The Fountain of Use-fulness

by, Christina Pierpaoli, ChangingAging Contributor

As a psychology Ph.D. student, most of my time is spent tucked away in a lab doing research. The lab is a curious place: at once beguiling, like a Siren, the complexities of the natural world while also keeping them cautiously at bay—controlled, compartmentalized.

But it is life’s laboratory that nourishes the stuff of the books and nooks and notes that live in our labs. The most interesting psychological questions are not those that we cautiously contrive, but those with which the natural world indiscriminately confronts us.

I did not always know or trust this.

Around the same time I’d submitted my first manuscript for publication, my sixty-something father had undergone rotator cuff surgery. Two things preoccupied me: (1) what question(s) would my next publication address, and (2) would my father be okay?

In the days following his surgery—between hours of frenetic note taking and reading—I’d call to check in with him. Our conversations usually went like this:

Me: “How ya doing, Dad? How are you feeling today?”

Dad (in full Brooklynese): “Ay, sweetie! I’m feeling great. In pain, but doing some exercises to feel better.”

Me (incredulously): “Exercises? Already? You weren’t even operated on 48 hours ago.”

Dad (jokingly): “I’m an important guy—people need me! Like your crazy motha (pronounced: muh-tha)! Gotta make myself useful around here.”

And suddenly, I found myself plopped unapologetically in the middle of life’s laboratory. I repeated his words to myself: people need me. People need me. I wondered: was my father’s perceived responsibility his proximal social world—my mother, me, his friends—in some way, influencing how he coped with his pain? Was he feeling needed by and useful to his friends and family, in part, motivating an exercise regime that Jane Fonda herself would envy?

My research interests—united in their attempts to understand associations of chronic illness (e.g. osteoarthritis, HIV/AIDS, obesity) with psychological health in older adults—emerge from this question. More specifically, it asks: “How do feelings of usefulness to others in later life influence the selection and application of adaptive health behaviors?”

And why am I asking it? Because, all too often in this culture of ours, if you’re old, you’re simply not useful anymore. And really, what’s the use of a culture like that?

I’ve begun — under the mentorship and support of Dr. Patricia A. Parmelee— slowly but surely, to answer this question using her samples of older adults with knee osteoarthritis (KOA)—an incurable, chronically painful joint disorder.

In the United States, osteoarthritis ranks among the top three health conditions causing disability and is estimated to affect 26.9 million adults. It also represents the most common source of chronic pain in older adults—with more than half over the age of 65 reporting KOA-related pain and about 80 percent reporting some degree of disability or movement limitation. And because KOA cannot be cured, adults learn to cope with the pain either actively—by attempting more or less directly to control it—or passively, through relinquishing control of it. Research across rheumatic diseases (e.g. rheumatoid arthritis) has linked active coping strategies— like direct problem solving— with less pain, functional disability, depression, and greater quality of life than passive approaches.

So, what exactly determines how we cope?

Deciding to cope actively or passively with knee pain—and pain in general—illustrates a psychologically interesting and complex question because beliefs, values, and goals are heavily involved in that decision. For example, if you believe you meaningfully contribute to, and are needed by a community, might you be motivated to be more active in your approach to coping with pain?

Gerontological theories of activity and continuity hold that, to age successfully, older adults aim to maintain the activities and relationships of their earlier years of life. Accordingly, decrements in social and economic participation notwithstanding, older adults desire to remain active, useful, and generative. It stands to reason that feeling useful to others in later life may, in part, motivate the selection of pain management strategies that reinforce and maintain feelings of usefulness, particularly with disabilities like KOA.

Indeed, using a sample of 199 persons with physician-confirmed knee osteoarthritis, preliminary results from our ongoing research suggest older adults who endorse feeling more useful— that is—who have relationships that offer opportunities for helping others and who feel validated for their interpersonal worth—are more likely to use active coping strategies to manage their knee pain than those who feel less useful. While further research is needed, our results provide preliminary support for the possibility that feelings of usefulness may motivate the selection of adaptive health behaviors, like active pain coping, that promote the maintenance of social engagement and function with disability.

This raises interesting implications for clinical care—specifically, the importance of recommending a broader range of interventions to persons with KOA aimed at both social and physical activity. Further research clarifying the psychological role of perceived usefulness in promoting health behavior is needed, but will continue to gain relevance as the population ages, rates of chronic disabilities like KOA continue to grow, and contributory roles of older adults as mentors, volunteers, and productive citizens increase.

And so while my mother may make my father crazy, at least she makes him feel useful.

What does usefulness mean to you?