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Purpose in life among very old people
Umeå University, Faculty of Medicine, Department of Nursing.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis is to explore purpose in life among very old people. The proportion of elderly is increasing in Sweden, especially among the group of very old aged over 85 years. Ageing has been associated from some perspectives with health, wisdom, maturity, and inner strength. Ageing can also, however, lead to reduced physical function, cognitive impairments, and loss of purpose in life. A loss of purpose in life can lead to mental health problems such as depression. This thesis is part of the Umeå 85 + study/GERDA begun in 2000. Half of all 85-year-olds, all 90-year-olds, and all those 95 years of age or older living in the municipality of Umeå were invited to the larger study, which was expanded in 2002 to include five rural municipalities in Västerbotten County with the same inclusion criteria. The Umeå 85 + study/GERDA is a collaborative project between several departments at Umeå University.

Selection criteria for participants in the thesis were the ability to answer Likert-type questionnaires and the ability to participate in interviews. A follow-up study was conducted in Umeå in 2005 and in Västerbotten County in 2007. Paper I is a cross-sectional study with 189 participants (120 women and 69 men) who had responded to several questionnaires including the Purpose in Life test (PIL). In the results women scored significantly lower on the PIL test than men; attitudes towards one’s own aging were associated with purpose in life for both men and women; and musculoskeletal disorders were associated with lower purpose in life in women. Paper II includes the 189 participants from study I. In results at baseline the 40 who were diagnosed with depression had significantly lower purpose in life, and women were diagnosed with depression more often than men (32/120 women and 8/69 men). The 40 participants with a diagnosis of depression were excluded five years later, when 78 of 149 participants were available for the follow-up, 21 of whom (26.9%) had developed depression. There was no difference in the mean scores on the PIL test between those who had developed depression and those who had not. Purpose in life does not seem to protect very old people from developing depression.

Paper III includes 51 people who responded to the PIL test on two occasions five years apart, and its results show that purpose in life decreased after five years. There was no difference in mean PIL scores at baseline between those with a diagnosis of depression and those without depression, but purpose in life declined significantly over the five years in those with diagnosed depression. In study IV, to gain a deeper understanding of purpose in life, content analysis was conducted on interviews from 30 women. To obtain 5 variety and breadth in the stories we selected 10 women with low estimated purpose in life, 10 women with undecided estimated purpose, and 10 women with high estimated purpose in life. The results show that despite the fact that women estimated their purpose in life lower than men, their stories were positive. The women experienced purpose in their daily life where social relations was important and on a spiritual level. However, there were also expressions of experiencing life as simply existing. In Study V we included 23 men who had responded to a question about purpose in life. Their answers were subjected to content analysis and the results show that for men work is an important part of purpose in life. All men except one had a positive outlook on life, and the men found purpose in life most strongly in memories of when they were younger.

Lack of purpose in life can result in mental disorders like depression. Stereotypes of older people can affect their views of their own ageing, which in turn can weaken their purpose in life. To prevent mental illness it is important to experience purpose in life throughout life. Society at large and the health care system must consider purpose in life integral to mental health and work to combat ageist stereotypes to support purpose in life through the entire lifespan.

Abstract [sv]

Det övergripandet syftet med avhandlingen är att utforska livsmening hos de allra äldsta. Andelen äldre ökar i Sverige, och de allra äldsta över 85 år har under åren 1990-2007 ökat med 40 %. Att åldras har beskrivits från olika perspektiv som att ha hälsa, mogna till visdom samt att ha inre styrka. Att åldras kan också innebära en försämrad rörelse förmåga, kognitiva nedsättningar samt förlust av livsmening. En förlust av livsmening kan leda till psykisk ohälsa vilket kan leda till depression. Avhandlingen är en del av Umeå 85+ studien/GERDA vilken utgår från Umeå och startade år 2000. Hälften av alla 85 åringar, alla 90 åringar samt alla som var 95 år och äldre boende i Umeå kommun inbjöds till studien. Studien utvidgades år 2002 med att innefatta fem inlandskommuner i Västerbottens län med samma urvalskriterier. Umeå 85+ studien är ett samarbetes projekt mellan ett flertal institutioner vid Umeå Universitet. Urvalskriterierna för deltagarna i avhandlingen var att de skulle kunna svara på frågeformulär av Likert karaktär samt att de skulle orka delta i intervjuer. En uppföljning genomfördes år 2005 i Umeå kommun samt år 2007 i Västerbottens inland.

Delarbete I är en tvärsnitts studie och innefattar 189 personer fördelat på 120 kvinnor och 69 män, alla deltagarna hade svarat på ett flertal frågeformulär varav ett av formulären var test för livsmening. Resultatet visar att kvinnor skattar livsmeningen signifikant lägre än män. Egna attityder mot åldrande var starkast associerat med livsmening för både kvinnor och män, för kvinnor var även muskeloskeletala besvär associerat med lägre livsmening. Delarbete II innefattar vid baslinjen de 189 personerna från studie I. Resultatet vid baslinjen visar att de 40 deltagarna av de 189 deltagarna som var diagnostiserade som deprimerade hade signifikant lägre livsmeningen. Kvinnor var diagnostiserade som deprimerade i högre utsträckning än män (32 kvinnor och 8 män). De 40 deltagarna med en depressions diagnos uteslöts och ingick inte i analysen 5 år senare. Efter 5 år fanns 78 personer av 149 deltagare tillgängliga, av dem hade 21 personer (26.9%) utvecklat depression, det var ingen skillnad mellan män och kvinnor i andelen som utvecklade depression. Det var ingen skillnad i medelvärdet på test för livsmening bland de som hade utvecklat depression efter 5 år jämfört med de som inte utvecklat depression. Det förefaller som att livsmening inte skyddar riktigt gamla människor från att utveckla depression. Delarbete III innefattar 51 personer vilka svarat på test för livsmening vid två tillfällen med 5 års mellanrum. Resultatet visar att livsmeningen minskar efter 5 år i högre grad bland kvinnorna jämfört med männen. Det var ingen skillnad i medelvärdet i livsmening vid baslinjen mellan de som hade en depression diagnos och de som inte hade en, men bland de med en depressionsdiagnos hade livsmeningen minskat signifikant efter 5 år. För att fördjupa kunskapen om livsmening analyserades intervjuer från 30 kvinnor med hjälp av innehållsanalys i delarbete IV. För att få en variation i berättelserna valdes 10 kvinnor som skattat livsmeningen som låg, 10 kvinnor som skattat livsmeningen som medel samt 10 kvinnor som skattat livsmeningen som hög. Kvinnornas berättelser om att åldras och vara gamla var positiva. De upplevde livsmening i både vardagen där sociala relationer var viktiga samt i kontakt på ett andligt plan. Det uttrycktes även i berättelserna att det inte fanns någon livsmening.

I delarbete V ingår 23 män vilka alla hade svarat på en fråga om livsmening, svaren analyserades med hjälp av innehålls analys och resultatet visar att för männen var arbete en viktig del för livsmening. Alla utom en man hade en positiv syn på livet, männen berättade om livsmening främst i relation till minnen från när de var yngre. Sammanfattningsvis visar studierna att inte uppleva livsmening kan resultera i psykisk ohälsa vilket kan leda till depression. Livsmening måste beaktas både i samhället och i sjukvården för att förebygga psykisk ohälsa. Det är av stor betydelse att uppleva livsmening under hela livet samt att samhällets syn på äldre människor är sannolikt en viktig aspekt för att de allra äldsta ska uppleva livsmening.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2010. , 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1384
Keyword [en]
Purpose in life, very old, depression, gender, ageism
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-37908ISBN: 978-91-7459-106-4 (print)OAI: oai:DiVA.org:umu-37908DiVA: diva2:371080
Public defence
2010-12-10, Aulan, Vårdvetarhuset, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-19 Created: 2010-11-18 Last updated: 2014-04-17Bibliographically approved
List of papers
1. Purpose in life among men and women aged 85 years and older
Open this publication in new window or tab >>Purpose in life among men and women aged 85 years and older
2010 (English)In: The International Journal of Aging & Human Development, ISSN 0091-4150, E-ISSN 1541-3535, Vol. 70, no 3, 213-229 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate purpose in life in relation to psychological well-being, social relations, and physical and psychological symptoms among very old women (n = 120) and men (n = 69). Their purpose in life was evaluated using the Purpose in Life (PIL) scale. Women scored lower on this PIL scale than men (102 vs.108 p = .0.013). Regression analysis was used to estimate influencing factors on the PIL score. Determinants for purpose in life did not differ between the men and women, except for musculoskeletal symptoms. Attitude toward own aging had the strongest relation to PIL scores for both men and women; to have family to talk to was also important, as were musculoskeletal symptoms, for women. Our study indicates that the very old people studied were feeling indecisive about their purpose in life and that feelings are linked with poorer psychological health. For this reason, the purpose in life must be discussed and taken into consideration in the care of the elderly.

National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-37887 (URN)10.2190/AG.70.3.c (DOI)000278150000003 ()
External cooperation:
Available from: 2010-11-18 Created: 2010-11-18 Last updated: 2017-12-12Bibliographically approved
2. Depression in relation to purpose in life among a very old population: a five-year follow-up study
Open this publication in new window or tab >>Depression in relation to purpose in life among a very old population: a five-year follow-up study
2010 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 14, no 6, 757-763 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate the relationship between purpose in life and depression and, in a five-year follow-up investigate whether purpose in life, adjusted for different background characteristics, can prevent very old men and women from developing depression. Methods: A cross-sectional study included 189 participants (120 women and 69 men) 85–103 years of age living in a county in northern Sweden. Those who had not been diagnosed as depressed at baseline were included in the five-year follow-up study (n=78). Depression was assessed using the Geriatric Depression Scale-15, the Organic Brain Syndrome scale, the Montgomery–Åsberg Depression Rating Scale, and Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Purpose in life was assessed with the Purpose in Life (PIL) scale. Results: In the cross-sectional study, 40 participants out of 189 (21.2%) were depressed, and those with depression had significantly lower PIL scores (mean score 107 vs. 99, p=0.014). In the follow-up study, 78 persons were available for the assessment of depression. Of those, 21 (26.9%) were diagnosed as depressed and their mean PIL score at baseline was 106 (SD=17.4) versus 108 (SD=16.0, p=0.750) among those not depressed. Using multivariate logistic regression analysis controlling for possible confounders, we found no association between purpose in life and the risk of developing depression after five years (OR=1.0, 95% CI 0.97–1.03). Conclusions: The results show a significant inverse relationship between purpose in life and depression in the cross-sectional study; however, a high PIL score does not seem to serve very old people as a protection against the risk of developing depression.

Keyword
depression, purpose in life, very old, gender
National Category
Nursing Geriatrics Psychiatry
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-37893 (URN)10.1080/13607861003713216 (DOI)000280635300014 ()20686985 (PubMedID)
External cooperation:
Available from: 2010-11-18 Created: 2010-11-18 Last updated: 2017-12-12Bibliographically approved
3. Purpose in life over a five-year period: a longitudinal study in a very old population
Open this publication in new window or tab >>Purpose in life over a five-year period: a longitudinal study in a very old population
2011 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 23, no 5, 806-813 p.Article in journal (Refereed) Published
Abstract [en]

Background: Few studies have specifically examined purpose in life among very old people, and we know of none that has used a prospective approach. The aim of this study was to examine changes in pupose in life over five years in very old men and women and to investigate whether depressed mood, malnutrition, inactivity in daily life, or cognitive impairment increased the risk for developing low purpose in life.

Methods: The study includes data from 51 participants (42 women and 9 men) living in Northern Sweden who completed the Purpose in Life Test once at baseline and again five years later.

Results: Purpose in life decreased over five years and the decrease was significantly associated with being a woman (p<0.001) and having depressed mood (p=0.009) or depression (p=0.002) at baseline. There were no differences in baseline PIL scores between depressed and not depressed, but those who had depression had significantly decreased PIL scores after five years (p=0.001).

Conclusion: A strong purpose in life does not seem to prevent very old people from developing depression, and being depressed at baseline and living with depression over five years is associated with a loss of purpose in life.

Keyword
purpose in life; very old; depressed mood; depression; gender.
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-37897 (URN)10.1017/S1041610210002279 (DOI)000290109500014 ()21205380 (PubMedID)
External cooperation:
Available from: 2010-11-18 Created: 2010-11-18 Last updated: 2017-12-12Bibliographically approved
4. Experiences of purpose in life when becoming and being a very old woman
Open this publication in new window or tab >>Experiences of purpose in life when becoming and being a very old woman
2009 (English)In: Journal of Women & Aging, ISSN 0895-2841, E-ISSN 1540-7322, Vol. 21, no 2, 125-137 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to illuminate how very old women describe their experiences of purpose in life (PIL) in narratives about becoming and being very old. The participants comprised 30 women selected from 120 women who had answered the PIL test and had been interviewed about their experiences of being very old. The interviews were analyzed with qualitative content analysis, which revealed four themes: having a positive view of life, living in relation to God, having meaningful activities, and simply existing. Our findings show that very old women experience purpose in life both in their daily activities and in their contact with a spiritual world. It seems to be facilitated by a positive view of life. Although the results were dominated by a positive view of life, some of the participants saw their lives in terms of simply existing, and did not experience purpose in life.

Keyword
very old women, purpose in life, content analysis, gender aspects
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-37901 (URN)10.1080/08952840902837145 (DOI)
Available from: 2010-11-18 Created: 2010-11-18 Last updated: 2017-12-12Bibliographically approved
5. Purpose in life among very old men
Open this publication in new window or tab >>Purpose in life among very old men
2013 (English)In: Advances in Aging Research, ISSN 2169-0499, Vol. 2, no 3, 100-105 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to illuminate very old men’s experiences and reflections of purpose in life. The participants were 23 men who were interviewed and answered a specific question about purpose in life. The answers were analyzed according to qualitative content analysis, which revealed three content areas: the purpose of one’s life as a whole; purpose in everyday life; and reflections on purpose in life. Our findings showed that very old men experience purpose in life most strongly when remembering the past and when work is stressed as important. The analyzed text was dominated by positive experiences of PIL, although one man said that he had given up and that there was no purpose in his life at all.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2013
Keyword
Aging, Men, Narrative analysis, Qualitative content analysis, Purpose in life
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-87470 (URN)10.4236/aar.2013.23014 (DOI)
External cooperation:
Available from: 2014-04-02 Created: 2014-04-02 Last updated: 2016-09-06Bibliographically approved

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