Rosemary Blieszner

Topics and Timestamps

• Background and career (0:00)
• The importance of friendship in aging (3:10)
• Cultural differences and caregiving (7:35)
• Culture and geographic barriers and culture (9:20)
• Solidarity in the family, and close-knit families (10:08)
• Culture in rural Appalachia vs. other parts of society (11:44)
• Key discovery or finding: Gratitude (14:16)
• Blieszner’s thoughts on successful aging (17:20)
• Dementia and aging successfully (20:20)

Alex Bishop

I am here today with Dr. Rosemary Bliezner from Virginia Tech. Dr. Blieszner is an alumni distinguished professor at Virginia Tech and was an associate director of the Gerontology Research Center there for over three decades. I think you might have even been president of the Gerontological Society of America at one time. It’s an honor to be meeting with you today and I appreciate you for coming on and sharing your expertise and wisdom. If you don’t mind, please share with us a little bit about your current role as a gerontologist or an aging expert and, if you don’t mind, share how you became interested, or how you gravitated toward the field of gerontology or perhaps how gerontology might have found you. And then how did you develop your interest, or what interest blossomed from there.

Rosemary Blieszner

Well I thought I would study Piagetian Infant Development and partly it’s because that’s all I knew, because I wasn’t really introduced to the study of aging. But there were some faculty who were saying “This is a new field, you should think about this field.” And when I looked into it and I realized that there was funding available through the administration on aging and through the National Institute of Health and National Institute of Aging specifically. So I ended up applying to Penn State to their program in Adult Development and Aging. And I had both an Administration on Aging traineeship, and I also had an NIA fellowship. And it was at a time when there was great interest in creating more faculty and more researchers to build and strengthen the field of aging. And so my fellowship required the payback, basically. So I was supposed to get a job and be teaching and doing research in the field of aging, which was fine with me because that’s what I wanted to do anyway. And so I proceeded, then, to find this position at Virginia Tech that was specifically in Adult Development and Aging in the department that’s now called Human Development and Family Science. And so my dissertation research had been on friendship. I met other colleagues at conferences that were doing similar kinds of work. I worked with them and they were in faculty positions at other universities. But then I also got involved with colleagues here at Virginia Tech who had interests in studying family-related issues.

So, my career has really been about studying relationships in adulthood and in the later years of life. But that’s how I got into it. It was really sort of a fluke, in a way, because I didn’t know about the field until faculty started telling me to look into it. And then when I looked into it I found these opportunities that were very supportive.

Alex Bishop (3:10)

Some wise mentors, definitely. Now you talk about and I know you have a quite extensive career, a lot of times students will run across your work in the area of friendship. There just isn’t a lot of research done on friendship, but you also have kind of shifted and looked in to some caregiving issues and particularly rural Appalachia, which is a very interesting population. Can you first share a little bit about the friendship piece? I know you wrote a piece, “A little help from my friends” was the title. Little bit of a Beatles reference there. Can you explain how friendship is part of the caregiving process, perhaps, or how it plays into the work you’ve been doing on caregiving?

Rosemary Blieszner

Well, one of the observations… let me just back up and say, we interviewed, we did end up doing interviews with older adults about their friendship. And I was working with Rebecca Adams who is at the University of North Carolina at Greensboro, and we both had done the dissertations in the area of friendship. She from a sociological point of view and me from the more psychological perspective, and when we came together we realized that our worldviews could be complementary. And we built on our observations that we had made during the background research we did for the dissertations on what were the gaps and what were researchers not asking about friendship?

And prior to this work that we were involved in, people had just treated friendship as kind of peripheral. Only family relationships were really delved into in any depth. And so we set out to do in-depth interviews to build knowledge about the nature of friendships. And over the years one of the… there were some observations that emerged from that research and that also emerged from looking at the literature and one of them was, it seemed to me in the caregiving literature the focus was only on families and yet in this era a lot of older adults don’t live near their biological family members. They’re around the country or around the world but yet they have friends close by. And so I really started to think a lot about the role of friends in actually providing care to older adults. And then some older adults don’t have relatives and so they, too, are relying on friends and there are some friends who begin to engage in family-like roles. And there’s a lot of theory about what friends are and are not likely to do that might not necessarily predict this. But this is the reality of what we observe. And so that led to thinking about the need for agencies and government organizations to recognize friends as potential caregivers and to extend benefits to them that might only be usually given to family members in terms of providing care. And then it also was an observation that there’s not a word for loss of a friend. And some friend relationships are deeply intimate and caring, and when friends die people kind of ignore it. We pay a lot of attention if you become widowed or if you become orphaned because your parents have died. But we don’t really talk about that friendship loss. So that’s how I saw the friendship research connecting with the caregiving research. And yes, we have been looking at dementia caring and the role of families and others (friends, siblings, other people) in taking care of older adults. And we focused on Appalachia because Virginia Tech is in the Appalachia area and because the resources that are available to families are not as well-developed as they are in urban areas. And the geography, and there are a lot of factors that interfere with getting help and resources. And so we were interested in looking at, OK, how do families manage in this particular subcultural context, which is different from rural Midwest or different from urban areas.

Alex Bishop (7:35)

And what are some of those cultural differences, do you think, that you noticed in your research when it comes to caregiving? Particularly dementia care in Appalachia compared to somewhere like the rural Midwest or even out west?

Rosemary Blieszner

Well, if you don’t have access, if you have to go a long geographic distance and you’re driving over unpaved roads in the mountains, sometimes you might be cut off by snow in the wintertime, but sometimes it just takes too much time to get somewhere. Or even the resources might not necessarily be available. And so you become a lot more self-sufficient. And there’s sort of a cultural stereotype about people in the Appalachian region being more independent and they don’t want government to be involved in their lives and maybe that’s true in a way but we had plenty of people who said “If there were services I certainly would access them because I need help.” And so it wasn’t so much the idea of “I want my privacy” it was “There are no services available” or they’re at a great distance. Or they’re inconvenient to access or so forth. And we did some follow-up interviews in our study about what happened during the Covid pandemic and some of the people were really pretty stuck. Like, how could they get their person vaccinated when the vaccine had to be kept refrigerated and they lived far away and the doctors weren’t making home visits and the person was bed-bound and they couldn’t take them to get a vaccination so they just didn’t do it. It wasn’t that they objected to it, it was that it wasn’t possible to do it.

Alex Bishop (9:20)

Some real barriers there. Some geographic barriers.

Rosemary Blieszner

And they had some issues with the service providers, “Well this person got Covid and can’t come anymore.” “Well this person has an immunocompromised family member; they quit working.” And so there arose a dearth of people to help even if you wanted help. And so some of the struggles that they had were the same as everybody and some of them were different. Some people said they were actually better off during the pandemic because their grandchildren or their children were out of school and they were off of work and so they could come around the house and help more than they might have otherwise. But some of them were pretty stuck and they couldn’t really do anything or go anywhere. There was a range.

Alex Bishop (10:08)

Now [NAME] talks about solidarity in the family. Did you find that to be the case here in your research, that these families in Appalachia tend to be very close-knit?

Rosemary Blieszner

Usually, I think so. Of course there’s always variety and it’s important to recognize a heterogeneity. I think that’s one of the things that we saw. We, in finding our sample, we specifically looked for people who were living in that region for twenty or more years because we wanted them to be embedded in the culture. And to look at how their views of culture and of the cultural traditions, and that sort of thing, how that would affect their use of caregiving. And so, yes, we did find some people who really believed that they needed to rely on family and they were more reluctant, maybe, to have service providers come into the home. But a lot of the time that wasn’t really the issue. The issue was that there was nobody available to come. There was a range. There were people who wished for more services and especially if they didn’t have to pay for it. There were people, I mean they certainly took advantage of anything that their insurance or the local Pace program would offer to them. If there were services available they would take care of it. But that didn’t diminish their sense of loyalty and solidarity within the family. It was really supplemental to what the family could do.

Alex Bishop (11:44)

Now that leads me to another question that’s kind of a little bit off, but maybe you could answer. How would you define the culture of care in rural Appalachia vs. the other parts of society, so to speak.

Rosemary Blieszner

Well I’m not so sure that it’s different in terms of attitudes and values and, kind of the motivation to provide care. The differences were more about the access and the availability of services and the funding and that kind of thing. But the people that we met were…generally they were very…they might not have loved the idea that they had to set aside their own personal interests to do this caregiving but they did it because they honored either their parent or their spouse and they were very loyal to those people and they wanted to provide the best possible care for them. Sometimes they were able to get a break and go out with other friends or do things and we know that helps to prolong the ability of people to do the caregiving. Sometimes they couldn’t because the person who had dementia and who needed care objected to having anyone else around and they, the family caregiver, thought it wasn’t worth the hassle. So I think it was the same kinds of issues but they were often more isolated than might be the case if you had neighbors just across the street or down the road a little way. There was more isolation. And this was particularly true during the pandemic because then of course the social activities that they would have relied on, for example, going to church, weren’t happening. The local senior center or the local gym or something like that, or community center. Those were all shut down. And so the same kind of isolation that people felt in urban areas was also evident for them. If they had relatives living down the road or across the road, then they had family around. It really was a lot of variation.

Alex Bishop (14:16)

Now kind of switching gears a little bit, but making you think, kind of a challenge question for you, in all the years you’ve been in the field of gerontology, of all the research you’ve done, what is that one discovery or finding that has intrigued you the most in your career? Maybe it’s advanced the field of gerontology, maybe not. Maybe it’s evoked your curiosity throughout your career. But in ways that you think you just didn’t expect?

Rosemary Blieszner

Well, here’s the first thing that comes to mind. I have this deep sense of gratitude for all of the people who were willing to let us come into their lives. And mostly the kind of research that I’ve done has been in-depth interviews, we have done some phone interviews that we would follow up on or something like that. And of course during Covid it was all phone interviews. We weren’t seeing people in person. But the willingness, the generosity of people with sharing their lives and sharing their stories to basically strangers. We tried to explain the value of doing research and how what they were telling us could be useful to other families. And indeed, in the very beginning of the research that we started on before dementia was studying families with mild cognitive impairment. Because when we started that research in, like, around 2003, nobody knew anything about mild cognitive impairment. It had sort of been defined in the medical literature but there was no guidance for families. There was no information that doctors or anyone else could provide them. And so we took our interviews and created a brochure and had it vetted by medical people and social workers and so forth.

But we were basically using the words of the people in our study about how to cope, what to think about, how to handle this confusing and uncharted territory that we now call mild cognitive impairment. And the people were willing to talk with us and we told them and we sent them a copy of this brochure and now it’s available on the Center for Gerontology website. And it’s been downloaded a bazillion times. And we sent it, also, all over the place back then. (Mail and print copies more than electronic now.) But it was just always so gratifying to me that these people…I don’t know if they exactly thought that they were contributing to science but they were. And they were contributing to better practice and they were contributing to policy. We often wrote policy briefs as a result of our studies. And that was something that I just hadn’t really thought about it that way. I knew how to do research and what I wanted to study but I didn’t think about it so much from the other side of the desk or screen or interview table.

Alex Bishop (17:20)

Yeah and I often find in my own research, and I’m sure you do too, that oftentimes people will say “Well why do you want to talk to me? My story is not important.” And I think they don’t realize yes it is and researchers sometimes don’t realize, well, thank you for sharing that and allowing us to use it. A big part of this course is centered around the concept of successful aging. For good or bad, successful aging has had a past and ongoing debate for several decades. What is your perspective on this concept of successful aging, surrounding Rowe and Kahn’s idea? And how do you define successful aging, or how do you approach it?

Rosemary Blieszner

Well I think that it’s OK to use that concept if it’s an inclusive concept. And by that I mean that it allows for analyzing how well people are managing the aging process in their own life from whatever perspective and whatever social status and health status they are. And so I think that one of the ideas that kind of bothered me when this term was first used, and why I like the notion of aging well better, was that it seemed to imply that if you weren’t really healthy, if you weren’t in good physical condition, if you needed to use assistive devices or if you were poor or if you had a mental health issue, that you weren’t able to age successfully because it was defined as sort of this white middle class, successful background, people with a successful background who were healthy and everything.

And so I think that we just need to recognize whatever term we use that somebody could have a lifelong disability and still be aging well within the context of their experiences and their body and their cognitive functioning and so forth. So I think that we would want to avoid this, sort of, “Oh poor them.” Sort of pitiful…even people with dementia can have a quality of life that’s positive if they have people around them who understand how to manage and how to help to give them positive experiences. And so this approach that comes from looking at the positive aspects of what can a person do and building on what can they do so that you can look at anyone as aging successfully. Or not. You know, it’s possibly that they aren’t. But not to have pre-defined characteristics that eliminate people who are from other groups.

Alex Bishop (20:20)

Yeah, I think you bring up a good point. Even with dementia, the question would be “Can those individuals age successfully?” Or are they just, we consider them unsuccessful agers? What do you think about that? Do you think a person with dementia can still age well?

Rosemary Blieszner

I think they can but it requires people around them to support that. And so, by that I mean instead of arguing with somebody, “No I’m not your sister. I’m your daughter.” And insisting on your version of reality all the time and getting into fights about it with the person, to give them pleasant moments. What difference does it make if they think you’re their sister instead of their daughter? Give them a happy moment. Talk about what did you enjoy doing with your sister, and things like that. And so I think that there can be a lot of ways people can learn to be supportive of the person. And I fully understand that people have a lot of really serious physical limitations and maybe there are people who have also depression or other kinds of personality disorders that they’re bringing into old age with them that would make what I’m saying not possible. I completely understand that. Again, recognizing heterogeneity. But I think what I’m trying to say is, don’t lump everybody into the hopeless category. That nothing can be done for them. Try to find out what can be done.