Self-concept in Older Adults: An Integrative Review of Empirical Literature

Mine for life: Charting ownership effects in memory from adolescence to old age

This study investigates the self-reference effect (SRE) with an ownership memory task across several age groups, providing the first age exploration of implicit ownership memory biases from adolescence to older adulthood (N = 159). Using a well-established ownership task, participants were required to sort images of grocery items as belonging to themselves or to a fictitious unnamed Other. After sorting and a brief distractor task, participants completed a surprise one-step source memory test. Overall, there was a robust SRE, with greater source memory accuracy for self-owned items. The SRE attenuated with age, such that the magnitude of difference between self and other memory diminished into older adulthood. Importantly, these findings were not due to a deterioration of memory for self-owned items, but rather an increase in memory performance for other-owned items. Linear mixed effects analyses showed self-biases in reaction times, such that self-owned items were identified more rapidly compared with other owned items. Again, age interacted with this effect showing that the responses of older adults were slowed, especially for other-owned items. Several theoretical implications were drawn from these findings, but we suggest that older adults may not experience ownership-related biases to the same degree as younger adults. Consequently, SREs through the lens of mere ownership may attenuate with age.

Older people's perception of being frail - a qualitative exploration

BACKGROUND

Frailty is a suggested consequence of ageing, but with a variety of different definitions the understanding of what it means to be frail is challenging. There is a common belief that frailty results in a reduction of physical functioning and ability and therefore is likely to significantly affect a person's quality of life. The aim of this study was to explore the understanding of older people about the meaning of frailty and the potential consequences of being classified as frail.

METHODS

This paper forms a secondary analysis of a process evaluation of a complex intervention that was embedded within the individually randomised Home-based Extended Rehabilitation of Older people (HERO) trial. A maximum variation, purposive sampling strategy sought to recruit participants with a wide range of characteristics. Data collection included observations of the delivery of the intervention, documentary analysis and semi-structured interviews with participants. Thematic analysis was used to make sense of the observational and interview data, adopting both inductive and deductive approaches.

RESULTS

Ninety three HERO trial participants were sampled for the process evaluation with a total of 60 observational home visits and 35 interviews were undertaken. There was a wide range in perceptions about what it meant to be classified as frail with no clear understanding from our participants. However, there was a negative attitude towards frailty with it being considered something that needed to be avoided where possible. Frailty was seen as part of a negative decline that people struggled to associate with. There was discussion about frailty being temporary and that it could be reduced or avoided with sufficient physical exercise and activity.

CONCLUSION

Our study provides insight into how older people perceive and understand the concept of frailty. Frailty is a concept that is difficult for patients to understand, with most associating the term with an extreme degree of physical and cognitive decline. Having a label of being "frail" was deemed to be negative and something to be avoided, suggesting the term needs to be used cautiously.

TRIAL REGISTRATION

ISRCTN 13927531. Registered on April 19, 2017.

Attitudes towards hearing difficulties, health-seeking behaviour, and hearing aid use among older adults in Thailand

Introduction

This qualitative study explores older adults' attitudes towards hearing difficulties, health-seeking behaviour and hearing aid use in Samutprakarn, Thailand.

Method

Three focus groups (n=25), with adults aged 60-88 years, were conducted within a residential complex for older adults. Qualitative data analysis, employing a phenomenological approach was completed.

Results

Four themes are presented: (1) Perception of hearing difficulties, (2) Experience of receiving care, (3) Attitudes towards wearing hearing aids, and (4) Raising awareness of hearing difficulties in older adults. Findings indicate that Thai older adults may not be aware or accepting of their hearing difficulties, due to the stigma associated hearing loss, older age, and disability. The consequential impact of these unacknowledged issues manifest in communication challenges and the adoption of avoidance behaviours across diverse situational contexts.

Conclusion

This study enhances our understanding of how Thai older adults perceive hearing problems and ear care. Findings underscore the potential pivotal role of familial and social networks in mitigating barriers associated with hearing difficulties among older adults in Thailand. These insights can raise awareness and inform effective management for older adults and their families. Additionally, the findings could guide healthcare providers, researchers, and policy makers, fostering improved care for this demographic.

How Do Older Portuguese and Mexican Adults Experience Their Sexual Well-Being? A Cross-Cultural Qualitative Study

Sexual well-being (SWB) refers to the subjective emotional and cognitive evaluation of the quality of the individual's sexuality. SWB plays a relevant role in quality of life and health promotion on old age and has cross-cultural implications. In addition to the scarcity of in-depth qualitative studies in this area and studies with cross-cultural samples, no studies have compared perceptions of SWB among Portuguese and Mexican older adults. The aim of this study was to comparatively analyze perspectives on SWB among older adults residing in Portugal and Mexico. Data were collected from 86 Portuguese and 80 Mexican community-dwelling participants aged 65 years and older, using a semi-structured interview protocol. Older adults were asked about factors that significantly contribute to their SWB. Sociodemographic data were also gathered. Content analysis was used to identify key themes. Eight themes were identified across both studied samples: eroticism, supportive relationship, positive self-concept, health and self-care, romance, active life, tenderness and care, and no pain and no pregnancy restrictions. Eroticism was most pertinent to Portuguese participants (31.4%). Health and self-care was most frequently reported by Mexican participants (26.5%). The findings of this study indicate that SWB is strongly influenced by sociocultural and psychosocial values. Cross-cultural comparisons between older Portuguese and Mexican people provide a broader understanding of SWB in older age and suggest a scenario for future culture-adapted interventions and comprehensive policies.

Older migrants' experience of existential loneliness

Background:

With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age.

Aim:

This study explored older migrants’ experience of existential loneliness.

Research design:

Qualitative study.

Participants and research context:

Data were collected through interviews (n = 15) with older (>65) migrants’ in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data.

Ethical considerations:

The study was conducted in accordance with the principles of research ethics.

Findings:

The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country.

Discussion:

Ethical reflection and knowledge about how older migrants’ life story can lead to experiencing existential loneliness, could be of use in care for older migrants’.

Conclusion:

This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.

Communication changes experienced by adults with cerebral palsy as they age

PURPOSE

Adults with cerebral palsy (CP) experience multiple, functional changes as they age, including changes to communication modes and methods that enable development and maintenance of relationships, communicative participation and quality-of-life. Little is known about the nature of communication changes experienced by this group. The aim of this study was to better understand how adults with CP experience changes in their communication abilities as they age and the subsequent psychosocial impact.

METHOD

Twenty adults with cerebral palsy aged 40-72 years with complex communication needs (CCN) participated in a series of in-depth interviews, framing their experiences of loss and grief throughout their lives. The impact of changing communication abilities emerged as an important area of focus. Data were analysed using constructivist grounded theory methodology.

RESULT

Themes arising from the participants' perceptions of their communication included experiencing communication change as a loss with subsequent impact on self-concept; and how communication is integral to the process of managing losses associated with older age.

CONCLUSION

Implications for speech-language pathologists working with older people with cerebral palsy and CCN include the need to understand the psychosocial impact of communication changes on social interaction, relationships and communicative participation. It is important to promote positive and meaningful communication options that maintain a coherent sense of self in addition to promoting functional communication skills and communicative participation.

‘Thinking you're old and frail’: a qualitative study of frailty in older adults

Many older adults experience what is clinically recognised as frailty but little is known about the perceptions of, and attitudes regarding, being frail. This qualitative study explored adults' perceptions of frailty and their beliefs concerning its progression and consequences. Twenty-nine participants aged 66–98 with varying degrees of frailty, residing either in their homes or institutional settings, participated in semi-structured interviews. Verbatim transcripts were analysed using a Grounded Theory approach. Self-identifying as ‘frail’ was perceived by participants to be strongly related to their own levels of health and engagement in social and physical activity. Being labelled by others as ‘old and frail’ contributed to the development of a frailty identity by encouraging attitudinal and behavioural confirmation of it, including a loss of interest in participating in social and physical activities, poor physical health and increased stigmatisation. Using both individual and social context, different strategies were used to resist self-identification. The study provides insights into older adults' perceptions and attitudes regarding frailty, including the development of a frailty identity and its relationship with activity levels and health. The implications of these findings for future research and practice are discussed.

How do nurses in palliative care perceive the concept of self-image?

BACKGROUND

Nursing research indicates that serious illness and impending death influence the individual's self-image. Few studies define what self-image means. Thus it seems to be urgent to explore how nurses in palliative care perceive the concept of self-image, to get a deeper insight into the concept's applicability in palliative care.

AIM

To explore how nurses in palliative care perceive the concept of self-image.

DESIGN

Qualitative descriptive design.

METHOD

In-depth interviews with 17 nurses in palliative care were analysed using phenomenography. The study gained ethical approval.

RESULTS

The concept of self-image was perceived as both a familiar and an unfamiliar concept. Four categories of description with a gradually increasing complexity were distinguished: Identity, Self-assessment, Social function and Self-knowledge. They represent the collective understanding of the concept and are illustrated in a 'self-image map'. The identity-category emerged as the most comprehensive one and includes the understanding of 'Who I am' in a multidimensional way.

CONCLUSION

The collective understanding of the concept of self-image include multi-dimensional aspects which not always were evident for the individual nurse. Thus, the concept of self-image needs to be more verbalised and reflected on if nurses are to be comfortable with it and adopt it in their caring context. The 'self-image map' can be used in this reflection to expand the understanding of the concept. If the multi-dimensional aspects of the concept self-image could be explored there are improved possibilities to make identity-promoting strategies visible and support person-centred care.