Self help tools here include: an assessment tool, seven domains to explore through the lens of aging (7E's), books to assist navigating aging, and a tutorial on replacing unhelpful thoughts with thoughts that are useful (and lead to goal directed behaviors).
Oyler’s "Controllables" Self Assessment
All Scoring on questions = 1- 5 points. Strongly Disagree = 1pt; Strongly Agree = 5 pt.
Each set of questions (questions 1 and 2; questions 3 and 4; etc. comprise a domain).
Exercise
- 1. I engage in some form of heart/cardio activity or exercise for at least 30 minutes at least twice a week. Note: this can include activities such as gardening/landscaping , swimming, or walking along with the traditional “cardio” exercises.
____ Strongly disagree = 1 pt
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree = 5 pt
- 2. I engage in some form of strengthening activity or exercise for at least 30 minutes at least twice a week. Note: this can include activities such as squats, pushups or pullups, along with traditional strength training such as kettlebells or weightlifting.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Dietary
- 3. I have knowledge regarding my best practice dietary habits that I have learned from my doctor, or other sources.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 4. I generally engage in best dietary practices as evidenced by: my bmi/weight , or my doctors feedback, or other factors tests. Those factors may include glucose levels, lipid panels re cholesterol, etc.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Environment
- 5. I reside in a safe environment that is likely to meet my physical, social, and spiritual needs for the foreseeable year 12 months and/or I have a methodology to ensure my environment can meet my likely future safety needs.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 6. I have family, friends , or neighbors that I can socialize with and would be available in case of an emergency.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Engagement in activities
- 7. I engage in activities on a weekly basis that are pleasurable or fun and I engage in those activities with others that I care for and/or who care for me.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 8. I engage in activities on a weekly basis that are meaningful or give a sense of achievement with others that I care for and/or who care for me. This can include volunteering, attending classes, etc.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Future Planning
- 9. I have engaged in planning for my living including:
Where I will reside.
Who can assist with my care. (Paid and unpaid persons).
Understanding likely expenses of my needs.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 10. I have planned for significant illness/my passing by:
Completing advance directives
Identifying a medical power of attorney
Identifying a durable power of attorney
Completing a last will.
Completing arrangements or identifying who will.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Education
- 11. On a weekly basis, I continue to learn in one or more of the following domains:
Spiritual or religious.
Health and wellness.
Traditional and/or non-traditional education.
Other.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 12. Generativity = “Others benefit from my experience, knowledge.”.
I pass my knowledge on to others in one or more of the following domains:
Spiritual or religious.
Health and wellness.
Traditional and/or non-traditional education.
Other.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Adaptation
- 13. Regarding adapting the aging process, I address the “controllable” aspects of aging through goal directed thoughts and behaviors. This can include my health/wellness regime, home modifications, adaptive socialization, etc.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 14. Regarding adapting to the aging process,I have formal and informal supports to assist with the “uncontrollable” such as medical concerns, adapting my living area, assisting with my activities of daily living, etc.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Meaning
- 15. I have identified life domains that have meaning to me and I engage in cognitions and/or behaviors that are meaningful in those domains on a weekly basis.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 16. I am leaving a legacy to other persons, institutions, or causes that are meaningful to me. This legacy can be an emotional legacy, a financial legacy, etc. Examples include: “My children love and respect nature and I have contributed to that.”, “My contribution of time and treasure to the pet shelter is meaningful to me.”, “My will contains…”
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Spiritual beliefs about problems
- 17. God, or the universe, is a partner in my problem solving methodologies. This can mean: I bring my problems to God, I believe that God cares about my problems, I believe God has the ability to assist with my problems.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 18. Looking back, and looking forward, I believe that: Though age-related challenges/problems can bring many hardships I can also factually say, “Problems are one method of producing spiritual growth.”
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
Emotional Health
- 19. I have a mental health knowledge and “tools” (KSA’s) to assist with age-related emotional challenges such as sadness, loneliness, grief, or anxiety when encountering challenges such as loss of others I care for, medical decline, less than desirable living options etc..
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
- 20. I have formal and/or informal supports to assist with those age-related emotional challenges.
____ Strongly disagree
____ Disagree somewhat
____ Neither agree or disagree
____ Agree somewhat
____ Strongly agree
RESULTS, SCORING, USE OF DATA
- Results are utilized to explore methods of increasing well-being.
- 100 possible points.
- Total score under 80 will benefit from deeper exploration.
- Each question with a score of 3 or less will benefit from being explored/addressed.
- Each domain (each set of 2 questions) with a combined score of 6 or less will benefit from being explored/addressed.
- Domains can be addressed through cognitive and/or behavioral adaptations.
Total Score _______________
Questions with a score of 3 or less ________________
Domains with a score of 6 or less ____________________________________
Replacing Unhelpful Thoughts and Behaviors Tutorial
CBT teaches methodologies of replacing unhelpful thoughts with thoughts that are accurate and useful. Useful replacement thoughts then lead to goal-directed behaviors. We can apply these skills to various aging domains.
Some thought replacement techniques include: disputation (“What is the ‘evidence’ for ABC, and the ‘evidence’ against ABC?”), dichotomy of control (“What part of this can I control or influence, and what part of this is not in my control?”), downward arrow (“And if that actually happened, what would I do?”), defusion ("I'm having a thought that I will end up in a nursing home, but it is only a thought and I do not even have to label it true or false"), and distancing ("I'm going to revisit this problem a bit later, as I'm a bit upset right now").
For example, in the domain of exercise, a factually inaccurate thought could be, "I'm 68 years old, it is too late to begin an exercise program." CBT teaches methods for testing and replacing thoughts such as these. In this case the thought can be tested with a technique called "disputation". Using disputation we could ask the question, "What actual evidence to I have that 68 is too late to begin an exercise program?" and "Is there any evidence at all that some exercise programs can be beneficial to a 68 year-old?". Disputation methods would also include these sources of evidence: "Books focused on aging usually contain a chapter on exercise", or "I may ask my PCP about adding an exercise regime to get their opinion" , or "I'm going to investigate what the National Institute on Aging has to say about this question".
As another example, in the domain of housing, an unhelpful thought could be, "Renovating the entire house to accommodate my health concerns is impossible...I'll have to move..." This thought can also be tested with disputation ("evidence" for and against). This thought can also be tested with one of the keys to serenity: Dichotomy of Control. "What part of my housing, and health, concerns can I control, influence, or change?". Using dichotomy of control, one would move from an unhelpful thought to thoughts focused on what one actually has control over. In this case it may be using a Certified Aging in Place Specialist (CAPS) and/or addressing the controllable portions of health concerns. It may also explore alternative housing options, but (and this is the important part) even if I am exploring alternative housing options it is because this is what I do have control over.
Finally, in the domain of human mortality, one could explore the following questions:
"Though I don't want to think about my death or the death of my loved ones, what do experts in this domain say about planning for this inevitable event?"
" Is avoiding the ultimate question of human mortality a useful strategy?"
* "Using my deeply felt spiritual values, what does the New Testament (or the Hebrew Bible, or other spiritual teachings) say about physical/corporeal mortality?"
Books on Aging, Dying, and CBT
Recommended Books on Aging Well :
* Outlive
Attia, P. (2023). Outlive: The Science and Art of Longevity. Harmony Books.
* From Strength to Strength.
Brooks, A. (2022). From Strength to Strength: Finding Success, Happiness, and Deep Purpose in the Second Half of Life. Portfolio Penguin.
* Blue Zones
Buettner, D. (2008). The Blue Zones: Lessons for living longer from the people who've lived the longest. National Geographic Society.
* The Art of Aging
Nuland, S. (2008). The Art of Aging. Random House.
* Aging Well
Vaillant, G. (2002). Aging Well. Little, Brown, Spark.
* Triumphs of Experience
Vaillant, G. (2012). Triumphs of Experience: The Men of the Harvard Grant Study. Belknap Press of Harvard University Press.
* The Good Life
Waldinger, R. & Schulz, M. (2023). The good life: Lessons from the world’s longest scientific study of happiness. Simon and Schuster.
* The Art and Science of Aging Well
Williams, M. (2016). The art and science of aging well. The University of North Carolina Press.
Recommended Books on Death and Dying Well:
* The Art of Dying Well
Butler, K. (2019). The Art of Dying Well: A Practical Guide to a Good End of Life. Scribner.
*The Lost Art of Dying"
Dugdale, L.S., (2021). The lost art of dying: Reviving forgotten wisdom. Harper One.
* Being Mortal
Gawande, A. (2014). Being mortal: medicine and what matters in the end. Henry Holt and company.
* A Beginners Guide to the End
Miller, B. and Berger, S. (2019). A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death. Simon & Schuster.
* How We Die
Nuland, S. (1995). How We Die. Vintage Books: A Division of Random House.
Recommended Books on CBT and CBT's Precursors:
Accepting, anticipating, and adapting to age-related change will entail modifying one's thoughts and behaviors. The recommended approach to changing one's thoughts. and behaviors is Cognitive Behavioral Therapy (CBT).
Books regarding using the Cognitive Behavioral Therapeutic approach to changing thoughts and behaviors include:
* Feeling Good
Burns, D. (1999) . Feeling good: The new mood therapy (Rev. ed.). Avon Books.
* Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks
Gillihan, S. (2020). Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks. Sheldon Press.
* Mind Over Mood
Greenberger, D., & Padesky, C. A. (1995). Mind over mood: A cognitive therapy treatment manual for clients. Guilford Press.
*Epictetus ' Discourses, Fragments, Enchiridion (Vol. I and II)
Oldfather, W.A. (1928). Epictetus Vol. II: Discourses, Fragments, Enchiridion. Harvard
University Press.
*Ancient Christian Wisdom and Aaron Beck’s Cognitive Therapy:
Trader, A. (2012). Ancient Christian Wisdom and Aaron Beck’s Cognitive Therapy: A Meeting of
the Minds. Peter Lang Publishing.
Exploring Seven E's
Seven Life Domains to Explore Regarding Aging
Effective behavioral health practices.
This domain is foundational for the older adult to maximize well-being. Historic and modern themes of effective psychosocial functioning include: acceptance of one’s mortality, focus on one’s controllables, working to change what can be changed, actively engaging in activities and relationships that are conducive to overall well-being, social maturity, emotional maturity, involvement in values-based thoughts and behaviors that are larger than oneself, coping strategies, and effective problem solving strategies.
CBT postulates that identifying and replacing unhelpful and factually inaccurate thoughts will reduce distress and increase well-being. Engaging in meaningful behaviors also increases well-being. Engaging in those meaningful behaviors with others further increases well-being. Effective behavioral health practices necessitate that unhelpful or unrealistic thoughts will be replaced by factually accurate and realistic thoughts and those replacement thoughts then facilitate older adults to engage in well-being based, goal-based, and values-based behaviors. These cognitive and behavioral techniques can be utilized when addressing various life challenges (housing needs, medical needs, recreation, socialization, generativity, legacy, etc.) faced by older adults.
Education.
Education, both teaching and learning, is another domain leading to positive outcomes for older adults. For example, the Harvard/Grant study found that inner city males who earned a college degree in a non-traditional (older) age range, experienced significantly improved aging outcomes (both health and longevity) when compared to their inner city peers.
The education sub-domains include: attaining a college degree in a non-traditional (later life) stage, education as a protective cognitive factor, educating oneself regarding methods of aging well (including diet, exercise, sleep, risks), educating oneself regarding end-of-life planning, and being an educator to others (passing on one’s wisdom, thus promoting generativity or legacy).
CBT-based interventions in this domain include addressing, and replacing, thoughts such as: “Going back to school at 65 would be impossible.” and “I don’t want to think about planning for my own incapacity or death.”. Factually inaccurate or unhelpful thoughts can be replaced, and goal-directed behaviors can be implemented.
Engagement
Active participation in meaningful relationships and meaningful or pleasurable activities on a weekly basis was a significant component in older adults' well-being in both historic and modern literature. All of the longitudinal studies mentioned in this website found that engagement in meaningful relationships was a constant factor in successful aging, and that successful outcomes through engagement can be facilitated through various types of activities.
Activities of engagement may be in the domains of exercise, recreation, socialization, spirituality, education, volunteer work, or other domains. A note on meaningful activities: all meaningful activities are beneficial, however activities having a meaning or purpose larger than the individual participating in them allowed those individuals to experience positive thoughts and feelings regarding generativity or legacy.
CBT’s behavioral activation theory, a method assisting clients to “experiment” with behavioral change, is an evidenced-based methodology of facilitating engagement in activities likely to increase well-being.
End game planning.
This includes end-of-life-planning, housing adaptations, sustaining important relationships throughout life stages, legacy, and asking oneself, “How will this course of action likely end?” in various life domains.
Regarding the end-of-life planning sub-domain, we found no case of a historic Christian document or data modern medical literature that would support ignoring one’s mortality. The literature and studies mentioned here agreed that planning for the future, including planning for one’s mortality, was of significant assistance regarding living well and dying well. Addressing this sub-domain would include: discussing the options with formal (medical providers, attorneys, etc.) and informal (family, friends) supports, making an informed decision, and documenting that decision in a manner that legal and medical personnel traditionally accept (Advance Directives, POLST, Last Will, Medical Power of Attorney, Financial Power of Attorney, etc.).
Environment and its' subdomains.
Environment (safety, socialization, proximity to support systems, sleep). Environmental factors, one’s home and proximity to supports, is another important domain to explore. The safety of the living space, including methods of adapting one’s home and consideration of an alternate living environment if safety is a concern, is an important factor in successful adaptations regarding addressing aging and age-related medical decline. Planning ahead for where one would like to reside due to medical decline is preferable to being told to make a decision regarding which unfamiliar institution to choose upon an upcoming hospital discharge.
The environmental proximity to one’s formal and informal supports is another predictor of positive aging outcomes in various longitudinal studies. The ability to access formal and informal supports such as family, friends, medical providers, and spiritual supports increases psychosocial functioning.
One example of applying the tools of CBT to the environmental domain would be to explore a thought such as, “It would be horrible to move from the home I raised the family in.” One could test that thought using disputation (What evidence do I have that it would be horrible?) or dichotomy of control (What about this is actually in my control?). One could also utilize formal and informal support systems to assist with the decision and logistical considerations. Once the issue has been addressed cognitively, the next step is to engage in goal-directed behaviors. The goal directed behaviors may be to move or to renovate the home (with the adult children assisting or by hiring a certified aging-in-place specialist). The application of CBT will entail turning unhelpful thoughts to goal-directed behaviors.
Exercise.
Engaging in various forms of exercise, movement, and physical activity were present in all of the longitudinal studies and and all of the medical publications regarding healthy aging. Regarding numerous studies of "successful aging" or "aging well", all of the experts found that engaging in exercise was highly recommended.
For the aging adult specifically, the exercise domain includes: walking, strength training, cardio training, balance, and flexibility.
One could address unhelpful thoughts such as: “It is too late in life to begin an exercise program.”, “I don’t have the time to exercise.”, and “I can’t afford a gym membership” with the use of disputation ("What actual evidence do I have that it is too late to start exercising?") and dichotomy of control ("What portion of beginning an exercise program do I have control over today?").
One can also utilize formal and informal supports (friends, geriatrician, PCP) to explore the benefits of late life exercise, safety, temporal recommendations for exercise programs, and the availability of friends or family to engage in physical activities together.
Behaviorally, we would emphasize the importance of engaging in a safe and medically approved exercise plan even if one does not feel motivated on any given day. If an age-appropriate plan was created, then engaging in the plan even if one does not always feel like engaging would be of paramount importance. From the well-being aspect of behavioral activation, when the exercise program involves active engagement with others, such as practicing group yoga or playing tennis with an old friend, is an additional well-being enhancer.
Eating (dietary habits).
One’s diet, eating in a manner that is consistent with health and longevity, was present in all of the modern medical literature. Choosing dietary habits conducive to health was a recurring indicator of healthy aging. The dietary domain affected one’s “health span” (healthy lifespan) significantly. Subfactors included one’s weight, food types, and amount of food processing. Cognitive and behavioral applications regarding this domain include exploring what a change may look like using one’s formal (PCP, Registered Dietician) and informal (friends, family, faith community) supports and engaging in sustainable behavioral changes. Thoughts such as, “When it’s my time to die, it’s my time…I’ll eat what I want.” and , “Anyone can get cancer” can be effectively explored through the cognitive restructuring methods of disputation, dichotomy of control, and downward arrow. Once unhelpful thoughts are replaced by factually accurate and helpful thoughts, the client can successfully begin engaging in healthy and sustainable dietary practices.
