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Background: The purpose of this study was to contribute to the analysis of older people’s Meaning in Life and the implications of dwelling in residential and nursing homes. The transition from one’s private home to a residential or nursing care facility is a challenge for many older people. An individualized (not standardized) approach to meaning in life programming can help professionals in developing tailored interventions to support residents and their families. Participants: The participants (n = 106, 76% women, mean age 84.4 ± 6 years, 93% Christians) were living in residential (52%) and nursing homes (48%). Methods: An anonymous cross-sectional survey was conducted in nine care homes in Southern Germany using validated instruments such as the Schedule for Meaning in Life Evaluation (SMiLE) and Religious Trust (SpREUK-15 subscale). Results: Leisure time, nature experience, and family were the most important meaning-giving areas. Spirituality was also perceived as a major resource. Conclusions: Residents living in retirement homes were more spiritually satisfied than those living in nursing homes. It will be necessary to specifically support individuals living in institutional-care in their spiritual and psychosocial dimension to improve their feelings of security and to meet their core needs.
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Journal of Religion, Spirituality & Aging
ISSN: 1552-8030 (Print) 1552-8049 (Online) Journal homepage: http://www.tandfonline.com/loi/wrsa20
Meaning in life of older adults living in residential
and nursing homes
Carlos I. Man-Ging, Jülyet Öven Uslucan, Eckhard Frick, Arndt Büssing &
Martin Johannes Fegg
To cite this article: Carlos I. Man-Ging, Jülyet Öven Uslucan, Eckhard Frick, Arndt Büssing &
Martin Johannes Fegg (2018): Meaning in life of older adults living in residential and nursing
homes, Journal of Religion, Spirituality & Aging
To link to this article: https://doi.org/10.1080/15528030.2018.1529648
Published online: 22 Oct 2018.
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Meaning in life of older adults living in residential and
nursing homes
Carlos I. Man-Ging
a,b
, Jülyet Öven Uslucan
b
, Eckhard Frick
c
, Arndt Büssing
d
,
and Martin Johannes Fegg
b
a
Pontifical Catholic University of Ecuador, Quito, Ecuador;
b
University of Munich, Munich, Germany;
c
Medical School, Technical University of Munich, Munich, Germany;
d
Witten/Herdecke University,
Herdecke, Germany
ABSTRACT
Background: The purpose of this study was to contribute to
the analysis of older peoples Meaning in Life and the implica-
tions of dwelling in residential and nursing homes. The transi-
tion from ones private home to a residential or nursing care
facility is a challenge for many older people. An individualized
(not standardized) approach to meaning in life programming
can help professionals in developing tailored interventions to
support residents and their families.
Participants: The participants (n= 106, 76% women, mean age
84.4 ± 6 years, 93% Christians) were living in residential (52%)
and nursing homes (48%).
Methods: An anonymous cross-sectional survey was con-
ducted in nine care homes in Southern Germany using vali-
dated instruments such as the Schedule for Meaning in Life
Evaluation (SMiLE) and Religious Trust (SpREUK-15 subscale).
Results: Leisure time, nature experience, and family were the
most important meaning-giving areas. Spirituality was also
perceived as a major resource.
Conclusions: Residents living in retirement homes were more
spiritually satisfied than those living in nursing homes. It will
be necessary to specifically support individuals living in institu-
tional-care in their spiritual and psychosocial dimension to
improve their feelings of security and to meet their core needs.
KEYWORDS
Aged care; family; older
adults; spirituality
Introduction
The transition from onesprivate home to a residential or nursing care
facility is a challenge for many older adults. An individualized (not standar-
dized) approach to meaning in life programming can help professionals in
developing tailored interventions to support residents and their families. The
purpose of this study was to contribute to the analysis of older peoples
Meaning in Life and the implications of dwelling in residential and nursing
homes.
CONTACT Carlos I. Man-Ging carlos.manging@gmail.com Berchmanskolleg, Kaulbachstr. 31a, Munich 80539,
Germany; Arndt Büssing Arndt.Buessing@uni-wh.de Univ.-Prof. Dr. med. Arndt BüssingProfessur für
Lebensqualität, Spiritualität und Coping Institut für Integrative MedizinUniversität Witten/Herdecke Gerhard-Kienle-
Weg 4, D-58313
JOURNAL OF RELIGION, SPIRITUALITY & AGING
https://doi.org/10.1080/15528030.2018.1529648
© 2018 Taylor & Francis
In many countries, the term residential homecovers a broad range of
institutions, from independent houses in a complex combined with apartments
up to apartments with assisted living. Most critiques of care situations identify
the rigidity of daily routines in total institutions, where all members follow the
same rules (Becker, 2003), a general lack of privacy, and perennial evidence that
staff is not sufficiently or in general poorly trained to meet the residentsneeds
(Kane, 2003). Nevertheless, during the past 20 years there has been a growing
interest in improving residential/nursing home culture in order to create a
better, more homelike atmosphere with closer relationships. In addition, there
is an implicit desire to improve quality of life of residents to maintain the
highest possible physical, mental, and psychosocial well-being (Grabowski et al.,
2014; Sieck, 2008). Therefore, it is also necessary to evaluate their psychosocial,
spiritual, and meaning-giving needs (Erichsen & Büssing, 2013; Mackinlay,
2015; Man-Ging, Öven Uslucan, Fegg, Frick, & Büssing, 2015).
Religion and spirituality represent related constructs (Hill et al, 2000)
rather than independent ones. Researchers have suggested, on the one
hand, various possible psychological, social, and physiological mediators
that may account for the religion and spirituality/health connection (Hill &
Pargament, 2003; Koenig, McCullough, & Larson, 2001; Plante & Sherman,
2001; Seybold & Hill, 2001; Thoresen, Harris, & Oman, 2001). On the other
hand, extensive research explores intrinsic and extrinsic religiosity (Cohen
et al., 2005; Musgrave & McFarlane, 2004). This old bifurcation was pointed
out by Allport and Ross. They stated a difference because of manipulation:
the extrinsically motivated person uses his religion, whereas the intrinsically
motivated lives his religion(Allport & Ross, 1967, p. 434).
Empirical studies, however, have had limited success at best in accounting
for religious and spiritual effects through these psychosocial mediators (George,
Ellison, & Larson, 2002). There is a risk of establishing a gap and polarization
between religiousness and spirituality. In fact, most people experience spiri-
tuality within an organized religious context (Hill & Pargament, 2008)and
research demonstrates largely positive associations between religiosity and well-
being (Koenig et al., 2001). However, Pargament states that well-being has been
linked positively to a religion that is internalized, intrinsically motivated, and
based on a secure relationship with God and negatively to a religion that is
imposed, unexamined, and reflective of a tenuous relationship with God and
the world (Pargament, 2002). It is a challenge caring for patients who integrate
spirituality to their particular circumstances in order to find hope, meaning,
and healing (Koenig et al., 2002 ;Grouden&Jose,2015).
Retirement institutions for older people
During the past century, death rates were substantially reduced, while life
expectancy dramatically increased (Wilkinson, 2002) resulting in greater
2C. I. MAN-GING ET AL.
numbers of older and frailer people needing supported care. As a conse-
quence, more retirement institutions are being established. Successful aging
is dependent upon maintaining healthy functional abilities, being actively
immersed in daily life concerns as well as engaging in specific aspects that
provide the individual with meaning, orientation, and hope (Edlund, 2014).
At present, awareness about psychosocial and spiritual well-being of sick
or frail older people in care facilities increases. (Erichsen & Büssing, 2013;
Nilsson, Bülow, & Kazemi, 2015). Thus, residentsneeds for spiritual and
psychosocial well-being require as much attention as issues concerning their
physical health. It is also important to evaluate how older adults construct
self-identity, and give meaning to experiences and emotions at this life phase
(Hays & Minichiello, 2005). Some tasks that family used to provide (financial
support, care, and social security) are becoming partially supported by
institutional environments, although the role of the family in old age is still
a major social support factor in times of illness (Golden, Conroy, & Lawlor,
2009; McPherson, Wilson, & Murray, 2007).
Older people have reached their age with virtues such as simplicity, wisdom,
humor, gratitude, patience, and prudence (May, 2000). However, they may also
feel fragile, more dependent on children, and may search for cohesion with
relatives and friends, and may feel lonely and depressed. Paradoxically, older
people may decide by themselves to move into a residential/nursing home, in
order to receive care and to maintain some distance from family, without
becoming isolated (Atchley, 2006;Chang&Yu,2012). Some of them might
feel pushed by family members into this decision (Sergeant & Ekerdt, 2008). In
any case, the significance of the move to a residential home as a life course event
is dependent on the reasons for moving, social pressures, and the impact of
relocation to a smaller downsized place.
Meaning in life
Quests for meaning in life (MiL) in residential and nursing homes are still
under-investigated. This subject has already been shown as a coping strategy
for people in critical life phases, e.g., suffering from a life-threatening or
chronic disease. However, it is unclear how MiL might become a strategy for
older people leaving their own homes (Krok, 2014; Pandya, 2018). Maybe it is
an implicit stabilizing factor developed through the course of life that makes
possible to perceive values in one´s life rather than an active coping strategy
in response to the new life situation in residential and/or nursing homes.
Aging-in-placeis a concept which not only relates to the possibility of
remaining at home, but also to situations whereby the older adult continually
re-integrates with place (home and community) in the face of change and uncer-
tainty through creative and social actions that foster meaning and identity
(Andrews, Cutchin, McCracken, Phillips, & Wiles, 2007, 157). The main issue
JOURNAL OF RELIGION, SPIRITUALITY & AGING 3
is to combine a sense of attachment, identity and security with feelings of
autonomy, independence, and social connection (Chang & Yu, 2012). Even
though adult children and older parents do not live together, the bonds of
affection and the frequency of contact between them may be firm. The will-
ingness of children to take direct responsibility for their older parents, with or
without support services, is a core principle in inter-generational relationships
(Göckenjan, 2002; Zhai, Zhuang, & Wang, 2017) with old people being cared for
by their own children.
Aging-in-placeis a positive aging paradigm (Fernández-Carro, 2013;
Johansson, Josephsson, & Lilja, 2009) that seems to bring some benefits in
quality of life, as well as a cost-effective solution to the problems of a growing
population of very old people (Sixsmith & Sixsmith, 2008).This approach
implies an integrative perspective focused on an interdependent process
between individuals and environment. Nevertheless until present examina-
tion of the relationship between aging-in-place and religious trust or attach-
ment to God has remained limited. Our research aims to study the
importance of religiosity among residents in care facilities and its relation-
ship with some areas of meaning in life such as family, work, and leisure
time, among others.
Philosophical and psychological research offer different models to
approach MiL concepts. Following Viktor Frankl´s perspective, MiL can be
considered as most important in dealing with negative life experiences:
There is nothing in the world, I would venture to say, that would so effectively
help one to survive even the worst conditions as the knowledge that there is a
meaning in ones life(Frankl, 1985, p. 47). Metz proposed a structure that
unfolds from personal to relational to social/universal to religious/spiritual
dimensions. He focuses on MiL through a cluster of three interdependent
issues, i.e., purpose, transcendence, and worthiness: Searching for what
makes a life meaningful is itself a source of meaning(Metz, 2015, 229).
Krause studied the interface between life-trauma and MiL, especially the
stress-buffering function of MiL among older people and the possibility to
reconcile events that have happened in the past. The purpose of this research
is to understand how MiL is associated with the process of older adults to
cope more effectively with stressors and/or the effects of traumatic events
within their lifetime (Harrington, 2016; Krause, 2009; Scott & DeBrew, 2009).
A sense of MiL may include having values, a sense of purpose, goals, and
the ability to reconcile the past (Frankl, 1985; Krause, 2009; Nakash, Nagar,
Barker, & Lotan, 2016). However, the relevance and importance of these
issues are highly individual and thus diverse. The best approach to evaluate
individual and specific meaning giving areas is to evaluate them in a semi-
structured, open interview without pre-defined categories (idiographic set-
ting) (Fry, 2000). This kind of research has already been conducted in a
representative sample of the general German population (Fegg, Kramer,
4C. I. MAN-GING ET AL.
Bausewein, & Borasio, 2007). It has been found that the experience of
meaning is related to successive life stages which seem to correspond with
Eriksons stages of psychosocial development: In youth (1619 y/o), friends
were most important, in young adulthood (2029 y/o) partnership,in
middle adulthood (3039 y/o) work,during retirement (6069 y/o)
health,and altruism,and in advanced age (70 y/o and more) spiritual-
ity/religionand nature activities/animals(Fegg et al., 2007). Through this
interview approach, it was also possible to identify distinct areas which gave
MiL, e.g., family, partner, friends, work, free time, spirituality, health, satis-
faction, nature activities, hedonism (comforts), social commitment, memory,
and personal environment (Fegg et al., 2007).
Well-being of older people might be influenced by various aspects, e.g.,
external factors (social resources, income, and negative life events) as well as
existential factors (religious affiliation, spirituality, feelings of inner peace,
and personal MiL) (Fry, 2000). The combination of these factors may help
older people to find a greater sense of purpose in life and to cope with
distress of physical and mental impairments (Krause, 2009).
This study aimed to address the following questions: (1) What areas of
MiL are important to older adults living in residential/nursing homes? (2)
How satisfied are older people in their chosen areas of MiL, and how
important are these areas to them? (3) What differences exist between
older people living in residential/nursing homes and those living at their
own home about leisure time, spirituality, family, health, among others?
Although the study was exploratory in nature, we expected that this
research would show differences between areas of meaning and satisfaction
in life among people living in residences and nursing homes and those living
at home. These results may lead to new understanding of spirituality (Hill &
Pargament, 2008) and religious trust (Büssing et al., 2009) in order to help
older people live together with better health and quality of life as well as
richer positive aging experiences (Koenig, 2002; Miller & Thoresen, 2003).
Methods
Participants
The interviewees lived in nine Bavarian care institutions that were selected as a
convenience sample. Permission was asked to anonymously interview the parti-
cipants for a maximumof 1.5 hours. Interviews were conducted face-to-face. No
incentives were offered. The study has a cross-sectional and post hoc design,
with an exploratorypurpose rather than a confirmatory one. The study does not
carry out any intervention, so there was no control group itself. We made a
comparison between participants living at home and residents in care facilities.
It is therefore a comparative design. All interviewees were informed about the
JOURNAL OF RELIGION, SPIRITUALITY & AGING 5
purpose of the study, were assured of confidentiality, and consented to partici-
pate. Inclusion criteria were an age of at least 70 years, good cognitive state-
ments, and the ability to provide written consent; exclusion criteria were acute
and significant health problems (e.g., stroke, paralysis), cognitive impairment
and/or acute psychiatric disorders. Selection process was held with guidance of
administrators care facilities personell. The Ethical Commission of the XXX
approved this study (#422/12).
The residents group was composed by 106 participants with a mean age of
84.4 (SD ± 5.96), three quarters were women (76.4%). Most of them were
mostly independent and living alone (63.2% were widowed), only 8.5% were
living with a partner, and 62.3% had access to the family. The education level
was lower than in other regions and overall in Germany: secondary school
69.8%; junior high school 7.5%; high school 18.9%. Christian denomination
was very high, 92.5%. Education level and Christian denomination were
typical of the idiosyncrasy of this Bavarian region in South Germany.
Participants living at home had similar characteristics as the residents
group, but more of them were living with a partner (43.2%) and they had a
higher education level.
Measures
Meaning in life
The Schedule for the Meaning in Life Evaluation (SMiLE) was used to assess
individual areas providing meaning to each interviewees life. The instrument
was developed following the recommendations of the Scientific Advisory
Committee of the Medical Outcomes Trust. In an open interview, the respon-
dents defined up to seven areas determined relevant for their MiL. Then they
rated their current level of importance of (scale range 0 not importantto 7
extremely important) and satisfaction with (scale range 3very unsatisfied
to +3 very satisfied) each mentioned area. Following this, these areas were
subsumed into 13 categories (Altruism, Animals/Nature, Family, Financial
Security, Friends/Acquaintances, Health, Hedonism, Home/Garden, Leisure
Time, Occupation/Work, Partnership, Psychological Well-Being, Spirituality/
Religion) from previous studies with the same scale (Brandstätter et al., 2014).
Overall indices of weighting (IoW, range 0100), satisfaction (IoS, range 0100),
and weighted satisfaction (IoWS, range 0100) are calculated as described else-
where (Fegg et al., 2007). Satisfaction ratings indicate the extent of MiL fulfill-
ment a person experiences, whereas the content of listed areas, the overall index
of weighting and the relative importance ratings reflect a persons individual
construction of the MiL framework.
For the analysis of the reliability of the SMiLE scale it was not possible to
use Cronbachs alpha on account of the variety of responses according to the
interviewees. This method of developing the SMiLE score prevents the use of
6C. I. MAN-GING ET AL.
standard reliability coefficients. SMiLEs construction system makes it closer
to the criteria-oriented tests than to the standardized ones (Fegg et al., 2007).
To answer research questions and hypotheses, descriptive and variance
analyses were carried out.
Religious trust
Because religious trust has been shown to be a predictor of spiritual
satisfaction often related to MiL (Perez, Fernandez, Rivera
&Abuin,2001; Büssing et al., 2009), we used the Religious Trust scale,
which is a 5-item subscale of the Spiritual and Religious Attitudes in
Dealing with Illness questionnaire (SpREUK) (Büssing, 2010). The scale
avoids terms such as God, Jesus, or church, in order to ask openly about
religious trust in a secular society. This trust scale (α= .91), or trust in a
higher guidance/source, is a measure of intrinsic religiosity that identifies
religion as an end in itself and deals with trust in spiritual guidance, the
feeling of being connected with a higher source, feelings that death is not
the end, etc. (Barber, Parsons, Wilson, & Cook, 2017). The items are rated
on a 5-point scale ranging from disagreement to agreement (0, does not
apply at all;1,does not really apply;2,dontknow[neither yes nor no]; 3,
applies quite a bit;4,applies very much). The mean score was referred to a
100% level (transformed scale score) with scores >60% indicating higher
agreement (high trust), scores <40% indicating disagreement (low trust),
and indifference with score between 40 and 60.
Statistics
Descriptive statistics as well as analysis of variance were computed with the
Statistical Package for Social Sciences (SPSS), version 20.0. The significance
level was set to p< .05.
Results
Description of the sample
In total, 76% of 106 enrolled persons were female (Table 1). The mean age was
84.4 ± 6.0 years. Most had a Christian denomination (92.5%), and the Religious
Trust scores were moderately high in the sample (68 ± 23). Interviewees were
recruited in residential (52%) and nursing homes (48%). When asked for their
self-care abilities, 22% were independent and 50% partially independent,
whereas 28% were completely dependent on external help. Most of them
were widowed (63%) but still had access to their family (62%).
The sample was compared to a historical reference sample of older
Germans (at least 70 years of age) living at home (Fegg et al., 2007).
JOURNAL OF RELIGION, SPIRITUALITY & AGING 7
Meaning in life
A comparison of residential and nursing homes (Table 2) showed that
spiritual satisfaction, F= 2.85, (1;66), p= .096, η
2
= .041, was the only factor
differing by trend between the groups. Older adults living in residential
homes were more satisfied in their spirituality compared to those in nursing
homes. There was also a trend in overall MiL satisfaction. The most impor-
tant meaning-giving areas for older people living in institutions were leisure
time, spirituality, family, and nature activities (Table 3). Regarding the areas
of MiL, a significant difference between both groups emerged with regard to
family which was listed by 82% living in nursing homes versus. 45% living in
residential homes (Table 4).
Religious trust
As can be expected, residents who show high religious trust (2.41 ± 0.91) are
more spiritually satisfied than those with lower religious trust (1.77 ± 1.01).
Similar results were found for the importance of spirituality: those residents
who show high religious trust (N= 51; 6.35 ± 1.14) pointed out more
Table 1. Sociodemographics of the interviewed older adults.
Variables
Residents
(N= 106) Non-Residents (N= 74)
Age (mean y/o ± SD) 84.4 ± 5.96 >70 y/o
Gender (%)
Men 23.6 32.4
Women 76.4 67.6
Family status (%)
Living with partner 8.5 43.2
Living alone 28.3 5.4
Widowed 63.2 51.4
Access to family (%) 62.3 NA
Education level (%)
Secondary 69.8 40.5
Junior high school 7.5 20.3
High school 18.9 31.1
Other 3.8 8.1
Denomination (%)
Christian 92.5 NA
Other 7.5 NA
Type of institution (%)
Residential home 51.9 NA
Residential nursing home 48.1 NA
Living at home - 100
Self-care abilities (%)
Independent 21.7 NA
Mostly independent 50 NA
Only with help 28.3 NA
Data are Means ± Standard deviation (SD) or percentages, compared to Non-Residents (N= 74) living at
home (Fegg et al., 2007)
8C. I. MAN-GING ET AL.
Table 2. Differences between older residents living in institutions versus living at home, and residents living in institutions (residential/nursing), religious trust
(high/low). Shown are trends and significant results.
By Variables
Institutions
(N= 106)
At home
(N= 74) F(df) Sign pPartial η
2
Older Germans living in institutions versus
at home
Family satisfaction 1.31 ± 1.74 2.41 ± .90 17.80 (1;119) < .001 .130
Leisure time satisfaction 0.86 ± 1.94 1.99 ± 1.36 7.10 (1;98) .009 .068
Health satisfaction 1.14 ± 1.88 1.94 ± 1.57 2.96 (1;53) .091 .053
Nature satisfaction 0.54 ± 1.76 2.10 ± 1.10 7.35 (1;71) .008 .094
Family importance 6.07 ± 1.04 6.70 ± .73 14.32 (1;119) < .001 .107
Leisure time importance 5.34 ± 1.04 4.78 ± 1.59 4.03 (1;98) .047 .039
By Variables Residential (N= 55) Nursing (N= 51) F(df) Sign pPartial η
2
Institution (residential vs. nursing) Spiritual satisfaction 2.46 ± 0.75 2.07 ± 1.14 2.85 (1; 66) .096 .041
IoS 74.93 ± 16.58 68.46 ± 20.54 3.20 (1; 104) .077 .030
By Variables Low Religious Trust (N= 55) High Religious Trust (N= 51) F(df) Sign pPartial η
2
Religious
Trust (high vs. low)
Spiritual satisfaction 1.77 ± 1.01 2.41 ± 0.91 4.94 (1; 66) .030 .070
Spiritual importance 5.31 ± 1.44 6.35 ± 1.14 8.05 (1; 66) .006 .109
Abbreviations: IoS = Satisfaction Index, IoWS = Index of weighted satisfaction, SD = Standard deviation, F= Fishers contrast test in ANOVA, df = degrees of freedom, Sign (p
value) = Significance (Bonferroni corrections: Significance level would be .0125 in the first two parts of Table 2 with four contrast, and .0071 in third part with seven contrasts),
Partial η
2
= Effect size
JOURNAL OF RELIGION, SPIRITUALITY & AGING 9
spiritual importance than those with lower religious trust (N= 55;
5.31 ± 1.44) (Table 2).
Residents versus living at home
Compared to a control group of Germans with persisting tendencies (at least
70 y/o) living at home (Fegg et al., 2007), differences emerged in the mean-
ing-giving areas. Furthermore, older subjects living in institutions were more
likely to list leisure time, spirituality, happiness, and health compared to non-
residents living at home. Compared to non-residents, residents did not list
house and finances as meaning-giving areas (Table 4).
Conclusions
The development of health-care services for older adults had been mainly
influenced by two factors during the past century: the decline of mortality
rates and the growth of life expectancy. Due to older individualsincreasing
fragility and dependency on others, nursing homes should offer an atmo-
sphere that gives them a feeling of connectedness, identity, and security. Our
study points out that not only physical well-being (i.e., health care), but also
psychosocial and spiritual needs (Erichsen & Büssing, 2013; Man-Ging et al.,
2015) are important for older people living in residential or nursing homes.
Table 3. Differences between older residents living in institutions and non-residents living at
home (Fegg et al., 2007) by frequency of meaning-giving areas as well as their satisfaction and
importance.
Meaning-giving areas - Yes % Mean Satisfaction (SD) Mean Importance (SD)
Areas that provide
meaning in life
Institutions
(N= 106)
At home
(N= 74)
Institutions
(N= 106)
At home
(N= 74)
Institutions
(N= 106)
At home
(N= 74)
Leisure time 76 (72%) 24 (32%) 0.86 (1.94) 1.99 (1.36) 5.34 (1.04) 4.78 (1.59)
Spirituality 68 (64%) 13 (18%) 2.28 (.96) 2.69 (.63) 6.15 (1.26) 6.25 (1.09)
Family 67 (63%) 54 (73%) 1.31 (1.74) 2.41 (.90) 6.07 (1.04) 6.70 (0.73)
Nature 63 (59%) 10 (13%) 0.54 (1.76) 2.10 (1.10) 5.71 (1.12) 5.32 (1.29)
Happiness 27 (25%) 4 (5%) 1.54 (1.47) 1.50 (1.29) 6.02 (0.85) 5.77 (0.88)
Health 24 (23%) 31 (42%) 1.14 (1.88) 1.94 (1.57) 6.23 (0.56) 6.52 (1.16)
Friends 22 (21%) 15 (20%) 1.84 (1.47) 1.87 (0.92) 5.43 (1.32) 5.60 (1.40)
Social
Commitment
12 (11%) 6 (8%) 1.50 (1.40) 2.50 (0.71) 6.00 (0.48) 5.60 (1.25)
Hedonism/
Comforts
10 (9%) 2 (3%) 1.20 (2.10) 1.67 (1.51) 4.55 (1.46) 6.30 (0.99)
Personal
Environment
8 (7%) NA 2.12 (1.46) NA 6.12 (1.36) NA
Memories 8 (7%) NA 0.75 (2.12) NA 5.87 (1.46) NA
Partner 7 (7%) 8 (11%) 0.50 (2.33) 2.50 (0.76) 6.92 (0.20) 6.70 (0.72)
Work 6 (6%) 6 (8%) 1.00 (2.19) 2.00 (1.26) 4.00 (2.00) 5.83 (1.05)
Home/House NA 9 (12%) NA 2.67 (0.50) NA 5.51 (1.69)
Finances NA 6 (8%) NA 2.00 (0.89) NA 4.20 (1.53)
10 C. I. MAN-GING ET AL.
Table 4. Differences in meaning in life areas by Institutions, Religious trust, and residents versus non-residents.
By
Meaning-giving
areas
Residential (N= 55)
Yes %
Nursing (N= 51)
Yes % CramersVSign p
Institutions (residential vs. nursing) Family 45.4 82.3 .382 < .001
Social commitment 16.4 5.9 .165 .089
By Meaning giving
areas
Low Religious Trust (N= 35)
Yes %
High Religious Trust (N= 71)
Yes %
CramersVSign p
Religious
Trust (high vs. low)
Family 74.3 57.7 .161 .097
Spirituality 37.1 77.5 .395 < .001
Hedonism/Comforts 17.1 5.6 .185 .057
Social commitment 0.0 16.9 .251 .010
By Meaning giving
areas
Institutions (N= 106)
Yes %
Home (N= 74)
Yes %
CramersVSign p
Older Germans living in institutions vs. at home Leisure time 71.7 32.4 .389 < .001
Spirituality 64.2 17.6 .461 < .001
Nature 59.4 41.9 .206 .006
Happiness 25.5 12.2 .275 < .001
Health 22.6 13.5 .460 < .001
House 0.0 5.4 .261 < .001
Finances 0.0 8.1 .222 .003
Hedonism/Comforts 9.4 2.7 .133 .075
Memories 7.5 0.0 .180 .016
Personal environment 7.5 0.0 .180 .016
Bonferroni correction: p= 0.05/15 = .0033
JOURNAL OF RELIGION, SPIRITUALITY & AGING 11
The purpose of this study is to contribute with the analysis of older
peoples MiL, addressing the following questions:
(1) What areas of MiL are important to older adults living in residential/
nursing homes? A major finding of this study is the importance of
spirituality, leisure activities, nature experiences, and family for older
subjects living in care facilities. In residential homes, social commit-
ment was more important, which might be influenced by the feeling of
belonging to a supportive community, whereas in nursing homes the
quest for family was of higher importance. A sense of MiL may
influence the well-being of older people, but depends on the impor-
tance of these issues as well as the individuals satisfaction in relation
to these issues. In both locations, focusing on MiL may help research-
ers devise more effective policies and interventions.
(2) How satisfied are older people in their self-defined areas of MiL and
how important are these areas to them? Older adults living in residen-
tial homes had higher spiritual satisfaction than those living in nursing
homes who were more focused on their family. Religious trust was
unsurprisingly a predictor of spiritual satisfaction and its importance.
Religious trust indicates a relationwith the Sacredwhich is of high
importance when relations to friends and family are lacking or less
satisfying. Older people living at home reported more satisfaction with
their meaning-giving areas than those living in institutional environ-
ments, which can be attributed to the continuing atmosphere of
memory, routines, and rituals that the private home may offer.
(3) What differences exist between older people living in residential
homes and those living at their own home? Compared to older sub-
jects living at home, residents were more likely to list leisure time,
spirituality, family, and nature as meaning-giving areas. In contrast,
older people living at home were more focused on health and family.
This finding is coherent with previous research of older adults who
tended to have higher levels of life satisfaction, self-esteem, and opti-
mism(Krause, 2003, 160) and with a research in meaning reconstruc-
tion in the context of religious coping (Matthews & Marwit, 2006).
The process of assuming the status of an I degradedpersonwho
progressively loses self-control through uselessness, helplessness,
defenselessnessis perceived to be painful and deleterious (Barenys,
1993). Therefore, it is necessary to experience intimacy at a distance,
to keep relationships meaningful, and to perpetuate belonging to a
family and social community. Although their relatives and friends may
die, in many cases older adults shall receive support from care-assis-
tants and other people with whom they share their lives. Older people
living at home have described an ideal good lifeas being healthy in a
12 C. I. MAN-GING ET AL.
safe place, with access to good social relationships, help, and support,
as well as retaining a role in society with independence and control
over life (Gabriel & Bowling, 2004).
Living in a residential/nursing home seems to be associated with more spare
time (leisure) with fewer responsibilities. According with Frankls thoughts about
thesearchforfinalmeaning,thisextraleisuretime might be a possibility to
open older peoples life from provisional to final meanings (Ellor, 2013).
Following Erikson´s developmental stage theory, we may find a way to under-
stand how older individuals reassure their dignity and integrity as previous steps
of wisdom in old age. Satisfaction provided from these categories might be
explained through gerotranscendence: a possible natural progression toward
maturation and wisdom, that is, a forward direction including a redefinition of
reality (Tornstam, 2011).Residentsalsoseemtogainwithregardtomattersof
spirituality and nature activities, as these may support their previous memories
and, most importantly, their personal private environment. Furthermore, they
seem to lose some kinds of abilities, like social (forced retirement, relationships
with friends), physical (movement, walking, etc.), and psychological abilities
(privacy and home tranquility). The reasons old people enter institutional envir-
onments include not being able to care for themselves or their homes (financial
worries, physical impairments, disturbing neighborhoods, etc.). At the same time,
there is a fear of being isolated in institutions or that ones retirement pension will
not be enough to cover their future costs (Sieck, 2008). A strong MiL experience
depends on how far people reported having a sense of order, a reason for
existence, a clear sense of personal identity, and a greater social consciousness
(Reker & Woo, 2011). Even though the quality of care and life of these institutions
varies from one to another, the results of this research among older people show
that those living in residential or nursing homes point out leisure time, spiritual-
ity, family, and nature activities as core areas that give them MiL.
For those responsible for the future care of older people, there is a significant
challenge to maintain physical and mental health on the one hand, and to support
unmet psychological and spiritual needs of an older and growing population on
the other hand. The importance and satisfaction of these psychosocial and
spiritual needs, and hence their psychosocial and spiritual well-being, should be
taken into account by the care-team and by relatives in order to ensure the welfare
of this growing population. It will thereforebenecessarytoincludeand/orfoster
spiritual care to residential homes. After evaluating the care needs of older
residents, supportive policies, programs, and training should focus on these
important aspects for life fulfilment to improve the quality and MiL of older
adults and most probably to overcome their physical and mental health problems.
JOURNAL OF RELIGION, SPIRITUALITY & AGING 13
Clinical implications
Meaningful areas such as leisure time, spirituality, family, and nature
activities are really important for older adults. Thus, health professionals
working with older adults living in residential or nursing homes need
information about every persons spiritual needs and MiL-resources.
When talking with them about their biography as well as about their
current life situation, an individualized (not standardized) approach
helps professionals in developing tailored interventions to support resi-
dents and their families.
Different life and dwelling situations are associated with different psycho-
social and spiritual needs and resources. Specialized institutions for older
adults provide opportunities for group meetings (e.g., gym, artwork, religious
activities). Health care professionals should foster these facilities of social
support.
Limitations
The cross-sectional design of the study does not allow one to describe causal
relations between the assessed variables. Most participants had a Christian
denomination that may not be generalizable to populations of older people
with a different religious or secular background. Because our sample size is
small, further confirmation is required to verify the statistical power of the
results. Another limitation deals with the lack of representation of the care
facilitiesinstitutions because of the free choice to participate in this research.
However, the sample does comprise different social levels of the population.
Further research might also include additional factors such as financial
concerns, physical, behavioral, cognitive, emotional, and social dimensions.
Description of authorsroles
Carlos Man Ging wrote the article, and carried out the statistical analysis. Jülyet Öven
Uslucan collected the data of the study and revised writing style. Eckhard Frick assisted on
writing and was responsible for revision. Martin Fegg designed the study, supervised the data
collection and assisted on statistical design. Arndt Büssing was responsible for the statistical
design of the study. All authors have read and approved the final version of the article.
Disclosure statement
No potential conflict of interest was reported by the authors.
14 C. I. MAN-GING ET AL.
Ethical statements
The Ethical Commission of the Ludwig-Maximilians University Medicine School approved
this study (#422/12).
ORCID
Arndt Büssing http://orcid.org/0000-0002-5025-7950
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... The decision to marry or not is often associated with happiness and life satisfaction. Several studies have stated that relationships with other people are the main source of meaning in life and family is important in the meaning of life for the elderly (Hupkens et al, 2016;Man-Ging et al, 2018). Some literature also states that a partner (husband/wife) is an important social support for a person (Kurniasari & Leonardi, 2013). ...
... Meanwhile, several studies state that relationships with other people are the main source of meaning in life and family is important in the meaning of the elderly's life (Hupkens et al, 2016;Man-Ging et al, 2018). some literature also states that partner as husband/wife is an important social support for a person (Kurniasari & Leonardi, 2013). ...
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Background: Due to the shift to an older population worldwide and an increased need for 24-hours care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents. Methods: In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority's decision of long-term NH care; (2) residential time three months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested using structural equation modeling (SEM) using Stata 15.1. Results: The SEM-model yielded a good fit (χ2=146.824, p=0.021, df=114, χ2/df=1.29 RMSEA=0.040, p-close 0.811, CFI=0.97, TLI=0.96, and SRMR=0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL. Conclusion: NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST. Keywords: interpersonal and intrapersonal self-transcendence, meaning-in-life, nursing, nurse-patient interaction, nursing home, older adults, wellbeing
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The rapidly ageing populations worldwide, particularly in Western countries, necessitate politicians, policymakers, and scientists to reflect on the implications of these unprecedented demographic developments. Gerontology, the multidisciplinary study of ageing and later life, aims to understand and improve the lives of older people. Scholarly efforts cover a wide range of research areas: from biomedical research aiming to increase longevity and health and find treatments for age-related diseases, policy research analysing the consequences of an ageing population for society and exploring the growing costs of healthcare and retirement, to healthcare research focusing on the improvement and quality of care for older people. Ageing, however, also is an existential part of human life, involving physical, mental, social, cultural, and spiritual change (Cole, Ray & Kastenbaum, 2010). Therefore, it is important to develop a broader view of what it means to grow older to accommodate the needs of older people receiving care. Attention to the potential of older people and to maintaining and restoring social connectedness and meaningfulness is a fundamental goal of caregiving, with significant expected gains in the overall health and wellbeing of older people (Penick & Fallshore, 2005). This report aims to contribute to a comprehensive view of ageing that acknowledges the potentials of older people, encompasses social and meaning dimensions of the ageing experience, and envisions old age as a life stage in which autonomy and wellbeing are accessible for individuals with and without care needs. It is based on an extensive literature review, complemented by qualitative interviews with a selection of older adults who participated in care projects chosen by the European SeeMe partners. In this report, we start with the dominant perspective on (successful) ageing and identify the most critical shortcomings of this perspective (Chapter 2). Then, we describe four aspects of a more comprehensive view that addresses these criticisms. We look, successively, in more detail at the potentials of older people (Chapter 3), their social needs, (Chapter 4), and their meaning needs (Chapter 5). Next, we present the empirical outcomes of the social and meaning needs expressed by the older adults in the SeeMe project (Chapter 6). We end this report with conclusions on the relationship between social needs and meaning needs and their implications for providing care to older adults (Chapter 7).
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Chapter
Die Geschichte des Alters, als die Summe der konventionalisierten Formen, in denen Erwartungen an Alter und ein Leben im höheren Lebensalter gedacht, antizipiert und erlebt worden ist, ist für die praktischen Gerontologien wie für die Alterssoziologie ein unübersichtliches Gelände. Es wird in der Regel gemieden oder in eher simplifizierenden Konzepten an die sie eigentlich interessierenden Gegenwartsanalysen anschlussfähig gemacht. Alter hat aber Geschichte, und ich denke, es lässt sich zeigen, dass dieser in der Regel recht sorglose Umgang der Gerontologien mit den historischen Vergleichsdimensionen ihres Gegenstandsfeldes Verzerrungseffekte in der Konzeptionierungsarbeit hat und vermutlich auch die Erledigung aktueller Analyseaufgaben erschwert. Es ist schlicht so, dass mit „Alter“ immer Themen im Spannungsfeld von Plastizität und Konstanten aufgerufen sind, dass immer Ähnliches und Unterschiedliches in Verhältnisse gebracht werden müssen. Wenn die praktischen Gerontologien glauben sollten, eine sorgfältige Integration ihrer Geschichte in die Gegenwartsanalyse vermeiden zu können, dann irren sie.
Thesis
In the industrialised countries, the longevity increase has lead into the extension of the time that elderly people remain in their homes. Whether de facto or by election, the reality is that the vast majority of older people are living in a private accommodation until a severe decline in health status forces a move towards a nursing institution. This experience, the fact to remain at home in later life, has been conceptualised as ‘Ageing in Place’ or ‘Independent Living’. This thesis has utilised the ‘ageing in place’ concept to explore the multidimensional relationship among older people and their living environment that permit them to remain at home despite changes in their living conditions due to ageing process. The aim has been to analyse how independent living is attained, what are its caracteristics and strategies that shape its development, and what the mechanisms enhance it. Given that ‘Ageing in Place’ notion have been used simoutanoeusly in the scientific field and in the institutional ambit, that has convert it in the mainstrean term under which present the social, care and housing policies in Europe, the emergents debates from this dichotomy are a central part of this investigation. All in all, the questions that this thesis sets out are “what we are talking about when we talk about ageing in place’ and “which factors that condition the ageing in palce experience?”. Focused in the European context, this thesis performs a cross-national analysis among the EU15 countries, exploring four components of Ageing in Place experience. The study of the demographic component aims to caractherise the profiles of those elderly people that remain living at home, quantifiying the magnitude of the phenomenon and highlighting the similarities and divergences among regions. The residential component analyse the living conditions of older Europeans, besides to analyse to what extent these conditions shape the residential satisfaction in later life. The social component of Ageing in Place is analysed idetifiying the support mechanisms, both formal or informal, that help older people to remain living in their own home. The role of family networks is essential in care provission, reason why family ties is a core aspect of the analysis. This thesis also aims to shed light on the individual component of ageing in place, investigating about the aspects that condition the ideal images that older people maintain about the best enviroment to growing older; in the own home, co-residing with a relative or in an institution. The spatial scope of this last analysis only consider one country: Spain. The two main data sources used are cross-European: Survey of Ageing, Retirement and Health in Europe (SHARE) and the European Union Statistics of Income and Living Conditions (EU-SILC), allowing the cross-national perspective. The objective is to assess if the North-South gradient based in the development of welfare states and the socio-cultural diversity in family relationships determine the way older people is ageing at home in the different regions of the continent. The empirical analysis is developed by means of multivariate techniques, from Logistic Regression models, to distinct applications of Discrete Choice Models, as Logit or Probit. The empirical results obtained invite to reflect about ageing, the new identities of older people and the discourses generated by demographic change. This work also contributes to the debate about the role that families and states have on well-being in later life.