Sweet After the Bitter - a life review

She is a slightly chubby woman with a friendly smile and an inquisitive spirit. Despite being in her 80s and a lack of formal education, she was able to show me around her home with her smart phone during our video calls. I asked her if she would like to tell me her story She replied, “where should I start?” “What were your first memories?” I asked. She took a sip of her tea and started telling her life story:

Born just before the Japanese invasion of Malaya, Jasmine’s* first memories were those of living in an Christian orphanage, being given a Christian name, and eating stale bread. After all these years, she still associates eating bread with poverty and hunger. After the Japanese retreated, her mother came to the orphanage to take her and her siblings home with her. She was and is grateful that her mother came for them. Their father was thought to have perished during the war.

They were very poor, so when Jasmine and her siblings reached the age of nine or ten, they had to work to help support the family. Despite that, they often did not have enough to eat. As Malaya recovered from the devastation of the Second World War, life became less of a struggle for Jasmine and her family. Eventually, when she was of age, she could afford to attend night school. There she learnt simple mathematics, and to read and write. “If you are illiterate, you always have to ask other people for help,” she explained.

After Malaya gained independence from Great Britain, Jasmine found a job as an apprentice at a printing firm. After a few years, she became skilled at retouching photographs and prints. She continued to attend night school on and off. She never married because she did not want to lose her independence. When her siblings got married and had children, she became godmother to their children. She lived with one of her siblings and her family until her forties. After that, she rented a tiny studio flat from the government, and lived there with her mother. During this phase of her life, she worked hard to save up for her old age.

Jasmine retired when she was 55, but continued to do odd jobs to supplement her small pension and to pay for package tours abroad. She also volunteered at a Buddhist temple, handing food packages to poor. As her mother became increasingly frail, the daily care of her mother fell on her shoulders. Although her mother didn’t like it, Jasmine still went on holidays once a year. When she was away, her sisters and their children would take turns to take care of Grandmother. Her mother passed away in her sleep when Jasmine was in her early seventies. Her mother was in her nineties when she died, so, although she mourns the loss, she is glad that her mother had a long life. She also feel relieved because she was really starting to feel the psychological and physical toll of caring for her mother.?

A couple of years after her mother’s death, Jasmine was diagnosed with cancer. Her sisters and their children took care of her until she recovered from cancer surgery. After six months of cancer therapy, her cancer went into remission. Since recovering from cancer, she noticed that she got tired much more easily. At first, she was quite frustrated, and had trouble accepting her physical limitations. Then the COVID19 pandemic hit. The strict lockdowns were both a curse and a blessing. She was stuck in her tiny flat feeling bored and isolated. So she spent her time resting and learning how to use smart phone apps so that she could keep in touch with her family and friends. She believes that being forced to rest has helped her regain much of her energy. Nowadays, she no longer feels the need to fill her days with activities, or go on holidays to far flung places. She prefers to spend time with her family and her few friends who are still alive, going out with them for meals and day trips organised by charitable organisations. She is content with her life at the moment. “I am an old lady now,” she said. “Family and friends have become more important to me.”

When asked what her thoughts are about the negative aspects of getting older, she said that getting forgetful bothers her the most. It frustrates her that she often misplaces her things, or has to go back to the market because she forgets to buy something she needs. She tried writing a shopping list, but sometimes she would forget to bring the list with her. At times like this, she would get angry with herself. When I probed further, she explained that she is afraid that she would go senile. I asked her if anyone in her family had dementia, she replied no. Nor does she have high blood pressure or diabetes. She is not really overweight and does not smoke or drink. She went on to tell me that she heard from her godchildren that eating salmon and avocados is good for the brain, so she tries to eat those as often as she can. She also avoids eating deep fried food because that is bad for her brain and her arteries. She went swimming three times a week but had to stop because of the lockdowns. When COVID measures were lifted and the community swimming pool was opened again, she resumed swimming three times a week. Besides physical activities, she stays mentally active by taking computer and smart phone classes at a nearby senior centre. Learning new skills at her age is probably beneficial for her cognition (Chan et al, 2016). When the senior centre was closed because of the lockdowns, she would follow English lessons on YouTube to keep her mind active. Since it does not seem like she has a genetic predisposition for dementia, and she is taking good care of her brain health by watching what she eats and being physically, socially and mentally active, her cognitive decline is most likely part of normal ageing (Sindi et al, 2015). Although she did not attend school as a child, she went to night school in her early adulthood, and has always been intellectually curious. The informal education over the span of her life could well be a protective factor against abnormal cognitive decline (Hertzog et al, 2008; L?vdén et al, 2020). Childhood malnutrition could still increase her chance of dementia after the age of 85 (Momtaz et al., 2014), but there appears to be more protective factors than risk factors, which should benefit her cognition as she continues to age (Kivipelto et al., 2018).?

After reassuring her that her forgetfulness is normal for her age, I asked her to elaborate on her concerns about getting dementia. She told me that, when she was diagnosed with cancer a few years ago, she was confronted with her mortality and the possibility that she might not be able to take care of herself. Even if the cancer does not come back, she has seen how dementia affects the elderly, she said. Since she has no children, she was afraid that no one would take care of her when she herself no longer could. Regardless of whether that is a realistic concern, it is not an uncommon worry amongst the childless (Bjorklund, 2015a). She once asked her oncology nurse if she could have euthanasia, the nurse got really upset and just told her “cannot!” without telling her why. “She is a missy (nurse)! Why she so pantang (superstitious)!?” she said in exasperation. I explained to her that euthanasia is against the law, perhaps that is the reason why the nurse overreacted. I promised her that I would find out whether home care and hospice care are available to her, and whether the cost would be subsidised by the government. Jasmine felt that she had lost her competence in making preparation for her future and her autonomy to decide how and when she would die if she were to suffer a degenerative disease like cancer or dementia (Deci & Ryan, 2008; Bjorklund, 2015b). Providing her with information about professional care could perhaps empower her by helping her regain some level of competency and autonomy.??

We continued our conversation sometime later. I started by passing on the information that I have promised to gather for her. There are different types of professional care she could get, and because she lives in low-income housing, the government would most likely reimburse most of the expenses. After hearing that, she looked relieved.??

We went on to talk about the positive aspects of ageing. She said that the best thing about being old is all the freebies and discounts that she is entitled to. She receives food parcels and food vouchers from the senior centre and charitable organisations because she is a senior citizen living in low-incoming housing. She gets so many freebies that she cannot consume them all, so she shares them with her siblings and her friends. She enjoys being able to travel at a significant discount on public transport. That allows her to get around without having to worry about the costs, so she can visit her family and go out with her friends more often. Being able to share food and other items with her family and friends, and being able to visit or go out for a meal with them have promoted her sense of relatedness (Deci & Ryan, 2008). Furthermore, her cancer is in remission, and she is now in relatively good health. “I have enough to eat and enough (clothes) to wear, I am content,” she said. “We were born into this world with nothing; when we die, we leave this world with nothing.” At this point in her life, she values her family and friends more than worldly possessions. Like her cohort, her idea of ageing well is being in relatively good health, not having to worry about money, and having family and friends around her (Wee et al, 2017). Although she did not have a good start in life, she is now enjoying her golden years. “Sweet after bitter. What more can I ask for?” she said with a smile.

Looking back at Jasmine’s life, her life course was somewhat atypical. We could use the concept of the social clock to look at her life story. According to Neugarten (1968), the “social clock” is a set of internalised concepts that regulate an adult’s progress through age-related events in the course of their lives, like getting married and having children. The roles we occupy, the duration and the order we occupy each of these roles is referred to as social timing (Bjorklund, 2015a). In Jasmine’s case, working as a child is not necessarily “off-time”, as child labour was not uncommon after the war, but to start attending school in one’s early adulthood was. Whilst taking care of an elderly parent in late adulthood and retiring at 55 were “on-time”, not marrying and not having children are considered “off-time”.?

In Jasmine’s case, the negative aspects of ageing are cognitive decline, and the concern about not having control over her dying days. When her inquiry about euthanasia was dismissed curtly, she felt that she was not being heard. Wanting to die a good death, that is to die with dignity and have some control over one’s dying moments, is an intrinsic goal (Hemati et al., 2016; Campbell, 2020). Attaining such a goal should promote a person’s well-being, which can be explained by the Self-Determination Theory (Ryan & Deci, 2017). The theory proposed that when we help a person to satisfy his or her basic psychological needs, namely autonomy, competence and relatedness, we are helping facilitate his or her well-being (Behzadnia et al., 2020). By providing her with information about other options like home care and hospice care, her sense of autonomy and competence was restored. One of the good things about being a senior citizen is that Jasmine qualifies for many discounts and subsidies. That gives her the resources to maintain her connections with family and friends, promoting relatedness with important people in her life. All these come together to promote her well-being.?

?Jasmine did not have a good start in life, and there were many obstacles in her journey, which she overcame. But in this last leg of her life journey, she can enjoy the fruits of her labour. The sweet has come after the bitter.?

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Reference

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Bjorklund, B. R. (2015a). Transformation of Social Roles In The Journey of Adulthood (8th ed., pp.179 - 181). Pearson Education.

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Momtaz, Y. A., Haron, S. A., Hamid, T. A., Ibrahim, R., & Masud, J. (2014). Does food insufficiency in childhood contribute to dementia in later life?. Clinical interventions in aging, 10, 49–53.?

Neugarten, B. L. (1968). Adult personality: toward a psychology of the life cycle. In Middle age and aging (pp. 137–147). Univer. of Chicago Press.?

Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Publications.

Sindi, S., Mangialasche, F., & Kivipelto, M. (2015). Advances in the prevention of Alzheimer's Disease. F1000prime reports, 7, 50.?

Wee, E., Lim, W., Thang, L., Gwee, T., & Cheong, W. (2017). What it means to age well? Lay perspectives from older adults in Singapore. Innovation in Aging, 713-713

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Footnote

* Interviewee’s name and some personal details were changed or left out to maintain confidentiality?