‘Old-Old’ Versus ‘Old-Young’ in Relation to Pediatric Resilience

The many stages of development have always fascinated me, but perhaps one of the most intriguing aspects from week one’s assigned reading regarding development is the concept of ‘old-old’ and ‘old-young’. As described in the textbook, the term ‘old-old’ refers to individuals who are 85 or older and typically dependent or disabled by age-related disease, whereas the term ‘old-young’ refers to people typically aged 65 to 85 who are active and independent. Although these terms refer to geriatric patients specifically, this paper is inspired by the developmental concepts of ‘old-old’ and ‘old-young’ as it pertains to resilience across the lifespan, particularly within pediatric nursing.

While the terms ‘old-old’ and ‘old-young’ are specific to geriatric individuals of both independent and dependent nature with often permanent disability, the many disabled children that were present during my upbringing illuminate the stark contrast between age-related disease and childhood illness. 

Given that I grew up near one of the top ten children’s hospitals in the United States, being surrounded by complexly disabled children was routine for me. Routine checkups would leave me awestruck by these disabled children and their resilience. One child in particular remains in my mind often. Her bright smile and curious eyes after undergoing open heart surgery merely a few days prior was not just a sign of her positivity, but rather a key factor in how children cope with childhood illness versus geriatric coping.

Many children’s hospitals in the modern day era have Certified Child Life Specialists, who are individuals that are focused on maintaining developmental milestones and improving the social and emotional aspects of pediatric patients and their everyday lives. Child life specialists assist in coping with procedures, processing, bereavement support, and other tasks. These critical members of the healthcare team can play a primary role in improving patient outcomes and medical trauma, preserving childhood coping and milestones. In terms of development, they are crucial to pediatric patient success from as early as newborns through the age of eighteen. One of the most intriguing aspects of child life and childhood coping is that oftentimes pediatric patients recover. This contrasts with ‘old-old’ geriatric patients, as many have to accept that their disability is permanent, progressive, or even terminal. This differentiates the previously mentioned resilient child whose young body is naturally optimized for recovery, and the many ‘old-old’ individuals who face the harsh reality of the irreversible loss of their independence. However, many terminal children maintain resilience, much like ‘old-old’ patients, by continuing to progress in development through play in manners often assisted by child life.

Age-related decline has become particularly relevant to my life as I have watched my grandparents become ‘old-old’ adults. Particularly, the development of my grandfather’s Alzheimer's has created a reality where I now understand the spectrum of disability and the true dependence of geriatric patients. Watching my grandfather go from an avid marathon runner and neonatologist to a man who can barely walk has been a stark difference, and one that is central to the theme of ‘old-old’ and ‘old-young.’

Furthermore, the varying spectrum of disability, ranging from congenital and acquired disability to the irreversible and terminal illnesses that are often accompanied with age-related changes, has led me to pursue a career in both healthcare and education. As a future pediatric hospice nurse, my goal is to help children who are dying learn to cope with their terminal illnesses in a way that is developmentally appropriate and to pass away in a manner that is pain-free and peaceful.

Furthermore, my interest in special education comes from my intrigue within neurodiverse individuals, which encapsulates a different type of disability that is often stigmatized and misunderstood. I intend to aid individuals of all types of ability in their educational journeys, being respectful to their neurodevelopmental status and the homeostasis of their nervous systems.

To conclude, the developmental concepts of ‘old-old’ and ‘old-young’ from this week's reading greatly inspired this paper on pediatrics, truly making me ponder resilience as an age-related factor and the loss of independence that comes with the natural aging process.