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Women's perceptions of life after 70 : a phenomenological study Sloss, Theresa Anne 1989

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WOMEN'S PERCEPTIONS OF LIFE AFTER 70: A PHENOMENOLOGICAL STUDY By THERESA ANNE SLOSS .Sc.N., The University of B r i t i s h Columbia, 1978 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING i n THE FACULTY OF GRADUATE STUDIES (The School of Nursing) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA September 1989 (S) Theresa Anne Sloss, 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of "0 XJL/S t ^\ The University of British Columbia Vancouver, Canada Date f 1 ' JO - // DE-6 (2/88) ABSTRACT WOMEN'S PERCEPTIONS OF LIFE AFTER 70: A PHENOMENOLOGICAL STUDY This study was designed to gain an understanding of how older women perceive t h e i r l i v e s . In order to gain t h i s i n s i g h t the q u a l i t a t i v e research methodology of phenomenology was selected. Data c o l l e c t i o n and analysis occurred concurrently. Data were c o l l e c t e d through f i f t e e n unstructured interviews. Eight women whose ages ranged from 75 to 88, and who l i v e d on t h e i r own i n the community par t i c i p a t e d i n the study. Each transcribed interview was analyzed separately and i n r e l a t i o n to the other interviews. Emerging themes were validated and c l a r i f i e d i n the second interview. The themes were synthesized and then integrated i n t o the f i n a l framework c a l l e d the cycle of contentment. The cycle of contentment had four phases: having independence and connectedness (sources of contentment), experiencing threats, c a l l i n g upon resources and redefining independence and connectedness. Contentment was a form of happiness preferred by the women and was characterized by calmness and freedom from uneasiness. Independence and connectedness were i d e n t i f i e d as the two main sources of contentment. Independence was composed of s e l f -r e l i a n c e , not having to inconvenience others and of being i n i i i c o ntrol of d a i l y events and personal a f f a i r s . Connectedness was equated with a sense of belonging with family and friends and being involved and aware of what was happening i n the world. Unfortunately, l i f e over 70 for these women was accompanied by many threats which disrupted t h e i r independence and connectedness and thus t h e i r contentment. The threats noted i n the study were: the death of a spouse, death of friends, health problems and the adverse attitudes and actions of others. In response to the threats the women c a l l e d upon t h e i r resources to counteract the impact of the threats. Two types of resources were noted i n the study: external and i n t e r n a l . External resources included finances, family, friends and h e l p f u l neighbors. Internal resources included f a i t h , memories, s e l f -confidence, a f i g h t i n g s p i r i t and personal a t t r i b u t e s which were somewhat unique to t h i s stage of t h e i r l i v e s . By drawing upon t h e i r resources i t was possible to move to the next phase of the cycle, that of redefining independence and connectedness. This r e d e f i n i t i o n occurred i n three ways. The women found new ways of experiencing independence and connectedness, they normalized common threats and they reappraised t h e i r s i t u a t i o n s . Once independence and connectedness were redefined, contentment returned. These findings were discussed i n r e l a t i o n to relevant l i t e r a t u r e . The implications for nursing p r a c t i c e , education and research were then i d e n t i f i e d . i v TABLE OF CONTENTS Page ABSTRACT . i i . TABLE OF CONTENTS i v LIST OF FIGURES v i ACKNOWLEDGEMENTS v i i CHAPTER 1: INTRODUCTION TO THE STUDY 1 Introduction 1 Background to the Problem 1 Conceptual Framework 5 Problem Statement 7 Purpose 7 Methodology 7 Def i n i t i o n s 8 Assumptions 9 Limitations 9 Organization of the Thesis 10 Summary 10 CHAPTER 2: LITERATURE REVIEW , 11 Introduction 11 P r o f i l e of Women 70 and Over 11 Psychosocial Theories of Aging 12 Research on Women 16 Recent Information on Aging 19 Summary 21 CHAPTER 3 : METHODOLOGY 23 Introduction 23 Overview of Phenomenology . 23 Selection of Participants 25 C r i t e r i a f o r Selection 25 Selection Procedure 25 Cha r a c t e r i s t i c s of the Participants 26 Data C o l l e c t i o n and Analysis 26 Data Analysis . . . 28 Ethics and Human Rights 29 Summary 30 V CHAPTER 4: RESEARCH FINDINGS 31 Introduction 31 Contentment 31 Threats , 37 Resources 41 External Resources 42 Internal Resources 43 Redefining Independence and Connectedness 49 Summary 54 CHAPTER 5: DISCUSSION OF FINDINGS 56 Introduction 56 The Research Questions 56 Theoretical Framework 58 Cycle of Contentment 59 Contentment . 59 Independence and Connectedness 60 Experiencing Threats 61 Resources 63 Redefining Independence and Connectedness 66 Summary 68 CHAPTER 6: SUMMARY, CONCLUSIONS AND IMPLICATIONS FOR NURSING 70 Introduction 70 Nursing Implications 74 Implications for Nursing Practice 74 Implications for Nursing Education 76 Implications f o r Nursing Research 77 REFERENCES . 79 APPENDICES 84 Appendix A: Letter of Information 85 Appendix B: Consent Form . . * . 87 Appendix C: Sample Trigger Questions f o r the I n i t i a l Interview 88 v i LIST OF FIGURES Figure Page 1. The Cycle of Contentment 32 y i i ACKNOWLEDGEMENTS I wish to thank the very s p e c i a l women who pa r t i c i p a t e d i n ^ t h i s study. Their willingness and a b i l i t y to share t h e i r unique perspectives were invaluable. To Paul, who provided an never ending supply of emotional support and computer expertise. To so many of my friends, and es p e c i a l l y , Susan, Ling, Carol, Nora and Marion. And f i n a l l y , I would l i k e to acknowledge the time, e f f o r t and assistance of my research committee, Professors A l i s o n Rice ( c h a i r ) , C l a r i s s a Green and Helen E l f e r t the external reader. 1 CHAPTER 1 INTRODUCTION TO THE STUDY Introduction Canadian society i s increasingly successful i n i t s endeavors to preserve and extend human l i f e . This success i s evidenced by the increasing numbers of older people, the majority of whom are women. To date, researchers have acquired a substantial amount of information describing the problems and i l l n e s s e s associated with old age. However, l i t t l e research exi s t s about wellness i n old age, or about the experience of l i v i n g through o ld age. In order to expand our understanding of old age, there i s a need to gain a more h o l i s t i c understanding from older people's perspectives. This study begins to address that need. Its aim i s to discover how a sample of women over 70, perceive t h e i r l i v e s . Background to the Problem By the year 2021, one i n every f i v e Canadians w i l l be over 65 years o l d . This i s a s i g n i f i c a n t increase from 1931 when 1 i n every 13 Canadians was over 65 (Hees, 1987). Currently, a woman of 65 can expect to l i v e f o r 19 more years; a man can expect 15 more years of l i f e (Hees, 1987). Since the 1950's, the r a t i o of women to men i n the older age group has increased. While women 75 years of age and over outnumbered men 125 to 100 i n 1956, by 1981 women i n t h i s group outnumbered men 195 to 100 (Stone & Fletcher, 1986). Thus, there are more very o ld women than men. 2 Unfortunately, much of the e x i s t i n g information pertaining to women who are now aged 65 and over i s both erroneous and li m i t e d . Erroneous information arises from negative stereotypes which portray older women as ph y s i c a l l y unattractive, unproductive and dependent on others as they age (Cohen, 1984). Or, older women and men may be grouped together as a single homogeneous group a l l suffering from i l l health, confusion and unhappiness (Chappel, St r a i n & Blandford, 1986). These negative stereotypes not only l i m i t our understanding of how older women f e e l about l i v i n g i n old age, but can also i n t e r f e r e with the de l i v e r y of adequate health care (Rodin & Langer, 1980? Panicucci, 1983). So l i t t l e i s known about women over 65 for several reasons. F i r s t , researchers now recognize that a number of previous studies suffered from a male bias (Eichler & Lapionte, 1985; Barnett & Bauch, 1978). This bias resulted from men having higher educational l e v e l s and occupying positions of power and status, which i n turn allowed them to design, implement and in t e r p r e t research studies from t h e i r own perspectives. In addition, many researchers i n c o r r e c t l y assumed that the findings of studies with e x c l u s i v e l y male subjects could be generalized to the population as a whole. Gender was not considered a s o c i a l v a r i a b l e f o r analysis (Eichler & Lapointe, 1985). Therefore women's perspectives tended to be ignored ( G i l l i a n , 1985). Second, some people suggest that women have been excluded from research studies because of t h e i r perceived lack of status and power (Burwell, 1984). Feminist researchers are beginning to 3 look at older women's issues, but to date most energy has been direc t e d toward the issues a f f e c t i n g younger women (Fennell, Phi l i p s o n & Evers, 1988). Thus the f a i l u r e to d i f f e r e n t i a t e gender perspectives, a lack of recognition of female issues f o r study, and past exclusion from research a l l contribute to our li m i t e d understanding of today's older women. Recent demographic data highlight two areas of concern. In 1982, 60% of the e l d e r l y unattached women i n Canada existed at or below the poverty l i n e (Gee & Kimball, 1987). These women have low incomes fo r a v a r i e t y of reasons. Most obviously, married women frequently become widowed, and f i n d that t h e i r income i s d r a s t i c a l l y reduced. In addition, i n previous decades many women remained i n the home and cared f o r t h e i r f a m i l i e s . They were r a r e l y involved i n out-of-home employment and thus were unable to accrue savings or contribute to t h e i r own pension plans, F i n a l l y , when women, either single or married, did work outside of the home, they almost i n v a r i a b l y earned less than t h e i r male counterparts which reduced t h e i r a b i l i t y to accumulate f i n a n c i a l resources f o r old age (Gee & Kimball, 1987). Low incomes can often lead to diminished states of health and lowered self-esteem f o r older women (Gee & Kimball, 1987; Harvey, Barnes, Greenwood & Kabahenda-Nyakabwa, 1987). A second further disturbing trend revealed by the demographic data, concerns chronic diseases. Although approximately 80% of older individuals are capable of independent l i v i n g , 3 out of every 4 have at l e a s t one chronic health condition (Ministry of Supply & Services, 1982). A f t e r 4 they are widowed, many women l i v e on t h e i r own. Although they do so despite chronic health conditions, there have been few attempts to understand the impact of these conditions on t h e i r l i v e s . Limited f i n a n c i a l resources and chronic health problems are two e a s i l y recognized factors that can place older women i n a high r i s k group. However, minimal attention has been directed towards i d e n t i f y i n g how older women draw on t h e i r inner resources and strengths which i n turn enable them to cope with t h e i r s i t u a t i o n s . Therefore, a research study that allows and encourages older women to share t h e i r experiences and perceptions of l i v i n g i n old age i s needed. This lack of information about women over 70 i s of serious concern to the nursing profession. In many areas of prac t i c e , the contact nurses have with older women, w i l l only increase. As consumers, older women expect nurses to know about t h e i r health care needs and use t h i s knowledge as a basis f o r providing assistance. However, nurses who do not have an adequate understanding of the older woman's perspective cannot provide q u a l i t y assistance. Nurses may unknowingly set goals which are eit h e r too high or that have no relevance f o r older women. Conversely, i f nurses base t h e i r approach to care on t h e i r previous contact with very d e b i l i t a t e d older people and believe t h i s to be the norm, then goals may automatically be set too low for other older women. An older woman may be loath to r a i s e the goal l e v e l as she may f e e l the nurse i s the expert. Therefore, as the population of aging women i s increasing, i t i s imperative 5 f o r the nursing profession to carry out research that w i l l increase the knowledge base of how women perceive l i v i n g i n old age. Conceptual Framework The experience of l i f e a f t e r 70 i s a broad t o p i c . Thus, i t i s important to have an organizing framework that w i l l be appropriate f o r t h i s age group, be f l e x i b l e enough to incorporate the uniqueness of each woman's experience, and s t i l l encourage i d e n t i f i c a t i o n of shared phenomena. The concept of " c r i t i c a l period" i n the UBC model for nursing (1987) i s seen as capable of meeting these requirements and thus i s used for t h i s study. According to the UBC model fo r nursing (1987), a c r i t i c a l period i s an event occurring during the ind i v i d u a l ' s l i f e which requires that i n d i v i d u a l to develop and use suitable coping behaviors to s a t i s f y basic human needs, achieve s t a b i l i t y , and reach optimal health. There are two kinds of c r i t i c a l periods: "maturational events and unpredictable events" (U.B.C. model for nursing, 1987, p.40). This study focusses p r i m a r i l y on maturational events. Within a c r i t i c a l period a maturational event i s a predictable change that occurs i n an ind i v i d u a l ' s l i f e . As a developmental stage, old age w i l l have a c o l l e c t i o n of these predictable changes. They may include: "body change, geographical change, i n t r a f a m i l i a l change, r o l e change, s o c i a l i n t e r a c t i o n change, and work and career change" (UBC model for nursing, 1987, p.40). 6 By contrast, an unpredictable event occurs with l i t t l e or no warning. Examples of such unexpected events or changes are: " c i r c u l a t o r y disorders, degenerative diseases, separation, and trauma" (UBC model for nursing, 1987, p.40). Several unpredictable events are associated with old age. The model further suggests that a l l events or changes associated with the c r i t i c a l period have associated losses and gains which are understood on an i n d i v i d u a l basis. In general, during a c r i t i c a l period an i n d i v i d u a l may perceive a loss or a gain of "a valued person, some aspect of s e l f , possessions, or p r i v i l e g e s within t h e i r s o c i a l context" (UBC model fo r nursing, 1987, p.41). As i n each developmental phase of l i f e , old age involves i t s own c h a r a c t e r i s t i c losses and gains. F i n a l l y , the model considers expectations to be a component of a maturational event. An expectation i s : "anticipated, hoped for , or perceived as required. ... Some expectations are personally derived, s o c i a l l y determined, and c u l t u r a l l y dictated" (UBC model fo r nursing, 1987, p. 41). Therefore, i t follows that older women have expectations about maturational events associated with aging. More information i s needed about the maturational and unpredictable events i n old age. Women's descriptions of changes or events that a f f e c t them and t h e i r responses to these events w i l l help us to understand t h e i r experience of being over 70. In summary, t h i s framework provides a way of conceptualizing the developmental stage of old age as including a number of associated changes. Each change has associated 7 losses and gains. Maturational events are shaped by i n d i v i d u a l expectations. Because the losses, gains, and expectations are uniquely perceived, the way to understand them i s to explore t h e i r meaning with the individuals who are experiencing the events of the c r i t i c a l period. Problem Statement As the number of older women increases, nurses w i l l be coming into contact with them more frequently. At present there i s l i m i t e d information about the perceptions of older women regarding t h e i r experiences of l i f e at age 70 and older. Without i t , nurses w i l l not have the understanding and knowledge necessary to adequately a s s i s t older women a t t a i n t h e i r desired l e v e l of health. Purpose The purpose of t h i s study i s to explore and to describe how women who are enculturated into Canadian society experience l i f e a f t e r 70. The s p e c i f i c questions that directed the study are: 1. How do women describe the gains or p o s i t i v e aspects associated with t h i s stage of t h e i r l i f e ? 2. How do women describe the losses or negative aspects associated with t h i s stage of t h e i r l i f e ? 3. How do women's actual experiences of being 70 and over compare with t h e i r e a r l i e r expectations of themselves at t h i s stage of t h e i r l i f e ? Methodology A number of factors were considered i n choosing a methodology. F i r s t , l i t t l e i s known about the l i v e s of women who 8 are 70 and over. As our knowledge i s limit e d , i t i s too early to i s o l a t e c e r t a i n factors or reduce women's l i v e s i n t o q u a l i t a t i v e u n i t s . Second, as E i c h l e r (1980) pointed out, i t i s important to choose a methodology that i s not sexist. Third, much of the extant research involving older people has been done by younger researchers from t h e i r younger perspectives. Therefore the chosen methodology must allow women's perceptions, b e l i e f s and experiences to unfold without the younger researcher's bias or d i r e c t i o n . Given the above requirements, phenomenology, a type of q u a l i t a t i v e research, i s the methodology of choice. A desc r i p t i o n of the methodology and i t s application to the study w i l l be outlined i n chapter three. Definitions C r i t i c a l period: An event occurring during an in d i v i d u a l ' s l i f e that requires the i n d i v i d u a l to develop and use suitable coping behaviors. The two types of events are maturational changes and unpredictable events. (UBC model fo r nursing, 1987, p.40). Enculturation: The process whereby indivi d u a l s are conditioned by, adjusted to, and integrated with the c u l t u r a l norms of t h e i r s ociety (Funk & Wagnalls, 1989, p.435). Gain: "Having that which i s or can be of value" (UBC model for nursing, 1987, p.41). Growing o l d : For the purpose of t h i s study, growing old represents a dynamic state of being i n the l a t e r portion of the l i f e c y cle. Health: "Health ... i s a resource f o r everyday l i f e , not the object of l i v i n g . Health i s a p o s i t i v e concept emphasizing 9 s o c i a l and personal resources, as well as physical capacities" (Ottawa, Charter, 1986, p. 426). Loss: "Being without that which has or could have meaning fo r an i n d i v i d u a l " (UBC model fo r nursing, 1987, p. 41). Old Age: For the purpose of th i s study old age begins at the chronological age of 65. Maturational Event: "Changes that occur with p r e d i c t a b i l i t y during an in d i v i d u a l ' s l i f e " (UBC model for nursing, 1987, p.40). Unpredictable events: "Changes that occur with l i t t l e or no warning" (UBC model fo r nursing, 1987, p.40). Assumptions There are a number of assumptions inherent i n t h i s study. F i r s t , i t i s assumed that women experience both gains and losses i n the maturational events and unpredictable events associated with old age. Second, women w i l l have had ce r t a i n expectations about growing older. Third, women who are currently l i v i n g alone have d i f f e r e n t experiences from those who are l i v i n g with a partner or i n an i n s t i t u t i o n . F i n a l l y , i t i s assumed that the women are w i l l i n g and able to t a l k openly and honestly, thereby giv i n g an accurate account of t h e i r perception of r e a l i t y . Limitations Informants i n the study are women who l i v e alone. They were selected from a s p e c i f i c metropolitan area and from a s i m i l a r c u l t u r a l group. The amount of data c o l l e c t e d was li m i t e d by time and resources and thus, the conclusions of the study's findings are l i m i t e d to the informants i n t h i s study. Furthermore, the 10 experiences of these women may not be the same as those i n future generations of older women. Organization of the Thesis The subsequent chapters describe both the process involved i n answering the research questions, and an in t e r p r e t a t i o n of the r e s u l t s . Chapter two presents l i t e r a t u r e that i s pertinent to the research problem. Chapter three describes and explains the implementation of the methodology adopted f o r t h i s study. The p a r t i c i p a n t s ' accounts and findings are presented i n chapter four. The findings are then viewed i n l i g h t of relevant l i t e r a t u r e i n Chapter f i v e . Chapter s i x concludes the study by summarizing the findings and o u t l i n i n g the implications for nursing p r a c t i c e , research, and education. Summary Chapter one highlights the lack of information about women over 70 and outlines the reasons why more research i s needed. It also describes the conceptual framework from the UBC model of nursing (1987), which was used as a guide f o r t h i s study. The chapter also defines s i g n i f i c a n t terms, and states some l i m i t a t i o n s . Chapter two reviews l i t e r a t u r e that i s pertinent to the research problem. 11 CHAPTER 2 LITERATURE REVIEW Introduction The purpose of the l i t e r a t u r e review i s twofold. F i r s t , from the des c r i p t i v e research and l i t e r a t u r e , a p r o f i l e of women who are now over 70 emerges. Second, the review uncovers relevant information that contributes to our understanding of l i f e f o r women who are now over 70. Three bodies of l i t e r a t u r e and research are outlined i n the second section. They are: the psychosocial theories on aging, research studies s p e c i f i c to older women, and f i n a l l y general research studies which address the experience of l i f e i n old age. P r o f i l e of Women 70 and Over Women who are over 70 belong to what i s termed a s p e c i f i c cohort group. A cohort may be defined as "the aggregate of ind i v i d u a l s (within some population d e f i n i t i o n ) who experience the same events within the same time i n t e r v a l . Each cohort has a d i s t i n c t i v e composition and character r e f l e c t i n g the circumstances of i t s unique o r i g i n a t i o n and history" (Ryder, 1985, p. 12). Women who are now over 70 l i v e d through the depression of the 1930's and two world wars. They witnessed great advances i n technology. As young women, t h e i r roles and l i f e s t y l e s were less f l e x i b l e than women born i n l a t e r decades. They generally married, had children, and then stayed home to r a i s e the chi l d r e n . For the most part they were dependent on t h e i r 12 husbands f o r t h e i r socioeconomic status (Maxwell, 1988). They expected marital s t a b i l i t y and aimed f o r f i n a n c i a l security, home ownership and a better l i f e f or t h e i r children (Baker, 1987). Choosing a career and opting for single l i f e was rare (Maxwell, 1988). Demographic data provide information on t h i s cohort's present status. In 1982, 78% of unattached women over 65 l i v e d near or below the poverty l i n e (Gee & Kimball, 1987). In general, as older women are l i v i n g longer and as they have married men older than themselves, they are four times more l i k e l y than men to become widowed (Gee & Kimball, 1987). Older women frequently experience at least one major health problem. These problems can include heart disease, cancer, Alzheimer's disease, osteoporosis, and depression. They have a higher incidence of diabetes mellitus than men. They can also s u f f e r from a v i s u a l or hearing impairment (Gee & Kimball, 1987, Doress & Siega l , 1987). Although we have a number of facts about older women, the p r o f i l e i s incomplete; few studies examine how the older woman herself f e e l s about her l i v i n g s i t u a t i o n . In an attempt to obtain a more complete p r o f i l e , the researcher examined four psychosocial theories of aging. Psychosocial Theories of Aging The four psychosocial theories of aging are the a c t i v i t y , disengagement, continuity, and socio-environmental theories. These theories are frequently c i t e d i n the l i t e r a t u r e about aging. The work of Cavan, Burgess, Havighurst and Goldman (1949) and Havighurst and Albrecht (1953) i s credited with creating the foundations of the a c t i v i t y theory (Gubrium, 1973). The goal of the Cavan et a l . , study (1953) was to define and analyze the nature, pattern and problems of personal adjustment to aging. The study found that two main factors influenced the person's a b i l i t y to adjust to old age: previous personality and a c t i v i t y l e v e l s . Adjustment was determined to be d i f f i c u l t because "older people no longer occupied a respected p o s i t i o n , had no recognized function and no sanctioned pattern of a c t i v i t y " (Cavan et a l . , 1953, p.10). The researchers concluded that a person's personality affected t h e i r adjustment, and that p e r s o n a l i t y remained constant throughout an i n d i v i d u a l ' s l i f e . They further concluded that people who maintained t h e i r a c t i v i t y l e v e l s were better adjusted. In the second study by Havighurst and Albrecht (1953) the researchers found that the adjustment and a c t i v i t y scores of the p a r t i c i p a n t s were highly correlated. They hypothesized that people who are more mentally, p h y s i c a l l y , and s o c i a l l y active are better adjusted. These studies were a beginning step towards the understanding that some older people enjoy a wide v a r i e t y of a c t i v i t i e s a f t e r retirement, and do i n fact enjoy l i f e i n old age. However, these studies seemed to imply that a l l people must be active to be happy. The next theory i s the disengagement theory which i s based on a study by Cumming and Henry (1961). Cumming and Henry 14 explained how young and old people d i f f e r i n t h e i r involvement with l i f e . They concluded that older people disengage from l i f e . They stated: "Aging i s an ine v i t a b l e , mutual withdrawal or disengagement, r e s u l t i n g i n decreased i n t e r a c t i o n between the aging person and others i n the s o c i a l system he belongs to. When the aging process i s complete, the equilibrium which existed i n middle l i f e between the i n d i v i d u a l and his society has given way to a new equilibrium characterized by greater distance and altered type of rel a t i o n s h i p " (p.15). Their study implied that a l l older people n a t u r a l l y withdraw from society as they age, but the study did not explain why some older people disengage more than others. F i n a l l y , there was a f a i l u r e to i d e n t i f y factors that may cause an extreme disengagement process. The t h i r d theory, the continuity theory, evolved from a study by Neugarten, Havighurst and Tobin (1963). They concluded that personality factors were the important variables i n adjusting to old age because neither the a c t i v i t y nor disengagement theories could adequately explain the r e s u l t s from t h e i r study. Their findings showed a high c o r r e l a t i o n between s o c i a l i n t e r a c t i o n and s o c i a l well-being, although they also found that some older people had a low s o c i a l a c t i v i t y r o l e and yet were highly s a t i s f i e d with l i f e . By examining patterns of aging, Neugarten et a l . , (1963) were able to i d e n t i f y four personality patterns: integrated, armoured or defended, passive-dependent and unintegrated. This study suggested that " i n normal men and women there i s no sharp d i s c o n t i n u i t y of personality with age but instead increased continuity" (Neugarten et a l . , 1963, p.177). Thus we can i n f e r 15 from t h i s study that men and women w i l l not suddenly change as they grow older. The f i n a l study i s la b e l l e d the socio-environmental theory. The study was constructed to understand the s o c i a l behaviors of the aged (Gubrium, 1973). The socio-environmental theory encouraged society to view older indiv i d u a l s not i n i s o l a t i o n , but within the context of t h e i r environments. Gubrium (1973) believed that the a c t i v i t y and disengagement theories were useful i n li m i t e d circumstances but were not conceptually linked. He conceptualized the environment surrounding older people as having both a s o c i a l and i n d i v i d u a l context. The s o c i a l context included a c t i v i t y norms and ce r t a i n behavioral expectations from society. On the other hand, the i n d i v i d u a l context included a c t i v i t y resources which consisted of state of health, f i n a n c i a l solvency and the state of s o c i a l support. If a person had many a c t i v i t y resources t h e i r behaviors could be much more f l e x i b l e . Gubrium (1973) further proposed that both the s o c i a l and i n d i v i d u a l components of an individual's environment had an impact on a person's morale. Morale was based on how persons judged themselves and t h e i r attitudes towards themselves. The judgements were i n turn affected by the s o c i a l and i n d i v i d u a l contexts. If the i n d i v i d u a l f e l t that society expected a certa i n type of behaviour, but they did not have the a c t i v i t y resources a v a i l a b l e to perform the behaviors, then t h e i r morale would be lowered. Therefore Gubrium (1973) concluded that i t was impossible to determine how people f e l t just by observing t h e i r 16 a c t i v i t y a l o n e . I t was n e c e s s a r y t o c o n s i d e r t h e c o n t e x t o r e n v i r o n m e n t i n w h i c h t h a t a c t i v i t y t o o k p l a c e . The a b o v e s t u d i e s and t h e o r i e s p r o v i d e v a r y i n g p e r s p e c t i v e s on d i f f e r e n t a s p e c t s o f a g i n g . T h e s e r e s e a r c h s t u d i e s h a v e b e e n c r i t i c i z e d f o r t h e i r l a c k o f c l e a r l y d e f i n e d c o n c e p t s , f o r t h e i r i n c o n s i s t e n t u s e o f t e r m s a n d f o r t h e i n a b i l i t y o f o t h e r r e s e a r c h e r s t o r e p l i c a t e t h e s t u d i e s i n t h e i r p r e s e n t f o r m ( B u r b a n k , 1 9 8 6 ; K a t r e n , 1 9 5 4 ) . I n g e n e r a l t h e s e s t u d i e s f a i l t o p r o v i d e a c l e a r , c o m p r e h e n s i v e and h o l i s t i c u n d e r s t a n d i n g o f t h e a g i n g p r o c e s s . F u r t h e r m o r e , f r o m t h e p r e v i o u s i n f o r m a t i o n d e s c r i b i n g t h e m a l e b i a s i n t h e r e s e a r c h , t h e f i n d i n g s o f t h e s t u d i e s as t h e y p e r t a i n t o women become e v e n more s u s p e c t . The g e n e r a l t h e o r i e s f a i l t o p r o v i d e a n y s p e c i f i c i n s i g h t i n t o t h e p e r c e p t i o n s o f women who a r e o v e r 70. I n f o r m a t i o n more p e r t i n e n t t o o l d e r women c a n be f o u n d i n t h e s p e c i f i c r e s e a r c h on women and a g i n g . R e s e a r c h on Women A l i t e r a t u r e r e v i e w on o l d e r women b y R o b i n s o n ( 1 9 8 6 ) s p a n n i n g a 1 6 y e a r p e r i o d f r o m 1 9 6 9 f o u n d v e r y l i t t l e l i t e r a t u r e o n women and a g i n g . She f o u n d n e i t h e r r e s e a r c h on women's a t t i t u d e s t o w a r d a g i n g n o r s t u d i e s t h a t l o o k e d a t h e a l t h a n d h e a l t h p r o m o t i o n i s s u e s f o r o l d e r women. The n u r s i n g r e s e a r c h f o c u s s e d on d i s e a s e and i n s t i t u t i o n a l i z a t i o n . R o b i n s o n ( 1 9 8 6 ) i d e n t i f i e d s u p p o r t n e t w o r k s , c a r e g i v i n g r e l a t i o n s h i p s and r e t i r e m e n t a s t h e t h r e e m a i n s u b j e c t a r e a s i n t h e r e s e a r c h . The r e s u l t s a r e summarized b e l o w . 17 In the s o c i a l support network l i t e r a t u r e , Robinson (1986) found that both l i f e s a t i s f a c t i o n and psychological well-being were strongly re l a t e d to women's s a t i s f a c t i o n with intimate r e l a t i o n s h i p s . Widowed c h i l d l e s s women had a lower sense of well-being than widowed mothers. In the caregiving l i t e r a t u r e , Robinson (1986) i d e n t i f i e d the two d i f f i c u l t i e s most often c i t e d by older women who were caring f o r a spouse or family member as lack of finances and s o c i a l i s o l a t i o n . This l i t e r a t u r e also examined the b e n e f i c i a l aspects of supportive counselling and support groups f o r older caregiving women. Robinson's (1986) review of the l i t e r a t u r e on retirement fo r women pointed out that, i n general, women were happier than men with the retirement phase of t h e i r l i v e s . This adjustment may be p a r t l y r e l a t e d to the fact that many women l e f t the work force a number of times ( i f they were i n i t at a l l ) to r a i s e t h e i r c h i l d r e n . As a r e s u l t , they had gradually learned to adjust to many d i f f e r e n t situations over the years. Robinson's (1986) three subject areas, s o c i a l support, caregiving, and retirement are important but s t i l l provide i n s u f f i c i e n t information on the l i v e s and experiences of women who are over 70. Next, the research on widows i s examined fo r relevant data on older women. Harvey et a l . , (1987) studied widowhood i n Canada. In t h e i r a r t i c l e , they f i r s t summarized the research findings from other widowhood studies that were performed i n the United States, Canada, Europe and B r i t a i n . Then, they presented t h e i r own 18 research findings. From the e x i s t i n g l i t e r a t u r e , they found that people with adequate incomes, who were healthy, r e l a t i v e l y well educated, and had a close confidant, coped better with widowhood than people who were poor, uneducated and unhealthy. For some women, widowhood created a s i t u a t i o n whereby they became aware of t h e i r own personal strengths. The morale of some widows was affected by a c t i v i t y l e v e l s and income. Women who were involved with more a c t i v i t i e s had a higher morale. Some women suffered from a lowered morale because of t h e i r reduced incomes rather than because of t h e i r change i n marital status. The data f o r the Harvey et al.,(1987) study were drawn from the data i n the 1978 Canada Health Survey. They found that married people i n general had a higher morale than widowed people. Income did not show a strong independent e f f e c t on morale. On the other hand, good health was p o s i t i v e l y correlated with morale. The researchers also found that l i v i n g alone did not have a detrimental e f f e c t on mood. Unfortunately, the data did not indicate how long the people had been widowed, which could be an important variable f o r study. Although t h i s study does help us to understand factors that may a f f e c t a woman's a b i l i t y to cope with widowhood, her perspectives on being a widow remain unknown. An ethnographic study by Matthews (1979) i d e n t i f i e d the strategies older women used to maintain t h e i r s e l f i d e n t i t y i n what Matthews determined to be a sexist and ageist society. The researcher concluded that women r e l i e d upon compliance, avoidance, r e c i p r o c i t y , monitoring warning signals and continuity. Women who had l i t t l e power and few resources to o f f e r as exchange i n a rel a t i o n s h i p often turned to compliance. Avoidance was used to prevent p o t e n t i a l l y embarrassing s i t u a t i o n s . Reciprocity or being busy and doing things f o r other people helped them to maintain t h e i r s e l f i d e n t i t y . The women monitored t h e i r health to help prevent a long and l i n g e r i n g death. Continuity, the f i n a l strategy, was described as staying i n f a m i l i a r surroundings with people that they knew. in general Matthews' study helps us to understand the need for c o ntinuity i n older women's l i v e s , e s p e c i a l l y i n the areas of r e l a t i o n s h i p s , a c t i v i t i e s and i d e n t i f i c a t i o n with a home area (Fennell, P i l l i p s o n & Evers, 1988 p.105). However, an understanding of how women perceive l i v i n g i n old age s t i l l remains el u s i v e . Fortunately, with the current i n t e r e s t i n longevity, recent studies have been completed which provide i n s i g h t i n t o the aging process. This general research i s described next. Recent Information on Aging Over the past decade, a number of q u a l i t a t i v e research studies have provided i n s i g h t into how older people experience old age. For example, a grounded study by Kaufman (1986) showed that older people's i d e n t i t i e s were not defined by t h e i r age. Older i n d i v i d u a l s d i d not see themselves as old, but rather as being i n the period of old age. Kaufman (1986) further concluded that l i f e was not a tr a j e c t o r y of r i s e and then 20 decline i n old age, but was a continuous process with meaning at a l l stages. Other studies show the importance of reminiscing i n aging. Previously, older people who reminisced were portrayed as l i v i n g i n the past, which was equated with unhealthy mental behaviour. Now i t i s understood that reminiscing or r e c a l l i n g the past i s a normal and healthy way of making sense of and putting t h e i r l i v e s i n order (Breystpraak, 1984, Burdman, 1986). The common image of a l l old people being f o r g e t f u l , confused, and s e n i l e i s no longer automatically accepted as a normal state. A closer unbiased examination of older people showed that depression, excessive medication, and malnutrition could cause confusion ( G r i f f i t h Kenney, 1986). Therefore, confusion i s not normal and warrants in v e s t i g a t i o n . Many younger people assume that older people are not very happy. Depression was c i t e d as a problem for women (Gee & Kimball, 1987). However t h i s does not mean that a l l older women are depressed. A Canadian study by Connidis (1987) found that there are both p o s i t i v e and negative aspects of aging f o r people over 65. Her study found that 90% of her sample l i k e d something about t h e i r age, while only 10% of the sample claimed that they did not l i k e anything about t h e i r age. In addition, 34% found nothing to d i s l i k e about t h e i r age. Areas of l i k e s included greater freedom and fewer worries. However, common d i s l i k e s included e f f e c t s created by declining physical functions and poor health. Therefore, we can assume there are some p o s i t i v e aspects about being over 70 but there are also some concerns. 21 A Vancouver study i n 1985 provided i n s i g h t into how men and women over 65 perceive health. S t a t i s t i c s show that many older people s u f f e r from at least one chronic disease. This phenomenological study on well seniors' perceptions of health demonstrated that they do not view health as simply freedom from i l l n e s s (Thorne, G r i f f i n & Adlersberg, 1985). The par t i c i p a n t s i n the study experienced chronic i l l n e s s e s , physical discomfort, and movement l i m i t a t i o n s . However, the study showed that they experienced health on three l e v e l s of awareness: physical comfort and a b i l i t i e s , connectedness and competence, and a sense of meaning. This study validates the idea that older men and women have unique perceptions about t h e i r health and other aspects of t h e i r l i v e s . These recent studies provide some in s i g h t into the world of the older person. They demonstrate that when older participants are encouraged to share t h e i r perceptions, new and more accurate information can emerge. The findings from these studies challenge many of the t r a d i t i o n a l b e l i e f s about aging. However, the knowledge s p e c i f i c to the experiences and perceptions of women over 70 remains li m i t e d . Summary This chapter has examined three bodies of l i t e r a t u r e and research i n order to discover more about women over 70. The psychosocial theories o f f e r limited information. The research studies on older women provide background on s o c i a l support, caregiving, retirement, strategies for protecting s e l f i d e n t i t y , and widowhood. More recent studies begin to delve into the perceptions of older people and challenge many of the b e l i e f s about old age. Although the studies are useful, they s t i l l do not y i e l d a complete, h o l i s t i c understanding of how womert experience l i f e a f t e r 70. 23 CHAPTER 3 METHODOLOGY Introduction Chapter three provides a broad overview of phenomenology, the research methodology employed i n t h i s study. I t also outlines the s p e c i f i c d i r e c t i o n for informant s e l e c t i o n , data c o l l e c t i o n , and data analysis. F i n a l l y , i t presents the study's e t h i c a l considerations. Overview of Phenomenology Phenomenology i s an inductive, d e s c r i p t i v e research approach (Omery, 1983). Its goal i s not to v a l i d a t e preconceived ideas or expectations (Omery, 1983). Rather, i t aims i s to describe c e r t a i n human experiences as they are l i v e d and understood. (Georgi, 1985; O i l e r , 1986; Parse, Coyne, & Smith, 1985). This method enables the researcher to gain an understanding of how those involved i n t e r p r e t and give meaning to a given s i t u a t i o n (Rist, 1978). The data are d e l i b e r a t e l y subjective as only the participants know what i s relevant and important to them. The researcher's task i s "to l e t the world of the describer, or more concretely, the s i t u a t i o n as i t exists f o r the subjects, reveal i t s e l f i n an unbiased way through the des c r i p t i o n " (Giorgi, 1975, p. 74). The researcher's knowledge must be held i n doubt. Biases must be acknowledged. Only then can the researcher take a fresh look at the subject so that new understanding can be reached (Oiler, 1986; G i o r g i , 1985). 24 The study begins with a series of interviews. The account unfolds through the participant's verbal descriptions which are then analyzed. The researcher must ensure throughout the interviews, that what he/she hears i s correct. This i s accomplished by v a l i d a t i n g the data with the part i c i p a n t s (Knaack, 1984). C r e d i b i l i t y and a u d i t a b i l i t y are the factors which determine the v a l i d i t y and r e l i a b i l i t y of the narration i n a q u a l i t a t i v e study (Sandelowski, 1986). She asserts that a study i s c redible i f the informants v e r i f y the truth of the findings. A study i s auditable whenever a l l the steps are c l e a r l y outlined, the data analysis i s c l e a r l y a r t i c u l a t e d and i t i s evident why c e r t a i n conclusions are drawn from the data. Giorgi (1985) states that "other researchers must be able to see what the o r i g i n a l researcher sees even i f they do not agree with i t " (p. 96). Also, others who are experiencing s i m i l a r circumstances should be able to confirm the findings i n the research analysis (Knaack, 1984). To obtain the type of data needed for the study, phenomenology uses t h e o r e t i c a l sampling. A t h e o r e t i c a l sample i s selected according to the t h e o r e t i c a l needs and d i r e c t i o n of the research, and consists of individuals who are able to a r t i c u l a t e t h e i r views c l e a r l y and who are receptive to being involved i n the research (Morse, 1986). With t h i s overview of the methodology, the next section describes the implementation process. 25 Selection of Participants Following the p r i n c i p l e s of the t h e o r e t i c a l sampling technique, the researcher chose women who could provide the most i n s i g h t f u l information f o r the study. To guide t h i s s e l e c t i o n , s p e c i f i c c r i t e r i a were outlined. C r i t e r i a for Selection The c r i t e r i a f o r s e l e c t i n g the participants included the following: 1. each woman was aged 70 or over. 2. each woman l i v e d on her own i n the general community. 3. each woman was enculturated into Canadian society. 4. each woman was fluent i n English. 5. each woman l i v e d i n the lower mainland. Selection Procedure The pa r t i c i p a n t s were recruited d i r e c t l y through the researcher and through an informal network of colleagues and acquaintances. I t was believed that an informal network could provide a s e l e c t i o n of suitable participants l i v i n g on t h e i r own throughout the community. The researcher contacted these colleagues and acquaintances, described the purpose of the study and outlined the selection c r i t e r i a . Those who knew of a pot e n t i a l p a r t i c i p a n t were given a l e t t e r of information and a Consent to Contact form (see Appendix A). They, i n turn, talked to p o t e n t i a l p a r t i c i p a n t s , explained the study, gave them the l e t t e r of information and requested that the woman eit h e r return the consent to contact form, or contact the researcher d i r e c t l y by telephone. Seven of the participants were obtained t h i s way 26 and one was recr u i t e d d i r e c t l y by the researcher. Mutually convenient times to conduct interviews i n the women's homes were arranged. At the f i r s t home v i s i t , the researcher explained the purpose of the study, discussed what p a r t i c i p a t i o n would involve and answered any questions. The Consent to Pa r t i c i p a t e forms were then signed (see Appendix B). A t o t a l of eight women took part i n the study. Charact e r i s t i c s of the Participants The eight women ranged i n age from 75 to 88. Six women were born i n Vancouver, one i n Ontario and one i n England. A l l were widows. The length of time they had been widowed varied from less that 1 year to over 35 years. A l l of the women were mothers. Two of the participants had un i v e r s i t y degrees. Six had worked outside the home i n various capacities while two had been f u l l time homemakers. They a l l l i v e d i n private dwellings, e i t h e r rented or owned, and were well established i n t h e i r neighborhoods. A l l but one woman reported at least one health impairment. These included a r t h r i t i s , cardiovascular diseases, impaired v i s i o n and hearing. One woman had i n j u r i e s from an automobile accident. Three of the women received homemaker help through the Long Term Care Program. Two of the women attended an adult day care program, three days a week. Data C o l l e c t i o n and Analysis Data c o l l e c t i o n and analysis are discussed separately. However, during the study, these two processes ran concurrently; the data were analyzed throughout the c o l l e c t i o n phase and the r e s u l t s of t h i s analysis influenced the ongoing data c o l l e c t i o n process. The interviews were semi-structured, the researcher asked open-ended questions to e l i c i t the participant's views. The researcher's intent was to obtain as much information as possible without steering the p a r t i c i p a n t i n a predetermined d i r e c t i o n . The three t r i g g e r questions used to i n i t i a t e the interviews arose from the l i t e r a t u r e (Connidis, 1987) and UBC model fo r nursing (1987), (see Appendix C). Although the same t r i g g e r questions were asked of everyone, not a l l of the interviews were i d e n t i c a l . In general, the researcher followed the lead of the informant who i n turn responded to the researcher. In t h i s way each woman helped to d i r e c t the data c o l l e c t i o n . The f i r s t round of interviews with each subject was used to c o l l e c t general information. Between the f i r s t and second interviews, the researcher transcribed each tape verbatim. Afte r interviewing each woman once, the researcher constructed a framework to i d e n t i f y themes and r e l a t i o n s h i p s . This framework guided the second interview i n which the researcher asked f o r c l a r i f i c a t i o n , validated the emerging themes and obtained more complete information about each woman's perception of being over 70. Data c o l l e c t i o n continued u n t i l "the data was deemed complete, without gaps, made sense and had been confirmed" (Morse, 1986, p. 184). Since the researcher accomplished these c r i t e r i a upon the completion of second interview with each 28 p a r t i c i p a n t , no further interviews were conducted and no new subjects were added to the study. The accounts were constructed from the 15 interviews which lasted between one and a half to two and a half hours each. One of the woman became i l l and was unable to p a r t i c i p a t e i n the second interview. Data Analysis The intent of the data analysis was to understand more about how these women perceived t h e i r l i v e s . To gain t h i s understanding the data were analyzed using the steps outlined by Giorg i (1975, 1985). The steps are summarized. A f t e r the tapes from each interview were transcribed, the i n i t i a l step was for the researcher to read each entire t r a n s c r i p t to get a sense of the whole or the general picture that the woman was presenting. Then before taking the s p e c i f i c aim of the study into account and inadvertently i n t e r p r e t i n g the accounts i n a s p e c i f i c way, the researcher i d e n t i f i e d the natural meaning units that were presented i n the accounts. The dominant themes which ran through the accounts were then i d e n t i f i e d . F i n a l l y , the data were examined with the s p e c i f i c purpose of the study i n mind. The question was asked, what did each statement t e l l the researcher about the experience of aging? Many small pieces of information gradually f i t i n t o a larger design which i n turn f i t into an o v e r a l l structure or framework. This f i n a l step i s what Gio r g i described as tying a l l the themes together into one non-redundant theme. The f i n a l structure helped to describe how t h i s 29 group of women perceived t h e i r l i v e s when they are over 70. The r e s u l t s of the data analysis are discussed i n chapter four. Ethics and Human Rights The e t h i c a l and human rights of the subjects were protected i n the following ways: 1. The University of B r i t i s h Columbia Behavioral Sciences Screening Committee for Research and Other Studies Involving Human Subjects gave written approval to carry out the study. 2. The p a r t i c i p a n t s had the option of returning a Consent to Contact form, or contacting the researcher d i r e c t l y f o r an interview. 4. The purpose of the study, the r o l e of the p a r t i c i p a n t s , the type of data to be c o l l e c t e d and what would happen to the data were c l e a r l y outlined for the subjects. 5. The p a r t i c i p a n t s were informed that they were free to withdraw from the study at any time. They could refuse to answer any questions, have the tape recorder stopped, or request that any portion of the tape be erased. 6. The p a r t i c i p a n t s were advised that t h e i r decision to not p a r t i c i p a t e or to withdraw from the study would not jeopardize t h e i r treatment or care i n any way. 7. The p a r t i c i p a n t s were assured of c o n f i d e n t i a l i t y . The taped material and t r a n s c r i p t s contained no i d e n t i f y i n g f a c tors. A l l of the p a r t i c i p a n t s were given an i d e n t i t y code number which was known only to the researcher. 30 8. The tapes were to be destroyed or erased at the end of the study. 9. Consent to P a r t i c i p a t e forms were signed by the participants p r i o r to commencing the interviews. These nine precautions helped to ensure that the e t h i c a l r i g h t s of the women were protected. Summary Phenomenology was the research methodology selected to guide t h i s study. In conjunction with t h i s approach, the eight p a r t i c i p a n t s who ranged i n age from 75 to 88 were selected for t h e i r a b i l i t y to provide accurate and l u c i d accounts of l i f e over 70. Data were c o l l e c t e d through 15 in-depth interviews. Data analysis took place concurrently with and subsequent to the interviews. The r e s u l t s of that data analysis are presented i n chapter four. 31 CHAPTER 4 RESEARCH FINDINGS Introduction The purpose of Chapter Four i s to report the research findings. The eight women i n t h i s research study t o l d many sto r i e s that described various aspects of t h e i r l i v e s . From their, s t o r i e s , a number of themes emerged. The researcher synthesized and integrated these themes into a framework c a l l e d "the cycle of contentment" (see Figure 1 ove r l e a f ) . Within t h i s cycle there are a number of phases. In order to understand the o v e r a l l cycle, the researcher has described each phase i n d e t a i l . I t i s important to note that these findings r e l a t e only to the eight women who participated i n the study. Therefore, references to "the women" re f e r only to the women i n t h i s study unless otherwise stated. Contentment One of the f i r s t themes to emerge was contentment. Contentment seemed to be a state of mind which these women presently desired. I t was loosely defined as a form of happiness characterized by calmness and freedom from uneasiness. The following quotes describe i n d i v i d u a l p a r t i c i p a n t s ' desire for contentment (I. and R. indicate Interviewer and Respondent r e s p e c t i v e l y ) . R. I don't think happiness i s the end a l l f o r every stage of l i f e and I think as you get older contentment i s the more important. I am very contented with my l i f e . Figure 1 The Cycle of Contentment EXPERIENCING THREATS - death of spouse - death of friends - health problems - attitudes of others CALLING UPON RESOURCES INDEPENDENCE & CONNECTEDNESS (Sources of Contentment) External - finances - family - friends - neighbours Internal - faith - memories - self-confidence - fighting spirit - personal attributes REDEFINING INDEPENDENCE & CONNECTEDNESS - normalizing threats - new ways of achieving independence & connectedness - reappraising situation to Another woman s a i d : R. As we get o l d e r , we don't f e e l we need those e x c i t i n g t h i n g s t h a t meant so much b e f o r e . Another woman was asked: I. Is contentment more important than happiness? R. I f you are content, you are happy. Contentment i s an extended form of happiness. I f you are going t o d i v i d e them then you would make happiness a r e a l b i g d e a l . And f i n a l l y : R. I t ' s not an e x c i t a b l e happiness because my l i f e i s calm now. Some people might say b o r i n g but t o me i t ' s not b o r i n g There i s n o t h i n g p r e s s i n g me now. There i s no s t r e s s . E x c e r p t s from the t r a n s c r i p t s i n d i c a t e t h a t contentment was not p e r c e i v e d as a s t a t i c phenomenon. One 79 yea r o l d woman s a i d : R. I t h i n k you've got to keep growing. There i s something c a l l i n g me on f o r another way, another p e r i o d of time, not as long, but n e v e r t h e l e s s i n t e r e s t i n g . I t became apparent t h a t contentment was a d e s i r e d s t a t e of mind t h a t each woman d e s i r e d . However, contentment d i d not mean the c e s s a t i o n of p e r s o n a l growth, nor was i t p o s s i b l e t o a s s o c i a t e a s p e c i f i c a c t i v i t y l e v e l w i t h contentment. F u r t h e r a n a l y s i s of the p a r t i c i p a n t s ' s t o r i e s r e v e a l e d two ot h e r themes t h a t were c o n c e p t u a l i z e d as "independence" and "connectedness". Independence and connectedness appeared t o be two sources of contentment. Independence was c h a r a c t e r i z e d as s e l f - r e l i a n c e which meant not having t o bother o r inconvenience o t h e r people and be i n g i n c o n t r o l of t h e i r p e r s o n a l l i v e s and d a i l y a c t i v i t i e s . 34 One woman described her view of independence: R. Ah well independence i s something that ah I'm not being a bother to anybody else. I l i k e s e l f - r e l i a n c e . I. S e l f - r e l i a n c e , so independence i s s e l f - r e l i a n c e ? R. Absolutely, to me i t i s . This same woman had been dependent upon others following an automobile accident. Her description of her experiences as both an independent and a dependent person, enhances our understanding of the importance of independence and thus i t s l i n k to contentment. She concluded: R. So that i s the one thing that I've always dreaded was the fa c t of having been so independent. I can't stand the thought of having to r e l y on somebody else. I've had enough of that i n the h o s p i t a l , t e l l i n g you when to get up, when to go to bed, when to take a p i l l and I'm not very good at taking orders. ... One thing I dread i s getting to the point of having to ask favours of people. I can't stand favours. I. So independence i s pretty important to you? R. My God i t ' s my l i f e . Without that you would be l o s t . If you give up that you've got nothing to f i g h t with. I think keeping your independence as much as you can i s of a tremendous help because without that you could end up i n a nursing home and be t o t a l l y dependent on other people. This i s something that you hate to give up, that l a s t l i t t l e b i t of independence. Obviously independence was a v i t a l component of her l i f e and a source of contentment. For some women, independence meant not being a bother to t h e i r families. An 80 year old woman described her view of independence. R. Independence i s not having to put anyone else out or be i n the way or i n t e r f e r e with the family. F i n a l l y , independence was characterized by having control over t h e i r l i v e s i n that they were able to manage d a i l y events 35 and personal a f f a i r s . One woman described the d i f f i c u l t y she experienced when she l o s t some of her contro l . She said: R . I had a bad f a l l and that r e a l l y upset me because I was not able to function on my own. I had a woman come i n and get the meals ready and she'd have to be here an hour or two and that kind of thing. I t r e a l l y upset me not to be i n control of everything myself. I l i k e as you probably know by now to be i n pretty firm c o n t r o l . That's the way I am, I haven't any intention of t r y i n g to change i t . The women i n t h i s study valued t h e i r independence very highly as i t was a source of contentment. However, i t proved to be no more so than "connectedness". Connectedness was characterized by a sense of belonging with other people and continued involvement with l i f e . This sense of belonging occurred through relationships and involvement with t h e i r family and f r i e n d s . One woman best i l l u s t r a t e d t h i s i n her descr i p t i o n of her r e l a t i o n s h i p with her daughter at t h i s stage i n t h e i r l i v e s . R. You are not l i k e mother or daughter. You are more just l i k e friends. Now that they've got children, I've got cl o s e r to them. I r e a l l y enjoy my grandchildren. Another woman said: R. We [daughters and herself] are buddies. Another woman talked about her involvement and dependence on her peers. R. Now I belong to a group at the church. We got quite dependent on each other and most of them widowed since I was. They are good friends and caring people and people who kind of, well i f I don't turn up at church, phone and ask what happened, are you okay? Having a re l a t i o n s h i p and involvement with friends was important but i t was also important to be connected to, and 36 p a r t i c i p a t e i n , world events and everyday l i f e . One woman of 79 described her fe e l i n g s : R. I always f e e l that every new experience, I don't want to say no to. I t does make l i f e more i n t e r e s t i n g , that i s part of the fun of l i v i n g . I've got my fingers i n quite a few pies. I f e e l that there i s a l o t that I want to do that I'm not going to have enough time to do, so I t r y to do a l l that I can. Involvement with l i f e d id not always mean active physical involvement. Involvement occurred i n a v a r i e t y of ways. One woman said: R. I r e a l i z e my li m i t a t i o n s r i g h t now. I can't go out and skip around. ... I don't think my views have changed too much. I read the paper from one end to the other, I do watch a l l the news and I know what i s going on. I l i k e time to myself. I never get bored because I read a l o t . I. So you are s t i l l very involved r i g h t now? R. Mentally yes, but not ph y s i c a l l y . I. So the way that you are involved does change? R. Oh yes, yes. Involvement may also mean being aware of and appreciating nature. The researcher asked one woman: I. What would I see i f I were standing i n your shoes? R. A l l r i g h t you are standing i n my shoes and you are just t h r i l l e d by what you see. You love the mountains, you love the trees and you love everything about i t , and I love l i f e and I love l i v i n g . I can go and just watch the r i v e r and the birds down there. I have a f e e l i n g of peace and happiness. I don't think I w i l l get over the love of l i f e and l i v i n g , so many of those wonderful things. A l l of the women i n the study experienced a sense of belonging with t h e i r family and friends. They continued to be involved with l i f e and nature, but the manner and mechanisms of t h e i r involvement appeared to change as they grew older. Through 3 7 further analysis, i t became apparent that contentment and i t s sources, independence and connectedness, were p i v o t a l parts of a larger dynamic process. Thus, i t became c l e a r that contentment consisted of a number of phases. The researcher l a b e l l e d them: having contentment, experiencing threats which disrupted contentment, c a l l i n g upon resources to counteract the threats, and redefining independence and connectedness. By redefining t h e i r independence and connectedness a f t e r experiencing threats, the women were able to return to a state of contentment. These phases constituted the larger process of the cycle of contentment. The remainder of the chapter describes the phases i n d e t a i l . Threats The women's state of contentment was disrupted by a number of threats, some of which created i r r e v e r s i b l e changes. These threats i n t e r f e r e d with the women's independence and connectedness. The threats i d e n t i f i e d i n t h i s study were: health problems, death of a spouse, death of friends and the attitudes and actions of others. Health problems made i t more d i f f i c u l t f o r many of the women to continue to manage on t h e i r own or to s o c i a l i z e with t h e i r f r i e n d s . Health problems i n t e r f e r e d with t h e i r a b i l i t y to have independence and connectedness, thus causing discontentment. One woman described the impact of angina on both her independence and connectedness: R. I have angina and that slows me down... I can't do things when I want. I might just take the notion and 38 go. I've always been independent. I might j u s t walk o r I might phone someone and say do you want t o meet me f o r t e a . But I can't do t h a t because I haven't got the s t r e n g t h . T h i s woman t o l d the r e s e a r c h e r t h a t she f e l t t h a t she had l i v e d too lo n g , an i n d i c a t i o n of her discontentment. The r e s e a r c h e r asked another woman of 75 who had a number of h e a l t h problems, how her l i f e was d i f f e r e n t now compared t o when she was 6 0 . She s a i d : R. That's one t h i n g a t age 6 0 I had so much t o do, so many involvements, and now I am l e f t w i t h v e r y few, not because the o p p o r t u n i t i e s a r e n ' t t h e r e o r my f r i e n d s a r e n ' t t h e r e . I t ' s the f a c t t h a t I am not p h y s i c a l l y a b l e t o do i t . I. Is i t any d i f f e r e n t keeping i n v o l v e d now than compared t o maybe 2 0 years ago? R. In a d i f f e r e n t way because 2 0 years ago I was doi n g a c t i v i t i e s much d i f f e r e n t , more a c t i v e . You d i d t h i n g s t h a t I c o u l d n ' t dream of doing today because I haven't got the c a p a c i t y . Another woman d e s c r i b e d the consequences of a h e a l t h problem t h a t a f f e c t e d her independence. She was no l o n g e r a b l e t o do her gardening. She s a i d : R. I t i s [the garden] the one t h i n g t h a t I t r e a s u r e most i n a l l of my l i f e I t h i n k a t the moment, but I'm going t o l e a v e i t because i t ' s got too much f o r me. H e a l t h problems proved t o be a major source of discontentment f o r the women i n t h i s study. Another s e r i o u s t h r e a t t o the women's independence and connectedness was the death of a spouse. Women who had depended on t h e i r husbands t o manage t h e i r f i n a n c i a l a f f a i r s found themselves without the e x p e r t i s e they needed t o manage on t h e i r own when they became widows. One woman d e s c r i b e d her s i t u a t i o n . 3 9 R. I'm one of those wives who had someone to look a f t e r things [finances and investments] f o r her and I didn't bother with i t . He" would say, "I looked into t h i s and i t seems safe and reasonable". I said "sure dear," and i t would go i n one ear and out the other. Now I r e a l i z e I should have l i s t e n e d . I would have been better o f f now had I taken more i n t e r e s t and faced the f a c t that t h i s [his death] could have happened to me. Other women depended on t h e i r husbands f o r companionship. With the husband's death, they were l e f t alone and lonely. One woman described her f e e l i n g s : R. You are not looking for sex but you are missing the love and the arm put around you and the thoughtfulness of being with you and the closeness. Husbands were also depended on to provide p r a c t i c a l assistance, such as d r i v i n g at night. Thus the death of t h e i r husbands could narrow t h e i r s o c i a l world. One woman gave the following example: R. When you've been used to a husband and a car to drive you, i t ' s an e n t i r e l y d i f f e r e n t l i f e and when you get on your own, you aren't able to depend on anyone f o r transportation. I have to spend more time i n the house. I had a great deal of evening entertainment i n those years. Now i t ' s become a seldom thing r e a l l y , i t ' s a turn around. Sometimes I get bothered by i t . The death of spouses can create a serious threats to women's a b i l i t y to maintain t h e i r independence and connectedness. The participants had to f i n d new ways of being independent and connected i n order to regain a sense of contentment. Losing friends also i n t e r f e r e d with the women's contentment. A f t e r age 70 they l o s t many friends within a r e l a t i v e l y short period of time. One 88 year old woman described what happened when she updated her telephone book. 4 0 R. So many of my friends have passed on. I was t r y i n g to make a new telephone direc t o r y and I crossed out t h i s one and t h i s one, my close friends. Another woman said: R. My friends are going, leaving f o r some reason and another and i t ' s going to be less and less togetherness. In the past two years f o r instance I've l o s t three or four of my very close friends that have died on me and so things are going to change with or without your permission. That's the way l i f e goes on. One f i n a l threat to the women's contentment was the attitudes and actions of others. The women related how other people could i n t e r f e r e with t h e i r independence and connectedness. Their actions could be well-intended or simply based on ignorance. For example, one woman described the caring actions of her daughter. R. My daughter takes the mother r o l e . Mother go and s i t down, I ' l l do i t . Come on Mom take i t easy. This i s very protective. I t makes you laugh, you f e e l quite as able as she to get i n there and do something f o r supper when the family i s coming home but she would rather see you s i t and re s t . So you give i n to make her happy. This woman f e l t that she was capable of being independent, but her daughter's protective actions inadvertently i n t e r f e r e d with that independence. Another woman described the actions of strangers at a bus stop. The strangers assumed that she needed help, but they unknowingly i n t e r f e r e d with her a b i l i t y to maintain her independence. She said: R. The other day I was waiting at the bus stop. Immediately t h e i r eyes go down to that walking cane and I need i t because I can't be without i t . Immediately two people jumped to my rescue, one helps me with one arm and I f e l t dreadful. You know I r e a l i z e they thought they were being h e l p f u l but I could have done with less of i t . A l i t t l e b i t of help 41 but people, mostly people are very kind but they rather overdo i t . I thought oh my God, maybe I look about a hundred and one years old and they think I need a l l t h i s assistance. I r e a l l y resent too much of that. You see i f they would only l e t me t r y . A 80 year o l d woman described how a bus driver's impatient a t t i t u d e affected her: R. What r e a l l y upset me was one day I was on the bus and the bus was crowded and I had to be kind of back and when i t came time for me to get off I pulled the big thing, and by the time I got up to the door to get off the bus dr i v e r had started the bus. I said, " Oh I want to get o f f here". And he gave me the d i r t i e s t look. He said, "You mean to t e l l me i t took that long to get from there to here?" I said, "I've got a bad knee and people were there and I couldn't get through. If I could have got here any sooner I would have". But oh he was so nasty. He said ,"Well i n that case you shouldn't be r i d i n g the buses". Oh I f e l t t e r r i b l e . I f e l t f o r awhile I would rather walk than r i d e on a bus. I just hated to get on and off the buses. That one bus d r i v e r just turned me off getting on buses. I would rather walk than get on a bus. This woman no longer uses public transportation and thus has to r e l y on others to help her complete her errands. In her case, someone else's thoughtless words have impaired her a b i l i t y to maintain her independence. The data i n t h i s study i d e n t i f i e d a number of threats to the women's independence and connectedness. These threats included health problems, the death of a spouse and friends, and the attitudes and actions of others. In order to counteract these threats, the women drew upon t h e i r resources, the next phase of the cycle, so that they could return to a state of contentment. Resources The women's sto r i e s described what the researcher conceptualized as external and i n t e r n a l resources. External 42 r e s o u r c e s i n c l u d e d f i n a n c i a l s e c u r i t y , t h e s u p p o r t o f f a m i l y , and t h e c o m p a n i o n s h i p o f f r i e n d s , and a c c e s s i b l e n e i g h b o r s . In c o n t r a s t , i n t e r n a l r e s o u r c e s were more i n t a n g i b l e ; t h e y a r o s e f r o m w i t h i n t h e women. T h e s e r e s o u r c e s i n c l u d e d s t r o n g f a i t h , m e m o r i e s , g o o d h e a l t h , e n h a n c e d s e l f - c o n f i d e n c e a n d s e l f -i d e n t i t y , a n d a f i g h t i n g s p i r i t . The women a l s o d e s c r i b e d a number o f p e r s o n a l a t t r i b u t e s w h i c h a c t e d a s r e s o u r c e s . B o t h e x t e r n a l a n d i n t e r n a l r e s o u r c e s p l a y e d i m p o r t a n t r o l e s i n c o u n t e r a c t i n g t h e t h r e a t s t o c o n t e n t m e n t . E x t e r n a l R e s o u r c e s A l l o f t h e women c l a i m e d t o h a v e a d e q u a t e f i n a n c i a l r e s o u r c e s . T h e i r s t o r i e s r e v e a l e d t h a t t h e y u s e d t h e i r money d i f f e r e n t l y a s t h e y g o t o l d e r . One woman d e s c r i b e d how h e r n e e d f o r m a t e r i a l t h i n g s h a d c h a n g e d . She s a i d : R. When y o u a r e y o u n g , a l l y o u c a n t h i n k a b o u t i s h a v i n g y o u r f a m i l y , g e t t i n g a home a n d h a v i n g n i c e t h i n g s , b u t o n c e y o u ' v e g o t them a l l , y o u ' v e g o t them. A d e q u a t e f i n a n c e s were an e x t e r n a l r e s o u r c e t h a t e n a b l e d t h e women t o p u r c h a s e s e r v i c e s t h a t h e l p e d them t o r e t a i n t h e i r i n d e p e n d e n c e a n d c o n n e c t e d n e s s . One woman d e s c r i b e d how h a v i n g enough money a l l o w e d h e r t o e n t e r t a i n h e r f r i e n d s i n a m o d i f i e d way. She s a i d : R. I t ' s [ p r e p a r i n g m e a l s ] j u s t a l i t t l e more d i f f i c u l t t h a n i f t h e r e were t h e two o f y o u . So I j u s t a s k t h e [ f a m i l y a n d f r i e n d s ] f o r d i n n e r a n d t a k e them o u t . F o r t u n a t e l y , I am f i n a n c i a l l y a b l e t o do i t . A n o t h e r e x t e r n a l r e s o u r c e was a s u p p o r t i v e f a m i l y . A s u p p o r t i v e f a m i l y p r o v i d e d e x t r a a s s i s t a n c e w h i c h h e l p e d some o f t h e women t o r e m a i n i n t h e i r own homes. An 80 y e a r o l d woman described her close r e l a t i o n s h i p with her children who provided p r a c t i c a l help and made her f e e l secure. She said: R. I've been close to my kids. There's not a day goes by that I don't hear from one of them, always. If i t ' s not i n the daytime, i t ' s usually at night. If I need anything that's i t . Friends were also important resources. One woman said: R. I s t i l l have these friends that I worked with so many years ago. We laugh and t a l k about the old days and how much we were paid. ... I love them a l l r e a l l y , they are important to me. Another woman said: R. I have l o t s of good friends, I am t r u l y blessed with good friends. Neighbors were also important resources f o r women who had l i v e d i n the same neighborhood f o r years. Although they d i d not provide actual assistance, the women could c a l l upon them for help. One woman described the r o l e of her neighbors. She said: R. If anything did go wrong, I know I've got a l l these old neighbors that I could always get i n touch with somebody. I know I'm not on my own r e a l l y . The external resources of f i n a n c i a l s t a b i l i t y , support of family, companionship of friends and accessible neighbors a s s i s t e d the women i n modifying the negative impact of the threats described i n the previous section. The resources appeared to augment t h e i r a b i l i t y to maintain t h e i r independence and connectedness so that they could return to a state of contentment. Internal Resources Internal resources were d i f f e r e n t from the external resources but they also helped to counteract the threats to the women's independence and connectedness. Their s t o r i e s revealed a 44 number of assets that were d i f f e r e n t from the concrete, tangible external resources. Internal resources were less v i s i b l e and appeared to originate within the women. In t h i s study, i n t e r n a l resources included strong f a i t h , memories, good health, enhanced self-confidence or s e l f - i d e n t i t y , a f i g h t i n g s p i r i t and f i n a l l y a combination of personal attributes that the women acquired i n l a t e r l i f e . Strong f a i t h appeared to a s s i s t the women to s t r i v e f o r and regain a state of contentment following a threatening event. One woman provided the following description of her f a i t h : R. Well I f e e l and I always have f e l t since I was a c h i l d that I have help from eit h e r within or a higher being. So I have f a i t h that whatever I am given to bear, I have the strength to go on. Another woman said: R. I couldn't give up, [after her husband died] I know some people do. No something i s pushing me always supporting me. Which I believe i s my f a i t h . Come, move on. This f a i t h appeared to provide the women with strength and guidance enabling them to f e e l that they could go on with t h e i r l i v e s . Memories were another important i n t e r n a l resource. Memories enabled the women to reminisce and remain connected with the past. As well, memories were used i n a therapeutic way. One of the women described her view of memories. R. Well memories are so important that i f you were down, you can think of a l l the nice things and a l l the pleasant things and a l l the nice places you went and how nice you got along together. So you've got no regrets.... It's the memories and the pleasantness and the d i f f e r e n t things that you did together that helps you when you are down and alone. Memories then, helped each woman to remain connected to her past. They reminded them of happier times. They were also used to replace the physical presence of a dead person which reduced the pain associated with the grieving process. Enhanced self-confidence and a strong s e l f - i d e n t i t y was another i n t e r n a l resource. The women appeared at ease with themselves and self-assured. A 79 year old woman said: R. It's [self-confidence] growing l i k e mad. It's b e a u t i f u l . I suffered from a lack of confidence for so many years even as an adult. I'm a f r a i d I f e e l very confident. I guess possibly my age has a b i t to do with i t because i f they don't l i k e i t , so what? Another woman of the same age added: R. By the time you are nearly 80 you are what you are and people know what you are and you don't have to be concerned about what people think. At t h i s time i n t h e i r l i v e s they seemed to have more opportunities to express t h e i r s e l f i d e n t i t y . One woman said: R. I don't think I am r e a l l y much d i f f e r e n t i n s i d e me that I have always been. But I'm a l o t f r e e r to express what I am than what I used to be. Because I don't have to l i s t e n to anybody else. I don't f e e l bound by anyone else's pattern and I don't have to say, yes, that i s very nLce, unless I f e e l that. These women described t h e i r new sense of s e l f or s e l f -confidence as growing a f t e r the age of 70. They appeared to have the freedom to make choices based on t h e i r own needs and thus enjoyed personal independence. Another i n t e r n a l resource the women valued highly was t h e i r good health. The women were very aware of t h e i r need for good health and the importance of maintaining i t . One woman said: 46 R. I t r y to take very good care of my l i f e , my health. I think you need your health. You have to be more ca r e f u l with your health when you l i v e alone. Although most of the women had some type of health problem, they focussed on t h e i r remaining good health. One woman said: R. I'm the health i e s t of a l l my friends. I r e a l i z e that I am well f o r my age and I don't know how long i t w i l l l a s t , but I don't have to f i g h t the b a t t l e of physical d i s a b i l i t y . Another woman of 79 said: R. I'm blessed with good health and that i s a tremendously g r a t e f u l thing as far as I am concerned. Good health was a precious resource f o r these women; they were aware of the consequences of los i n g i t . To overcome threats to her independence i t seemed important f o r each woman to have a strong f i g h t i n g s p i r i t . One woman described how attitude helped her to regain her independence a f t e r a major health problem. She had been admitted to a r e h a b i l i t a t i o n f a c i l i t y . She said: R. I had two choices, f i g h t and get out of that wheelchair or s i t back with the droolers.... There would only be one choice that I would make. ... I had to f i g h t myself to get back into i t [being independent] but you know I did i t . Without her f i g h t i n g s p i r i t , t h i s woman implies that she would have l o s t her independence which would have compromised her contentment. The women also r e l i e d upon a combination of other personal a t t r i b u t e s to help them meet the challenges that accompanied the threats to t h e i r independence. The women implied that they had acquired these at t r i b u t e s as they grew older. They described t h e i r a t t r i b u t e s as follows: R. ... I know I'm more patient when things don't come. You learn to wait. You learn to endure. You don't know how a thing i s going to turn out and whether i t ' s a health problem or whether i t ' s just something you just s i t and t r y and work your way through and then some times, and you r e a l i z e there i s value and growth i n waiting. R. I t [ l i f e over 70] takes away the sense of urgency that we have when we are younger. R. I see things with a l i t t l e b i t more compassion than I d i d . R. I think I am more patient and I hope I am i n many ways, more wise. And f i n a l l y : R. You get very philosophical when you get old you know. You say well i t ' s [death] going to come someday but when? I'm not going to s i t down waiting f o r i t . ... you mellow with age. ...You see things i n a s o f t e r way. You don't l i v e l i f e so dramatically or get such crazy notions. One of the personal attributes the women had was the a b i l i t y to d i f f e r e n t i a t e between chronological age, an aging physical body and a sense of inner s e l f that remained ageless. R. I s h a l l be 75 i n a few days time. Only when I put i t i n t o words do I r e a l i z e that i t i s on the up and up. B a s i c a l l y , I never think about old age, because the number of years that you've got on you has any connection r e a l l y . You don't necessarily f a l l apart because you are going to be 75. R. I'm 80 but I don't f e e l o ld. 48 R. The calendar t e l l s me that I'm an old person, but I don't f e e l o ld. The women described t h e i r aging physical bodies. R. It's a downhill thing p h y s i c a l l y . You are wearing out. R.You don't do things as well or as fa s t as you used to. The fac t that I forget things...the f a c t that I could maybe have a l i t t l e more trouble taking the top off a jar than I would have ten years ago. The f r u s t r a t i n g l i t t l e things are the things I think of as aging. The women had the a b i l i t y to d i f f e r e n t i a t e between t h e i r aging bodies and t h e i r sense of inner s e l f . One 79 year old woman said: R. I don't think [ p l a s t i c surgery] would be j u s t i f i e d i n my case, but i t would be lovely because I would be as young as I f e e l when I looked i n the mirror. Another woman described the contrast between her external aging body with her i n t e r n a l s e l f . R. You see yourself i n a window and you think who i s that old woman, and i t i s yourself. The women's a b i l i t y to not f e e l old despite the fac t that t h e i r bodies were getting older was an important resource. For t h e i r s t o r i e s revealed that to be old was i t s e l f a threat. Being old was associated with possessing fewer a b i l i t i e s , having less control and being less involved. One 80 year old woman described old as: R. ...one morning you go to get out of bed and you can't get out of bed, then you say well I must be old. Another woman added: R. When I begin to f e e l that I have to have s p e c i a l 49 attention shown to me, then I w i l l think that I'm old. R. I t doesn't a l l of a sudden happen unless you have a very bad accident and you are incapacitated. And f i n a l l y : R. I think an old person i s a person that has allowed themselves to become old not only i n years, but i n feelin g s and attitudes and things l i k e that. The women's a b i l i t y to d i f f e r e n t i a t e between t h e i r aging physical bodies, advanced chronological age and t h e i r ageless inner s e l f was another resource of great importance. These personal a t t r i b u t e s were important to the women f o r they could be drawn upon to help the women redefine t h e i r independence and connectedness. This study revealed many resources a v a i l a b l e to these eight older women. External resources appeared to a s s i s t the women i n modifying the impact of threats to t h e i r independence and connectedness. Internal resources arose from within the women and appeared to be more s p e c i f i c a l l y associated with being an older woman. By drawing upon a l l of t h e i r resources the women were able to move towards redefining t h e i r independence and connectedness, the next phase of the cycle i n the return to contentment. Redefining Independence and Connectedness The fourth phase of the cycle begins with choosing to overcome the impacts of the threats i n order to return to contentment. The following quotes describe t h i s choice. 50 R. Now I think a l l of us come to crossroads i n our l i v e s where we make a choice of which way to go or what we do i n a s i t u a t i o n , that we know there has to be a change i n what we do. R. You must carry on. You can't c a l l i t quits just l i k e that, you have to go on. It might be a l i t t l e harder but i t doesn't hurt you. You might fi g u r e , oh i t takes you a b i t more time and a l i t t l e b i t more patience but i f you make up your mind, you can do i t . Not a l l women made a choice to regain t h e i r independence and connectedness. One woman who had r e l u c t a n t l y agreed with her childr e n that she should r e t i r e described what she d i d soon a f t e r retirement: R. I just didn't get up. Oh I'd get up f o r my meals and get bathed and that, but I didn't t r y . I just l a i d there and read and my daughter and her husband would come i n and t h i s was t h e i r doing. I was quite capable of doing my own. Now I have homemakers. This woman allowed others to be responsible f o r her. She did not t r y to regain her independence. A f t e r they chose to return to a state of contentment, the women described a number of actions that the researcher l a b e l l e d "redefining independence and connectedness". The researcher i d e n t i f i e d three ways of redefining independence, including f i n d i n g new ways to be independent and connected, normalizing threats that accompany aging and reappraising the s i t u a t i o n . Even women who had been confronted by threats which caused i r r e v e r s i b l e changes were able to regain t h e i r independence and connectedness. One woman described how she depended on her husband fo r companionship and support. A f t e r he died, she wanted 5 1 to continue l i v i n g i n the house but she had to do so alone. She described how she was able to become independent. R. I had a job of accepting how I was going to manage being alone by myself at night and the secu r i t y of coming into the house and everything w i l l be a l l r i g h t . So I had to think of things that bothered me and figured the best way to solve i t by putting bars on the bathroom and bedroom windows so that I could have fresh a i r . Make sure that i t was well locked up insi d e and at the top of the s t a i r s so that I f e l t more secure and then I was a l l r i g h t . I f e l t quite safe. Another woman described how a health problem i n t e r f e r e d with her a b i l i t y to s o c i a l i z e with her friends. Aided by her physician, she chose to attend a seniors' day care centre where she became involved with new friends. She described her s i t u a t i o n . R. The doctor said that I've got to get out... I used to l i k e bowling but I can't do that anymore....I do l i k e the centre because as I say i t ' s got me out and I have met you know some r e a l l y nice people, a l l together d i f f e r e n t than the bunch I used to go with. It i s something to look forward to. We go for lunch and once a month we go on a t r i p and we go someplace fo r a nice lunch. Both of these women found new ways of being independent and connected. The researcher noted i n a previous section, that the women l o s t a number of friends i n a r e l a t i v e l y short period of time. This was a threat to t h e i r connectedness that they were able to normalize. Several women described how they resigned themselves to los i n g friends. They looked upon the death of t h e i r friends as a loss but they also remembered and appreciated what t h e i r friends had given them when they were a l i v e . One woman said: R. You see when you l i v e to be nearly 80, you develop a resignation about losing f riends. You know i t i s going to happen. You see i t a l l around you. You have l o s t a l o t of them. And another woman remarked: R. I get phone c a l l s at night and some of them are sad and I see so and so i s gone. You have a l i t t l e s i l e n t tear and then you r e a l i z e that you enjoyed t h e i r company while they were there. Personal a t t r i b u t e s and memories, two powerful resources, as s i s t e d the women i n normalizing the loss of t h e i r friends. The f i n a l way of redefining independence and connectednes occurred when the women reappraised t h e i r s i t u a t i o n s . In most cases t h i s meant finding the po s i t i v e aspects of the s i t u a t i o n One woman described how where once she f e l t a l l alone, she was now able to concentrate a l l her energies on caring f o r herself She said: R. It's d i f f e r e n t and you miss these other people i n one respect, but on the other hand, you have something else there you see. It's got i t s compensations. It's not r i g h t f o r a person your age. At my age when you are t i r e d and have to, and should be able to, a l l o c a t e a l l of your own strengths according to your own needs and wishes, i t ' s quite d i f f e r e n t from the time when your strength goes to looking a f t e r somebody el s e . Another woman described how she r e a l i z e d that i t was better that her husband had died before her, because he would not have been able to look a f t e r himself. She said: R. I've got to r e a l i z e one was going to go f i r s t . I just got to accept i t and I am pleased i n a way that my husband went f i r s t . I know he wouldn't manage the way that I do because a man i s not adept at the same things. She also added: R. I am r i g h t now I have a l i t t l e time to get adjusted and I am enjoying myself. I don't mean i t wrong but I make my own decisions. I do what I want when I want. I get what I want when I want. I've got to accept that my partner i s n ' t there so I have to do i t i 5 3 myself....It's a sense of s a t i s f a c t i o n when you make up your mind yourself. Reappraising her s i t u a t i o n involved making a choice that enabled t h i s woman to maintain her independence. Another woman did not dwell upon the loss of her house and garden but rather viewed the s i t u a t i o n as one where she could maintain her independence by making her own choices and being i n con t r o l . She described her circumstances: R. I'm going to leave i t [the garden] because i t ' s too much for me. ... I am moving the way that I want to. When I move, I ' l l do i t i n an organized and reasonable manner, having decided what I want to take with me and what I don't want to take. Yes, that i s my plus to do i t i n my own way. I am going to miss t h i s very much because I've been here for twenty-two years. I want to make the move when I want to and i n the circumstances that I choose. Then I w i l l have the ego s a t i s f a c t i o n even i f I'm not going to be a l l that happy fo r awhile i n an apartment. Another way of reappraising a s i t u a t i o n was by choosing to l i v e i n the present, rather than dwell on an uncertain future. One woman stated: R. Now I just enjoy one day and I am thankful f o r that day, i f I get another day f i n e . I just seem to take time as i t goes along. It's more or less day by day now. I don't make any plans. These women's sto r i e s demonstrated how they t r i e d to f i n d the p o s i t i v e aspects of a p o t e n t i a l l y d i s t r e s s i n g s i t u a t i o n i n order to redefine t h e i r independence and connectedness. When t h i s stage of the cycle was completed, the women returned to a state of contentment. This contentment was d i f f e r e n t than at the beginning of the cycle but i t was contentment nevertheless. A f t e r describing a number of threatening events, one of the women described her l i f e i n t h i s way: 54 R. It's d i f f e r e n t and i t i s narrower. It can be just as f u l f i l l i n g and content you know. Summary Chapter four has presented the process the researcher l a b e l l e d the "cycle of contentment" which originated from the themes that arose out of the women's s t o r i e s . Contentment was a c y c l i c a l process that involved having contentment, l o s i n g i t and regaining i t . The phases i n the cycle of contentment included: having independence and connectedness, experiencing threats, drawing upon resources and redefining independence and connectedness. Contentment was a form of happiness the women desired. I t was characterized by feelings of calmness and freedom from uneasiness. I t seemed that a f t e r age 70, contentment was e a s i l y disrupted by a number of threats such as the loss of a spouse and f r i e n d s , d e c l i n i n g health and the attitudes and actions of others. In response to these threats the women drew upon t h e i r resources. External resources included: adequate finances, and the support of family, friends and neighbors. Internal resources included: f a i t h , memories, good health, enhanced self-confidence and s e l f - i d e n t i t y , a f i g h t i n g s p i r i t , and a number of personal a t t r i b u t e s that the women acquired as they got older. These resources modified the impact of the threats and assisted the women to redefine the meaning of t h e i r independence and connectedness. The researcher i d e n t i f i e d three ways of redefining independence and connectedness. They included: f i n d i n g new ways of experiencing independence and connectedness, normalizing common threats that occur i n old age and reappraising s i t u a t i o n s . When independence and connectedness were redefined, the women were content once more. 56 CHAPTER 5 DISCUSSION OF FINDINGS Introduction The o v e r a l l purpose of chapter f i v e i s to discuss the findings of the study. This discussion i s divided into three sections. The f i r s t section i l l u s t r a t e s how the questions that directed t h i s study can be answered based on the findings of t h i s study. The second section analyzes the usefulness of the concept of a c r i t i c a l period from the UBC model of nursing (1987), as a t h e o r e t i c a l framework for the study. The f i n a l section compares t h i s study's findings with those of other researchers. This examination i l l u s t r a t e s how current knowledge of older women can be enhanced by e l i c i t i n g t h e i r perspectives. The Research Questions The cycle of contentment provides information that answers two of the three research questions. The f i r s t research question was: how do women describe the gains or p o s i t i v e aspects associated with t h i s stage of t h e i r l i f e ? This study showed that contentment i t s e l f can be considered a gain. Other gains were i d e n t i f i e d i n the t h i r d phase of the cycle of contentment, drawing upon resources. In t h i s phase a number of i n t e r n a l and external resources were i d e n t i f i e d . The women's i n t e r n a l resources were the gains or p o s i t i v e aspects associated with l i f e over 70. The women in f e r r e d that by l i v i n g f o r a number of decades and experiencing many things, they acquired these i n t e r n a l resources which i n 57 some cases were unique to t h i s stage of t h e i r l i v e s . They valued t h e i r f a i t h , memories, enhanced self-confidence, and f i g h t i n g s p i r i t . They were proud of t h e i r personal a t t r i b u t e s which were made up of wisdom, patience, tolerance and t h e i r a b i l i t y to d i f f e r e n t i a t e between t h e i r aging bodies and t h e i r ageless inner selves. The study showed that t h e i r i n t e r n a l resources played a v i t a l r o l e i n a s s i s t i n g the women to redefine t h e i r independence and connectedness so that they could return to a state of contentment. The second question was: how do women describe the losses or negative aspects associated with t h i s stage of t h e i r l i v e s ? The second phase i n the cycle, experiencing threats, provided the answer to t h i s question. The major losses at t h i s stage of t h e i r l i v e s included: the death of a spouse, death of friends and health problems. The study showed that i n l i f e over 70 these losses seemed to occur with great frequency. The t h i r d question was: how do women's actual experience of being over 70 compare with t h e i r e a r l i e r expectations of themselves at t h i s stage of t h e i r l i f e ? The findings i n t h i s study could not answer t h i s question. The women were unable to r e c a l l or verbalize any previous expectations about what t h e i r l i f e would be l i k e when they were over 70. This f i n d i n g may be att r i b u t e d to the fac t that these women are part of the f i r s t large cohort group to reach advanced age. Many of them l i v e d longer than t h e i r parents did and they outlived t h e i r spouses. Although there have been many research studies and vast amounts 58 of s t a t i s t i c a l data c o l l e c t e d i n the past few years, these women did not have access to t h i s information. Therefore, both the lack of older r o l e models and a paucity of pertinent information may have contributed to t h i s finding. The information from the cycle of contentment was able to answer two out of the three research questions. Contentment and the a c q u i s i t i o n of i n t e r n a l resources seemed to be the most important gain or p o s i t i v e aspect of l i f e over 70. The major losses were the death of a spouse, the death of friends and the increase i n health problems. This group of eight women could not a r t i c u l a t e any previous expectations regarding what t h e i r l i v e s would be l i k e and thus were unable to make a comparison between t h e i r expectations and actual experiences of being over 70. Theoretical Framework The t h e o r e t i c a l framework was based on the concept of a c r i t i c a l period from the UBC model for nursing (1987). This framework was useful for two reasons. F i r s t , i t s implementation i d e n t i f i e d the importance of seeking the women's perspectives. Second, i t was useful i n designing the research questions. An unexpected finding was that the women could not a r t i c u l a t e any previous expectations about t h i s maturational event. However, now that they are i n t h i s maturational event they do have expectations. For example, i n terms of body change, they expected that t h e i r bodies would wear out and they would slow down. In terms of r o l e changes, they no longer expected to have to look a f t e r t h e i r children. The expectations around 59 s o c i a l i n t e r a c t i o n changes included the acceptance of the fact that more of t h e i r friends died as the women grew older. In summary, the concept of c r i t i c a l period was a useful framework f o r d i r e c t i n g the researcher to seek the women's perspectives. The framework was also useful i n designing the research questions. Cycle of Contentment The t h i r d section of chapter f i v e discusses the findings from the cycle of contentment. An exploration of the l i t e r a t u r e revealed that many of the findings that were fundamental i n conceptualizing the cycle of contentment were also noted i n other research studies. As the researcher could f i n d no l i t e r a t u r e that explained the c y c l i c process of contentment, each of i t s four phases i s considered separately. Contentment The o v e r a l l theme i n the cycle of contentment was, n a t u r a l l y , contentment. Other researchers have noted the importance of contentment. George, (1986), i n reviewing the l i t e r a t u r e on l i f e s a t i s f a c t i o n , concluded that, "Euphoria i s the prerogative of youth, whereas contentment i s the reward of o l d age"(p.6). Two recent Canadian studies found that the majority of the older respondents were content and s a t i s f i e d with t h e i r l i v e s (Connidis, 1987; Gooding, Sloan, Amsel, 1988). In popular l i t e r a t u r e , contentment again emerged as a theme. In w r i t i n g a personal journal describing her l i f e at 70, Sarton (1984) stated "I am coming into a period of inner calm" (p. 334). Therefore, both popular l i t e r a t u r e and research supported 60 t h i s study's f i n d i n g that contentment can be a desired state of mind f o r older women. The women's preference for contentment highlighted a major difference between t h e i r l i v e s now compared to when they were younger. I t seemed that t h e i r desire f o r contentment and i t s associated calmness and freedom from uneasiness was a natural progression of events; they could use t h i s quieter time to r e f l e c t on and make sense of t h e i r l i v e s . Washbourn (1977), i n her quest to understand the wholeness of the woman's experience, said "The c r i s i s of old age i s not undergone i n a day, i t i s a lengthy process of bringing together, of f i t t i n g the pieces of the past i n t o a whole" (p.146). I t seemed that the women's preference f o r contentment was necessary i f they were to complete the work of old age with a sense of peace. Independence and Connectedness This study demonstrated that independence and connectedness are two of the possible sources of contentment. This was s i m i l a r to, and yet d i f f e r e n t from, the findings of other studies which linked independence and connectedness to morale, a sense of well-being, l i f e s a t i s f a c t i o n and happiness. Larson (1978) found that the loss of independence and a reduction i n s o c i a l i n t e r a c t i o n adversely affected the older person's morale. A Canadian study on widowhood showed that independence and s o c i a l involvement contributed to higher le v e l s of morale (Harvey et a l . , 1987). Two q u a l i t a t i v e studies involving older people also i d e n t i f y the importance of both independence and connectedness. 61 A q u a l i t a t i v e study by Myerhoff (1978) showed how that while a group of older Jewish people had a strong desire f o r independence, they s t i l l desired t h e i r sense of cohesion and sense of community which could be likened to a sense of connectedness. A second q u a l i t a t i v e study by Erikson, Erikson, and Kivnik (1986) described the older person's desire f o r independence and connectedness. Erikson, who was i n his nineties at the time the study was conducted said "It i s f a s c i n a t i n g that we as a people should c l i n g so tenaciously to our pipe dream of independence as we become increasingly dependent on our interconnectedness" (p.328). These research studies confirm that independence and connectedness are both important to older people. However, i n the cycle of contentment, both the nature of independence and connectedness, the dynamic re l a t i o n s h i p of independence and connectedness to contentment, are more c l e a r l y demonstrated. By obtaining the women's own perspective, t h i s study has helped us to understand how contentment can be disrupted by threats. Experiencing Threats Experiencing threats i s the second phase i n the cycle of contentment. Numerous researchers have i d e n t i f i e d a number of threats to the older person's well-being and morale. One of the major threats was poor health. Lohr, Essex and K l e i n (1988) explained that health problems could reduce an older i n d i v i d u a l ' s a b i l i t y to communicate and i n t e r a c t s o c i a l l y . Washbourn (1977) noted that a physical decline may be e s p e c i a l l y 62 d i f f i c u l t f o r women because they have spent a great part of t h e i r l i v e s doing things for other people. Researchers noted other threats: low incomes, lack of s o c i a l i n t e r a c t i o n , loneliness, and loss of support and the negative attitudes of others (Connidis, 1987; Harvey et a l . , 1987; Larson, 1978; Martin Matthews, 1987; Matthews, 1986). The women i n the study d i d not i d e n t i f y low income as a threat to them personally, however they acknowledged that they were fortunate to have enough f i n a n c i a l resources. The other threats mentioned above are s i m i l a r to those that can threaten the women's connectedness. The women i n the study helped us to understand the impact of these threats more c l e a r l y . One of the threats discussed by the partic i p a n t s i n t h i s study was the conduct of others. Rodin and Langer (1980) conducted a number of studies which showed that other people's attitudes and actions could decrease the older person's f e e l i n g of control which i n turn reduced his or her self-esteem. A reduced self-esteem could lower a person's a b i l i t y to maintain t h e i r independence and connectedness. The findings of t h i s study showed that although people may think that they are a s s i s t i n g an older woman, they may i n fact be i n t e r f e r i n g with her independence. Both the published research studies and the women i n t h i s study i d e n t i f i e d many s i m i l a r threats. However, by gaining the women's perspectives, threats were seen i n a larger context. The study showed that the threats i n t e r f e r e d with the women's 63 independence and connectedness and the women could o f f s e t the threats, by c a l l i n g upon t h e i r resources. Resources Drawing upon resources i s the t h i r d phase i n the cycle of contentment. Information regarding resources tended to i d e n t i f y factors that contributed to the older person's s a t i s f a c t i o n and well-being. However, unlike the cycle of contentment, many of these studies d i d not i d e n t i f y these factors as resources, and consequently they did not d i f f e r e n t i a t e between external or concrete resources, and the more intangible i n t e r n a l resources. Good health was i d e n t i f i e d i n several studies as a major contributor to well-being (Connidis 1987; Larson, 1978; George & Landerman, 1984). Other factors i d e n t i f i e d included adequate finances, s o c i a l support, family support, and dependence upon r e l i g i o n (George & Landerman, 1984; Harvey et a l . , 1987; Martin Matthews, 1987). Lazarus and Folkman (1984), conceptualized resources i n a manner s i m i l a r to the cycle of contentment. These researchers did not believe that a person coped a c e r t a i n way because of t h e i r personality t r a i t s . They believed that the way a person coped was dependent upon how the s i t u a t i o n was perceived by the person coping and that people coped better i f they had a number of resources. They i d e n t i f i e d these resources as "health and energy,, e x i s t e n t i a l b e l i e f s , problem solving s k i l l s , s o c i a l s k i l l s , s o c i a l support and material resources" (p.179), a l l of 64 which are very s i m i l a r to those described i n the cycle of contentment. Other q u a l i t a t i v e studies provided information regarding i n t e r n a l resources (Coleman, 1986; Connidis, 1986; Erikson et a l . , 1986; Myerhoff, 1978). Perhaps q u a l i t a t i v e studies are best suited to revealing inner resources because these resources are d i f f i c u l t to see and therefore must be i d e n t i f i e d by the older people themselves. In the Erikson et a l . , (1986) study, people described themselves as "more tolerant, more patient, more open-minded, more understanding, more compassionate and less c r i t i c a l than they were when they were i n t h e i r younger years" (p. 60). These statements were s t r i k i n g l y s i m i l a r to the ones i d e n t i f i e d i n the cycle of contentment. In a Canadian study by Connidis (1987), older people described l i k i n g t h e i r increased personal freedom, reduced r e s p o n s i b i l i t i e s and enhanced self-confidence. Again, these findings were noted i n the cycle of contentment. Few studies acknowledged the fa c t that women d i f f e r e n t i a t e d between t h e i r aging external bodies and t h e i r ageless inner selves. However, a grounded study by Kaufman (1986) found that "when o l d people t a l k about themselves, they express a sense of s e l f that i s ageless, an i d e n t i t y that maintains continuity despite the physical and s o c i a l changes that come with old age" (p. 7). The cycle of contentment furthers our understanding of t h i s f i n d i n g . If older people are judged on a physical basis alone, t h e i r other c a p a b i l i t i e s and resources may be overlooked. 65 Although widowhood can be a time of g r i e f , t h i s study found that a number of women increased t h e i r s e l f confidence as a r e s u l t of having to make t h e i r own decisions a f t e r they were widowed. A study by Martin Matthews (1987) concurred with t h i s f i n d i n g ; i t concluded that some widows gain a sense of s a t i s f a c t i o n when they are able to overcome the g r i e f of widowhood and move on to f e e l i n g confident about making t h e i r own decisions. Memories are another important resource i d e n t i f i e d i n the cycle of contentment. Other q u a l i t a t i v e studies h i g h l i g h t the importance of memories and reminiscing for the older person, but memories are not i d e n t i f i e d as resources (Coleman, 1986; Erikson et a l . , 1986; Myerhoff, 1978; Recker, Peacock & Wong, 1987). The Erikson, et a l . , (1986) study indicated that memories could help older people f u l f i l l t h e i r sense of intimacy by remembering t h e i r dead loved ones. I t also concluded that memories and reminiscing could a s s i s t an older person to suc c e s s f u l l y reevaluate and resolve past unachieved psychosocial stages. Myerhoff's study, (1978) focussing on older Jewish people showed that they used t h e i r memories to help them stay connected with t h e i r past and to help them carry on t h e i r Jewish t r a d i t i o n s . Therefore, these studies supported the importance of memories as a resource. In general, the q u a l i t a t i v e studies i d e n t i f i e d a number of factors that were s i m i l a r to the i n t e r n a l resources outlined i n the cycle of contentment. If we can see these resources as part 66 of a cycle, we can begin to understand how they can be used to meet the challenges and threats associated with old age. Redefining Independence and Connectedness Redefining independence and connectedness was the fourth phase i n the cycle of contentment. The women i n t h i s study completed the fourth phase i n three ways. They found new ways to experience independence and connectedness, they normalized the events or changes that they encountered r e g u l a r l y at t h i s time i n t h e i r l i v e s , and they reappraised t h e i r s i t u a t i o n s . Although the general l i t e r a t u r e did not use the terminology "redefining independence and connectedness," a number of studies revealed s i m i l a r findings. For example, other researchers have noted that older people normalized threats i n that they had greater acceptance of t h e i r own death, and the death of friends and they recognized that health problems were in e v i t a b l e with increasing age (Costa, Zonderman, McCrae, Cornoni-Huntley, & Barbano, 1986; Matthews, 1986; Recker et a l . , 1987,). These studies, however, placed more emphasis on naming the threats than showing how the people overcame the threats. The cycle of contentment showed that women drew upon t h e i r resources, e s p e c i a l l y t h e i r personal att r i b u t e s to normalize the threats. Other researchers have shown that reappraising a s i t u a t i o n was an important process for older people. A study by Lohr et a l . , (1988) found that p o s i t i v e cognitive coping, a form of reappraisal, was e f f e c t i v e for women who experienced many det e r i o r a t i n g physical conditions. For these women, p o s i t i v e 67 comparisons with peers and a focus on the good aspects of t h e i r health helped them to cope with t h e i r physical condition. Other researchers described the process of reappraising one's s i t u a t i o n as f i n d i n g a new match between as p i r a t i o n l e v e l s and a b i l i t i e s (Fooken, 1981) or thinking about the whole of one's l i f e rather than focussing on one p a r t i c u l a r aspect (George, 1986). Recent research on coping processes has enhanced our understanding of the reappraisal aspect of the findings i n t h i s study. The research i d e n t i f i e d two forms of coping, emotion focussed and problem focussed. The l i t e r a t u r e showed that when a person was faced with a challenge or a s i t u a t i o n that cannot be changed, emotion-focussed coping was more e f f e c t i v e . I t diminished the threat by changing the meaning of the s i t u a t i o n without changing the objective s i t u a t i o n (Lazarus & Folkman, 1985). In challenging situations that can be changed, problem-focussed coping was mOre e f f e c t i v e . (Folkman, Lazarus, Dunkel-Schelter, Delongis & Gruen, 1986; Lazarus & Folkman, 1985). The l i t e r a t u r e emphasised defining the problem, generating a l t e r n a t i v e solutions and choosing the best a l t e r n a t i v e (Lazarus & Folkman, 1985) . A study by Folkman, Lazarus, Pimley & Novacek (1987) examined age differences i n r e l a t i o n to stress and coping processes. They found that older people used proportionately more passive, intrapersonal, emotion-focussed forms of coping (distancing, accepting r e s p o n s i b i l i t y and p o s i t i v e reappraisal) than d i d younger people. However, older people used more 68 confrontive coping i n health encounters than did younger people (p. 182). These fi n d i n g were consistent with the findings i n the cycle of contentment. Many of the women used emotion-focussed forms of coping when they were faced with situations that could not be changed, and problem solving coping when they f e l t that a s i t u a t i o n could be changed. The women i n t h i s study recognized that c e r t a i n threats were i r r e v e r s i b l e . They were wise enough to know that i f something could not be changed, the only reasonable thing to do was to reappraise the situations so that they could return to contentment and get on with t h e i r l i v e s . They were able to turn to t h e i r unique combination of resources, often acquired l a t e i n l i f e , that were e s p e c i a l l y suited i n a s s i s t i n g them to cope with the threats. Summary The f i r s t section of chapter f i v e described how the study's findings answered two of the three research questions. The second section outlined how the conceptual framework, based on the nursing concept of a c r i t i c a l period, was useful i n d i r e c t i n g the researcher to seek out the women's perspective and i n designing the research questions. In the t h i r d section of chapter f i v e , findings i n the cycle of contentment were compared to other research findings. Although the l i t e r a t u r e did not describe the cycle of contentment, a number of research studies validated the findings i n each phase of the cycle of contentment. The r e s u l t s from t h i s 69 study showed the re l a t i o n s h i p between a number of factors that many researchers have looked at i n i s o l a t i o n . This study extends our knowledge because i t c l e a r l y defines each factor and then shows the linkages between them. The cycle of contentment provided a window through which we can see how the eight women i n the study perceived c e r t a i n aspects of t h e i r worlds. Through the cycle of contentment we learned that from the outside looking in-, the women may have appeared o l d and f r a i l , but from the inside looking out, they d i d not see themselves as such. Contentment was the form of happiness that they preferred. Although they are confronted by many threats which challenge t h e i r contentment, the cycle of contentment showed that they possessed an unique repertoire of resources. These resources reduced the impact of these threats and helped them to redefine t h e i r independence and connectedness. This study has shown that by seeking the women's perspectives, we can see that a preoccupation with the i l l n e s s associated with o l d age might cloud our v i s i o n of the naturalness of old age and the strength and resources that these women possess. 70 CHAPTER 6 SUMMARY, CONCLUSIONS AND IMPLICATIONS FOR- NURSING Introduction This study explored how older women perceive t h e i r l i v e s . The demographic data show that as the year 2000 approaches, the number of older women l i v i n g on t h e i r own w i l l s t e a d i l y increase. Older women are l i k e l y to experience increasing health problems. Therefore, nurses can expect to come into contact with more and more older women, i n both i n s t i t u t i o n a l and community settings. At present, the information a v a i l a b l e to nurses about older women i s pri m a r i l y l i m i t e d to disease processes. This study evolved from a need to begin to redress that imbalance, to learn more about older women i n general, but more s p e c i f i c a l l y to understand how they perceive t h e i r l i v e s . A l i t e r a t u r e search revealed few studies focussing s p e c i f i c a l l y on older women. Of the studies that did e x i s t , most examined i n s t i t u t i o n a l i z e d older women i n poor health. Widowhood studies provided a d d i t i o n a l information, but generally concentrated on the impact of the death of the husband. However, the q u a l i t a t i v e studies involving both men and women did o f f e r in s i g h t s i n t o health, aging, and the l i k e s and d i s l i k e s of the older c i t i z e n . Nevertheless, there appeared to be no subjective account of women's experience of aging. This study attempted to r e c t i f y that s i t u a t i o n . Phenomenology proved the most p r a c t i c a l method f o r conducting t h i s research; i t i s an e f f e c t i v e way of gaining a broad perspective about a little-known research t o p i c . Furthermore, because the aim of phenomenology i s "to understand the experience as i t i s l i v e d " (Omery, 1983, p.50), i t was compatible with the conceptual framework that guided the study. The concept of a c r i t i c a l period from the UBC model fo r nursing (1987) i d e n t i f i e d the importance of seeking the women's perspectives and was useful i n formulating the research questions. The researcher recruited subjects i n the study, who l i v e d alone i n the community, through an informal network of colleagues and friends. The eight women who pa r t i c i p a t e d were a l l widows and mothers. Their ages ranged from 75 to 88. Intensive interviews which were tape-recorded and subsequently transcribed provided the data for t h i s study. Seven pa r t i c i p a n t s were interviewed twice. One woman became i l l and was unable to p a r t i c i p a t e i n a second interview. The researcher selected Giorgi's (1975, 1985) phenomenological method as a guide i n analyzing the data. Within the women's s t o r i e s , the researcher i d e n t i f i e d the natural meaning u n i t s . From these units e s s e n t i a l themes emerged. These themes were synthesized and then integrated into a f i n a l framework c a l l e d the "cycle of contentment". Through t h i s framework i t was possible to gain insight into how these older women perceived t h e i r l i v e s . The cycle of contentment had four phases: having independence and connectedness (the sources of contentment), experiencing threats, c a l l i n g upon resources, and redefining 72 independence and connectedness. Contentment i n t h i s cycle was described as a f e e l i n g state that was characterized by calmness and freedom from uneasiness. It was these women's preferred form of happiness. Independence and connectedness were two sources of contentment. Independence was composed of s e l f - r e l i a n c e , of not having to inconvenience others and of being i n control of d a i l y events and personal a f f a i r s . Connectedness, on the other hand, was equated with a sense of belonging with family and friends, and being involved arid aware of what was happening i n the world. Unfortunately, the women found t h e i r independence and connectedness e a s i l y disrupted by threats. Threats were experienced when a spouse or friends died, when there were health problems, and when the women were exposed to the adverse attitudes and actions of others. Ultimately the threats created discontentment. In response to discontentment the women made a choice about whether or not to draw upon t h e i r resources. There were two types of resources: external and i n t e r n a l . External resources included finances, family, friends and neighbors. Internal resources included f a i t h , memories, s e l f -confidence, a f i g h t i n g s p i r i t and personal a t t r i b u t e s . Internal resources were usually intangible and thus d i f f i c u l t f o r an outside person to i d e n t i f y . By drawing upon both types of resources, i t was possible for the women i n t h i s study to move to the next phase of the cycle, that of redefining independence and connectedness. 73 This r e d e f i n i t i o n took three paths: fi n d i n g new ways of experiencing independence and connectedness, normalizing the threats that occur regu l a r l y i n old age and reappraising the si t u a t i o n . Once independence and connectedness were redefined, contentment returned. This study drew a number of conclusions: 1. Women over 70 experience l i f e d i f f e r e n t l y than they d i d when they were younger. 2. Women do not consider themselves to be old based on t h e i r chronological age alone. 3. The women i n t h i s study prefer contentment over a more excitable or euphoric form of happiness. 4. Two sources of contentment are independence and connectedness. The meaning of independence and connectedness are subj e c t i v e l y determined. 5. The women's contentment could be e a s i l y disrupted by a number of threats including: the death of a spouse and friend s , health problems and the conduct of others when i t i n t e r f e r e s with t h e i r independence and connectedness. 6. When contentment i s l o s t i t can be regained i f the older woman draws upon her resources i n order to redefine independence and connectedness. 7. Women can have external or i n t e r n a l resources. Internal resources are extremely valuable, but since they are intangible, they are d i f f i c u l t f o r an outside person to i d e n t i f y . 7. Women who are able to redefine t h e i r independence and connectedness can return to contentment. 74 Nursing Implications The findings of the study suggest a number of implications f o r nursing pr a c t i c e , nursing education, and nursing research. The following section presents these implications. Implications f o r Nursing Practice The nurse can use the findings from the study i n each phase of the nursing process. As independence and connectedness are important sources of contentment, the nurse w i l l need to assess the woman's perceived l e v e l of independence and connectedness. If the woman i s not content, the nurse should assess f o r the presence of threats. The nurse can then determine what resources the woman has avai l a b l e to help her o f f s e t the threats. As i n t e r n a l resources are d i f f i c u l t to i d e n t i f y , the nurse w i l l recognize the importance of spending time t a l k i n g with the woman i n order to i d e n t i f y the resources. In planning the care, the nurse and the older woman may i d e n t i f y that some of the woman's resources need supplementing. For example, the woman may want to be discharged home from the h o s p i t a l but because she has l i t t l e money and no family support, the nurse may involve community agencies to provide the assistance that the woman needs to continue l i v i n g independently i n her home. The nurse may also want to incorporate some of the woman's resources into the nursing care plan. For instance, a woman who has just l o s t her husband may have many memories that would help her work through the grieving process, but she needs to be able to t a l k about them. Therefore, the nurse can encourage the woman to v e r b a l l y share her memories. 75 The nurse can also help the woman to redefine her independence and connectedness by helping her f i n d new ways of experiencing them. The nurse may encourage the woman to attend a seniors' day care or a seniors' wellness group. F i n a l l y , i n evaluating the nursing intervention the nurse can determine i f the woman perceives that she has independence and connectedness and thus contentment. If the woman does not have contentment, then the nurse should reexamine each phase of the cycle of contentment to determine where the woman i s i n t h i s process. Next, t h i s study's findings show that the attitudes and r e s u l t i n g actions of others can i n t e r f e r e with a woman's independence and connectedness. Therefore, nurses should i d e n t i f y and examine t h e i r own b e l i e f s about and attitudes toward older women. They should also t r y and understand more about how the older woman perceives her l i f e . With t h i s information, the nurse can i d e n t i f y any biases that could i n t e r f e r e with his or her a b i l i t y to d e l i v e r e f f e c t i v e nursing care and begin to work i n collaboration with older women for goal s e t t i n g purposes. Health i s a valuable resource f o r the partic i p a n t s i n t h i s study. Although the women have a number of health problems, they focus on and take care of t h e i r remaining good health. Therefore, nurses should focus not only on the older woman's health problems, but should also help these women to maintain and enhance t h e i r health. The focus of care should be directed 76 towards both primary and secondary prevention thereby enabling the women to maintain t h e i r independence and connectedness. Implications f o r Nursing Education Many of the implications for nursing practice discussed i n the previous section are relevant to nursing education. This study shows that women over 70 can remain independent and involved with l i f e . Although the women may be p h y s i c a l l y o ld and f r a i l , they do not see themselves as old. Therefore, i t may be useful f o r nursing students to have t h e i r f i r s t contact with healthy older women rather than i l l and d e b i l i t a t e d older female patients. This contact would enable students to d i f f e r e n t i a t e between old age and i l l n e s s i n old age. The study demonstrates.the importance of seeking older women's perspectives. Although the women experience a number of chronic health problems they do not necessarily consider themselves to be unwell. They want to have t h e i r independence and connectedness. Therefore students could be taught that when they are dealing with chronic i l l n e s s , the emphasis i s not on cure but on helping the woman regain her independence and connectedness. Only by obtaining the women's perspectives can the student determine whether the women have regained t h e i r independence and connectedness. Students can be taught the importance of i d e n t i f y i n g the women's i n t e r n a l resources. This study i d e n t i f i e s a number of intangible inner resources that may be present i n the older women. The students can use th i s information when they are engaged i n a nursing assessment. F i n a l l y , as there i s such an emphasis on youth i n our society, nursing students, l i k e p r a c t i c i n g nurses, should i d e n t i f y t h e i r b e l i e f s about old women and picture themselves i n that p o s i t i o n . Then they must be taught how to e l i c i t information from the older woman so that they can understand how each older woman perceives herself. From these experiences the students can be taught to recognize how t h e i r own b e l i e f s can influence t h e i r d e l i v e r y of care. Implications f o r Nursing Research This study provides an i n i t i a l understanding of how older women perceive t h e i r l i v e s when they are over 70. I t also helps to i d e n t i f y the need f o r more studies. This study explores one group of older women. Further studies are needed that focus on women from d i f f e r e n t ethnic groups, d i f f e r e n t socio-economic l e v e l s , and women l i v i n g alone with a v a r i e t y of health impairments. The cycle of contentment has been i d e n t i f i e d and described; however, each phase of the cycle warrants further examination. For example, t h i s study acknowledges the importance of i n t e r n a l resources, but the ways these resources can be recognized and incorporated into the nursing care of older women requires further research. Future studies could increase the understanding of discontentment. Longitudinal studies would be useful to gain i n s i g h t into how the cycle repeats i t s e l f year a f t e r year as the woman ages. They could provide i n s i g h t into why some women are unable to return to contentment. This chapter concludes the research study. The findings have been summarized. 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The seniors' boom: Dramatic  increases i n longevity and prospects f o r better health. Ottawa, ON: Ministry of Supply and Services. Thorne, S., G r i f f i n , C. & Adlersberg, M. (1985). How's your health? Well seniors' perception of t h e i r health and w e l l -being. Gerontion, 5., 15-18. Washbourn, P. (1977). Becoming woman: The guest f o r wholeness  i n female experience. New York: Harper & Row. World Health Organization. (1986). Ottawa charter f o r health promotion. Canadian Journal of Public Health, 77, 425-427. 84 APPENDICES 88 APPENDIX C SAMPLE TRIGGER QUESTIONS FOR THE INITIAL INTERVIEW 1. When you were younger, what did you think i t would be l i k e to grow old? 2. Is growing o ld s i m i l a r to what you thought i t would be? 3. What do you l i k e about being your age or what do you consider the gains of being your age? 4. What do you d i s l i k e about being your age or what do you consider to be the losses associated with your age? 5. What information would you l i k e to have had about growing older when you were young? 6 What would you l i k e health professionals to know about growing older? 

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