This blog is based on an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Helen Anderson is a registered nurse and a researcher at the University of York with a special interest in identity research. She has studied professional identity in health care professionals, and identity issues in people aged 95 years and older.
In this blog, Helen reflects on her recent research, which explored identity construction in the very old, and gave voice to a group that is not often heard. The aim was to inform how support is planned and negotiated with very old people in our society.
As people grow older, the way they see themselves, how they behave, and how they interact with others can change. In this study, we set out to investigate how people aged 95 years or more hold on to their sense of identity and continue to negotiate their place in society.
According to the 2021 census, 609,000 people in the UK are aged 90 years or more. Typically, society sees ageing as a period of decline where people withdraw from society. There is little research on how older people see themselves.
We therefore interviewed 23 people in the North East who were all aged 95 years and older. We asked about their day-to-day life, health, and thoughts about the future. 5 themes were generated from the interviews.
Contentment. Interviewees saw themselves as largely content and, despite their world becoming smaller, found pleasure in small routines. People often reflected on past achievements, to create a sense of self. They believed that accepting the realities of getting older, rather than focusing on what had been lost, was the key to happiness: “Your senses get older and they deteriorate. I accept that and I think because I accept it, I’m still a pretty happy person." - Alan
Independence. People wanted to maintain some level of independence to retain their dignity. Achieving this, despite medical issues and reduced physical capabilities, could become a battle between them and their family or carers. Some people deliberately took risks (such as not wearing a call button, or not taking medication) to maintain a sense of independence. “I don’t wear [a call button] no… I seem to remember having one at one time. Maybe I have put it away [laughter].” - Margaret
Family roles. After years of taking care of others, older people were increasingly taken care of by family and carers, who did their shopping, cooking, and managed bills. These changing relationships could be difficult to manage; interviewees were often frustrated and referred to ‘being allowed’ to do everyday activities. Many saw the support they received as something family members wanted to do rather than being necessary: “Well, if they want to help, I just let them.” - Angela
Keeping up appearances. For some, especially women, appearance was an important part of identity. They said that a smart appearance meant they were looking after themselves; looking younger than they were was a source of pride. “She brought this lady doctor in, she said, "If I get to 95, I hope I look like you.” - Maureen
Reframing ill health. Older people were reluctant to acknowledge their progressive ill health, and they often minimised serious events. Some wanted their ill health to be seen as manageable and not reflect their increased need for support. Even multiple and complex health conditions were generally accepted as a normal part of getting older. This extended to attitudes towards death: “I just take [my health] as it comes, and I reckon sooner or later I will fall ill and that will be it.”" - Russell
A better balance between surviving and thriving?
Our interviews revealed how very old people negotiated their everyday lives and maintained their sense of identity. While their world had often shrunk, they had managed their own expectations to help them adapt to a new way of life.
Older people wanted to be involved in decisions about their lives and care. They often felt that those involved in their care wanted to avoid risk at all costs and valued safety over quality of life. Older people themselves were prepared to take more risks to preserve their identity and independence. We would like carers and service providers to be mindful of the views of the very old and for this to inform how support is planned and negotiated with older people.
Many interviewees saw successful aging as a process of acceptance and adaptation. However, this could hide the level of formal support they need, which often fell to family members. Some interviewees viewed falls as one-off events outside their control. They didn’t use call buttons because to them, the risk of seeming dependent on others outweighed risks to their health and safety. Many described small acts of resistance to assert control over their life. For example, negotiating bedtimes, defining themselves as ‘non-fallers’, and deciding not to take medication.
We hope our research will help family and carers understand the reasons behind these acts and encourage greater sensitivity to the stigma that very old people can feel in asking for help. We hope this will reduce frustration or conflict.
Our study was carried out in one area of the UK; studies in other areas may help us to understand different contexts. More research about older people needs to focus on people aged 90 years or more.
Overall, our study provides insight into the experiences and views of very old people. We found that striving for independence sometimes meant risk-taking and resistance, because this was preferable to losing autonomy. This finding might help us rethink how very old people in society view safety and risk; and the tensions this may cause with those who provide care. Ultimately, we ought to question whether we should work to achieve a better balance between surviving and thriving.
You may be interested to read
This Alert is based on: Anderson H, and others. Identity construction in the very old: A qualitative narrative study. PLOS One 2022; 17: 1-24.
Summaries of the research published in The Guardian, The Times, and The Mail.
A Johns Hopkin’s Medicine article about balancing safety risks for older people with their independence.
’Risking happiness’, a video of a play about balancing risks for older people and a second video on clinicians' reflections on the play.
A BMJ article about balancing patient safety and autonomy.
Funding: The study was funded by the NIHR Research for Patient Benefit Programme.
Conflicts of Interest: The authors had no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
