Advances in health care mean that we can now treat diseases that once cut lives short. However, the increase in life expectancy has not been matched by improvements in quality of life. The World Health Organization warns us that all countries should prepare to meet the challenges of an aging population and this is integral to the United Nations 2030 Agenda for Sustainable Development. This may require a shift in attitude toward aging. We aimed to use meta-ethnography to explore the experience of adults living beyond the age of 80. Our conceptual model illuminates the phenomenon of connection in older age and reflects on the paradox of time: ephemeral, yet interminable. Our findings encourage us to reflect on the influence of enlightenment philosophies that underpin the desire for autonomy at all costs. Our study challenges the stereotypes of old age and has the potential to influence people’s perspectives toward aging.
Abad-CorpaE.González-GilT.Barderas-ManchadoA. M.de la Cuesta-BenjumeaC.Monistrol-RuanoO.Mahtani-ChuganiV.Martínez-HernándezA. (2010). Research protocol: A synthesis of qualitative studies on the process of adaptation to dependency in elderly persons and their families. BMC Geriatrics, 10, 58–58. doi:10.1186/1471-2318-10-58
2.
*AléxL.HammarstromA.GustafsonY.NorbergA.LundmanB. (2006). Constructions of various femininities among the oldest old women. Health Care for Women International, 27, 853–872. doi:10.1080/07399330600880467
3.
*AléxL.LundmanB. (2011). Lack of resilience among very old men and women: A qualitative gender analysis. Research & Theory for Nursing Practice, 25, 302–316. doi:10.1891/1541-6577.25.4.302
4.
*AnderssonM.HallbergI. R.EdbergA.-K. (2008). Old people receiving municipal care, their experiences of what constitutes a good life in the last phase of life: A qualitative study. International Journal of Nursing Studies, 45, 818–828. doi:10.1016/j.ijnurstu.2007.04.003
5.
Barnett-PageE.ThomasJ. (2009). Methods for the synthesis of qualitative research: A critical review, Economic and Social Research Council National Centre for Research Methods Working Paper Series No. (01/09). Available from www.ncrm.ac.uk
6.
*BehmL.IvanoffS. D.ZidénL. (2013). Preventive home visits and health: Experiences among very old people. BMC Public Health, 13, Article 378. doi:10.1186/1471-2458-13-378
7.
BradshawS. A.PlayfordE. D.RiaziA. (2012). Living well in care homes: A systematic review of qualitative studies. Age and Ageing, 41, 429–440. doi:10.1093/ageing/afs069
8.
*CaldasC. P.BerteröC. M. (2007). Living as an oldest old in Rio de Janeiro: The lived experience told. Nursing Science Quarterly, 20, 376–382. doi:10.1177/0894318407306542
9.
CampbellR.PoundP.MorganM.Daker-WhiteG.BrittenN.PillR.. . . DonovanJ. (2011). Evaluating meta-ethnography: Systematic analysis and synthesis of qualitative research. Health Technology Assessment, 15(43), 1–164. doi:10.3310/hta15430
10.
CampbellR.PoundP.PopeC.BrittenN.PillR.MorganM.DonovanJ. (2003). Evaluating meta-ethnography: A synthesis of qualitative research on lay experience of diabetes and diabetes care. Social Science & Medicine, 56, 671–684. doi:10.1016/S0277-9536(02)00064-3
11.
*CarlssonM.BergS.WenestamC. (1991). The oldest old: Patterns of adjustment and life experiences. Scandinavian Journal of Caring Sciences, 5, 203–210. doi:10.1111/j.1471-6712.1991.tb00109
ClarkeL. H.GriffinM. (2008). Failing bodies: Body image and multiple chronic conditions in later life. Qualitative Health Research, 18, 1084–1095. doi:10.1177/1049732308320113
14.
*Dahlin-IvanoffS.HaakM.FangeA.IwarssonS. (2007). The multiple meaning of home as experienced by very old Swedish people. Scandinavian Journal of Occupational Therapy, 14, 25–32. doi:10.1080/11038120601151714
15.
*DarviriC.DemakakosP.TiganiX.CharizaniF.TsiouC.TsagkariC.. . . MonosD. (2009). Psychosocial dimensions of exceptional longevity: A qualitative exploration of centenarians’ experiences, personality, and life strategies. International Journal of Aging & Human Development, 69, 101–118. Retrieved from http://journals.sagepub.com/doi/pdf/10.2190/AG.69.2.b
16.
DicksonM.RiddellH. (2017). Delivering dignified care: A realist synthesis of evidence that promotes effective listening to and learning from older people’s feedback in acute care settings. Journal of Clinical Nursing, 26, 4028–4038. doi:10.1111/jocn.13856
17.
Dixon-WoodsM.BoothA.SuttonA. (2007). Synthesizing qualitative research: A review of published reports. Qualitative Research, 7, 375–422.
18.
Dixon-WoodsM.SuttonA.ShawR.MillerT.SmithJ.YoungB.. . . JonesD. (2007). Appraising qualitative research for inclusion in systematic reviews: A quantitative and qualitative comparison of three methods. Journal of Health Services and Research Policy, 12, 42–47. doi:10.1258/135581907779497486
DugglebyW.HicksD.NekolaichukC.HoltslanderL.WilliamsA.ChambersT.EbyJ. (2012). Hope, older adults, and chronic illness: A metasynthesis of qualitative research. Journal of Advanced Nursing, 68, 1211–1223. doi:10.1111/j.1365-2648.2011.05919.x
21.
EbrahimiZ.WilhelmsonK.MooreC. D.JakobssonA. (2012). Frail elders’ experiences with and perceptions of health. Qualitative Health Research, 22, 1513–1523. doi:10.1177/1049732312457246
22.
*EliasT.LowtonK. (2014). Do those over 80 years of age seek more or less medical help? A qualitative study of health and illness beliefs and behaviour of the oldest old. Sociology of Health & Illness, 36, 970–985. doi:10.1111/1467-9566.12129
23.
ElliottJ.McNeilH.AshbourneJ.HusonK.BoscartV.StoleeP. (2016). Engaging older adults in health care decision-making: A realist synthesis. Patient, 9, 383–393. doi:10.1007/s40271-016-0168-x
24.
*FängeA.IvanoffS. D. (2009). The home is the hub of health in very old age: Findings from the ENABLE-AGE Project. Archives of Gerontology and Geriatrics, 48, 340–345. doi:10.1016/j.archger.2008.02.015
25.
*FischerR. S.LundmanB.NorbergA. (2010). Feeling whole: The meaning of being consoled narrated by very old people. The Journal of Pastoral Care & Counseling, 64(1), Article 3.
26.
*FischerR. S.NorbergA.LundmanB. (2008). Embracing opposites: Meanings of growing old as narrated by people aged 85. International Journal of Aging & Human Development, 67, 259–271. doi:10.2190/AG.67.3.d
27.
*FlemingJ.FarquharM.BrayneC.BarclayS. (2016). Death and the oldest old: Attitudes and preferences for end-of-life care: Qualitative research within a population-based cohort study. PLoS ONE, 11(4), e0150686. doi:10.1371/journal.pone.0150686
28.
FrankA. (2004). The renewal of generosity: Illness, medicine, and how to live. Chicago, IL: University of Chicago Press.
29.
*FreemanS.GarciaJ.MarstonH. R. (2013). Centenarian self-perceptions of factors responsible for attainment of extended health and longevity. Educational Gerontology, 39, 717–728. doi:10.1080/03601277.2012.750981
30.
*GilbertC.HagertyD.TaggertH. (2012). Exploring factors related to healthy ageing. Self-Care, Dependent-Care & Nursing, 19, 20–25.
31.
*GranbomM.HimmelsbachI.HaakM.LöfqvistC.OswaldF.IwarssonS. (2014). Residential normalcy and environmental experiences of very old people: Changes in residential reasoning over time. Journal of Aging Studies, 29, 9–19. doi:10.1016/j.jaging.2013.12.005
32.
*GraneheimU. H.LundmanB. (2010). Experiences of loneliness among the very old: The Umeå 85+ project. Aging & Mental Health, 14, 433–438. doi:10.1080/13607860903586078
33.
*GreenS.SixsmithJ.Dahlin IvanoffS.SixsmithA. (2005). Influence of occupation and home environment on the wellbeing of European elders. International Journal of Therapy and Rehabilitation, 12, 505–509. doi:10.12968/ijtr.2005.12.11.20061
34.
*GrogerL.LeekJ. (2008). Images of Ohio centenarians: An exploratory study. Oxford, OH: Miami University.
35.
*HaakM.FangeA.IwarssonS.IvanoffS. D. (2007). Home as a signification of independence and autonomy: Experiences among old Swedish people. Scandinavian Journal of Occupational Therapy, 14, 16–24. doi:10.1080/11038120601024929
36.
*HaakM.IvanoffS. D.FängeA.SixsmithJ.IwarssonS. (2007). Home as the locus and origin for participation: Experiences among very old Swedish people. OTJR: Occupation, Participation and Health, 27, 95–103. doi:10.1177/153944920702700303
37.
HaakM.Malmgren FangeA.IwarssonS.Dahlin-IvanoffS. (2011). The importance of successful place integration for perceived health in very old age: A qualitative meta-synthesis. International Journal of Public Health, 56, 589–595. doi:10.1007/s00038-011-0282-4
38.
HannesK.MacaitisK. (2012). A move to more systematic and transparent approaches in qualitative evidence synthesis: Update on a review of published papers. Qualitative Research, 12, 402–442. doi:10.1177/1468794111432992
39.
HarrisR.WathenC. N.MacGregorJ. C. D.DennhardtS.NaimiA.EllisK. S. (2015). “Blaming the flowers for wilting”: Idealized aging in a health charity video. Qualitative Health Research, 26, 377–386. doi:10.1177/1049732315570121
40.
HaugeS.HeggenK. (2008). The nursing home as a home: A field study of residents’ daily life in the common living rooms. Journal of Clinical Nursing, 17, 460–467. doi:10.1111/j.1365-2702.2007.02031.x
41.
*HedbergP.BrulinC.AléxL. (2009). Experiences of purpose in life when becoming and being a very old woman. Journal of Women & Aging, 21, 125–137. doi:10.1080/08952840902837145
42.
*HedbergP.GustafsonY.BrulinC.AléxL. (2013). Purpose in life among very old men. Advances in Aging Research, 2, 100–105. doi:10.4236/aar.2013.23014
43.
*HolstonE. C.CallenB. (2017). Growing up on an Appalachian farm: A centenarian perspective. International Journal of Aging & Human Development, 85, 289–304. doi:10.1177/0091415016688306
44.
*HovbrandtP.FridlundB.CarlssonG. (2007). Very old people’s experience of occupational performance outside the home: Possibilities and limitations. Scandinavian Journal of Occupational Therapy, 14, 77–85. doi:10.1080/11038120600773013
45.
*HutnikN.SmithP.KochT. (2012). What does it feel like to be 100? Socio-emotional aspects of well-being in the stories of 16 Centenarians living in the United Kingdom. Aging & Mental Health, 16, 811–818. doi:10.1080/13607863.2012.684663
KharichaK.IliffeS.DaviesN.WaltersK.ManthorpeJ. (2018). Strategies employed by older people to manage loneliness: Systematic review of qualitative studies and model development. International Psychogeriatrics, 30, 1767–1781. doi:10.1017/S1041610218000339
48.
KitzmüllerG.ClancyA.VaismoradiM.BondasT.WegenerC. (2018). “Trapped in an empty waiting room”: The existential human core of loneliness in old age: A meta-synthesis. Qualitative Health Research, 28, 213–230. doi:10.1177/1049732317735079
49.
KlugarM.CapJ.KlugarovaJ.MareckovaJ.RobersonD. N.KelnarovaZ. (2016). The personal active aging strategies of older adults in Europe: A systematic review of qualitative evidence. JBI Database of Systematic Reviews and Implementation Reports, 14(5), 193–257. doi:10.11124/JBISRIR-2016-002393
50.
*KochT.PowerC.KralikD. (2007). Researching with centenarians. International Journal of Older People Nursing, 2, 52–61. doi:10.1111/j.1748-3743.2007.00037.x
51.
*KochT.TurnerR.SmithP.HutnikN. (2010). Storytelling reveals the active, positive lives of centenarians. Nursing Older People, 22(8), 31–36. doi:10.7748/nop2010.10.22.8.31.c7995
52.
*LarssonA.HaglundL.HagbergJ. (2009). Doing everyday life: Experiences of the oldest old. Scandinavian Journal of Occupational Therapy, 16, 99–109. doi:10.1080/11038120802409762
53.
LederD. (1990). The absent body. Chicago, IL: University of Chicago Press.
54.
LevinasE. (1998). Philosophy and the idea of infinity. In LingisA. (Ed.), Collected philosophical papers (pp. 47–59). Pittsburgh, PA: Duquesne University Press.
55.
LewinS.BoothA.GlentonC.Munthe-KaasH.RashidianA.WainwrightM.. . . NoyesJ. (2018). Applying GRADE-CERQual to qualitative evidence synthesis findings: Introduction to the series. Implementation Science, 13(1), Article 2. doi:10.1186/s13012-017-0688-3
56.
*LoeM. (2010). Doing it my way: Old women, technology and wellbeing. Sociology of Health & Illness, 32, 319–334. doi:10.1111/j.1467-9566.2009.01220.x
57.
*LöfqvistC.GranbomM.HimmelsbachI.IwarssonS.OswaldF.HaakM. (2013). Voices on relocation and aging in place in very old age—A complex and ambivalent matter. The Gerontologist, 53, 919–927. doi:10.1093/geront/gnt034
58.
*LudvigssonM.MilbergA.MarcussonJ.WressleE. (2015). Normal aging or depression? A qualitative study on the differences between subsyndromal depression and depression in very old people. The Gerontologist, 55, 760–769. doi:10.1093/geront/gnt162
59.
*MackowiczJ.Wnek-GozdekJ. (2017). The process of (non) ageing in the perception of Polish centenarians. Educational Gerontology, 43, 101–111. doi:10.1080/03601277.2016.1263926
ManningL. K. (2013). Navigating hardships in old age: Exploring the relationship between spirituality and resilience in later life. Qualitative Health Research, 23, 568–575. doi:10.1177/1049732312471730
62.
*ManningL. K.LeekJ. A.RadinaM. E. (2012). Making sense of extreme longevity: Explorations into the spiritual lives of centenarians. Journal of Religion, Spirituality & Aging, 24, 345–359. doi:10.1080/15528030.2012.706737
63.
MartzK.MorseJ. M. (2016). The changing nature of guilt in family caregivers: Living through care transitions of parents at the end of life. Qualitative Health Research, 27, 1006–1022. doi:10.1177/1049732316649352
64.
MaslowA. (1943). A theory of human motivation. Psychological Review, 50, 370–396.
65.
MolonyS. L. (2010). The meaning of home: A qualitative meta-synthesis. Research in Gerontological Nursing, 3, 291–307. doi:10.3928/19404921-20100302-02
66.
National Institute on Aging. (2017). Healthcare perceptions about older patients. Bethesda, MD: Author.
67.
*NilssonI.LundgrenA. S.LiliequistM. (2012). Occupational well-being among the very old. Journal of Occupational Science, 19, 115–126. doi:10.1080/14427591.2011.595894
68.
*NilssonM.SarvimakiA.EkmanS. L. (2000). Feeling old: Being in a phase of transition in later life. Nursing Inquiry, 7, 41–49.
*NosratyL.JylhäM.RaittilaT.Lumme-SandtK. (2015). Perceptions by the oldest old of successful aging, Vitality 90+ Study. Journal of Aging Studies, 32, 50–58. doi:10.1016/j.jaging.2015.01.002
71.
*NygrenB.NorbergA.LundmanB. (2007). Inner strength as disclosed in narratives of the oldest old. Qualitative Health Research, 17, 1060–1073. doi:10.1177/1049732307306922
72.
Office for National Statistics. (2017). Health state life expectancies, UK: 2015 to 2017. London: Author.
73.
*PascucciM. A.LovingG. L. (1997). Ingredients of an old and healthy life. A centenarian perspective. Journal of Holistic Nursing, 15, 199–213. doi:10.1177/089801019701500209
QSR International. (2010). NVivo qualitative data analysis software (Version 9) [Computer software]. Melbourne: QSR International Pty Ltd.
76.
RegisterM. E.HermanJ. (2006). A middle range theory for generative quality of life for the elderly. Advanced Nursing Science, 29, 340–350. doi:10.1097/00012272-200610000-00007
77.
RegisterM. E.HermanJ. (2010). Quality of life revisited: The concept of connectedness in older adults. Advanced Nursing Science, 33, 53–63. doi:10.1097/ANS.0b013e3181c9e1aa
78.
SandelowskiM.BarrossoJ. (2007). Handbook for synthesising qualitative research. New York: Springer.
79.
*ScelzoA.Di SommaS.AntoniniP.MontrossL. P.SchorkN.BrennerD.JesteD. V. (2018). Mixed-methods quantitative-qualitative study of 29 nonagenarians and centenarians in rural Southern Italy: Focus on positive psychological traits. International Psychogeriatrics, 30, 31–38. doi:10.1017/s1041610217002721
80.
*SixsmithJ.SixsmithA.WoolrychR.FangeA. M.TomsoneS.HaakM.. . . Dahlin-IvanoffS. (2014). Healthy ageing and home: The perspectives of very old people in five european countries. Social Science & Medicine, 106, 1–9. doi:10.1016/j.socscimed.2014.01.006
81.
SongM.KongE. H. (2015). Older adults’ definitions of health: A metasynthesis. International Journal of Nursing Studies, 52, 1097–1106. doi:10.1016/j.ijnurstu.2015.02.001
82.
*StonesD.GulliferJ. (2016). ‘At home it’s just so much easier to be yourself’: Older adults’ perceptions of ageing in place. Ageing & Society, 36, 449–481. doi:10.1017/S0144686X14001214
83.
TavoryI.TimmermansS. (2014). Abductive analysis: Theorizing qualitative research. Chicago, IL: University of Chicago Press.
84.
ToyeF.SeersK.AllcockN.BriggsM.CarrE.AndrewsJ.BarkerK. (2013a). A meta-ethnography of patients’ experiences of chronic non-malignant musculoskeletal pain. Health Services and Delivery Research, 1(12), 1–189. doi:10.3310/hsdr01120
85.
ToyeF.SeersK.AllcockN.BriggsM.CarrE.AndrewsJ.BarkerK. (2013b). ‘Trying to pin down jelly’: Exploring intuitive processes in quality assessment for meta-ethnography. BMC Medical Research Methodology, 13, Article 46. doi:10.1186/1471-2288-13-46
86.
ToyeF.SeersK.AllcockN.BriggsM.CarrE.BarkerK. (2014). Meta-ethnography 25 years on: Challenges and insights for synthesising a large number of qualitative studies. BMC Medical Research Methodology, 14, Article 80. doi:10.1186/1471-2288-14-80
87.
ToyeF.SeersK.BarkerK. L. (2017). Meta-ethnography to understand healthcare professionals’ experience of treating adults with chronic non-malignant pain. BMJ Open, 7(12), e018411. doi:10.1136/bmjopen-2017-018411
88.
ToyeF.SeersK.BarkerK. L. (2019). Living life precariously with rheumatoid arthritis: A mega-ethnography of nine qualitative evidence syntheses. BMC Rheumatology, 3(1), Article 5. doi:10.1186/s41927-018-0049-0
89.
VaismoradiM.SkärL.SöderbergS.BondasT. E. (2016). Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes. International Journal of Qualitative Studies on Health and Well-being, 11, 31203. doi:10.3402/qhw.v11.31203
90.
*WandA. P. F.DraperB.BrodatyH.PeisahC. (2018). Why do the very old self-harm? A qualitative study. American Journal of Geriatric Psychiatry, 26, 862–871. doi:10.1016/j.jagp.2018.03.005
91.
*WesterbotnM.FahlstromE.FastbomJ.Aguero-TorresH.HillerasP. (2008). How do older people experience their management of medicines?Journal of Clinical Nursing, 17(5), 106–115. doi:10.1111/j.1365-2702.2007.02151.x
*WondolowskiC.DavisD. K. (1991). The lived experience of health in the oldest old: A phenomenological study. Nursing Science Quarterly, 4(3), 113–118. doi:10.1177/089431849100400308
94.
*WongW.-C. P.LauH.-P. B.KwokC.-F. N.LeungY.-M. A.ChanM.-Y. G.ChanW.-M.CheungS.-L. K. (2014). The well-being of community-dwelling near-centenarians and centenarians in Hong Kong: A qualitative study. BMC Geriatrics, 14, Article 63. doi:10.1186/1471-2318-14-63
95.
World Health Organization. (2014). WHO handbook for guideline development (2nd ed.). Geneva, Switzerland: WHO Press.
World Health Organization. (2019). Older people and Primary Health Care (PHC). Geneva, Switzerland: Author.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
