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Sybil D. Smith, PhD, RN
The age wave is beginning to hit the beaches as baby boomers are nearing retirement age. The age wave consists not only of record numbers of baby boomers nearing retirement but also the increased numbers of older persons living well into their 90s. The oldest-old (ages 85 and up) is the fastest-growing population group
Obvious is the demands of changing demographics on health systems. What might not be so obvious are the demands placed on congregations by increased numbers of older persons.
Health-care economists and system planners have been evaluating the capacity of health systems to meet the needs of rising numbers of older persons for some time. However, it is not clear whether congregations have yet begun to ask the right questions about the impact of increased numbers of older persons on the life of the congregation.
More will be required of congregations than maintaining accessibility for the disabled, appropriate placement of bathrooms and assuring that the sound system does not offend those with hearing aids. Just adapting the building and grounds for those with functional deficits is insufficient. Meeting the spiritual and support needs of older persons and their family members will become a new frontier for current congregations.
Older persons are facing the health challenges of aging while attitudes of independence and self-sufficiency prevail. The Social Security dilemma is looming. Resources are already scarce. Family networks are weak, and deep roots in neighborhoods are few.
Middle-aged family members are leaving the work force to become home caregivers. Persons with aging parents at a distance are spending much of their free time going back and forth. Disruption is taking place in the routines and daily life of older persons and their children and grandchildren.
In the past, congregation members with special needs were served well by Sunday school groups. However, Sunday school groups are less vital today. Few congregations are able to provide support for families with long-term health needs for lack of organizational structure and a finely tuned model, either biblical or academic.
The triumph of modern medicine over the past several decades has left its mark on our society. Excesses of medical therapeutics have created an illusion that death can be avoided if we work at it hard and long enough. In a death-denying culture, the drive becomes to avoid all woundedness. Dr. Keith Meador of Duke University, in "Growing Old in Christ," suggests there may be some sort of dementia or forgetfulness of the soul in the life of the congregation. Have we traded in the truth of our dependence on God for dependence on a therapeutic culture?
The impact of the age wave on health-care economics will shift the paradigm from medicalization of aging and death to something that will be unfamiliar for the younger generations to live out. Some may see death as the optimal allocation of scarce resources. The shift to nonprofessional care in non-institutional settings will be difficult for those who have never sat at the bedside of a dying person, those who have no memories of a grandparent dying in the home and those who fear aging, suffering and death.
Age-wave economics means that much care of the sick, the suffering and the dying will shift from market-driven systems of care. Health care bought and sold in the free market will be for those who can afford to pay.
Congregations that can grasp the picture of what is at stake will proactively be involved in teaching about death and dying, and guiding members to grapple with the question, "Is my reason for living big enough to prepare me for my dying?" When individuals have not yet settled the questions about life and living, they are less reality-bound about death and dying.
Today, families are struggling with questions such as: Should I be cautious in initiating life support? When is it time to remove life support? If I remove the life support, am I responsible for the death? Is it ethical to withhold fluids and nutrition? Should suffering be avoided at all costs? How can I cope with the unrelieved suffering? What does it really mean to be healed?
The shifting of hope and expectation from the wonders of medical therapeutics back to an embodied hope and utter dependence on God will create a spiritual crisis for many. Just what is the capacity of congregations to provide a ministry of sustaining presence for those treading the murky waters at end of life? Conversations about sanctity and dignity in end-of-life issues need to enter the dialogue with a goal to renew and build relationships that can prevent suffering in isolation, and sustain the presence of God.
More articles
The Changing Face of Parish Nursing
Ten Options for Congregational Healing
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