The Sociology of Aging and Death
The Old Man and His Grandson
There was once a very old man, whose eyes had become dim, his ears dull of hearing, his knees trembled, and when he sat at the table he could hardly hold the spoon, and spilled the broth upon the tablecloth or let it run out of his mouth. His son and his son's wife were disgusted at this, so the old grandfather at last had to sit in the corner behind the stove, and they gave him his food in an earthenware bowl, and not enough of it. And he used to look towards the table with his eyes full of tears. Once, too, his trembling hands could not hold the bowl, and it fell to the ground and broke. The young wife scolded him, but he said nothing and only sighed. Then they bought him a wooden bowl for a few halfpence, out of which he had to eat.
They were once sitting thus when the little grandson of four began to gather together some bits of wood upon the ground. "What are you doing?" asked the father. "I am making a little trough," answered the child, "for Father and Mother to eat out of when I am big."
The man and his wife looked at each other for a while, and presently began to cry. Then they took the grandfather to the table, and henceforth always let him eat with them, and likewise said nothing if he did spill a little of anything. (Yolen, 1986)
Folktales may teach us about our past, but they can also tell us about our present and our future. The above tale, published by the Grimm brothers, has variants that have been found all around the world. The ubiquitousness of this tale suggests that treatment of the aged was an issue in the past, and in a variety of societies, which means that despite the modern twist to the medicalization of dying, the issue of treatment of the aged is not limited just to our own culture and time.
How should we, as a society, treat the aged and infirm? The tale of “The Old Man and his Grandson” tells us that how we treat those who are aged now, so shall we be treated by suceeding generations when we ourselves become old, which should give society pause for thought, as parents and grandparents who wish to age and die in their own homes, instead spend the end of their lives in institutions. Just as aged individuals shape the expectations of aging, so does our treatment of aging individuals shape the expectations of how the aged will be treated in the future.
In the past century there has been a shift in the place of death for the aged. Traditionally, death occurred in the home but in modern times, deaths occurring primarily in an institution, (McCue, 1995) which effects not just the dying individual, but society in general. A century ago, not only did the aged die in their homes, but were also laid out in the home, with the entire family taking part in the preparation of the body, the wake, and sitting over the body before the funeral. Recently, however, there has been a swing towards the medicalization of death and dying, with death occurring in an institution, and preparation of the body done by the funeral industry.
Additionally, funerals are no longer attended by the community at large, but are instead only attended by close family and friends, which changes to support system for bereaved families. (DeSpelder & Strickland, 1987)
In an earlier time, when society was more agrarian, the whole community could pause from the daily round and rally to support the family at the funeral. In this urban age, however when families live anonymously and work miles from their bedroom communities, and when approximately 60 percent of the women are in the work force, it is increasingly difficult for people to attend daytime funerals unless the deceased is a close relative. The policy of many companies is to give released time to employees only for the funeral of an immediate family member. Consequently, the tendency is for acquaintances to call at the parlor during evening visitation hours and for only the closest friends and relatives to attend the funeral itself. Many clergy feel this deprives the family of a powerful support system and renders impossible a corporate celebration of the life of the deceased. Frank Minton (DeSpelder & Strickland, 1987)
There has been a change in the aging and dying processes as well. In the past, aged persons lived at home with family members, while now they spend their final days living in institutions or living alone. Elders have become disengaged from their jobs and from their community, but it is not clear whether this disengagement is occurring through choice, or because elders, especially those who are more frail and ill, are being pushed to the fringes of society.
This shift has various implications both for families and for the community at large. Death has shifted from a natural occurrence that is experienced by everyone on a regular basis, to a strange occurrence that is rarely seen . It is now an event that takes place in a hospital or only in a funeral parlor. Death has become a alarming stranger. Funerals and wakes no longer involve the entire community, but are limited to family and close friends.
As a society, we may never have been comfortable with death, but current shifts make it an even stranger experience. This serves to shift death from an ordinary occurrence that is accepted as inevitable, to one that is terrifying and fought every step of the way—one that some individuals may believe can be postponed indefinitely. Death and dying have become unfamiliar issues to the populace of most first world countries as death has moved away from the home, both the act of dying and mourning practices.
The process of dying and death are now completely removed from the experience of life, and this separation is a self-replicating process. The further dying is removed from society, the stranger and more frightening it becomes, which in turn pushes death and dying further away from the consciousness of society.
Perhaps part of this fear has to do with the medicalization of death, with the profusion of strange tubes and monitors placing the sick or dying patient at arm’s length. Someone so wound up in tubes and monitors does not seem approachable, huggable, touchable. Children, who are now more likely than ever before to know their grandparents, are frequently kept away from dying elders, and away from funerals and wakes. The very machinery of medicalized death places the witnesses of that death at a distance from the patient. Even the terminology creates a distance, with the dying elder no longer a father or a grandfather or a husband, but instead simply a dying patient.
This is not to say that we are not well served by some of the improvements in the medical system, or that we should accept all death and disease without a fight. There are cases where death should be fought with all the medical technology at hand, but we may be better served by accepting death as a natural and inevitable part of life for the oldest old, who have come to accept their death as inevitable and even perhaps welcome.
The institutionalization and medicalization of death do have benefits, which include better awareness of the pain that is suffered by many elders, which brings the realization that pain in the aged dying patient can and should be treated aggressively. This makes the end of life easier for not just the elders, but for the family and friends who may gather to spend the time at the end with the dying elder. Part of the reason children may be kept away from the bedside of a dying elder is because seeing an adult in pain is a very frightening experience for a child. If the pain of the dying aged can be kept at bay, this may make it easier for children to spend more time with dying grandparents, aunts, and uncles, which in turn may make the process of dying less frightening.
Medical advances have also allowed life to be extended long enough to allow family members time to arrive from where they may be across the country. This means that distant family members can arrive in time to say goodbye, and perhaps even to resolve issues, instead of only having the funeral and regrets.
Medicine is making advances in the treatment of some illnesses, as well as in the field of pain management, that then allow those treatments to occur in the home instead of in an institution. This allows the elders, if they have the support, to spend their final days at home with their families instead of in a hospital or care facility.
Whether there will actually be a shift back to death occurring in the home instead of in a hospital or institution remains to be seen. The technology is advancing rapidly enough that most seniors who would like to die in their homes should be able to do so, but whether family members and caregivers will agree to this shift is yet unknown. It is also possible that the changes occurring as a result of the graying of the baby boomer generation may place greater power in the hands of the aged, and may help to shift the place of death from the hospital back into the home.
References
DeSpelder, L. A., & Strickland, A. L. (1987). The Last Dance: Encountering Death and Dying (2nd ed.). Mountain View: Mayfield Publishing Company.
McCue, J. D. (1995). The Naturalness of Dying. JAMA, 273(23), 1039-1043.
Yolen, J. (1986). Favorite Folktales from around the World. New York: Pantheon Books.