Review
Elderly Health and Literature Therapy: A Theoretical Review
2014 Volume 232 Issue 2 Pages 79-83
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2014 Volume 232 Issue 2 Pages 79-83
Recently, the problems of old age have been discussed in terms of two aspects: preventive and therapeutic approach. The previous studies on the preventive aspect have been mostly concerned with the educational preparation for successful approach to elderly, directing focus toward the transitional period of the old age. Most research into the therapeutic aspect on the elderly diseases has focused on organic mental disorders such as dementia and functional mental diseases such as depression. This study aims to suggest the preventive and new therapeutic possibility in old people through combining the elderly health with literature. First, the research results regarding the social background for the elderly problems indicate that geriatric diseases increase in proportion to the increase of the population. Secondly, for the literature therapy, it is initially required to seek a comprehensive understanding about the health of the elderly through the phased consideration for the elderly problems. Thirdly, for the treatment of geriatric diseases by using literature, it is necessary to develop more active and integrative literature therapy than passive bibliotherapy. Literature therapy is the use of literature in the treatment of people with emotional or mental illness. Fourthly, theoretical approach should be considered for the health of the elderly and the literature therapy. From a literary approach, the literature therapy can help the study on geriatric diseases such as dementia and depression. Thus, the program for the health of geriatric issues and literature therapy should be developed as the next step in the future.
As people age, their sense of content and well-being results in part from their preparation for old age (Kang 2012). Although everyone hopes for a healthy, joyful old age (Jung and Kim 2004), realistically problems of old age often develop at the transitional stage, including poverty, disease, loneliness, and idleness (Lim 2011). Recent researches on the problems of old age emphasize preventive and therapeutic approaches.
Older research on prevention is primarily concerned with educational preparation for a successful approach to old age, focusing upon the transitional period (Kang 2012). In Japan the paradigm of the elderly education program has shifted from the individual to society and from the elderly as a minority to the elderly as a healthy majority (Kim 2007). This shift explores elderly education as preparation for the elderly society. Most research argues for the necessity of educational preparation for the elderly but specific programs for happy elderly life are lacking (Kim and Jeon 2011).
Most therapeutic research on elderly diseases is focused on organic mental disorders such as dementia and functional mental diseases such as depression (Hong 2007; Apil et al. 2012; Mavrodaris et al. 2013). Elderly depression has been studied extensively worldwide, as well as in Korea (Floyd et al. 2006). Joling et al. (2011) found that only 10% of the elderly suffering from depression had been properly treated, and it was difficult for them to be accurately diagnosed. It can be challenging for research results with varying perspectives, subjects, and methods to be developed into clinically applicable treatment.
This study suggests new preventive and therapeutic approaches for the aged society by use of literature. Usual clinical treatment for the elderly does not consider patients’ affective or emotional aspects, so this study highlights patient-oriented literature therapy. This study further seeks to develop a theoretical approach to strengthening psychological and pedagogical aspects for the elderly. It is expected that this study can provide better understanding of the elderly health and theoretical foundation for the literature therapy as a new treatment method for the drastically increasing elderly society.
The population of Korea, as of June, 2012, is over 50 million. Such an increase should be welcomed, but it is problematic in that the rapid increase of the elderly population results in a super-aged society. As indicated in (Fig. 1), the aged between 50~64 are greatly concerned about the problems with aging (Kang 2012). Even worse, elderly diseases will increase in proportion to the increase of the population. Consequently, the Government and individuals inevitably must cover the cost (Frieswijk et al. 2006).
Problems and concerns of aging with the aged between 50-64 years old (n = 120).
Korean society is encountering unprecedented problems of the elderly as social issues due to the lengthening of average lifespan and the decreasing birthrate. Moreover, there is little understanding of the aging process and elderly diseases due to the lack of preparation and education for the transition into old age (Kang et al. 2008). In such circumstances, it is necessary to seek a comprehensive understanding about the health of the elderly through phased consideration of elderly problems (Fig. 2).
The first phase explores the natural physical changes and mental problems associated with aging. It intends to address elderly problems through a variety of approaches. This phase is a primary step to approach aging more scientifically and flexibly through understanding healthy old age, geriatric diseases, and physical and psychological illness caused by aging. Based on such knowledge, researchers can understand preventive and therapeutic approaches to the elderly problems.
In the second phase, understanding is needed of the elderly’s individualistic inclination caused by the social structure with nuclear family and the development of Western thought and culture. The elderly are likely to be less interested in family and neighbors and to view the world with egocentric point of view. Consequently, they feel loneliness in the public and experience isolation from neighbors. To understand the elderly in such circumstances, it is necessary to reduce the gap between the theory of literature therapy and actual practices through the life experiences of the elderly in community centers, hospitals, and sanatoriums. How they can live together by shaping community with isolation from their neighbors.
The third phase focuses on investigation of traditional therapy for geriatric diseases, exercise methods, and their problems. Considering physical and psychological changes due to aging and its problems identified in previous research, this phase investigates the existing preventive and therapeutic methods in detail. Possible solutions are examined through understanding related information for problems and limitations. The theoretical perspectives regarding the influence of emotional and psychological aspects on the body will be emphasized, that traditional therapies have not considered. In the fourth phase, treatment methods are analyzed through with a variety of methods. After considering physical, psychological, literature therapeutic, and clinical aspects, this phase needs to focus on the advantages and disadvantages of differing approaches to geriatric diseases. Throughout this phase, the researcher should organize his or her thoughts and discover channels for the prevention and treatment of geriatric diseases. For instance, although literature therapy originated from bibliotherapy, literature therapy employs the basis more actively to highlight the activeness of clients. In this phase, therefore, the researcher should realize that literature therapy is a treatment method to maximize the client’s expressive capability.
Last, the fifth phase introduces appropriate literary works to the elderly suffering from psychological distress in modern society. The elderly can then address their problems and are given the opportunity of active education to manage their everyday life. Throughout this phase, the researcher should realize that literature therapy is a low-cost and easily accessible mediated method for maintaining the health of the elderly. In this last phase, the researcher should determine how to implement literature therapy programs for the health of the elderly at the clinical level.
Phased consideration of literature therapy for elderly health.
The ongoing treatment of the elderly using literature can be divided into two categories, bibliotherapy and literature therapy (Park and Lee 2010; Reeves 2010; Apil et al. 2012). Bibliotherapy, as the basis for literature therapy, usually involves reading texts. It aims to change clients by making them understand the meaning of texts. Literature therapy is a psychological treatment approaching human psychology using literature (Mintz et al. 2012; Moldovan et al. 2013). For instance, integrative arts therapy was developed by combining art therapy and music therapy with literature therapy as its main method (Kan 2003). More recently, a collective program called ‘narrative therapy by using literature’ has been employed in senior welfare centers. Positive psychology can help the mental health of the elderly. The figure below reflecting current needs presents the therapeutic process of geriatric diseases through literature therapy (Fig. 3).
Integrative therapy for geriatric diseases by combining clinical treatment and literature therapy.
A clear understanding of terminology related to ‘therapy’ should precede consideration of the theoretical approach for the health of the elderly and literature therapy. The literature therapy-related theories commonly used include poetry therapy, mainly using poetry for treatment, literature therapy through reading and writing, narrative therapy through creating stories by direct conversation between client and therapist, and journal therapy, aiming at goal-oriented and self-reflective writing. Other types of therapy include cinema therapy and video therapy using movies or films. A therapist needs to have professional understanding of each therapy to provide appropriate literature therapy.
Bibliotherapy, a basis for literature therapy, usually has the client read given texts. It then aims to change clients through an understanding the meaning of texts (Reeves 2010). Bibliotherapy involves four stages: recognition, examination, juxtaposition, and application, originally based on the principle of identification, catharsis, and insight. Throughout this process, the therapy makes changes that are more appropriate for the patient. However, this therapy might result in reducing active activities and losing client interest due to its strong passiveness. Therefore, it is theoretically necessary to use literature therapy by expanding expressive therapy. Diverse discussion is needed in that the recipients make their own meanings by themselves (Hong 2007).
For effective literature therapy for the health of the elderly, they need to reflect upon their own lives and believe that literature therapy is an effective way to reconstruct a positive meaning of life. This is because the cognitive and behavioral approach to the elderly is considered easy (Floyd et al. 2004). The therapist should be able to integrate ‘cognitive insight’ with ‘emotional insight’. Throughout the process, the therapist needs to be able to suggest effective solutions for the prevention and treatment of problems such as depression or dementia.
Dementia and depression can be measured by using ‘MMSE-K’, ‘Korean Form of Geriatric Depression Scale (K-GDS)’, ‘Self-esteem Scale’, and ‘Emotional Balance Scale’ (Park and Kim 2010). This is necessary to assess the effectiveness of pre-/post- literature therapy programs. The development of therapy programs for geriatric diseases will promote the understanding of the geriatric diseases, and furthermore, will help strengthen the prevention and treatment of those diseases.
Future researchThis study will strive to provide opportunities for the treatment of the elderly by developing preventive and therapeutic programs for the health of the elderly. To summarize the future direction of the study briefly, ‘a program for the health of the elderly and literature therapy’ to be developed by the researcher, will be applied for the elderly in welfare centers, hospitals, and sanitariums. Through this practice, the researcher will develop better literature therapy programs based on clinical experience from welfare centers or sanitariums. Korean society is about to become a super-aged society, beyond the elderly society. The ‘program for the health of the elderly and literature therapy’ to be developed by this study will endeavor to be a desirable program to meet the changes of the times.
ConclusionAging populations pose a serious social problem around the world, including Korea. Nevertheless, there is little research and education regarding the transitional period toward the elderly. New types of therapy using literature have recently been developed, particularly bibliotherapy and literature therapy. However, systematic and integrative literature therapy is still in the beginning stage. This study suggests a theoretical foundation of literature therapy for prevention and treatment by supporting the health of the elderly with literature. The results are summarized as follows.
First, research of the social background for elderly problems indicates that geriatric diseases increase in proportion to the increase of the population. Second, for literature therapy, a comprehensive understanding is initially required about the health of the elderly through phased consideration for the elderly problems. Third, for treatment of geriatric diseases using literature, it is necessary to develop more active and integrative literature therapy than passive bibliotherapy. Fourth, a theoretical approach should be considered for the health of the elderly and the literature therapy. Throughout this approach, literature therapy can help the study of geriatric diseases such as dementia and depression. To do this, a program for the health of the elderly and literature therapy should be developed as the next step.
This research was supported by Sahmyook University Research Grant.
The authors declare no conflict of interest.
