evans, and I demonstrated that such persons could be cared for safely, without resorting to psychoactive drugs and precious extra staff. To this day, I credit the stories that we first heard from patients who were restrained, in effect immobilizing them in time, as giving us the necessary clues that physical restraint had a profoundly negative physical and emotional impact, and that any possible good that might come from tying someone up was far outweighed by its many harms. Restrained patients said to us: "If there was a fire, I'd be caught. When someone is tied and chained in a fire, how will you save the person? How would I get out?"; or "I felt like a dog and cried all night. It hurt me to have to be tied up....the hospital is worse than a jail;"or "After a while, I gave up. I became a mouse."

Gratefully, we no longer trap people in hospitals and nursing homes in the endless time of physical restraint, although we have in our institutions for the aged many impositions on the quality of life.

Rosemary Stevens discussed changes in the medical and social structure of hospitals, and how this reflects societal values about aging. We have, in works such as Kate Quinton's Days by Susan Sheehan, an illuminating illustration of cultural attitudes in health care. Sheehan provides a compelling and all-too-true account of the Herculean efforts by one patient to go from hospital to home, rather than face discharge from hospital to nursing home, and the many complexities that revolve around distribution of resources for the aging poor, difficulties in securing and coordinating reliable home help that works for everyone, and the enormous bureaucracy that characterizes health care services. At the end of the story, through an experimental program in home care and against great odds, we find 80 year old Mrs. Quinton, an independent-minded, Irish immigrant who had spent most of her life in domestic service, sitting in a wheelchair in her apartment with a home health aide, listening to the ticktock of the grandfather clock she had first heard as a child in the house in Kirkintilloch. "Time was passing as agreeably as she could expect. She looked forward to walking in the spring."

As we have heard in the earlier presentations by Susan Stewart, Christine Poggi, and Jeffery Kallber, great literature, painting and music, give to aging, even with its loss, frailty, disease, growing dependency, and imminent mortality, alternative visions that minimize the negative stereotypes and "erode modern culture's strong temporal prejudices" (Cole, 1994). As Thomas Cole says so well: "While scientific research and medical technology will continue to alter the biological possibilities of human life, they cannot free us from the necessity of living within limits. Time--invisible, intangible, yet inexorable--is perhaps the most mysterious limit of all. Aging is about living in time." Our previous speakers have illustrated that creativity remains a powerful source of growth, inspiration and spiritual transcendence at all ages.

John Trojanowski has briefed us on the newest treatments in Alzheimer's disease, and the anticipated therapies that delay onset, slow progression, and someday will cure this dreaded and tragic disease, one which completely alters the universe of time for its victims. In Yasushi Inoue's book, Chronicle of My Mother, we have a devoted son's astute observations of his mother's descent into extreme dementia: "She was rubbing off from one end the long line of life she had drawn....Mother continued erasing her seventies, her sixties, her fifties, and her forties....But somewhere there were parts that remembered and did not forget...." Once in a while, a word, a name, a smell, a taste, would be as if "an X-ray had just penetrated Mother's mind, a keen arrow of light piercing the inside of her head making a slice of memory become crystal clear."

On Saturday afternoon, I hadn't the time, but would make the time, even as I fretted over these remarks about time, to visit my friend Barbara, a renowned physician and scholar, who lives in a special care unit for persons with Alzheimer's disease, just one of 4 million victims. Knowing how much she had always enjoyed brownies, I had some with me, and shared in her delight as she readily ate them, after days of eating and drinking almost nothing. I was pleasantly surprised by the fact that she was also wearing her shoes, which had been the source of much recent frustration and confusion. I proposed that we go outdoors, something Barbara had not done in many weeks, although she had always loved gardening, bird watching, and walking in the woods. We made our way into an enclosed garden with tables, benches, raised flower boxes, and some lovely borders with blooming azaleas. Painstakingly and carefully, I conjured up memories of trips together in the Adirondacks, commented on the Canadian geese flying overhead, and repeatedly, named the spring flowers spread out before us. I looked directly into her eyes, stroking her back or arms--we talked, or gazed up at the woods and broad expanse of sky, felt the warmth of the sunshine, smelled the air redolent of spring. There were periods of silence, but not uncomfortable ones--I wondered whether I had any right whatsoever to try to bring Barbara back into this world and "my time." I longed to recover and give back to Barbara her time, to give to her what disease had so unfairly taken away--and then I thought about the gift of time, the one thing that we could both give to one another, if only for a moment. And I remembered how much Jane loved opera, and cats, and poetry. And then these lines from a poem by Yehuda Amichai came to me:

"And late in life I discovered
a quiet joy

like a serious disease that's discovered too late:

just a little time left now for quiet joy."

Thank you, Barbara. I'll be back next week, in hopes that we still can give to one another, that quiet joy, that last small vestige of time.

Neville Strumpf

*****

Neville E. Strumpf, PhD, RN, C, FAAN, is Edith Clemmer Steinbright Professor in Gerontology at the School of Nursing, University of Pennsylvania, and Director, Center for Gerontologic Nursing Science and Director, Hartford Center of Geriatric Nursing Excellence

Last upadated April 13, 2005