Old Age and Unfinished Business

Introduction

It is well known that people around the world are living longer. Countries around the world are facing the reality that they are experiencing growth in both the size and proportion of older people in the population. By 2030, it is estimated that 1 out of every 6 people in the world will be 60 years of age or older. By 2050, the world’s population aged 60 and over is expected to double, while the number of people aged 80 and over is expected to triple [1].

This change in the population distribution of a country is known as population aging. Although population aging has started early in high-income countries such as Japan, by 2024, it is seen that this change has been experienced to a great extent in low- and middle-income countries. According to population projections, by 2050, two-thirds of the world population aged 60 years and older is expected to live in low- and middle-income countries [1]. The structure and culture of the society in which we live have a great impact on the differences between societies in terms of aging. Although the aging of the population brings many difficulties for societies, these difficulties are an indicator of some development and civilization. It is seen that societies with high rates of old age across the world also have high levels of welfare. In developed countries, the majority of the population consists of elderly individuals. The point to be considered is the decline in birth rates, decreasing mortality rates and migration dynamics in the demographic transformation process [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28].

The elderly population of each society has its own sociodemographic characteristics. When we look at the characteristics of Turkey’s elderly population, we see a population structure with low welfare and education levels, limited consumption practices, no retirement planning and difficulty in adapting to the aging process. Under all these conditions, while there is a need for a multifaceted planning and study on aging and aging, in Turkey, aging is approached only with a focus on health and care [28]. However, aging and old age is not a phenomenon that occurs only in these areas, and a broader and more comprehensive perspective is needed.

Aging leads to physical, psychological and social changes. These changes also affect the lifestyle, quality of life and life span of the individual. Health-promoting behaviors can be defined as behaviors that increase the well-being of the individual and provide self-improvement. Health promotion includes living a life focused on achieving satisfaction and using productivity effectively [29]. Taking responsibility for health-promoting behaviors, balanced nutrition, adequate exercise, avoiding bad habits, paying attention to hygiene, establishing positive social relationships and stress management are of great importance for a healthy life. Improving the health of elderly individuals and their independence in their lives are related to the adequacy of their cognitive and physical functions [26].

Health-promoting behaviors ensure that the lives of older individuals are better and contribute to raising their living standards [29]. It is important to adopt a health promotion approach to each elderly individual by recognizing that aging is a part of the life cycle, focusing on healthy aging and increasing the positive effects of elderly individuals on their own health [30, 31].

Aging brings about many physical, psychological and sociological changes. Aging means having a wide range of experiences and going through changes both mentally and physically. Throughout life, the body and mind try to adapt to external factors and events as we age. It happens secretly over a long period of time, such as during work or family life. It can also happen more noticeably during a workout or during and after a serious illness. People continue to change as long as they live. The aging process is often so slow that this adaptation is continuous and gradual. Because family and friends age with the person, they experience most of the changes together. In order to cope with the challenges of aging, the individual uses his/her life experience and wisdom to stay physically active. Contentment and happiness are as valuable in old age as in the early years of life. Many older people want a life free from previous expectations and restrictions [2].

It is important to mature the necessary conditions for the formation of a life free from expectations and constraints and to ensure adaptation to the present. One of the factors affecting the adaptation of the elderly individual to the present time is that he/she has a task that he/she has not completed, a task that he/she has not completed or a task that he/she has not finished in his/her youth or in his/ her life so far. Especially in Gestalt therapy, “unfinished business” is a concept related to unfinished, unmet needs and unresolved emotional states of a person in the past. People accumulate many “unfinished business” throughout their lives. This is also true in old age and can make it difficult for a person to be present in the moment, to be here and now. The memories that individuals encounter in old age can be positive or negative. These memories have the potential to affect personal development by confronting the past and working on unfinished business [7, 9].

Individuals may develop various strategies to cope with unfinished business in old age. In older individuals, the completion of unfinished tasks aims to provide emotional relief and inner peace. In this context, feelings of longing for the past and dissatisfaction in the present can have a significant impact on the psychological state of individuals.

Unfinished business, the emotions, thoughts and behaviors that stem from a person’s past and prevent them from being present in the moment; emotions, thoughts and behaviors that they do not express; all kinds of physical and psychological needs that they do not meet constitute the unfinished business of the person. As unfinished business accumulates, it causes the person to experience various psychological problems. Being aware of one’s unfinished business has an important place in terms of ensuring and maintaining psychological well-being. It is important to gain awareness of the psychological problems of the elderly and to prevent them before they progress further; even to prevent the problems before they occur, if possible, and to treat psychological and emotional problems, depression, anxiety or physical disorders that may occur in old age [11, 16].

Moreover, in old age, it is an important activity for individuals to express their feelings and thoughts about unfinished tasks. This supports the individual’s social and psychological well-being. These unfinished tasks encountered in old age both affect the quality of life of the individual and are directly related to difficulties in social relations. Therefore, it is critical to emphasize this issue and develop supportive treatment methods. The aim of this study is to raise awareness about the concept of unfinished business, which is a reflection of individuals’ relationships with the past and the emotional and psychological difficulties they face, in order to improve the quality of life of individuals in old age.

Aging and Old Age

Old age is defined as the stage of life above 60 or 65 years of age [1, 2]. Aging is a process starting from birth until death and old age is one of the stages of aging [20]. This process is too complex a concept to be restricted to a specific time period through biological, psychological, cognitive and social components [7]. Aging at the biological level results from the accumulation of a wide range of molecular and cellular damages over time. This leads to a gradual decline in physical and mental capacity, increased risk of disease and ultimately death. These changes are neither linear nor consistent and are only loosely related to a person’s age. The variation seen in old age is not random. Beyond biological changes, aging is often associated with other life transitions, such as retirement, moving to a more suitable home, and the death of friends and partners [1]. The shortcomings, deprivations, isolation, illnesses and gradual loss of lifelong achievements brought about by the aging process make people face their mortality, albeit very difficult. However, for those who have lived and are living a productive and creative life by protecting their physical and cognitive health and with the support of the social environment, old age can also be a period filled with wisdom, peace and joy of living [7]. This period is a process characterized by changes in roles within the family [20].

Aging is a process of change. Biological and chronological aging may differ for individuals in terms of genetic inheritance, gender-related characteristics, work life and social status governing different periods of life. Therefore, it is very problematic to explain the distress related to this process only in biological or environmental terms. This is because problems such as depressive mood, insomnia, anger, difficulty concentrating, etc. can be interpreted as the depressions of menopause/andropause and hormonal changes, while the psychological concerns related to aging can be ignored. Aging requires very intense spiritual work. Thinking, seeking representation and change are inevitable. Aging as a subjective experience arises from the encounter between one’s external reality and one’s spiritual reality. The aging person finds himself/herself in a spiritual work, moving through the repetitions and regressions of his/her childhood, adolescence and maturing years. In time, in its own rhythm, the person realizes that it has an end and that it must face this end. Beyond the physical aging process, the work of aging is rooted in complex experiences that mobilize and structure the psyche. Losing, missing and giving up; these words push the person to seek new ways of fulfillment with disappointments from an early age [8]. All this makes one think about life and death.

Verdon [8] explains the process of change in aging in terms of cognitive symptoms, physical, biological, social, spiritual causality and temporality. At this point, psychic temporality should be considered in terms of life crises, transitional paths, and the problematics that change and remain constant in the psyche. Thinking about the repetitions and regressions in childhood, adolescence, and maturation years brings along many things such as unfinished business, what ifs, mistakes, what was meant to be done, what was never done. How the aging individual spent the past time, his/her experiences and memories function as the most fundamental determinant of his/her present time.

In old age, the perception of worthlessness, feeling helpless, indecisiveness and the predominance of regrets about the past can be important factors in the individual’s depression and hopelessness. When the individual makes a negative evaluation, in cases where regrets about the past predominate, he/she may feel hopeless, that his/her life is not as it should be and that he/she has no choice but to try different ways of living. The elderly individual who analyzes his/her life with the thought of impending death in old age, if he/she thinks that he/she has not lived his/her life well enough and if his/her regrets about the past are dominant, the feeling of hopelessness may even bring the individual to the brink of suicide [27, 30].

The conditions under which the individual ages, past experiences, traumas, family and social-social dynamics, health habits and behaviors make it possible for the individual to face a state of satisfaction or unhappiness towards life [32]. The fact that hopelessness and feeling useless in the elderly have ties with their past experiences in the pre-elderly period contains important information about whether depression and feeling hopeless in the elderly lead a good life or not. However, the rate of psychological vulnerability in the elderly who feel hopeless can be as high as 68.4% [33].

Emotional and psychological state plays an important role in old age. Many older people search for meaning and purpose in this period of their lives. It is common to evaluate past life experiences and review achievements and regrets. During this period, the risk of depression and anxiety increases if individuals feel worthless or lose their social role. However, maintaining a positive life perspective during this period positively affects psychological health and general well-being [34, 35, 36].

Unfinished Business

Unfinished business, which is one of the basic concepts of Gestalt therapy theory, originates from the past and affects the individual’s present life, that is, his/her existence “here and now” [16]. Now is very important in Gestalt therapy. Because the impact of past and future events on the person can only be realized through the present. Awareness is a feature that can only be gained through relationships, here and now. Gestalt Therapy contributes to the client’s gaining awareness and increasing the level of awareness. If the client can get rid of the effects of the past and the future, it will be easier for him/her to exist in the present and now [5, 10, 11, 12, 13, 17, 18, 19].

According to Perls, the term “unfinished business” is used for the gap between the past and the present, and “anxiety” for the gap between the present and the future [16]. If a person is caught between unfinished business and anxiety, he/she cannot capture the present moment and this causes him/her to disconnect from life. If an individual wants to improve his/her quality of life by using his/her full potential, he/she should focus on the present whenever possible. If the person starts to disconnect from the moment and where they are, unfinished tasks and anxieties increase continuously, which leads to less self-actualization [4, 6, 16, 17].

Unfinished work causes the individual to stay in too much mental intensity looking back to the past, which prevents the person from being present in the here and now. The famous Russian psychologist Zeigarnik states that the person tends to return to the unfinished work and finish them spontaneously. This is known as the “Zeigarnik Effect” in psychology literature. After many experiments, Zeigarnik reported that incomplete tasks are remembered much more than completed ones [5, 6]. It was hypothesized that when a person aims to finish a task they have started, a tension builds up. This tension tends to be released upon task completion. If task completion does not occur, the tension in the person will not be released. As a result, the desire to complete a task will remain in place until the activity is completed and the tension is released. According to the Zeigarnik Effect, individuals generate motivation to minimize tension. Zeigarnik’s findings supported Lewin’s thesis about tension. It has been argued that unreleased tension determines the nature of an individual’s behavior until the action is completed. If the action is interrupted, this tension does not disappear and so the interrupted action remains in memory. In parallel to Zeigarnik’s research, Ovsiankina also conducted a study and found the Ovsiankina Effect. According to this effect, people tend to restart an interrupted action when it has not yet been done [6].

There is thought to be a relationship between the psychoanalytic approach and the fact that people remember interrupted activities more. To better explain this relationship, it is useful to look back to Freud’s theory of repression. The tendency to suppress the affect and expression of bad feelings or painful cognitions in order to prevent damage to one’s good self-image is called repression [5, 6]. In Breuer and Freud’s writings on repression, they explained the term as the suppression and blocking from the conscious mind of unpleasant memories that the patient wants to forget. This happens because unpleasant feelings are blocked from conscious thoughts. Related to this, Kurt Lewin once emphasized that Zeigarnik’s basic findings about interrupted activities are close to Freud’s basic assumptions about repression. Freud has a statement that supports this point. Unresolved problems, depressive thoughts, disturbing worries follow our thought activity during sleep and try to cope with psychic processes called preconscious [5].

According to Gestalt therapy theory, it is accepted that if people have unfinished work, they suffer from the pain of finishing their unfinished work. Until they finish their unfinished work, people are in a sense under the bondage of unfinished work [5]. Polster and Polster said the following about unfinished business: “Most people have a large capacity for unfinished business [15]. Fortunately so, because each person accumulates a large amount of unfinished business over the course of a lifetime. While some may be able to tolerate this backlog as much as possible, unfinished business accumulates, waiting to be completed; when it becomes strong enough, it invades the mind, leading to obsessive behavior, excessive vigilance, repressive energy, and self-destructive activities”. From this point of view, in order for people to lead a healthy life, it is necessary for them to be aware of their unfinished tasks as much as possible and to seek, find and utilize opportunities to complete them [6]. According to Polster, et al. [15] holism is important for Gestalt therapy. It is the awareness of the here and now that ensures the integrity of the person with his/her whole being from the past to the future. Awareness provides a better understanding of the structure of the events experienced by the person [5, 6].

According to the Gestalt therapy theory, if people have unfinished work, it is constantly present in the person’s thought content, creates more or less different degrees of distress and anxiety, and creates motivation to finish it. People are intellectually, emotionally and behaviorally under the influence of their unfinished tasks until they finish them. Among unfinished business, the most disturbing ones are the ones that the person has experienced from the past to the present with people important to him/her. Every person has countless unfinished business in their lives. Although some people can tolerate these unfinished business as much as possible, they keep waiting to be completed as they accumulate; when they are strong enough, they can affect the thoughts and feelings of the person and lead to obsessive behaviors, oppressive energy and activities that can harm the self. As unfinished tasks accumulate, various psychological problems and psychosomatic reactions may emerge over time [11, 12, 19]. As a matter of fact, as people complete unfinished work, they experience relief in terms of thought, emotion and behavior, and they direct their energy to other vital activities with the comfort of completing that work. In this respect, being aware of one’s unfinished tasks is important in terms of ensuring and maintaining psychological well-being [5].

Possible emotional reactions to unfinished tasks may include negative emotions such as regret, anger, guilt, shame, unexpressed resentment, anxiety, sadness, abandonment, hatred, and positive emotions such as gratitude, love, joy, enthusiasm, excitement [4]. It has been determined that people with more unfinished work experience feelings of anger, guilt and shame more intensely [5, 6].

People can have a wide variety of unfinished business. One of the important indicators of unfinished business is that one is living in the past; in other words, it becomes difficult for one to exist in the here and now. Among unfinished business, the most troubling ones are the ones that the person has experienced in the past and present with other people who are important to him/her. Especially in family relationships, situations such as not receiving enough attention from family members, not having one’s needs such as acceptance, love and appreciation met, sulking and cutting off communication can be considered as examples of unfinished business. They may also have important unfinished business in their relationships with people outside the family, that is, people around them [5].

Klingspon, et al. [22] study by in a sample of 224 bereaved individuals, they examined the presence and severity of unfinished business reported in open-ended qualitative narratives as well as common themes of unfinished business. The study findings revealed information about grief interventions aiming to alleviate distress related to unresolved relational problems with the deceased. With ageing, the concept of death becomes a more common situation. The aging individual encounters the death of his/her spouse, close friends and peers. This may bring unfinished business with the deceased person to the agenda.

In the study of Lee, et al. [24], they examined the grief experiences of 209 adult mourners who lost their loved ones due to coronavirus, focusing on feelings of self-blame and unresolved problems related to the deceased. In the study, those who had a closer relationship with the deceased reported both more distress due to unfinished work and more intense and dysfunctional grief symptoms. Therefore, people with a lot of unfinished work accumulate unfinished work continuously by not expressing their feelings and not being aware of their own needs. Psychosomatic reactions may occur in these people in time [5, 6]. In addition to the health problems caused by the change and slowdown in body functions during the aging period, the presence of psychosomatic problems caused by unfinished work will make the process more difficult.

In the study of Shahar in the short-term emotion- focused group therapy in which nine people participated, the participants were enabled to express their emotions that they did not express in their relationships and it was concluded that it was very effective in finishing unfinished business.

Unfinished work prevents the individual from being present in the moment. Being present in the moment, that is, being here and now, is when our consciousness focuses on the moment with awareness and experiences its surroundings without being stuck in the past or the future. Although the past and the future are important concepts for our lives, they are concepts that are not present in the moment we live in. People who experience discomfort due to unfinished work may tend to live dependent on others, rather than being autonomous and independent. The person who has too much unfinished work is so busy with himself/herself that he/she may keep his/her feelings inside instead of expressing them to the other party [5]. In the aging process, it is an important concept that the individual continues to live independently by continuing to use his/her functions.

Being here and now is a technique that can be used interdisciplinary in therapies. According to Irvin Yalom, the idea of being ‘here and now’ in the therapy process is based on the idea that the client’s interpersonal problems will eventually arise between the client and the therapist [23]. Gestalt therapy is one of the therapy methods that emphasise being here and now. In Gestalt therapy, the past and the future are unimportant; the only thing that is important for therapy is the experiences experienced ‘here and now’ [11]. In individual psychotherapies such as Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), Acceptance and Commitment Therapy (ACT), Mindfulness- Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT) and group psychotherapies such as psychodrama and emotion-focused group therapy, unfinished business can be worked on here and now.

Conclusion

Uncompleted tasks take up more space in people’s memories and recollections of the past, especially in old age. According to Erik Erikson, one of the personality development theorists, the individual experiences despair confusion against ego integrity in old age. The individual will reach ego integrity if the life period conflicts up to this period are concluded positively. If it results in a negative outcome, the feeling of hopelessness will lead the individual to find his/her life unsuccessful [9, 12, 36]. Talking about memories frequently in old age is an important activity. Some of these memories are positive and some are negative. While talking about one’s own life, it is usual for people to feel proud of the choices they made or regret their regrets when they look back. But they will also feel the need to complete the aspects of their past that are incomplete and will take action to fulfill this need. Even if this is not a physical movement, it will be a mental and spiritual process. Thus, the older person will seek a sense of completion and when they find it mentally and spiritually, they will reach the whole of their story. This will enable them to be present in the here and now and they will be able to make better use of their time.

Considering that aging rates are increasing in the world today, it is necessary to work psychotherapeutically with unfinished work in old age. Because with the completion of unfinished work, the elderly will be physically, psychologically and socially healthier. It is thought that the elderly will be able to reach the goal of healthy and active aging more easily.

Conflicts of Interest

The authors declare no conflict of interest.