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My educational preparation as a professional registered nurse was in a collegiate baccalaureate program, an emergent leap forward in the struggle nursing has always experienced in accessing a respected place in professional opportunity, capacity and status. What was experienced by all women as a requirement to be “better than” was true for my entire discipline, viewed as a discipline of women, not welcomed into the halls of academe. As a result, we students were always alert to the expectation to be “better than” and were immersed in many topics designed to optimize our performance. One was the newly minted concepts about human development, initially largely shaped by Erik Erikson (and it turns out, with extensive help from his wife, Joan Erikson).


As a result of this educational thrust, our thought processes traveled along the path of the developmental descriptors of the patients we cared for, and our assessment of their health status was a comprehensive snapshot of all the competencies associated with their developmental stage.  This focus on developmentally appropriate competencies shaped the decisions we made about their needs and the care we provided. This was most pronounced in pediatric nursing and obstetric nursing. While we had a specialty called adult nursing, the specialty called geriatric nursing had not yet emerged. Had the latter existed, it would have been clear that the competencies for this developmental stage simply “did not exist”!


At that time in the US (and to a disturbing degree still), persons entering the final stage of human development (called the eighth stage by the Eriksons) were expected to simply fade and die. Competencies were not a serious consideration.  It was also assumed that the stage was brief, and hence any focus on achievements seemed unrealistic.  So little time…


Longevity has disrupted these assumptions, though society has not really caught up with the implications of all these added years. It is as if we “invented” longevity without even the vaguest notion of why or what we intended to do with it. Even more interesting to me is the obvious question.  With all this “new time” on our hands, are there actually competencies that define the nature of this final stage in the human life cycle.


I think there are such competencies.


And I think this creates one of the most interesting challenges facing those who are elderly, those who are on the verge of being elderly, or those seeing it down the road a piece, not here yet but fast arriving, visible on the horizon. What if we imagined this developmental stage was like all prior ones, that there were some competencies that once achieved demonstrated a constructive or successful completion of the "tasks" of this stage of living a full human life. The one unique factor, of course, would be that this would not prepare one for the next developmental stage but more appropriately for the conclusion of the human life cycle, the experience of death.


Pondering all this has led me to some initial imaginings of potential competencies.  These do not constitute a robust list, certainly not a taxonomy, but perhaps a useful point of departure, essentially a few examples. Others who are experiencing aging might find it interesting to add items to a beginning list of competencies appropriate to the final eighth stage of human development.


The most obvious first one is adaptation, the ability to pragmatically see that certain capacities are now functioning at a less resilient level, and to accept this as true and adapt life activities accordingly.  An example of this for me is realizing I need brighter lights for reading, and simply buying lamps with brighter lights. Realizing the importance of walking at least 5 days a week to  sustain overall function, I realized that walking shoes needed to be reliable and safe, not necessarily lovely. Over time, these became the only shoes I would wear for the safety they provide. A friend and I shared a laugh over one of our favorite adaptations: the thrill of finding a really functional jar opener to adapt to the decline in hand grip strength needed to open a whole range of containers.


As is thus obvious, related to adaptation is one I am calling assistance, where getting help augments the constraints introduced by an emergent limitation. Sometimes that help is human, such as the Lyft driver who takes me to my eye appointments.  Sometimes that is an actual assistive device, like the walking sticks I use daily for my walks at the beach or the cane I use while shopping.  As short term memory has become less crisp, I find simply keeping a small notebook handy at all times, and recording ideas or interests or plans serves as a mobile and handy “memory”. In such competencies, one figures out what help is needed and then sets out to acquire it and to make this an achievement rather than a problem.


Another competency is what I call focus, or what can also be called awareness. As aging compromises balance, energy levels and musculoskeletal function, many actions that once were simply done on “automatic pilot” without thought or awareness, slowly begin to require awareness or focus. I must pay attention to where I place my feet when walking, how quickly I take a step, what I can do as a second activity while walking, if anything.  It is not that I cannot do these things, simply that I must now do them with focus and deliberate awareness. They are decisions I make and enact. It will take longer and does not permit distractions, but it works. To fail to do so can result in injury and harm.


I think this is a competency because it makes it possible for me to walk where I wish. It is a good example, however, of how little our culture has thought out any of this.  My focused and deliberate walk is often not seen as an achievement but an indicator that I must truly be deteriorating since I now walk slowly and methodically, stopping as needed to assess any potential dangers or challenges ahead.   To my chagrin, my effort to safely optimize my functionality and take responsibility for my safety is often socially interpreted as an indicator of decline.


Interestingly, this often leads to people leaping forward to be “helpful”, disrupting my focus and increasing my risk of falling.  It is a persistent dilemma. There is something very gracious and kind about the impulse to help someone perceived as needing help.  As offered, it often seems the judgment has been made that my effort at “focus” appears to be confusion or uncertainty. I often wonder how many falls among the elderly are the result of a person avoiding the necessary focus to move safely knowing that others may judge this as a person with compromised functionality, or alternately, the result of a person deliberately being focused, but suddenly startled enough to get distracted by the ardor of the “helpful”  other.


These are merely examples, but all shine a light on the idea that the eighth developmental stage presents a range of life challenges that when successfully grappled with, can be viewed as competencies. If like me many older people want to optimize autonomy, then these competencies are part of that story. They can be experienced as a source of achievement and personal pride. It is not hard to imagine a whole raft of these competencies that once achieved, optimize the life experiences of persons aging.

While the ones I listed tend to have a “daily living” focus, the relational ones are even more intriguing. Managing your possessions and their downsizing to minimize the challenges you leave behind for those administering your estate might be an example here. An enormous one is navigating the shifting tides of the relationships with those we are closest to, those who have our commitments and our love.


We tend, as a society, to focus on how to avoid the inevitable final developmental experiences that eventually arrive at every human’s door, culminating in death.  Rather than fixating on delay, which is interesting but hardly a long-term solution, it might serve us better to begin to chronicle the competencies of this final chapter in a human’s life, the "work" of the developmental stage that once completed, can bring peace, satisfaction and joy.


We might begin to think of this final chapter as one of creativity, imagination and achievement.  As we chronicle what we learn, we might make the transition into this developmental stage an interesting opportunity. Currently, too often we are essentially saying it is sad, depressing, debilitating, pitiful, even shameful.  It isn’t hard to imagine a better proposition might be attractive.


Most authors who try to write about this developmental stage include in their lists of observations that this stage is one where humans explore their understanding of their personal spiritual dimension and increase their focus, experiences, and successes in the “spiritual realm”. I use quotes because while it is usually mentioned, it is rarely explained or explored beyond noting that this is not necessarily the same as a “religious realm” though it could be.  It is a rather foggy inclusion, sounding quite good but leaving the meaning afloat in a miasma.


While I will not presume to declare what competencies accompany the exploration of the “spiritual realm”, as an elder, the idea itself is powerfully compelling for me. Certainly, the awareness of one’s self as a spiritual entity facing death is one of the great acts of consciousness for the deliberate and deliberating elder.  For me, this expression and actualization of my essential spiritual nature is the overriding “focus” of my embrace of this eighth developmental stage. It is also the most interesting and entertaining.


As a result, the exploration of eighth stage competencies fascinates me, and often amuses me. I feel grateful for the humor provided by those interacting with me who have with limited consciousness defined me as "the befuddled little old lady" not as a woman accumulating life cycle competencies (something I realize I have always been). I just keep racking up competencies.


I like to think that someday we will have as much familiarity and insight into these competencies as we now have for walking, eating, talking and loving, competencies that start our life cycle.



“And those who were seen dancing were thought to be insane by those who could not hear the music.”


 -Friedrich Nietzsche-


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