The Lived Experience of Aging: Listening to the Oldest-Old PDF
Preview The Lived Experience of Aging: Listening to the Oldest-Old
Loma Linda University LOMA LINDA UNIVERSITY School of Nursing in conjunction with the Faculty of Graduate Studies ____________________ The Lived Experience of Aging: Listening to the Oldest-Old by Julia A. Pusztai ____________________ A Dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Philosophy in Nursing ____________________ September 2015 © 2015 Julia A. Pusztai All Rights Reserved Each person whose signature appears below certifies that this dissertation in his/her opinion is adequate, in scope and quality, as a dissertation for the degree Doctor of Philosophy. , Chairperson Betty W. Winslow, Professor of Nursing Patricia S. Jones, Professor of Nursing Lana M. Kanacki, Associate Professor of Nursing iii ACKNOWLEDGEMENTS It is through a wide-circle of support that this work has been completed. There are many people to whom I am ever grateful. The honesty and transparency with which each of the participants shared their lives with me provided the inspiration to push through to the end while hoping to be a good steward of their remarkable narratives. Each was inspirational in their own distinct way. I am thankful to have known, talked with, and through their generosity to have gained understanding from them. To Dr. Betty Winslow, my advisor and chair whose calm patience and insight never wavered, I give my heartfelt gratitude. She supported me in pursuing this long journey to completion. Offering both prodding and encouragement when needed, her steadfast commitment made this study possible. To Dr. Pat Jones and Dr. Lana Kanacki, my other committee members, I also give a very sincere thank you. Their dedication to quick reading and thoughtful insight and correction is deeply appreciated. While pushing me for quality, clarity, and rigor, they made the road as smooth as possible. Dr. Lee SmithBattle made a commitment to this project without even knowing me. Her expertise and perspective as a phenomenologist and researcher was offered wisely and without reservation—for that I am deeply grateful. Her quick and insightful review of each chapter challenged me to deeper thinking, a broader understanding of phenomenology, and a richer interpretation of the narratives shared with me. I am thankful for Lee’s long commitment and encouragement in this pursuit. I must thank Marcia Berry for her Monday morning prayers on my behalf over these last two and one-half years. Her prayers were life-giving. Claudia and Mike Pohl iv generously offered their beautiful “cabin” for my private writing retreats, for that I am forever grateful. To my family and friends who both lived with me and lived without me, I give my love, and my sincere and deep gratitude. Their encouragement, wisdom, love, and listening ears kept me going. To my Dad, Douglas Blake, I also give my love and thanks. He has given me his lifelong support and the inspiration for this attempt in understanding the aging experience. To my children and grandchildren, I thank you for your ongoing love, encouragement, confidence, understanding, and patience. Finally and most important, I could not have completed this without the love and unwavering support, and patience of my husband John. He cooked, he read, he edited. He saw this as “our” work. John, you are my rock and I thank you. v CONTENT Approval Page .................................................................................................................... iii Acknowledgements ........................................................................................................... iv Abstract ........................................................................................................................... xiii Chapter 1. Introduction: Listening and Learning from our Oldest-Old: A Continued Need .........................................................................................................................1 What Is the Data Revealing? ..............................................................................2 What a Personal and Professional Perspective Is Revealing .............................3 What History Is Revealing ................................................................................5 What Three of the Oldest-Old Have Revealed Through Their Pen ...................8 Seeking Further Revelation and Its Significance .............................................11 2. Literature Review: Where We have been: Where We can Go ..............................13 Lifecourse and Lifespan Views of Aging ........................................................14 Erikson’s Life Cycle Stages of Psychosocial Development ............................16 Successful Aging .............................................................................................18 Considering the Oldest-Old .............................................................................19 Aging Research of the Last Decade .................................................................21 Phenomenology of Aging ..........................................................................24 Using Other Qualitative Approaches .........................................................35 Quantitative Studies Addressing Aging Issues ..........................................44 Conclusion .................................................................................................56 3. Methodology and Method: Seeking Understanding From the Oldest-Old ............59 Seeking Understanding: The Research Questions ...........................................60 Methodology: Why Hermeneutical or Interpretive Phenomenology? .............61 Research Design and Underlying Assumptions .........................................62 The Hermeneutic-Circle.............................................................................68 Entering the Circle: The Fore-Structure ....................................................69 Laying Out My Fore Structure ...................................................................69 To Summarize ............................................................................................74 Method .............................................................................................................75 Sample........................................................................................................75 vi Setting ........................................................................................................76 Method of Data Collection.........................................................................76 Nature of the Interview ........................................................................78 The Initial Interview ............................................................................79 The Second Interview ..........................................................................80 The Third Interview .............................................................................81 Procedures ........................................................................................................81 Recruitment and Consent ...........................................................................81 Protection of Data ......................................................................................82 Method of Data Analysis: The Interpretive Task ............................................82 Thematic Analysis .....................................................................................83 Paradigm Cases ..........................................................................................87 Exemplars ..................................................................................................87 Field Notes .................................................................................................88 Data Analysis Tools ...................................................................................88 Evaluation of the Interpretive/Hermeneutic Phenomenological Inquiry .........88 Conclusion .......................................................................................................91 The Method as Lived .......................................................................................92 4. When the Body Speaks ..........................................................................................95 Living in the Aging Body ................................................................................96 The Paradigm of Alma ...............................................................................96 Noticing the Body’s Changes: When it is Hard to Grow Old Gracefully ..................................................................................................99 “The Shocker”: “I Am Old”—Rebekah’s Exemplar ...............................102 When Losses of Health are Devastating ........................................................103 The Paradigm of Madeline: Sadness Comes When the Body Disappoints ..............................................................................................104 Slowing Down: When Everything Goes Slower ...........................................107 Slowing Down: A Common experience ..................................................107 “I’m Lethargic” ........................................................................................110 When Vision and Hearing are Diminishing ...................................................111 vii Living With the “What if?”......................................................................111 Eyesight Gone Crazy .........................................................................112 Using Your Vision for Only Necessary Things .................................113 Experiencing Hope in Vision Loss ....................................................114 The Impact of Hearing Loss ....................................................................115 “So I Grin, and Smile, and Nod…” ...................................................115 When Hearing Loss Is not Worth Mentioning ...................................116 Hearing Loss and Marital Negotiation ...............................................116 When the Mind Reveals Its Age ....................................................................117 Strategizing to Remember ........................................................................118 Puzzles, Numbers, Pneumonia, and More ...............................................119 Caring for the Aging Body ............................................................................122 Getting up at Night: “When You Gotta Go, You Gotta Go” ..................123 Alma’s Paradigm: Daily Life Takes a Well-Thought-Out Approach ......125 The Primacy of Exercise: A Way of Being .............................................128 Louis’s Approach: “Get One of My Walkers and Down the Hall” ...128 William’s Approach: “I Have a Fixed Routine” ................................129 Being Faithful to the body: “Come Hell or High Water” ..................130 Adjusting and Adapting to This Changing Body ...........................................132 Pain as the New Normal ................................................................................135 When Falling Is a Real Concern: Loss of Trust in the Body .........................138 Lack of Confidence: “Will It Work?” ......................................................139 Thinking of Every Step ............................................................................140 “Here I Go Again” ...................................................................................141 “Don’t Back Up”......................................................................................142 “I Have a Fear of Falling” ........................................................................144 More Stories .............................................................................................144 An Experienced Faller .............................................................................145 Loss of Mobility: Fading Physical Strength ..................................................147 An Old, Old Story Told ...........................................................................149 Fatigue and Frailty ...................................................................................150 Fear Compounded: When Bodies Speak at a Different Pace ........................153 viii Conclusion .....................................................................................................156 5. The Challenge to Independence and Autonomy ..................................................159 The Paradigm of Rebekah: The Passage Into Old Age..................................160 The Paradigm of Betty: Anticipation of a Loss .............................................168 Exemplars of Loss of Driving: Loss of Independence...................................173 Dependence: Feeling Like a Burden, an Imposition, a Bother ......................175 Exemplars of Loss, Maintenance of Decision Making, and Role Reversal .................................................................................................178 Relinquishing the Finances With Gratitude: John’s Exemplar ................178 “Not Ready for That Yet”: Alma’s Exemplar ..........................................179 “So I Smile”: Sarah’s Exemplar ..............................................................180 And for Others .........................................................................................181 Conclusion .....................................................................................................182 6. Accumulating Losses: The Endless List ..............................................................185 Paradigm of Betsy: “Getting Tired of It” .......................................................185 Loss of a Spouse and Life Partner: “My life Course Changed Precipitously” .................................................................................................189 When Loss Comes Suddenly ...................................................................189 “This Is What I Have to Do . . .”: Sarah’s Exemplar .........................189 “I Have a Big problem . . .”: John’s Exemplar ..................................191 “You Live Through It . . .”: Norma’s Exemplar ...............................192 When Loss Is a Long Process ..................................................................193 “I Did Well at This Time . . .”: Louis’s Exemplar .............................194 “I’m Just Thankful . . .”: Alma’s Exemplar .......................................195 “It Is More Difficult . . .”: William’s Exemplar .................................196 “It’s Fine Now”: Douglas’s Exemplar ...............................................197 “I Lost Him Gradually”: Betty’s Exemplar .......................................198 Out Living so Many: “I Don’t Know Many People My Age” ......................199 Those That Are Younger: Exemplars of Loss of Family .........................199 “I’m Still Here”: Exemplars of Loss of Friends ......................................200 Loss of Meaningful Work: “Outlived Usefulness” ........................................204 Losses of Former Pleasurable Activities: Faded Energy and Interests .......................................................................................207 ix
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