This Holiday Season Consider the Hospital Experience of Gifted Elders

By Marianne Kuzujanakis, MD MPH.

As we in the gifted field – parents, educators, clinicians – work to improve medical professionals’ support and understanding of gifted children, we must be sure not to overlook the needs of our gifted elders.

Gifted children become gifted adults. Gifted adults, in turn, become the gifted elderly. One thing is certain: the gifted do not outgrow their giftedness. But who are the gifted elderly? Earlier this year, the incomparable Annemarie Roeper reflected upon her own life as an octogenarian in “Growing Old Gifted.” You can read other articles on the experiences of gifted adults by Deirdre Lovecky, Stephanie Tolan, Helen Prince, and Mihaly Csikszentmihalyi.

The U.S. population is aging, and the Department of Health and Human Services estimates that currently one in every eight citizens is age 65 and older. In the next decade the number of elderly is projected to increase by almost 40 percent. Today most elderly live independently, and, on average, one-third live alone. With increasing life expectancies through the benefits of lifestyle changes and medical progress, many elders (gifted and otherwise) will remain active and vital all their lives. As family matriarchs and patriarchs, they will dispense valued wisdom and tradition to their families. The influence of family elders is brought prominently to the forefront for many people during this end-of-year holiday season.

Not all elderly enjoy a smooth life journey. Due to a variety of health factors, the elderly comprise upwards of one-third of all hospitalizations. If percentages of gifted are equivalent across the lifespan, three to five percent of these hospitalized elderly are gifted, accounting for close to three-quarters of a million hospital stays for gifted elderly per year. While very reasonably equipped to address the specific issues surrounding medical care of the elderly, physicians do not typically have any body of knowledge that addresses the gifted elderly’s unique needs.

The elderly – as a whole – are frequently far more sensitive to medications, drug interactions, and the risk of hospital complications. With a lessening sense of smell due to aging, many elderly also have reduced appetites and resulting weight loss, placing them at further risk. Hearing and vision impairment may make communication of needs far more difficult. Some elderly are also the primary caregivers for spouses with complex health conditions, and therefore are themselves at high risk for stress-induced health issues. Mental impairment, as a normal result of aging or a progressive condition like dementia, can make a variety of cognitive issues even more challenging. For gifted elders, their giftedness can be a two-edged sword, presenting them with a greater long-view of life and interconnectedness, while also leading for some to increased anxiety and frustration at the changes which come with aging and ill health.

What unique needs and/or strengths can medical professionals in hospitals and skilled nursing facilities look for in the gifted elderly?

· Self-Awareness: The gifted typically have a deep sense of self-awareness and sensitivity that may assist them in the normal process of aging and their journey of life. Gifted elders may fully comprehend and accept the idea of their own mortality, but if not surrounded by loving friends and family, they may be at risk for existential depression. Dr. James T. Webb has written an excellent article about this issue.

· Spirituality: Many gifted individuals have a strong sense of spirituality originating in childhood. This may stem from the sense of being interconnected to all people, and sometimes to all living things, in a timeless universal journey. A wonderful article by Joy Navan addresses this topic. While some gifted individuals remain spiritual their entire lives, others return deeply to the spirituality of their youth only once they are elders or have experienced a significant turning point in their lives.

· Overexcitabilities (OEs): The intensities of gifted children, while sometimes managed to some degree during the adult years, may return again in full force in the elder years as a result of a variety of issues that may affect their mental and emotional states. They may be easily and quickly frustrated. These OEs can lead to strong conflicts in healthcare settings where they are not properly supported or understood. Some gifted elders never fully control their OEs and may have life-long struggles adapting. Try to understand conflicts you yourself may have with your own gifted elders, and ask yourself whether OEs may play a significant role in misunderstandings on both sides.

· Independence: Many of today’s elders lived their formative years during the period of World War II. They grew up in an era when education, careers and job security, and home ownership were common goals. The gifted elders often were persistent and determined in reaching any and all of the goals they set out to achieve. Some of these elders, as a continuation of their childhood desire to be autonomous and in control, may have a particularly difficult time dealing with health issues that require hospitalization and/or skilled nursing home placement. Gifted elderly may insist on independence even when it is medically contraindicated. They may question medical authority, striving to become experts in the knowledge of their health status and prognosis in a desire to maintain control.

· Motivation: This can be a strongly positive and powerful trait, if it encourages a gifted elder to follow recommended medical advice