Purpose in life among very old people

Abstract: 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.