It's known as "terminal decline", something everyone needs to face at some point.

Whether we see it in ourselves or in aging loved ones, the last two to three years of  years of life are often marked by a steep drop in physical and mental functioning.    Along with significant diseases of old age, people in terminal decline often find themselves experiencing a sharp drop in cognitive functioning, including memory, as well as increased depression and anxiety about the future.

This often means more expensive medical treatment, or even needing to be placed in an extended care facility for people unable to care for themselves.   Research studies looking at older adults in different societies suggest that terminal decline often sets in about three to five years before death with a steep decline in life satisfaction and physical well-being. 

But the picture isn't necessarily all that bleak. These same studies have also found enormous individual differences among older adults. While many older adults do experience dramatic terminal decline, others manage to stay mentally and physically active until the very end of life depending on their personal circumstances and overall health.  Among the factors that can influence successful aging are:  biological factors such as poor health or chronic pain, psychological resources (including how much perceived control older adults have over their own lives), and, perhaps most importantly, psychosocial functioning (also known as social orientation).

Human beings are social by nature and how successful we are at aging often depends on the kind of social networks we are able to maintain. Granted, this isn't always easy for older adults, especially if they outlive many of their long-time friends.   Certainly, research has already shown a clear link between social isolation and poor mental health.  The stronger our social links are, the more likely we are to stay happy and healthy for as long as possible.

According to psychologists Karen Fingerman and Frieder Lang, social relationships get better as we grow older due to our greater emotional maturity as well as the greater value we place on the friends and family in our lives.  Ironically, social networks also tend to become much smaller as we grow older though the quality of those friendships that do survive are much greater as well.  Older adults report typically report experiencing much more positive emotions when interacting with social partners than younger adults do. Even when friends are lost to sickness or death, the level of social support usually stays the same.

Though social relationships can stay stable well into extreme old age, the final years of life are usually when these relationships become especially strained.  Not only is the stress of dealing with serious illness much greater, but being emotionally balanced when death seems so much closer becomes extremely difficult.   While social support networks can be invaluable for people dealing with cancer or other life-threatening diseases, the sense that time is running out may make socializing seem less important.   But what does this mean for emotional well-being in older adults nearing the end of life?

A new research study published in the journal Psychology and Aging examines social orientation and how it affects well-being for people in terminal decline.  Denis Gerstorf of Berlin's Humboldt University and an international team of researchers used longitudinal data collected on participants of  the German Socio-economic Panel study (SOEP).  Since 1984, data on over 11,000 private households in Germany has been collected by the German Institute for Economic Research.  This includes self-report data on social activities, emotional well-being, family life, and recreation as well as data on medical history, demographic information, educational and occupational history, and earnings.  

To examine terminal decline, Gerstorf and his fellow researchers focused on SOEP participants who had died over the course of the study.  Of the over 50,000 participants, 2,910 were listed as having died between 1991 and 2011.  While not all participants had been in terminal decline before dying (younger people who had died in accidents, for example),  the deceased participants tended to be older, less well-educated, and reported lower life satisfaction overall compared to still-living participants. 

According to the study results, participants who reported living a more socially active life as well as those who attached a strong value to social goals reported higher overall well-being late in life. They also stayed mentally and physically active for much longer and experienced terminal decline much later than less social participants.   There seemed to be a strong interaction effect between being socially active and having strong social goals since they both promoted emotional well-being.   These results hold up even when other factors such as age, gender, hospitalization, disability, and having other life goals are taken into account.

Though terminal decline is often unavoidable, especially for people with serious illness at the end of life, remaining socially active for as long as possible has important health benefits that are only beginning to be understood.  The impact of loneliness on health in old age is certainly well-recognized with widowhood (whether for men or women) or the death of important friends being found to lead to premature death in many cases.   Older adults should be encouraged to maintain friendships and family ties, especially if they are dealing with the loss of morale that often comes with feeling too ill or depressed to stay social.   

Still, having social relationships is often a "mixed bag" as Gerstorf and his colleagues point out.  Being with family and friends can often bring sorrow as well as joy, whether due to friends developing serious illness, children growing apart from parents, or simply due to the natural life problems that everyone develops with time.   Even with this kind of added stress, older adults in their declining years of life can still make an active contribution to the lives of people who matter to them.   

Though more research is definitely needed, this latest study is one of the first to examine how important social living can be for people facing terminal decline.  Participating in social activities and interacting with family and friends may be a critical part of staying healthy and happy for as long as possible.

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