This idea of rounding up former chairs of the Generations Editorial Advisory Board for a dedicated journal to mark ASA’s 70th anniversary is delightful, and something to celebrate, indeed!

For 7 1/2 years between 2006 and 2015 I served as chair of the Editorial Advisory Board, and my choices of journal issues that were of particular interest or held special meaning for me (I have hard copies of all of them) are taken from those years.

The experience of looking back over the journals prompted a cognitive and affective road trip for me as I recalled all the people who served on the Editorial Advisory Board during my tenure as chair. They were a terrific group, individually wonderful people from whom I learned so much. Some topics we selected as a group in a very careful (and lively!) process were more interesting to me personally and professionally than others, but they all turned into good editions.

Two editions jumped out at me for different reasons. One was devoted to a topic relevant to my clinical work: “Couples in Later Life” (Fall 2007; vol. 31, No. 3). In fact, I contributed an article (Loss of the 'Supplementary Spouse' in Marriages in Later Life) to that edition. (The only time I did so.)

But another edition spoke to me as being incredibly relevant, indeed prescient, to what we have all gone through these past 4 years during the pandemic. I'm referring to the Winter 2007–2008 (vol. 31, no. 4) edition, “Disasters and Older Adults.” The contributing authors spoke mainly of hurricanes Katrina and Rita (both in 2005), and the terrorist attacks of Sept. 11, 2001, and their impacts on older adults.

I read the edition twice, once when it came out and now, 19 to 23 years later, and identified several points as being similar to our pandemic experience, identifying points of what we did that “went right” and what “went wrong.” Most important is what we learned that can inform our societal and public health behaviors going forward.

A major difference between the events is that the disasters addressed in Generations were unpredicted, singular events. The pandemic, in contrast, had a long runway building up to it, and maintains an interminable “4 years and still counting” presence. Where one addressed disaster victims’ identification and rescue, the emphases of the pandemic were victim identification and care.

Where one was rebuilding (after the hurricanes and after the terrorist attacks), the other’s emphasis was on containment (during the pandemic).

A common theme found to be of great importance was the interconnectedness of people who supported the most vulnerable victims, including and especially, older persons. With the protracted disaster, family caregivers, direct care, and healthcare workers, who form the backbone of formal care services, became horribly burned out from the sheer volume of victims and the way the acute phase of the disaster played out across such a vast amount of time. And the sheer volume of deaths. Older persons died in numbers way out of proportion to their percentage in the population.

And many, many more suffered while living. They were isolated and locked up with other older people. They shared the virus, became ill, and died together. They were separated from those they loved and who wanted to support them but were not allowed to be with them.

We learned that loneliness was a powerful secondary killer. I suspect that many of us hold an image of an older person on one side of a windowpane and a loved one on the other side, both reaching out to the other and denied touch, which is so vital to being human.

Those older people who made it into the hospital also were disconnected from the support of their families and friends. Faces were masked. This was especially difficult for older people who rely upon seeing the face and lips to help them hear. And protective masks also muffle sound. Everyone wore gloves, so even skin-to-skin touch was denied. Latex does not feel like skin. Any attempt at cheerful or culturally meaningful attire was covered by surgical gowns.

As the severity of the virus made its power known, no visitors were allowed. The burden of providing the fear-reducing, hope-inducing benefits of a loving presence was put on the hospital staff. In addition to their complex clinical duties, they would spend time holding hands with patients, comforting them, and managing iPads for Zoom meetings with desperate family members.

We found that those older adults who survived the acute pandemic displayed a remarkable resilience that enabled them to “bounce back.” We in the “aging business” know well that older people are more vulnerable than younger people in many ways. And we also know that having survived for many years, elders are often more resilient. “Been there. Done that. And lived through it.”

The COVID pandemic is no longer a pandemic. The WHO has declared it over. The current view of the virus is much like a seasonal flu. As always, older adults are selectively at risk to develop serious illness if they get a virus, and more likely to be hospitalized and die from the illness. If they survive a lengthy hospital stay, they are more likely to be transferred to a step-down facility or a nursing home, where many will live out their lives.

Because the pandemic has been declared “over,” globally we are moving from a reactive phase to a proactive phase to prepare for the next one. And there will be a next one (bird flu is trending in that direction as I write this).

We must anticipate that future health emergency, prepare for it, and use what we have learned from prior ones. Besides supporting the laboratory science that will help us to avoid and cope with the next virus, to minimize its spread and lethality, we need to remember the power of connection and how we can enable that. We must recall that putting old vulnerable people together might not be smart, even if it is expedient. We must understand that older people do not move well, and that a reasonable risk for them to remain in place is sometimes better than moving to someplace “better.”

Preparedness also means attending to the “runway” as well as the acute and post phases of a pandemic disaster, as we are still learning. COVID is not over for the many who have long COVID, for instance. The disaster is not over for older folks who are still isolating in place because they are afraid to resume their pre-COVID lives. They are more at risk of dying from the isolation and the loneliness than they are from the virus in its present iteration.

We were caught unprepared, and older people took the hit first and hardest. We need to make sure we support our public health system and keep it provided with whatever it needs to attend to the next disaster. And the federal government and media need to be prepared with clear public service announcements to keep us all up-to-date on what is coming, to the extent that it is known, recognizing that some disasters come out of nowhere. But many do not.

Erlene Rosowsky, PsyD, FGSA, is professor emerita in the Clinical Psychology department at William James College (WJC). Prior to her retirement she served as director of the Concentration in Geropsychology and founding director of the WJC Alliance for Aging. She is a teaching associate in the Department of Psychiatry at Harvard Medical School, and a fellow of the Gerontological Society of America.

Photo credit: Creativa Images

Loss of the 'Supplementary Spouse' in Marriages in Later Life

By Erlene Rosowsky

When problems arise in a marriage of many years (marriage here refers to all long-term relationships of committed life partners), one cannot help but ask, Why now? What has happened to challenge and stress the marital bond? What challenge with which they cannot cope is the couple facing now? Is the challenge itself so daunting, or rather, are the resources available to address it inadequate? After all, the couple has a long history of individual and dyadic coping that has been strengthened and refined over the years, and has been applied to numerous challenges. So why now?

As a clinician, I often train a diagnostic lens on the individual, appraising what change might have served as precipitant to the current distress. The same questions can be posed when looking at a couple. Is there a new personal challenge for one of the partners? A change in medical condition or medication? Or did something happen to the couple to engender the distress? Has the couple been unsettled by a move, perhaps? Or retirement from work?

These frequently occurring events in older age can contribute to structural changes within a marriage, often of sufficient power to cause distress in one or both spouses. The clinical literature addressing these events is extensive. The theme of loss and its impact on the marriage is of continuing importance in later life—most significant, of course, with the eventual death of a spouse.

There are, however, other losses, often connected to transitional events, that are powerful yet less well identified as contributors to significant structural change in the marriage in later life. These are para-spousal losses, that is, losses of a significant person who plays a very important role in the life of one of the partners in the couple, but is not the spouse—thus the idea of the “supplementary spouse.”

While many, perhaps most, marriages in later life are most fittingly thought of as dyads, some are more appropriately described as triads. An apt metaphor could be that of a tripod, a frame with three legs supporting something, in this case a marriage, wherein sturdiness and stability rely on functional intactness of all three legs. In these marriages, the supplementary spouse is the third leg of the tripod.

While the specific relationships are different, all supplementary spouses serve a common function of supporting the marriage. When this critical support is lost, the effect is to bring stress upon the marriage. Consider the supplementary spouse as a supporting beam in a building structure. If this beam becomes damaged or collapses, the consequence can be that the entire structure becomes damaged or collapses. Sometimes the loss of a supplementary spouse is behind the presenting problems that come to clinical attention.

The major functions of marriage in older age (truly, at any age) are collaboration, companionship, support, intimacy, and self-continuity; the supplementary spouse serves to fulfill these functions well. The supplementary spouse, thus, is an integral segment of the marital triad. Included in this collection of relationships, among others, are the long-term lover, the intimate friend and confidante, the work companion, the “work wife,” and the “recreational buddy.”

In the case of the long-term lover, an affair often develops over the years into a “parallel marriage” with defined rules, roles, and responsibilities and the lover now aparallel. What begins as a relationship outside the primary marriage evolves, over the long term, into a parallel marriage defined as a committed life-partner relationship. Over time, the edges of the two marriages—once having been parallel, maintaining a constant distance apart and thus never meeting—often become increasingly comparable and, not unusually, meet and cross.

Loss of the parallel spouse can have an enormous impact on the primary marriage. An unsanctioned, hidden bereavement occurs; it cannot be comforted by the primary spouse, or possibly by anyone, as it has been held secret. From another perspective, it is not uncommon for the parallel spouse to provide support—often concrete and direct—when the primary spouse functionally begins to fail. The parallel spouse may become a de facto case manager for a primary spouse who increasingly needs care as a dementing disorder progresses, for example.

Marriages also can be greatly stressed upon loss of a special friend of one of the spouses. It is not unusual for a friend to have become a supplementary spouse, for example, when one’s primary spouse is unable (for any reason) to be present, engaged, and emotionally supportive. Frequently a special friend becomes a confidante and fulfills these functions. When this special friend is lost, the one left behind turns to the primary spouse seeking to replace this emotional support, and once again is left wanting. The spouse who is unable to provide this support and fill the vacant role is left feeling bewildered and inadequate.

The work companion and “work wife” are other supplementary spouses who can provide a frame for self-continuity, which typically comes to an abrupt end with retirement. I treated a man for a reactive depression after he lost his supplementary spouse when he entered retirement—even though he had been looking forward to retiring. For over forty years, he had carpooled with another man who worked in the same office. They traveled to and from work; an hour’s drive each way. They had spent ten hours each week together, for over forty years, talking, sharing their lives, hopes, dreams, and demons. They had not developed a pattern of socializing outside of work; their relationship was strictly work-bound, and so when retirement occurred, they each lost, at the least, a most special friend. For my patient, his friend had evolved into a supplementary spouse who came to know more about what he held in his heart than did his wife. Raising a family, working long hours to earn a living, had left them—the primary pair—“running on automatic,” with little time alone dedicated to cultivating the kind of intimacy he had developed with his friend.

Another common phenomenon is the emergence of a “work wife”—someone at work who is counted on for “wifely duties” for his or her boss (a “work wife” can be of either sex). Occasionally the “work wife” will evolve into a lover, but that is not the usual script. However, over the years, being together eight or more (waking!) hours a day, the work wife can become a supplementary spouse. When this relationship is lost, it is less the performance of “duties” that are missed than it is the valued reflection of one’s being competent and powerful, especially when this is not the same mirror held up by the spouse at home, and especially for those individuals who in the main define themselves by their work role. The function of self-continuity is often in part secured through a supplementary spousal role assumed in older age by a long-term “recreational buddy.” The “golf widow” refers to a spouse who is left behind when one goes off to play the game. Loss of one’s long-term recreational buddy can result in a feeling of being widowed, and a deep grief can ensue. This means not only the loss of the person or the loss of support of self-continuity, but also the recognition of no longer being a player, of being at the end of the game.

Erlene Rosowsky, Psy.D., is assistant professor of psychiatry, Harvard Medical School, and a clinical psychologist in Needham, Mass.