Embracing Opposites: Meanings of Growing Old as Narrated by People Aged 85

Understanding the experience of living well, beyond the age of 85 years: a qualitative analysis using themes from a meta-ethnography

BACKGROUND

Increase in life-expectancy is not necessarily matched by an increase in quality of life.

OBJECTIVE

(1) To explore the quality of life of patients over the age of 85 in the second decade following unicompartmental knee replacement surgery (2) To understand the usefulness of a priori themes from an evidence synthesis as a framework for primary qualitative analysis.

DESIGN

Qualitative Research. A hermeneutic phenomenological approach, using a priori themes as sensitising concepts.

PARTICIPANTS

Adults over the age of 85 who were part of an outcomes study in the second decade following unicompartmental knee joint replacement.

METHODS

Semi-structured interviews in people's homes. Transcripts were coded and data sorted using a priori themes as sensitising concepts. Data that did not fit these themes, or that added nuance, were analysed thematically through constant comparison.

RESULTS

We interviewed seven white women and five white men, aged 85-100. Data resonated with a priori themes and supported additional themes that help us to understand older peoples' experience: (1) losing our autonomy can be challenging, so be kind; (2) we must take care of our own bodies and the NHS; (3) I am more afraid of not dying.

CONCLUSIONS

Findings indicate that health outcomes for older people should incorporate measures of participation and well-being; they highlight the importance of kindness in healthcare; they indicate that older people do not want to place additional burden on the NHS, and this can act as a barrier to care; they support the need for open conversations about dying well.

The Experience of Living to an Extreme Age: A Meta-Ethnography

Advances in health care mean that we can now treat diseases that once cut lives short. However, the increase in life expectancy has not been matched by improvements in quality of life. The World Health Organization warns us that all countries should prepare to meet the challenges of an aging population and this is integral to the United Nations 2030 Agenda for Sustainable Development. This may require a shift in attitude toward aging. We aimed to use meta-ethnography to explore the experience of adults living beyond the age of 80. Our conceptual model illuminates the phenomenon of connection in older age and reflects on the paradox of time: ephemeral, yet interminable. Our findings encourage us to reflect on the influence of enlightenment philosophies that underpin the desire for autonomy at all costs. Our study challenges the stereotypes of old age and has the potential to influence people's perspectives toward aging.

Relational Reasoning

This article addresses two goals. First, it considers the nature and importance of relational reasoning, the ability to discern meaningful patterns within informational streams. Second, it examines four principles about relational reasoning derived from the empirical literature. Specifically, we argue that relational reasoning is foundational and pervasive; varies as a consequence of age, domain, and context; can be measured in diverse ways; and is malleable and teachable. Evidence supports each of these principles, and the implications for educational policies and practices are weighed.

Inner strength as identified in narratives of elderly women: a focus group interview study

By identifying sources of inner strength, health care personnel can be given valuable information about elderly people's capacities regardless of frailty. The focus of this interview-based study was to explore how inner strength and its dimensions can be identified in narratives of elderly women. The analysis was based on a theoretical model where inner strength is composed of 4 interacting dimensions of connectedness, creativity, firmness, and flexibility. Our findings add nuance to the notion of inner strength and deepen empirical knowledge about the concept.

"Struggling for independence": the meaning of being an oldest old man in a rural area. Interpretation of oldest old men's narrations

The amount of older people receiving home nursing care is increasing; in rural areas, they are at additional risk because of the distance between people and health care facilities. No specific studies have been found about oldest old men living alone and receiving home nursing care and the meaning of living alone in one's own home. The aim of this study was therefore to illuminate the meaning of being an oldest old man living alone in a rural area and receiving home nursing care. A sample of 12 oldest old men living in rural areas in the middle of Norway was chosen for this study. Narrative interviews were conducted, and data were analyzed using the phenomenological hermeneutical method. After a naïve reading and a structural analysis of the text, we identified three themes: feelings of insufficiency in everyday life, finding hope in life, and feeling reconciliation with life. The comprehensive understanding suggested that being an oldest old man living alone in a rural area means a struggle between a dependent existence and a desire to be independent. Living in the tension between independence and dependency is a complex emotional situation where one is trying to accept the consequences of life and loss--reconciling the wish to live with the fact that life will come to an end.

Normal Aging or Depression? A Qualitative Study on the Differences Between Subsyndromal Depression and Depression in Very Old People

PURPOSE OF THE STUDY

The aim of this study was to make a qualitative comparison of experiences of being in very old people with subsyndromal depression (SSD), in relation to the experiences of very old people with syndromal depression or nondepression. Through investigation and deeper understanding of the interface between depressive disease and normal aging, clinicians might give more accurate prevention or treatment to those very old persons who need such help.

DESIGN AND METHODS

Semistructured qualitative interviews were conducted for 27 individuals of 87-88 years of age, who were categorized in the 3 strata of nondepressive, SSD, and syndromal depression. Transcripts were analyzed using qualitative content analysis within each stratum and later with a comparison between the strata.

RESULTS

The content analysis resulted in 4 themes in people with SSD, as defined by a self-report depression screening instrument, giving a comprehensive picture of SSD in very old people, and also showed qualitative differences between the SSD, syndromal depression, and nondepressive groups. A main finding was that SSD differs qualitatively from syndromal depression but not clearly from nondepression.

IMPLICATIONS

The results might indicate that SSD in very old people is not related to pathology but to normal aging, even though the condition correlates with negative health parameters. Overlooking certain psychosocial aspects of living in the very old may pose a risk of both underdiagnosis and overdiagnosis in the spectrum of depressive disorders.

Self-respect through ability to keep fear of frailty at a distance: successful ageing from the perspective of community-dwelling older people

With population ageing, there is an increased interest in how to promote a good old age. A predominant concept in these discussions is successful ageing, which is mainly based on researchers’ definitions. This article aims to explore successful ageing from the perspective of community-dwelling older people (24 persons aged 77–90 years). Individual open interviews were conducted and analysed according to qualitative content analysis. An overarching theme was formulated as “self-respect through ability to keep fear of frailty at a distance”. This embraced the content of four categories: “having sufficient bodily resources for security and opportunities”, “structures that promote security and opportunities”, “feeling valuable in relation to the outside world”, and “choosing gratitude instead of worries”. Ageing seems to be a dynamic process rather than a static structure and might therefore be susceptible to actions. Paying attention to attitudes and treating the older person with respect, particularly with regard to worries about increasing vulnerability, can lead to better ways of promoting successful ageing.

Living an unfamiliar body: the significance of the long-term influence of bodily changes on the perception of self after stroke

The aim of this study is to illuminate the significance of the long-term influence of bodily changes on the perception of self after stroke by means of narrative interviews with 23 stroke survivors. A phenomenological-hermeneutic approach inspired by the philosophy of Merleau-Ponty and Ricoeur is the methodological framework. Zahavi's understanding of the embodied self and Leder's concept of dys-appearance along with earlier research on identity guide the comprehensive understanding of the theme. The meaning of bodily changes after stroke can be understood as living with an altered perception of self. Stroke survivors perceive their bodies as fragile, unfamiliar and unreliable and tend to objectify them. The weak and discomforting body that 'cannot' demands constant, comprehensive awareness to keep itself in play. These long-term and often permanent consequences of bodily weakness may turn stroke survivors' intentionality inwards, away from external activities and projects and relationships with others. Negative judgements from others are added to lost roles and positions and threaten the vulnerable self. Stroke survivors try to regain familiarity with their body by their life-long project of testing its boundaries. Mastering important tasks helps them strengthen their self-concept. Health care workers should be aware of the embodied self and engage in long-term dialogues with stroke survivors to strengthen positive perceptions of body and self. More research is needed to understand destructive post-stroke phenomena such as fatigue and pain and to find effective methods to help stroke survivors regain wholeness of body and self.

Older people's dependence on caregivers' help in their own homes and their lived experiences of their opportunity to make independent decisions

AIM

The aim of this study was to illuminate the meaning of older people's dependence on caregivers' help, and of their opportunity to make independent decisions.

BACKGROUND

Throughout the world, the older population is growing, and in Sweden, the system of care for older people is currently undergoing change. Older people in the need of care are expected to live at home for as long as possible.

DESIGN

A qualitative and life world approach was used.

METHODS

Audio-taped interviews were conducted with twelve older persons living at home, dependent on daily municipal home help service. A phenomenological hermeneutic method was utilised to disclose the meanings of lived experiences.

FINDING

The findings revealed three themes: being facilitated to make one's own decisions, being hindered from making one's own decisions, struggling for vs. resigning oneself to losing the opportunity to make one's own decisions. The comprehensive understanding revealed that as older people become more dependent on caregivers' help, their opportunity to self-determine is challenged and this is stressful for them.

CONCLUSION

The older persons assess their opportunity to self-determine differently, depending on who they are as a person. The caregivers need an awareness of this, and further research is needed to gain knowledge and understanding of how caregivers can improve the way they support and enhance older people's opportunity to decide for themselves.

IMPLICATIONS FOR PRACTICE

The findings revealed older persons need to exercise more self-determination and caregivers' need for knowledge to enable this. Further, it indicates a move towards a person-centred approach to focus on persons as individuals and see them as interdependent. The findings contribute to improvements in similar contexts worldwide.

Validation of Self-Image of Aging Scale for Chinese Elders

Researchers are increasingly interested in the “image of aging” concept. Models on the image of aging abound, but few have rigorously tested measures that are culturally sensitive and domain-specific. This study first translates Levy et al.‘s (2004) Image of Aging Scale into the Chinese language and revises it into the Chinese Version of the Self-Image of Aging Scale (SIAS-C). Based on the results of a survey of 445 elderly people in Wuhan-China, it then reports the factorial structure of SIAS-C and some of its psychometric properties. Confirmatory factor analysis (CFA) supports a conceptually meaningful five-factor model, as suggested in an exploratory factor analysis (EFA). The 14-item SIAS-C vindicates an acceptable level of internal consistency and test-retest reliability. Its criteria-referenced validity is demonstrated by its correlation with several criteria in expected directions. In conclusion, the SIAS-C is a psychometrically sound instrument which is recommended for use among Chinese older people.

Lack of Resilience Among Very Old Men and Women: A Qualitative Gender Analysis

High degree of resilience has been described as an enduring positive view of life despite difficult circumstances during the aging process. How to become old and being old with low resilience have not been studied. The aim of this study was to illuminate experiences about becoming old and being old among very old people with low resilience. Interviews from very old women and men were analyzed using content analysis with the following themes identified: being out of it, emphasizing life experiences from the past, religiousdoubting, and accepting age. Except for religious doubting, the themes contained both similarities and variations between women and men. Our study showed that in spite of scoring low on the Resilience Scale (RS), very old persons can experience integration and well-being. However, the women seemed to be more vulnerable compared to men, and for them, it is important to strengthen social and relational possibilities for contributing to resilience.

Nursing home residents' views on dying and death: nursing home employee's perspective

AIM

To reveal nursing home employees' views on dying and death among older people they cared for.

BACKGROUND

Palliative care stakeholders recently included more groups in their definition of palliative care; older people constitute one such group. Consequently, palliative care systems, which will serve a large, aging cohort, will require new skills. The first stage in skills acquisition is to gather current views on dying and death.

DESIGN

Qualitative descriptive study that uses focus group discussions for data collection; 20 employees in 4 Swedish nursing homes participated.

METHOD

Data were analysed using qualitative content analysis.

RESULTS

The following categories were conceptualised: alleviating suffering and pain; finding meaning in everyday life; revealing thoughts and attitudes about death; taking care of the dead person's body; and coping with the gap between personal ideals and reality.

CONCLUSIONS

A deeper understanding of the palliative care philosophy is needed to further develop and tailor care for the dying persons in nursing homes.

RELEVANCE TO CLINICAL PRACTICE

To get public support for palliative care, the silence surrounding dying and death must be broken. Employees must receive education to prepare for all aspects of their work, and management must account for employees' situation when planning the care.

Experiences of loneliness among the very old: the Umeå 85+ project

OBJECTIVE

This study aims to elucidate experiences of loneliness among the very old, who live alone.

METHOD

Twenty-three women and seven men, aged 85-103 years, were interviewed about their experiences of loneliness. The text was subjected to qualitative content analysis.

RESULT

The descriptions of loneliness were twofold: on the one hand, living with losses and feeling abandoned represented the limitations imposed by loneliness; and on the other, living in confidence and feeling free represented the opportunities of loneliness. The findings indicate that experiences of loneliness among the very old are complex, and concern their relations in the past, the present, and the future.

CONCLUSION

Experiences of loneliness among the very old can be devastating or enriching, depending upon life circumstances and outlook on life and death. We interpreted these two aspects of loneliness as feelings of homelessness and at-homeness.