Finding a Balance Between Integrity and Despair: A Challenging Task for Older Adults in Residential Care

Abstract

Erikson described the late life developmental task as a complex and dynamic dialectic between ego-integrity and despair with substantial impact on older adults’ functioning. Limited knowledge is, however, available on how older adults cope with this task within the existentially challenging context of nursing homes. A person-oriented perspective within a longitudinal approach is implemented to test Erikson’s premise, offering insight into how old and frail adults come to terms with this task and how this process is related to better or worse psychological functioning. Three hundred twenty-seven adults living in nursing homes were interviewed three times by means of structured questionnaires, every 6 months. Typological methodology (latent class growth modeling) was used to reveal specific profiles of ego-integrity and despair and to test relations between profiles and psychological functioning over time. Three specific groups emerged (Despairing group, Struggling group, and Integrated group) and each group was associated with a unique pattern of psychological functioning (depressive symptoms, life satisfaction, subjective health). The Integrated group showed the most optimal functioning whereas the Despairing group, and to a lesser extent the Struggling group, showed suboptimal functioning. Furthermore, in the Despairing and Struggling group, different trajectories for subjective health were present, as compared to the Integrated group. Older adults in nursing homes handle the developmental tasks of late life in distinct and dynamic ways over time and these different trajectories are related to their psychological functioning. Our findings emphasize the need to focus on developmental psychological aspects in long-term care for older adults.