AIGNA Conference 2018

1. Connectedness and Meaningful
Living in Older Adulthood
Dr. Elizabeth Weathers, PhD, RGN, BSc, PGCTLHE
Lecturer in Nursing, RCSI Bahrain
Date: 3rd May 2018
Royal College of Surgeons in Ireland - Medical University of Bahrain

2. Older Than Ireland
YouTube clip:
https://www.youtube.com/watch?v=WjSBDE2dKm8

6. Where is Bahrain??
• Bahrain is officially known as the Kingdom of Bahrain and is a small Arabian
monarchy in the Persian Gulf
• Population = approx. 1.2 million
• Area = 780km2
• It is connected to Saudi Arabia by a 25km causeway
• One of the earliest countries to convert to Islam around 628AD
• Since the 1800s, it is been ruled by the Al Khalifa royal family – Shaikh Hamad
bin Isa Al Khalifa

7. Image credit: http://www.gulfweekly.com/Articles/33753//Care-for-the-elderly
• How society views older adults
in Bahrain
• Long term care facilities are
almost non-existent
• Cultural influences
• Co-habiting with children
Image credit: https://www.istockphoto.com/photos/turkey-rural-scene-women-village

8. Image credit: https://www.pinterest.com/pin/125256433364620863/
What is my view of ageing? What is society’s view of
ageing?

9. Reports on Attitudes and Ageing

10. Image credit: https://www.saatchiart.com/art/Photography-old-hands/290894/1299045/view

11. Image credit: http://www.dreams.metroeve.com/aging-dreams-meaning/
• Physical changes
• Psychological changes
• Spiritual changes

12. Research on Ageing
• Internationally, there is a plethora of studies that have demonstrated the
losses and changes that occur during ageing and the correlations with many
other variables (Balogun et al. 2018, Fong and Feng 2018, Martinez-Gomez et al.
2018, Sterling et al. 2018, Watanabe et al. 2018).
• National longitudinal research studies have been undertaken worldwide to
better understand the ageing process.
• Irish Longitudinal Study on Ageing (TILDA) led by Prof Rose Anne Kenny of
Trinity College Dublin and involving many institutions throughout the
country.
• Reports and papers published on depression, death ideation, disabilities,
cognitive health, risk factors for many physical disease, effect of retirement,
sexual activity, relationship quality.

13. Connection = Better Ageing
Good
relationships
keep us
happier and
healthier!

14. Meaning in Life = Better Ageing
• A study published by Harvard Chan School of Public Health in JAMA
Psychiatry, reported that having meaning or a purpose in life helped people
to maintain their function and independence as they age (Kim et al. 2017).
• Other recent studies have demonstrated the relationship between
meaning/purpose in life and healthcare utilization, quality of life, reduced
physical disability, and reduced incidence of stroke (Kim et al. 2013, Mota et al.
2016, Musich et al. 2018).
But how can people have better meaning/purpose in life?? How
do we help to enable opportunities for older adults to create
meaning and connection?

15. Viktor Emil Frankl 1905 - 1997
Image credit: www.waitingforbarbarians.com

16. Core Concepts
Freedom of
Will
Will to
Meaning
Meaning in
Life
“Man’s freedom is no
freedom from conditions
but rather freedom to take
a stand on whatever
conditions might confront
him” (1988, p16).
“…human beings are not
pushed by drives, instincts,
and past histories of
reinforcement but drawn
forward by the need to
fulfil future meanings”
(Wong 2013, p621).
“What matters, therefore,
is not the meaning of life in
general, but rather the
specific meaning of a
person’s life at a given
moment” (Frankl 1985,
p622).

17. What does the empirical literature say?
 Explored perceptions of
being an older adult and the
ageing process
 Six focus groups with 39
people aged between 50 and
92 years
 One overarching theme:
continuity and change.
 Three sub-themes:
freedom/liberation,
independence/autonomy,
personal responsibility /self-
care

18. Shaw and Langman (2017) Findings
“It doesn’t matter
what other people
think. And you’re
accepted for what
you are…freedom to
do what I like”
(George).
“I have more
freedom to choose
and not as many
obligations” (Alice).
Freedom/Liberation
“I think if there’s
one thing I really
do fear about
extreme old age,
it’s losing your
independence”
(Bill).
“I certainly don’t
want to end up in a
nursing home…”
(Betty).
Independence/Autonomy
“You have to work at it”
(Marjorie, on
retirement).
“I try each day to
accomplish at least one
thing. Whether it’s
clean the house, or
write something…
(Ron).
“I find it all quite
fulfilling. So I don’t have
time to be cranky, or
lonely” (Ken).
Personal Responsibility

19. More of Frankl’s Concepts
▪The presence of a spiritual dimension
▪Soma, Psyche, Noos (spirit)
▪It is at the level of the spirit that a person can find
meaning in life and overcome or transcend the darkest of
pressures placed on the other two dimensions
▪Self-transcendence
▪ A way of accessing the spiritual dimensions and finding meaning

20. “The pain, misery, or loss experienced by a
person”
”The state or an instance of enduring pain”
“Suffering is serious pain which someone
feels in their body or their mind” (Collins’
Dictionary)
Image credit: www.coacingconfidence.co.uk

21. How do we create meaning and connection?

22. Creative
Values
Experiential
Values
Attitudinal
Values
How to create meaning in life and connection?

23. Some exemplars….
• Irving et al. (2017) suggested that we provide opportunities for older adults
to:
– Continue contributing roles (creative values)
– Participate in meaningful activities (experiential values)
– Leading to a sense of relevance and sustenance of their social value
(attitudinal values)
• Living Legends Intervention (Chippendale and Boltz 2015) – significantly
increased sense of purpose and meaning in life for those in the intervention
group. Qualitative feedback was also positive:
– “The other reason I loved this experience was the fact that getting old is
not that bad. It showed me how vibrant you can be even into your 90s”.
• Many ways to give older people similar opportunities as those described
above– from a personal, professional and wider community perspective.

24. • Person-centered approach and
philosophy of care
• Creativity
• Being rather than doing
Professional
• Volunteering
• National and local groups
• Examples: befriending services,
senior citizens groups etc.
Community

25. Persons with Cognitive Impairment
• Consider Frankl’s theory and assumptions i.e. every person
has a responsibility and has the freedom to choose.
• Those with cognitive impairment still retain emotional
responsiveness and ways of connecting with others through
actions/behaviours, feelings and emotions (McFadden et al. 2000,
Kimble, 2000).

26. McFadden et al. (2000) findings…Actions
Marge gets off the couch and starts
touching objects in the living room. She
throws a rag on the desk, takes her plate
to the sink. She stops on her way to talk
to Mary. She says to a staff member, ‘Are
you sure you can take my plate?’ She sees
a knife on the counter and says,
‘Shouldn’t have a knife in the kitchen!’
She will not give it to anyone; instead she
insists on bringing it to the sink herself.
‘I’m glad I caught this,’ she says.
Marge is seeking to
control an aspect of
her environment.
She may not be able
to recall the episode
ten minutes later, but
she still “did a deed”
(to paraphrase
Frankl).

27. McFadden et al. (2000) findings…Feelings
Sometimes when residents
expressed their feelings, their
statements sounded like poetry.
One woman said happily, “this is the
first time the sky has been all
around you can see it.”
One day, a staff member asked a
resident how she liked her dessert.
She replied, “we are all quite joyful.”
The researchers
observed a wide
variety of emotions
including anger,
sadness, joy, agitation
envy, and wonder.

28. McFadden et al. (2000) findings…Humour
Often, we observed that some
residents seemed to be aware of
their own and others’ problematic
cognitive functioning. Several
residents began talking about the
fact that it was Groundhog Day. At
one point, Betty interjected, “What
does the groundhog look like? He
must be a popular guy!” and three
women broke up in laughter.
Frankl stated that when
humans display a sense of
humour, they are showing
that they have mastered
the “art of living”. To live
in an institution, and to
suffer from an incurable,
progressive illness such as
dementia, and still be able
to find humour in daily life
represents a triumph of
the human spirit.

29. McFadden et al. (2000) findings…Humour
One time Marge picked a metal
object off the floor and said
“sorry” to it. She offered it to
Joe, stating, “Here, you hold him
for a little while.” They both
giggled and talked to each other
about it, albeit in a way only they
could understand.
Does this interaction make
sense? Does it have meaning?
Perhaps, to some it doesn’t
make sense or have meaning.
And yet Marge and Joe are
having a conversation; they
are talking to each other and
are sensitive to one another’s
difficulties. The tone is
pleasant and they are clearly
enjoying the interaction. They
are making meaning together.

30. Jenny Joseph - Warning
Image credit: https://www.theguardian.com/books/2018/jan/19/jenny-joseph-obituary
 Freedom to
choose our
response
 Responsibility
to oneself
 Attitudinal
change

31. THANK YOU
ANY QUESTIONS?
Royal College of Surgeons in Ireland - Medical University of Bahrain
THANK YOU! ANY QUESTIONS?