Is boredom a risk factor for the elderly?

Old age used to be perceived as a state of "illness" or "abnormality", due to the biological deterioration that accompanies it, and was treated according to purely medical criteria in the past. The new ecological view of ageing shows that physical and cognitive decline in the elderly can also be attributed to environmental conditions. Many studies have shown that loneliness is one of those contextual factors that play against optimal aging. Is boredom also a factor? Levels of satisfaction and perception of well-being in the last stage of life are intimately associated with boredom. But is boredom a risk factor in ensuring dignified ageing? And, if so (which is not a priori anything clear), is it for exogenous or endogenous reasons? 

Boredom in the elderly did not arouse the curiosity of researchers until almost the second half of the last century. Since then, many experts have agreed that older people are not bored or are much less bored than the rest of the population. A brief review of the literature shows that in the 1930s it was thought that older people were less bored because time passed more quickly after a certain age (Hoagland 1934). In the 1960s, it was emphasized that boredom diminished with age, as interaction with other people declined (Dean 1962). In the 1980s, studies suggested that older people were less bored because lower levels of activity were adopted in old age as part of adaptation to physical and cognitive limitations (Golant 1984). Before the turn of the century, some praised the abilities of older people to deal with the passage of time and the organization of it, boredom being a marginal experience among this age group (Vodanovich and Kass 1990). In fact, a study published in the journal Social Science & Medicine by a group of researchers from St. Bartholomew's Hospital Medical College and the Institute of Gerontology in London showed in 1993 that only 13-33% of seniors admitted to being bored. At the beginning of the new millennium, there are still those who defend that it is false that the elderly feel lonely and bored (Tornstam 2007). On the contrary, they postulate that boredom is an emotion absent in the lives of the elderly because they do not feel the urge of the young to seek constant stimulation (Anda 2012). Are they right? Are we the youngest ones who wrongly attribute to the elderly the unconfirmed experience of boredom? 

While it is true that there is a bias on our part to think that older people are bored because they are less active, it is also true that only a minority of thinkers argue that just because they are, older people are able to avoid boredom. Most studies show just the opposite. In the 1950s, it was stated that boredom was a psychosocial disease that was the biggest problem of aging, one that worsened exponentially with age (Still 1957). Specifically, an article published in the journal Psychology and Aging in 1992 showed that between the ages of 65 and 70 the experience of boredom began to increase to worrying levels. Recently, it has been discovered that time, far from passing faster, stops after 75 years, provided that the cognitive functions remain intact (Droit-Volet 2019). Especially among the elderly dependents, this is a condition that concerns 61.3% of them (Pérez Ortíz 2006). Even with the facilities of modern life, boredom seems to be one of the biggest problems in old age (Morioka-Douglas 2004) in all parts of the world (Du Toit et al. 2014), ranking number 7 in the top-10 of the most important setbacks for them, according to HelpAge India (Bantwal 2006). 

If we ask the older people around us, we will find answers that confirm both the position of the former and the latter group; although the balance is currently tipped towards the latter. Boredom does not affect everyone equally, even within the same age group. Within the one that conforms the one that popularly we know as "third age" also exists an undeniable heterogeneity that makes impossible to extend any type of conclusion to all the population that conforms it. However, we cannot deny that there is evidence that the elderly, with their different circumstances, are affected by this "plague" in very different ways. 

Studies emphasize that boredom in the elderly is very varied depending on many sociodemographic factors. For example, it is said that in men it has to do with the loss of the ability to carry out certain activities, while in women it is more attributed to the perceived sense of lack of usefulness to others (Pérez Ortíz 2006). In addition, it has been noted that their experience varies greatly depending on whether we refer to the age group 65+ or 85+ (Bowling et al. 1993). Finally, a key factor in determining the degree of impact of boredom on physical and cognitive well-being is the place where older people go about their daily lives. Those who live in residences seem to be more bored than those who age in their usual communities, as we will have the opportunity to see. 

There are many triggers for boredom in the elderly. In the 1940s, the main recognized cause of boredom was limited opportunity due to physical and cognitive impairment (Pollak 1948). In the 1960s, studies by gerontologist Lois R. Dean (1962) suggested that boredom in the elderly was the result of lack of energy and their own preference for more passive states and less interaction with others. Dean saw clearly then that the elders felt an invasion of their privacy that led them not to want to socialize, to like to be quiet and alone so as not to be disturbed by people's noises and stories. In their view, what made them most uncomfortable was the fact that others were scolding them and trying to help them do things. All of this led to isolation and inactivity that eventually resulted in boredom. In the following decades, other researchers claimed that boredom in the elderly was a correlate of lack of independence in decision-making (Baltes and Zerbe 1976; Schulz and Brenner 1997), abandonment of adult roles and breakdown of routines after retirement (Farmer and Sundberg 1986), withdrawal into excessively safe environments (Parmelee and Lawton 1990), or lack of activity planning (Skeet 1991). 

Currently, boredom in the elderly is referred to the context (exogenous boredom), for example, lack of company (Dickinson and Hill 2007), financial problems (Benefield and Holtzclaw 2014) or lack of opportunities to care for others (Rasquinha and Bantwal 2016). But recently it has also been suggested that boredom may have an endogenous cause, that is, that it is caused by reduced cognitive functions. Conroy and his team's studies (2010) go in this direction, when they explain that many older people develop a propensity for boredom that makes them unable to take an interest in their surroundings, even if they are stimulating. 

Whether it is endogenous or exogenous boredom, or a mixture of both, boredom has come to be considered a risk factor in ensuring dignified ageing because its sustained suffering over time causes both physical and psychological problems that affect the development of the elderly's lives. Boredom leads to states of anger, irritation and frustration (Dean 1962; Chipperfield et al. 2003), agitation and nervousness (Cohen-Mansfield et al. 1990), sleep disorders (Ancoli-Israel et al. 2008; Bowling et al. 1993), decreased functional abilities and perceived sense of health (Bowling et al. 1993; Chipperfield et al. 2003), loneliness (Bowling et al. 1993; Creecy et al. 1985), disinterest in the outside world (Cooney 2012), depression (Morioka-Douglas 2004), increased alcohol consumption (Brody 1982) and even suicidal ideation (Batchelor 1953). Only one study of all respondents reports that boredom is positive in older people because it urges them to relate to each other, making them more active and making the decision to embark on projects (Anda 2012). 

Simone de Beauvoir was right when she said, in La Vieillesse, that only by having projects in old age was it possible to escape boredom. But what happens when projects are not within reach or it is simply assumed that the elders have already fulfilled all their purposes in this life? This is the problem faced by older people living in residential homes, where they depend on others to be able to promote an exciting context that moves away exogenous boredom and prevents the development of the permanent state of endogenous boredom. In this delicate circumstance, I believe that there is no doubt that boredom can become a risk factor to which attention must be paid in order to ensure dignified ageing by the institutions. Do we currently recognise that boredom is a risk factor in retirement homes? I'll tell you about it in the next post.