The elderly are often less vulnerable than they appear. They may attribute their health to exercise, religion and a positive attitude. It is well known that genetics, good health practices and a certain degree of luck are involved. The very process of enduring beyond the average life span indicates personal survival capacities beyond those of the ordinary person.

In our era, however, this is complicated by the fact that many would have died of various disorders, having now been kept alive through sophisticated medical technology. Therefore, among the oldest-old we find two distinct groups: those hardy souls genetically meant to endure for a century, and the extreme frail who walk a “tightrope” between survival and death.

Investigators, for several decades, have studied the concept of “hardiness” as it relates to survival and coping among the oldest-old with chronic illness and multiple stressors.

Hardiness is defined as a personality style characterized by three elements: (1) feelings of control, (2) deep commitment to something or someone, and (3) enjoyment of a challenge.

Researchers propose an investigation of this concept and a clearer understanding as “hardiness”, increasingly becoming a way of explaining the survival capacity of the frail and vulnerable.

However, one of the issues that can adversely affect the oldest-old, and that may lead to frailty, is identified as “energy allotment” (i.e. a decreased energy level). An elderly individual may be able to walk but prefers to use a wheelchair in order to travel great distances in less time and have more energy remaining. Although the ability to walk should be maintained, the desire to be more mobile should be respected and a wheelchair provided to permit a wider range of social opportunities.

The opportunity for choice in energy expenditure may be ignored if we have an “all” – or “more” approach to the dependencies of the aged.
From my perspective, the goal of maximizing function and delaying decline while using and building on personal strengths and desires is the goal of a wellness-oriented rehabilitation.

Working with older adults, however, who are having serious difficulty coping with their lives, demands a great deal from their caregiver. Sensitivity is needed to research out the exact difficulty.

Older people, because of reasons of pride or because of mental impairments, may not always state their problems directly. Tolerance and patience may be required by “teasing out” the issues. Often a great deal of trust must be present before a frail elder will confide to a caretaker who is working with this individual and may require more time.

The old person may also be acting hostile and aggressive as a way of feeling less dependent and needy in an attempt to still have control over a situation.

It is important to remember always that these older adults are survivors – people who have lived through major world wars, social upheavals, and numerous personal hardships.