The tremendous increase in the number of elderly people over the next few decades will be accompanied by an even more dramatic increase in the number of old people suffering from chronic diseases and disorders. Aside from infirmity resulting from chronic conditions such as diabetes and heart disease, the number of people with depression and dementia--especially primary degenerative dementia such as Alzheimer disease, but also vascular dementia and the like--will increase markedly.[1] In Germany, churches and social welfare organizations have traditionally played a strong role in the care of the elderly and handicapped people. Due to substantial financial restrictions, however, their activities will be reduced in the future, but without adequate compensation from the public sector. Financing the rapidly increasing costs of chronic care and introducing a new general long-term care insurance system have become two of the most important and most virulently argued topics in Germany today. This public debate shows quite clearly that even now, those of the elderly who are afflicted by chronic disease have strong lobby. Given that their number will increase dramatically, it may reasonably be feared that the public's concern for their plight will become even more problematic. This trend is all the more disturbing when it is set against the background of a general shift in values, in our country as well as in other Western societies, from solicitude and beneficence to autonomy and self-fulfillment. This fundamental shift only influences public opinion by eroding appreciation for long-term care, it also affects the self-esteem of the afflicted persons. What old age accompanied by chronic disease means to the individual is closely correlated with what it means to the individual's family and other caregivers, as well as what it means to the public. In reflecting on these three domains of meaning, we should always keep in mind that meaning can be construed on different levels, depending on underlying frames of reference and value systems. Meaning and Life Narrative The social understanding of old age has a long history that comprises various models of meaning. In Western societies, the development of modern medicine in the late nineteenth century established on a broad scale a model that had already become known as the model. In this model the aging person is regarded primarily from the perspective of an ongoing deterioration of his or her mental and physical abilities. Aging is seen as a continual diminishing of personal resources and activities. Compared to the adult person, small children and old people who are not yet or no longer in full possession of their strength are regarded as imperfect. In contrast to these deficiency models, which are based on a purely biological understanding of the person, other theories, especially widespread in Eastern cultures, emphasize the growth of wisdom and life experiences of the elderly.[2] Other models, for example the psychodynamic model of Erik H. Erikson, focus on inner conflicts and crises related to psychodynamic development and personal growth in successive life periods. Erikson distinguishes eight consecutive life periods, the last of which--mature adult age--is characterized by the conflict between integrity on the one hand and loathing of life and self-contempt on the other. Integrity is the acceptance and positive evaluation of the personal life cycle, as it stands in community with other peoples and cultures.[3] Other psychoanalytically oriented authors such as Anneliese Heigl-Evers and Franz Heigl emphasize the problem of accepting personal limits and failure. In the last period of life, people have to cope with failed hopes, personal guilt, and loneliness. But the elderly have special resources such as calmness, serenity, and sense of humor as Well.[4] In assessing the variety of understandings of old age it is obvious that the deficiency theories in particular do take into account the great span of individual differences among the elderly. …