Some time ago, I sent an article to Carole Lewis in which I advocated a view of geriatric rehabilitation as a developmental endeavor. I held that if we indeed believe aging to be a developmental process, rather than merely a series of progressive losses following the climax of our young adulthood, then we must ask ourselves, as function declines, what is it that we are helping our patients develop?

The article appeared in the March 2002 issue, and Dr Lewis graciously offered me the unexpected opportunity to edit an issue on geriatric rehabilitation "for the soul." A journal with a history of addressing topics of meaning and import was once again willing to explore the complexities of the rehabilitation profession on behalf of the older client.

And so this issue was born. Geriatric Rehabilitation for the Soul.

What is soul? An elusive concept, not entering willingly into the captivity of words, soul is less defined than it is recognized. We know soul when we encounter it-in music, in food, in paintings. It is soul that gives depth to experience. It lives in the complexities and depths of our lives.

In an era when we tend to look to technology and medicine to solve our problems and cure our ills, the risk has been neglect of the soul. It has left much of our "care" hollow. But it has been my sense that geriatric rehabilitation draws to it people who have an intuitive appreciation of the depth and intricacies of old age. Several years ago, my dissertation explored the experiences of physical therapists working with older adults. Their most commonly cited positive aspect of working with the ill elderly was that of benefiting from their wisdom, experiences, and life perspectives. Clearly these were people who could see beyond the body to the person, who recognized a value that does not rely purely on physical or cognitive ability. Such health professionals are dissatisfied with superficial care. Their instinctive longing to enrich patient interactions causes them to be frustrated in a system that favors regulations, protocols, and efficiency.

These are the people who would agree with my elderly patient with advanced Alzheimer's disease who, upon walking outside and seeing the newly planted pansies at the entrance to the nursing home, looked at me with momentary lucidity and said almost angrily, "You just can't take the growing out of people!!"

It is for these people that this issue was created.

An issue on geriatric rehabilitation for the soul, like the soul it speaks to, will not be a checklist of activities or instructions. It will present an image for our reflection, embodying a variety of textures and angles, encouraging us in our efforts to nurture the soul of the elder in rehabilitation. In this spirit, this issue is offered. The articles together speak of a full life, lived in the present.

Thomas Moore, whose landmark best-seller made "care of the soul" a household phrase, opens with a thoughtful consideration of aging as a call to soul, reminding us that body and soul are not separate entities. When we care for the body, we care for the soul. Viewing patient interactions as care of the soul rather than as therapy, improvement, or cure allows us to see rehabilitation in a whole new light.

It is the generally accepted approach in rehabilitation to address physical function in the context of improving quality of life. At some point, however, the question arises, "Is development of quality of life possible even when physical ability declines? Is there still a place for rehabilitation when physical function is not a goal?" "Rising With the Fall" renders a confident yes. While physical function and quality of life can be related, there is a potential gap between them-a gap that offers rehabilitation specialists a unique opportunity to enhance quality of life for even the frailest older adult.

Next, Dr Phillips gathers thoughts and suggestions from different areas of health care on ways to infuse spirituality into our everyday professional practice, recognizing the importance of spirituality to both patients and practitioners. Spirituality is not simply the application of a technique. It requires both an internal and an external attentiveness.

In "Soul Music in the Twilight Years," Bridgit Hogan describes the role of music in the final weeks, days, and minutes of patients' lives. In example after example, Hogan illustrates the power of music to speak to the soul even when other means of contact fail, to facilitate healing of emotions and relationships even when the body itself will not be healed.

In a culture that is not easily still, Dr McBee has been teaching mindfulness to older clients and the people who care for them. Her inspiring article draws on years of experience leading groups of older adults in mindfulness workshops in a variety of geriatric settings, including long-term care and Alzheimer's units.

The image of holistic patient interaction visits us again in "Empathy and Transcendence." Through her diligent examination of its nature, Dr Davis reveals the transcendent quality of empathy that causes it to be central to moral health care. Practicing true empathy during patient care deepens our professional practice, providing access to the spiritual dimension of healing through closer connection with our essential selves and through a "crossing over" to others.

The work concludes with a description of "Elderhood in Eden," a vision of eldercare rooted in the belief that late life is a time of great potential and should be nurtured in an environment of growth, relationships, and spontaneity. Dr William Thomas, founder and president of the Eden Alternative(TM) to nursing homes, speaks with passion of the need to recreate the world of long-term care in the image of a garden.

I selected the authors and gave them the topic. As the separate authors carefully crafted their pieces and sent them to me, I read them and watched similar themes emerging from them all. The soul savors the moment. The soul is fed by community and by relationships. It expresses itself in imagination and longs for texture and richness in its experience. Throughout the articles, the message was clear that old age is not something to be prevented or conquered but to be experienced fully.

How do we bring "soul" to our rehabilitation efforts? One cares for the soul by tending to the senses, by using imagination, by honoring our attachments and relationship, by relinquishing our illusion of control to the possibilities of transcendence. Soul calls for us to deepen our understanding, to acknowledge the depth beyond the surface, the ethereal beyond the tangible, the mystery that is a part of all of us and of which we are all a part.

I often find, when I am reading about old age, a tendency for authors to use poetry to speak for them. I believe the concepts of old age, frailty, and mortality call out the poetic in us. We are aware that there is more to these elders than the physical, and we intuitively seek something suitable to express that reality. We choose poetry because it, too, conveys great truths by means of a limited frame.

I find myself similarly enticed, as the themes of this issue are captured in a poem by Mary Oliver. 1:

I don't know exactly what a prayer is.

I do know how to pay attention, how to fall down

into the grass, how to kneel down in the grass,

how to be idle and blessed, how to stroll through the fields,

which is what I have been doing all day.

Tell me, what else should I have done?

Doesn't everything die at last, and too soon?

Tell me, what is it you plan to do

With your one wild and precious life?

Soul does not turn from the wrinkles that form in old age. It finds itself in the folds of the weakened flesh. We as health professionals have the opportunity, as a presence in this time of vulnerability, to support our elder clients in their quest to live this "one wild and precious life."

Holding the sheaf of papers that will become this issue is like holding a special gift that I can open, again and again. I am grateful to all the authors who contributed their energy and wisdom to this work; to Carole Lewis for her guidance and insight; and to the thousands of individual patients who have shared their elderhood experiences with me, whose stories may not be individually recorded but whose contributions are woven into my life and work.

In the classroom, my physical therapy students sometimes ask, "Will this test cover material that was on the last test, too?" My unfailing answer, as I break the news that indeed it will, is, "Every patient is a cumulative exam." In the same way, I find that every patient experience is a cumulative one; I bring to each patient moment all the moments of experience that have led me to it.

Finally, I dedicate this issue to Patricia Johansson-my elder, guide, and close companion-my mother. Her appreciation of the richness of simple things-a love of words, a love of dancing, a love of the garden-have nurtured the souls of many. Her words and touch are in everything I write.

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