Discussions at the national and global level about the ageing population cannot be avoided anywhere in the modern world. We argue that there are two central modern old age discourses: an economic discourse of care crisis and an active ageing discourse. Economic discourse looks at ageing and older people from instrumental and financial perspectives. The core concerns within this discourse are the increasing costs of social and health care and how to finance care services of older people, and/or how to diminish the need of social and health care services. The other discourse, active ageing, focuses on different kinds of physical and social activities. The aim is to support older people to live ‘independently’ in their private homes and for them to be able to manage and cope without help for as long as possible. In a broader sense, the active ageing discourse also emphasises older people as active participators in a community and in a society, who should have a chance to live a life of their liking and to participate in any activities they are interested in. Finances, as well as physical and social activities are important matters. Our argument here is that there is still something missing in this view of old age and older people.

What is missing?
When looking at care needs, access to home-based or residential care is based largely on how much help a person needs with ‘activities of daily living’. These include eating, taking medication, dressing oneself, going to bed and getting up and washing up; to have help with these is seen as ‘meeting basic needs’. There was a time in Finland when home care workers helped clients to go shopping, cooking, cleaning, running errands and going for a walk – in other words, the clients received help to live their daily lives and to be able to leave their homes every now and then with the help of home care worker. In the aftermath of economic crisis of 1990s that approach to care was changed and, as we know, the trend of older people’s care services has been largely the same in many other countries. The direction has been to make care services more ‘efficient’ and to save time and money spent on the care of individual people. Home care visits are shorter than before and care workers’ responsibilities are more and more divided into itemised tasks which are done on behalf of, or to, a client, rather than with them.

Help with daily living and with these basic needs is vital for many older people and particularly for those who have no other assistance from family or other close ones. Still, human life is much more than meeting the needs defined as basic needs in care contracts. Neither is old age only about worsening health, functional ability and care needs; nor are all older people the same, even though the economic care crisis discourse orients us to view all older people as potential users of care services, and thus a source of looming financial crisis.

In Finland, in several research projects studying older people’s experiences of ageing and how ageing has affected their daily lives, we have seen that health is an important factor in wellbeing and cannot be sidestepped. Even when talking about social wellbeing, health and illnesses are brought forward as important factors which give a sort of framework to discuss other aspects of wellbeing. The availability of help and support should one need it, is a matter of great concern and arouses worry about the future. With younger people who have perhaps never faced severe health problems health does not come up in a similar way in discussions of wellbeing, which is perfectly understandable. Still, what we want to argue is that even for older people, health is not a goal in itself, but more a factor that enables or hinders doing other things. Social and health care services should be seen as the means to enable older people to overcome the problems caused by poor health, and to continue doing those things important for them. These other things depend, of course, on the wishes, aims, aspirations and lifestyles of individual people. The key question is, what is it that makes a person want to get up in the morning, even when health problems make it difficult, if not outright painful? What gives life meaning in old age? Surely different things give meaning to life for different people, but the topic in itself remains unaddressed in developing old age services.

Meaning in life has been examined in research, for example, through purpose, significance and coherence. Am I engaging in activities which have a purpose, which produce something? Is my contribution significant to others or for a higher cause? And does all this cohere with my values, what is important for me personally? According to recent research, these questions apply for the majority of persons, regardless of their cultural environment or age. The question about meaning in life is, however, particularly important in older age, when continuation of an accustomed lifestyle is no longer self-evident or not possible at all. Worsening health and physical ability in old age poses existential questions, but these questions are rarely discussed in research or public discussions looking at aged care policies.

Worsening health or advanced stages of dementia are not synonyms for old age. Ageing concerns every living organism, younger humans included. However, there is a significant number of older adults living with dementia and related conditions, associated with partial, gradual or total loss of communication, consciousness and connection to other persons. What gives meaning to a person’s life when the contribution to others is seemingly minimal? An answer by, for example, the Dutch ethicist, Prof. Frits de Lange is that the meaningfulness in life arises from the life itself. Embracing old age entails recognising the mystery and uncontrollability in life and valuing each lived moment. Life is not over until it is literally over, and until that, we remain incomplete, mere possibilities of ourselves, de Lange states. When meaning in life is approached in the context of the life of the oldest old, new perspectives arise in the scientific study of meaning itself: are purpose and significance really the essence of meaning in life? Could focusing on spirituality give new insight in the role of meaning in the lives of older persons?

Spirituality and meaning of life are especially relevant in the context of ageing for various reasons. These are also examined in research, recommendable examples being the handbooks “Spiritual Dimensions of Ageing” (2016), edited by M. Johnson and J. Walker, and “New Dimensions in Spirituality, Religion and Aging” (2019), edited by the late V.L. Bengtson and M. Silverstein. A third inspiring book we can recommend to the readers is “Ageing, Insight and Wisdom” (Edmondson 2015), which addresses ethical and temporal aspects of later life as well types of wisdom older people may offer. These volumes show how both spirituality and ageing are deeply embodied experiences, taking place in the context of psychobiological ageing, where changes are inevitable. Spirituality can also provide resources for coping with both age-related and other changes in life. A third reason is framed by the existence of cultural imagery related to life-stages and spiritual qualities like wisdom. Regardless of whether a person conforms to these shared expectations or not, or if they are found to be useful or restricting, they shape the individual’s experience about themselves, their spirituality and life as an older person.

Ageing and spirituality in the lived context
The observation we have made with interviews of Finnish, older people is that when talking about wellbeing one topic that came often up was the need to prepare for the future and end of life. This observation shows that many older people view wellbeing from a very different angle than younger people. For example, in the interviews of people aged 65 or older, some of the interviewees talked about cleaning their apartment or a house, sorting out possessions and getting rid of unnecessary things in order to prepare for the future. Some were also preparing to move to a smaller and more easily manageable apartment as part of this process of ‘downsizing’ one’s life. The studies from other cultural contexts suggest that this is not culture-specific but a shared feature of later life (Eckerdt 2019). Awareness of life’s finitude give reason to ponder what is really important in life and how to use the remaining time. Practical actions and sorting out belongings were part of a mental process of coming to terms with approaching the end of life and focusing on those things deemed most valuable for oneself. This is a phenomenon elaborately examined in the context of gerotranscendence. This concept, forged by the Swedish gerontologist Lars Tornstam (2005), encompasses ”a shift in meta-perspective, from a materialistic and rational view of the world to a more cosmic and transcendent one, normally accompanied by an increase in life satisfaction.” It entails decreased importance of status symbols and material worth, and increased ability to put one’s life in perspective.

Spirituality and spiritual needs, including the ones finding their expression through gerotranscendence, may be equated with psychology and psychological needs, or alternatively with religious needs. For some, religion and religious practices are the means to express spirituality and to manage the question of finitude of one’s life. This certainly poses a psychological challenge to a person. Yet, these views to spirituality are too narrow. Spirituality would be better understood in terms of self-actualisation, striving to develop oneself in one’s goals and aspirations in life and seeing oneself as part of ‘something bigger’ than an individual person, and coming to terms with the course of one’s life and the finitude of life. This is often discussed in the framework of self-transcendence, apparent in also many predominantly secular spheres of life. Very often older people themselves show awareness of the finitude of life, but very often any talk about end of life questions and approaching death is hushed by younger people, being seen as overly morbid. The benevolent comments of how there are still years and years to go actually reveal younger people’s difficulty in accepting life’s finitude. Or talk about death is interpreted as a sign of depression, which is of course a medical condition treatable with right medication. Apparently, many older people want and need to discuss these matters; but younger people are not always prepared and willing to do so. Nor is our service system attuned to address the ‘spiritual needs’ as an important part of human life, which needs to be part of good quality care. It seems that current aged care systems and care workers are well prepared for and aim to support and maintain various physical and social ‘activities’, but questions about meaning of life and the inevitable ending of life are not sufficiently addressed if at all.

A focus on spiritual needs in older age is needed globally. The themes, e.g., meaning and finitude in life, might be universal, but the forms and wordings it takes are specific to a culture, to a generation and even gender. Additionally, individual differences in experiences and worldview strongly affect a person’s spirituality and its expression. This is merely one of the reasons why questions of meaning and spirituality should be taken into account wherever lives of older – or younger – persons are discussed. This is also one of the reasons why various ways of approaching spiritual questions, ranging from religious rituals to philosophical literature and nature experiences, should be offered to all older persons.

The idea for this text arose from our observations based on interviews with older people, and from our long experience as researchers of gerontology and as ‘ageing researchers’. However, this text might not have been written had there not been the care crisis in Finland 2019 which apparently was similar to the care crisis taking place in Australia 2019. In both countries, similar problems with understaffing, maltreatment and inadequate staff training rose up, and sadly not for the first time. One can ask if the economic discourse is part of the explanation of the continuous problems in aged care? Is old age seen merely as an economic question of how to meet the needs of people needing care with as little money as possible, or how to finance care services and how to delay and diminish care needs? It is easy to forget that we do not talk about factory production, but human beings whose life has a value of its own. This boils down to our view of meaning and value in life:  if ‘activity’ is seen as a route to good life and wellbeing in old age, what is the value of people who are no longer able to be physically active or to participate in social activities without assistance of other people, or not even then?

Once again this shows, how the most abstract and intangible questions, like our values or view on humanity, affect the most brutally concrete and substantive parts of our lives, like the funding directed to aged care. This is why we see it as vital that existential matters and the question of meaning of life in old age, as well spiritual needs of older people, are raised as equally important matters which need to be addressed in research, public discussion and aged care policies. Economic discourse of care crisis and active ageing discourse need to include ‘spirituality discourse’ which sees old age as something else and more than matter of finances and activities. One can argue that the whole aim of the welfare system is to enable a good life, even for those people those with poor health and disabilities.  A ‘good life’ is difficult to define since its meaning varies from person to person, but clearly it is a question which requires going beyond mere physical abilities and activities and pondering questions of spirituality and meaning in life.

Suggested readings:

Bengtson, Vern L. (Ed.), Silverstein, Merrill (Ed.). (2019). New Dimensions in Spirituality, Religion, and Aging. New York: Routledge.

de Lange, Frits (2015). Loving Later Life. An Ethics of Aging. Grand Rapids: Eerdmans.

Edmondson, Ricca (2015). Ageing, Insight and Wisdom.Meaning and practice across the lifecourse, Policy Press: Bristol.

Ekerdt, David (2019). Things and Possessions. In, Katz Steve (Ed.) Ageing in everyday life. Materialities and embodiments, Policy Press: Bristol.

Johnson, Malcolm and Walker, Johanna (Eds). (2016). Spiritual dimensions of ageing, Cambridge University Press.

Tornstam, Lars (2005). Gerotranscendence: A Developmental Theory of Positive Aging. New York: Springer Publishing Company.

 

Authors:
Dr. Outi Jolanki, Adjunct Professor, CoE AgeCare, Tampere University and University of Jyväskylä, Finland and Dr. Jenni Spännäri, University of Eastern Finland, Åbo Akademi and University of Helsinki, Finland