Introduction
Nourishing the holistic wellbeing of older people requires a deeper understanding of what makes life meaningful in the late years (Vaarama et al., Reference Vaarama, Siljander, Luoma, Meriläinen, Vaarama, Moisio and Karvonen2010; MacKinlay, Reference MacKinlay2017). Getting old promotes the experience of meaning in life (see e.g. Reker and Chamberlain, Reference Reker and Chamberlain2000; Schnell, Reference Schnell2009). Yet, many researchers are united in the view that the experience of meaning is related to struggle, crises and the need to negotiate life events to be able to find coherence in life (see Erikson, Reference Erikson1994; Tornstam, Reference Tornstam1997, Reference Tornstam2005; Ganzevoort, Reference Ganzevoort2010; MacKinlay, Reference MacKinlay2017; Woodward and Kartupelis, Reference Woodward and Kartupelis2018). Finding life meaningful positively correlates to health and spiritual wellbeing (e.g. Moreira-Almeida and Koenig, Reference Moreira-Almeida and Koenig2006; Atchley, Reference Atchley2009; Hodge and Horvath, Reference Hodge and Horvath2011; Haugan, Reference Haugan2014).
Researchers found that wellbeing is related to the ability to participate in meaningful activities and perceive individual autonomy (e.g. Woodward and Kartupelis, Reference Woodward and Kartupelis2018). Ageing Finns find living in their own homes meaningful; they have a strong desire to do so for as long as possible (THL, 2016; Alastalo et al., Reference Alastalo, Vainio and Kehusmaa2017). These wishes are supported by the current Finnish legislation, which promotes caring for older people in their own homes. According to Finland's Elder Care Act,Footnote 1 an older person has the right to institutional care only for medical or safety reasons (Article 14a). Similar policies are favoured in many countries (Iecovich, Reference Iecovich2014). As the number of people staying at home with less-formal care is increasing rapidly (Alastalo et al., Reference Alastalo, Vainio and Kehusmaa2017; Kröger et al., Reference Yalom2019), it is vital to discover new means of meeting the holistic needs of the ageing population.
In Finland, older people's quality of life decreases when their physical capacities decrease, reducing social activity and psychological wellbeing. The poorest quality of life among all Finns is expressed by widows who have turned 80. (Vaarama et al., Reference Vaarama, Siljander, Luoma, Meriläinen, Vaarama, Moisio and Karvonen2010: 138–139). Further, neglect (Read and Suutama, Reference Read and Suutama2008) in close relations and loneliness (Saarelainen, Reference Saarelainen2019; Tiilikainen, Reference Tiilikainen2019; Saarelainen et al., Reference Saarelainen, Vähäkangas, Pöyhiä, Saarelainen and Salminen2020 ) are shown to arouse a sense of loss of meaning. The ill-being and isolation of older people is likely to lead to depression (Crewdson, Reference Crewdson2016; Tiilikainen and Seppänen, 2016).
Technology can provide an alternative route to alleviate loneliness among older people (Crewdson, Reference Crewdson2016: 7). Gerontechnology includes a variety of technological tools and means that can be used in home care for older people (Piau et al., Reference Piau, Campo, Rumeau, Vellas and Nourhashémi2014: 99). With the resource challenges in health care, the hope is that technologically assisted care will partly solve socio-economic problems (Greenhalgh et al., Reference Greenhalgh, Procter, Wherton, Sugarhood and Shaw2012: 8–9). In Finland, technology has mainly been used to observe the safety of home-based care clients with a range of monitoring systems (Topo, Reference Topo, Heikkinen, Jyrkämä and Rantanen2008; Hammar et al., Reference Hammar, Vaino and Sarivaara2017). As early as 2001, the Finnish government stated that technology should be seen as part of home care (Kuusi, Reference Kuusi2001). Still, the range of possibilities that technology can offer in home care need to be better understood, and it remains crucial to identify the risks involved in using such technology (Hammar et al., Reference Hammar, Vaino and Sarivaara2017).
Virtual connections and Service TV (STV) are forms of gerontechnology used in the Finnish home-care system. As a setting, STV is much like Skype; attendees can see and hear each other from their home screens. STV is mostly utilised to host physiotherapy and other activation of the home-based clients of hospitals. In Finland, care providers in the South Karelia (Etelä-Karjala) and capital (Uusimaa) areas are utilising these virtual connections the most. In South Karelia, 75 per cent of home-based care units and clients have a virtual connection and 15 per cent have an STV unit. In the capital area, 40 per cent of home-based clients have a virtual connection and a small percentage of older people have the STV unit (Hammar et al., Reference Hammar, Vaino and Sarivaara2017).
Stemming largely from these notions and gaps in earlier research, the authors analyse how older people living at home portray the connection between relational aspects of meaning in life within STV group discussions.
Theoretical framework
This paper binds together two theoretical discussions about meaning in life and relationality. Both of these frameworks are manifold and utilised within a range of disciplines. Drawing on the psychology of religion, existential psychology, social sciences and law, the authors next illustrate how closely meaning in life and relationality are linked.
Meaning in life is a very individual experience (Frankl, [1959] Reference Yalom2010; Baumeister, Reference Baumeister1991; Schnell, Reference Schnell2009) that changes during the lifespan: life events and ageing modify the experience of meaning in life (see Reker et al., Reference Reker, Peacock and Wong1987). Meaning in life is understood to incorporate three different aspects: sources of meaning (SoMe), meaningfulness and loss of meaning (Schnell, Reference Schnell2009; Park, Reference Park, Paloutzian and Park2013). SoMe emerge in a number of ways. These elements form the experience of meaningfulness, but are at stake if meaning in life is violated. According to Schnell (Reference Schnell2009), SoMe can be categorised within four groups.
The first category of SoMe is self-transcendence, or objectives that go ‘beyond one's immanent needs’. These elements can manifest on the vertical (e.g. orientation towards cosmic powers, God) or horizontal level (e.g. worldly responsibilities). Second, self-actualisation is formed from employing and challenging personal capacities. Order, the third category, stands for following personal values in life. The fourth category, wellbeing and relatedness, shows the strong positive correlation between caring for oneself and caring for others. Life is enjoyed, on the one hand, in private; on the other hand, company is needed to share the joys of life (Schnell, Reference Schnell2009: 488).
SoMe build an individual experience of meaningfulness; the same sources are at stake when one encounters loss of meaning. Meaningfulness forms from experience of coherence, significance and direction in life, as well as from the sensation of belonging. Meaningfulness incorporates basic trust in life, whereas violations of meaning can be defined as loss or crises of meaning. Loss of meaning is likely to shake up the experience of meaning in life and violate SoMe. When an individual loses the sense of meaning in life, he or she seeks new meanings and finds remaining SoMe more important (Schnell, Reference Schnell2009, see also Baumeister, Reference Baumeister1991; Park, Reference Park, Paloutzian and Park2013). Figure 1 demonstrates how the authors understand the linkage between meaning in life and relationality.
Figure 1. Interaction between meaning in life and relationality.
Figure 1 shows that meaning in life includes three closely interlinked aspects: sources of meaning, meaningfulness and loss of meaning. On the one hand, when an individual finds life meaningful, personal sources of meaning are found as satisfactory and fulfilling. On the other hand, when an individual encounters a crisis, sources of meanings are wounded. Imbalance in sources of meanings can lead to the loss of meaning in life.
In Figure 1, relationality is positioned in the middle of everything as the authors see relationality as central to exploring meaning in life. Relationality is seen as interwoven with meaning in life. Through, with and within a personal web of relations, people construct a self-image, test individual thoughts and build their values (e.g. Ganzevoort, Reference Ganzevoort1998a, Reference Ganzevoort1998b; Miller-McLemore, Reference Miller-McLemore and Dykstra2005). In everyday life, the experience of meaning is based on personal relations (Gergen and Gergen, Reference Gergen and Gergen2016). Relationships provide a strong anchor to meaningfulness as in hardships of life and can provide meaning when everything else is lost (see Moltmann, [1965] Reference Moltmann and Leitch1993: 188–190, 313–317; Park, Reference Park, Paloutzian and Park2013; Saarelainen, Reference Saarelainen2019).
People make decisions and seek support for their decision-making within their trusted web of relations. This means that we make important life decisions together with people who are significant to us. From the perspective of individual autonomy this means that we should understand autonomy as relational; that is, autonomy is based on relationships with others (e.g. Nedelsky, Reference Nedelsky1989, Reference Yalom2011; MacKenzie and Stoljar, Reference MacKenzie and Stoljar2000). A person tries to make life decisions that lead to an outcome that is good for ‘us’ rather than best for ‘me’ (Harding, Reference Harding2012, Reference Harding2017; Herring, Reference Herring2013). Therefore, it is misleading to talk about ‘my decision’. From the perspective of relational autonomy, it is central to build and discover relationships that support people rather than trying to maximise personal freedom (Harding, Reference Harding2012, Reference Harding2017; Herring, Reference Herring2013). Even though freedom to choose in life and the opportunity to live according to personal goals are important sources of meaning, these factors are bound to our personal relations and context of life (Baumeister, Reference Baumeister1991; Schnell, Reference Schnell2009). Further, the role of power in care relationships should be acknowledged in order to prevent exploitation and neglect (Feder Kittay and Feder, Reference Feder Kittay, Feder, Kittay E and Feder2002). Neglect in close relationships can contribute to loss of meaning and a sense of meaninglessness (Stillman and Baumeister, Reference Stillman and Baumeister2009; Lambert et al., Reference Lambert, Stillman, Hicks, Kamble, Baumeister and Sincham2013; Saarelainen, Reference Saarelainen2018, Reference Saarelainen2019).
From these premises, it becomes crucial to scope how meaning in life and relationality are experienced by older people. In the next section, the authors explain the methods utilised to do this.
Methods
Data gathering
Ethical clearance was obtained from the Ethical Review Board in the Humanities and Social and Behavioural Sciences at the University of Helsinki, after which the hospital board of the collaborating hospital accepted our research plan. For potential participants, information meetings via STV were held. In these informal meetings, we shared ideas about the themes of the discussions, built trust in the group and informed participants about the recording procedure. Potential participants also had the opportunity to meet investigators and ask questions about the group (e.g. clarifying that they were not expected to take part every time if they had other commitments).
The data are formed from three separate existential discussion groups which met five to seven times. In most meetings, two researchers participated: this promoted our interdisciplinary approach as the researchers work in the fields of theology, law and social sciences. To support continuity and trust among the participants, the first author took part in each group meeting. Groups met on a weekly basis for 45–60 minutes. All the data were recorded in mp4 format including image and voice. The group discussions yielded 110 pages of transcription. Each meeting was given a theme for discussion, as described in Table 1.
Table 1. Themes of the group discussions
The discussion themes were based on earlier research findings. Topics – e.g. me as ageing, turning points, and life here and now – were selected because dimensions of the past, present and future need to be balanced in order to find coherence in life (Lester, Reference Lester1995: 94–99) and experiencing coherence in life becomes important when growing old (Tromp and Ganzevoort, Reference Tromp, Ganzevoort, Francis, Robbins and Astley2009: 206). Respect for individual autonomy and values promotes the experience of meaningfulness (see Schnell, Reference Schnell2009; Tromp and Ganzevoort, Reference Tromp, Ganzevoort, Francis, Robbins and Astley2009), therefore, the themes ‘my right to choose’ and ‘my values and worldview’ were incorporated into the discussion. Yet, encountering death and dying challenges the existential stability of an individual (Yalom, Reference Yalom1980; Leget, Reference Leget2017), so it was important for us to understand how participants experienced their personal mortality. Originally, the planned theme for the last meeting was ‘my important relationships’. However, participants shared thoughts on their relationships at each meeting and wished to talk about their youth. As the opportunity to remember may confirm the experience of coherence and provide joy (Gothóni, Reference Gothóni1987; Ganzevoort and Bouwer, Reference Ganzevoort, Bouwer, Ziebertz and Schweitzer2007), the participants’ wishes were followed. The two later groups had five meetings, as the research team were looking for the ‘ideal’ length for an existential discussion group and wanted to reduce the high level of overlap between the discussions.
Participants
The STV co-ordinators from two different hospitals (one in the capital area, the other in South Karelia) introduced the idea of the discussion group to their weekly service users. The inclusion criterion was that participants could not have severe problems with memory. The study had 16 volunteer participants, three male and 13 female, in our three groups. To protect their anonymity, all attendees were given a pseudonym and identifying factors are left out of the paper. All citations from the data are translated by the authors.
The participants were born in the 1920s and 1930s. Their age ranged from 80 to 95 years old; the mean age was 90. All were widowed and lived on their own. Only a few of them had found a new companion for life. All the participants were war veterans which in the Finnish system currently includes men who fought in the Second World War, their wives and Lottas, or women who served in the women's voluntary paramilitary service (following its independence in 1917, Finland had a civil war in 1918, fought the Winter War against the Soviet Union in 1939–1941, then fought the Germans in 1941–1944, known as the Continuation War).
Thematic analysis
The qualitative data were analysed thematically, using template analysis. First, all the spoken data were transcribed by a transcription service. Then the data were independently coded by the first two authors. Coding was conducted on a meeting-by-meeting basis and then codes were clustered into a thematic template one group at a time. The template analysis provides an initial template as a basis for analysis. The final template then provides a full picture of the themes found in the data (King, Reference King, Cassell, Cunliffe and Grandy2018). In this study, the initial template was formed from the analysis of the first group. This thematic template was supplemented with the findings from the other two groups. To validate the analysis, the authors discussed and negotiated their findings and selected terminology. The analysis was partly theory oriented, as it concerned meaning in life and relationality; yet, the authors were not bound to one theory nor were the authors looking to consolidate a priori assumptions. Table 2 summarises the main themes relevant to the relational aspects of meaning in life.
Table 2. Main themes regarding the relational aspects of meaning in life
Results
Significance of autonomy
In this section, the authors analyse how participants expressed their thoughts on autonomy, or independence and freedom, to make their own choices in life. The authors found that individuals needed safety networks in order to live life as they wished. Close relations were also clearly important in terms of legal planning and preparing for the future with the help of family members. However, weakening capacities and the acceptance of external support provoked a fear of losing independence.
Many of the participants described strong safety nets, which mainly consisted of children and grandchildren. The role of the family was significant as it allowed older people to continue living at home. Overall, the participants were quite content with and even proud of their families’ support. They often described feeling that their families were there for them, as Aili (aged 95) did:
I am a bit of a hermit, I like to be alone. Yes, my children visit every day, but two of them have already retired and one is still at work. So every day they come and in a way, I wait for them to come.
Being closely connected to children and grandchildren (and sometimes great-grandchildren) provided content and contributed to meaningfulness in Aili's life. Like Aili, many of the participants depicted children and grandchildren visiting regularly and providing support with grocery shopping, cleaning and household chores, which strengthened their sense of independence and autonomy. In Group 1, where the participants had the most reduced physical capacities, such positive expressions about active family support were most frequent.
Regularly visiting family members brought comfort and care, a sense of community and of being loved. Personal mental wellbeing and relatedness to others were described as highly associated, which correlates with Schnell's (Reference Schnell2009) findings that personal wellbeing and relatedness are closely linked. Items such as community, fun, love, comfort, care, attentiveness and harmony form this category of meaning. Nevertheless, Aili depicted being alone as part of everyday living; she experienced this as solitude, that is, loneliness that is not found as painful (see Tiilikainen and Seppänen, Reference Tiilikainen and Seppänen2017).
Despite close relations, the older people appeared to share a common goal: to remain as independent as they could. The importance of independence is clear in the words of Helena (aged 91):
Yes, I am able to visit the store and take care of all my issues by myself, and I am very happy that I can take care of myself. It's so important.
As Helena expressed, independence was seen as a form of happiness, something worth pursuing. For those participants whose physical capacity was limited, independence was linked to personal ability to take charge of decisions over one's own life. Therefore, cognitive capability was significant, as Johannes (aged 94) stressed:
And it's a big trouble, or a bad thing, to lose one's independence. It is the only thing that a man has to be afraid of, and should be afraid of. That you can't decide for yourself anymore. About your own things.
Johannes’ description indicates the fear of loss of memory and cognitive function are linked to the fear of losing autonomy. Within all three groups, participants shared an emphasis on the importance of cognitive capacity. As long as their memories were functioning, they had the experience of personal autonomy. Living at home is meaningful as it promotes the experience of having control over one's life (Oswald et al., Reference Oswald, Schilling, Wahl, Fänge, Sixsmith and Iwarsson2006). Especially when people are less able to function, home provides roots for personal identity as well as supporting experiences of security and freedom (Dahlin-Ivanoff et al., Reference Dahlin-Ivanoff, Haak, Fänge and Iwarsson2007; Kylén et al., Reference Kylén, Löfqvist, Haak and Iwarsson2019). For ageing individuals, losing autonomy and being forced to follow the rules of others causes suffering (Reis et al., Reference Reis, Menezes, Freitas, Pedreira, Freitas and Pires2019: 1634–1635). Freedom to choose is one item of self-actualisation that provides a source of meaning in life (Schnell, Reference Schnell2009). Freedom contributes to meeting the existential need to control personal life decisions; yet, when it is lost, existential concerns are likely to emerge (Yalom, Reference Yalom1980; see also Herring, Reference Herring2009).
When the participants indicated that they were preparing for losing personal capacities in future, they highlighted the significance of family, as depicted by Irene (aged 92):
I have a continuing power of attorney. They [the family] will take care of my things if I become so dumb, that I don't understand anything (laughing), so they will take care of me … [now] they tell me to do this or that and I either accept or then I don't.
Irene's words can be seen as expressing the relational aspect of autonomy (see Nedelsky, Reference Nedelsky1989; Harding, Reference Harding2017). On the one hand, she still has strong autonomy regarding decisions related to her life. On the other hand, she has agreed with her family about what will happen if and when her cognitive abilities are reduced. She has negotiated and discussed her autonomy with significant others and agreed plans for the future with close relations. SoMe become relational: people negotiate how they wish to be treated when they are more fragile, how their personal needs are taken care of when they their capacity for self-actualisation is reduced (see Schnell, Reference Schnell2009). When negotiating values and forming meanings, individuals are always context bound; decisions are examined within the network of relations (Baumeister, Reference Baumeister1991). Irene, like some other participants, had drafted a continuing power of attorney and appointed a proxy decision-maker. Many participants stated that they trusted their family to take care of matters on their behalf in case of incapacity, even if they had not had these kinds of legal documents drafted. This type of deep trust can be seen as contributing positively to meaningfulness as it reinforces the belief that personal wishes are heard and followed.
Family assistance was not always enough, and external support was needed. Many of the participants had cleaning services but only a few had meals delivered. As the participants were war veterans, the law requires the state to provide them with extra services and financial support.Footnote 2 Therefore, the participants could afford many services, and felt that they were mainly happy with what they received. Yet, it seemed that receiving and accepting assistance at home was sometimes hard, as the group discussion illustrates:
The services are available, that is not the issue. It takes a lot for you to accept them, when you haven't needed the services earlier … For the past two or three months, I have not been able to drive a car because of my leg … I used to be the one who gives lifts to others … As said, it is just so difficult to accept the services. How to adapt to that [the fact that one needs help]. (Kyllikki, aged 84)
I didn't have the knowledge [about the available services]. Now that I've been involved [with the veterans’ assosiation], I try to make everyone else see that we are at that age that we just have to keep the doors open [be open to receiving help]. We have to take what is given. It is our right [to have the services]. (Martta, aged 86)
The discussion between Kyllikki and Martta reveals the negotiation process that older people need to go through when getting frail. In Kyllikki's story, the sudden decrease in physical capacity has altered her role from active member of her community to more passive person needing support. Martta demonstrated her previous ignorance about the services provided. Based on Martta's positive experiences of services, she tried to push Kyllikki to see the value of external support. Yet, in Kyllikki's case, the adaption process is still unfinished and she is not as ready to accept her reduced ability to be active in her community.
Kyllikki has not been able to adapt to her physical changes and violations of meaning are vivid in her words from multiple perspectives. First, horizontal self-transcendence is at stake as she is not physically able to meet her social commitments. Second, self-actualisation is challenged when her daily freedom becomes restricted. Moreover, relatedness that could serve as grounds for wellbeing and meaning is threatened when she seems to withdraw from Martta's suggestion of accepting more support. A sudden physical change had generated a crisis of meaning for Kyllikki (see Schnell, Reference Schnell2009). Freund and Baltes (Reference Freund and Baltes1998) suggested that when individuals can accept their changed life situation, they can adjust to more reachable daily goals.
Besides the sudden changes in physical capacity that impacted on daily life, quite a large number of participants described pain that was difficult to handle. Especially Finnish women over the age of 85 find that they have lower physical capacity and activity and experience more pain. Of older Finns (80+), 64 per cent of men and 69 per cent of women find that pain impacts on their daily life (Vaarama et al., Reference Vaarama, Siljander, Luoma, Meriläinen, Vaarama, Moisio and Karvonen2010: 158).
It can be concluded that connectedness to family provided a strong source of meaning when deep connections to other people were found as fulfilling, promoting safety and autonomy. Yet, the meaningfulness was contested when one had to face sudden changes in personal physical capacity and needed external support for daily chores. These findings show how deeply relational SoMe are. The next section shows how crises of meaning are likely to arise when relationships are found to be inadequate or non-existent.
Ambivalence of relations
Ambivalence of relations included echoes of violations or challenges of meaning. These painful situations were revealed when participants found their close relations insufficient. Scars in family relations, missing friends of one's own age and the pain of widowhood were described within this theme.
Scars in family relations showed that even when participants had family members and social connections, they felt lonely. The following discussion indicates that experiences of loneliness were related to longing for meaningful discussion and companionship:
Loneliness comes from longing for someone to talk with. Younger people, they have so many things going on that they don't really have time. Luckily, there are phones and we phone every day. Yet, the phone does not compensate for everything. (Anneli, aged 83)
I wonder if the younger generation even want to chat with us. We don't have that many things in common. It's about being the same age. To have a discussion with someone who is the same age … Every now and then we should get out of here [home], I'm not saying a prison but outside these walls … I guess we are expected to grow into this lonely life. (Johannes, aged 94)
This extract expresses ultimately painful experiences. In Anneli's words, her yearning for more active connections with her family remained unfulfilled. Phoning provided alleviation, but the calls did not replace the need to meet family members. Johannes’ guesses about family members’ interest in even talking seem to reach a deeper sense of isolation. The need to meet people who are important to him was highlighted with a new tone when Johannes explained his wish for contact with his own peers. These expressions of loneliness are both emotional and social; lack of opportunity for emotional connectedness and sharing, and lack of contact with larger numbers of people (e.g. Weiss, Reference Weiss1973; Tiilikainen and Seppänen, Reference Tiilikainen and Seppänen2017; Tiilikainen, Reference Tiilikainen2019). When important others are engaged elsewhere and time spent together is felt to be insufficient, the experience of connectedness is reduced (see Reis et al., Reference Reis, Menezes, Freitas, Pedreira, Freitas and Pires2019: 1635). Loneliness also seems to increase with age, as Finns over the age of 85 found themselves lonely more often than those aged between 80 and 84 (Vaarama et al., Reference Vaarama, Siljander, Luoma, Meriläinen, Vaarama, Moisio and Karvonen2010: 156).
Johannes also talked about generational differences which lead to the experience of feeling different from younger generations who ‘don't get us’. Therefore, it would make a difference to have people of the same age to share thoughts and memories of life. Participants commonly stated that many (and often most) of their friends had already passed away. The participants were not longing for some random individual; rather, they were looking for a true friend. As Johannes made us aware, when growing old you learn to identify relationships that are good for you. Relationality includes a darker side. Not all relationships are good or meaningful; they can be abusive and exploitative which exposes the fragile position of an individual, especially in caring relations (van Drenth and de Haan, Reference van Drenth and de Haan1999; Svensson, Reference Svensson2002). Yet, age peers are often found to share the same values in life, which makes peer relations very important in old age (see Kylén et al., Reference Kylén, Löfqvist, Haak and Iwarsson2019: 310).
Loneliness violates SoMe by challenging the experience of relatedness; as discussed above, personal wellbeing and relatedness form a unity (see Schnell, Reference Schnell2009). The loneliness of older people is a multi-layered phenomenon and includes longing for true emotional sharing (Tiilikainen and Seppänen, Reference Tiilikainen and Seppänen2017). For those who miss out on personal connections, the loss of meaning in life can grow from loneliness (Takkinen and Ruoppila, Reference Takkinen and Ruoppila2001: 63).
Even starker descriptions of existential pain arose when participants described the pain of widowhood. Deep longing for lost spouses were often spontaneously shared within the group discussions. This pain was shared by nearly all the participants. Losing a life partner leaves a hole that cannot be filled. The death of a spouse is one explanation for decreasing purpose in life in old age (Read and Suutama, Reference Read and Suutama2008: 136), as when one is widowed, the experience of one's quality of life decreases (Vaarama et al., Reference Vaarama, Siljander, Luoma, Meriläinen, Vaarama, Moisio and Karvonen2010).
The length of time since participants had lost a spouse or loved one varied from brief periods to decades. Veikko (aged 93), whose lady friend passed away only recently, shared with tears in his eyes: ‘pretty much it has been idle. Longing and that sort of thing’. Veikko formulated his inner emptiness when his closest relationship has gone and nothingness exists in that spot where daily sharing used to be. In Veikko's case, it seems that he questioned self-transcendence as a source of meaning on the vertical level. When the nearest and dearest was gone, who could he relate to? For Veikko, the tragedy seems touching as this was the third time he had lost a life partner and was left behind. Losing a meaningful relationship is likely to cause emptiness for older people (Reker et al., Reference Reker, Peacock and Wong1987). Further, the experience of loneliness grows if one must go through sequential losses (Gott et al., Reference Gott, Ibrahim, Binstock, Gott and Ingleton2011; Grande and Keady, Reference Grande, Keady, Gott and Ingleton2011).
For many, the emptiness seemed somehow to remain, as, decades after the death, participants were still moved into tears when remembering their spouses. Existential questioning was expressed in Aili's (aged 95) questioning of God's will in the death of her husband: ‘Why was he taken away from me, why now when the companionship would be needed the most?’ Years after the death of her spouse, Aili targeted her questions on the horizontal level. For believers, questioning God's goodness can be seen as shaking the meaning system: if God, who is normally seen as protective and loving, becomes a source of mistrust, the source of meaning becomes violated and meaning structures contested (Tromp and Ganzevoort, Reference Tromp, Ganzevoort, Francis, Robbins and Astley2009; Ganzevoort, Reference Ganzevoort2010: 334, 336). If life is appraised as unpredictable and coherence of life cannot be restored, the experience of mistrust expands, and loss of meaning increases (Stillman and Baumeister, Reference Stillman and Baumeister2009).
When the nearest and dearest are lost, older adults lose the people with whom they are used to sharing the big questions of life (Ganzevoort, Reference Ganzevoort2010: 335–336). The participants faced existential struggles related to loneliness: when one is born or when one dies, ultimate loneliness is experienced. Therefore, people have an intrinsic will to hold on to relationships, which provide existential stability in the face of death (Yalom, Reference Yalom1980: 9). In this section, the authors have presented the pain that follows when the relational networks of older people narrow. These social webs were significant in still other ways. The relational sphere – friends and social networks – enabled older people to discover joy, as the next section shows.
Joy of friends and social networks
Many of the participants expressed the comfort and belonging found among peers. This significance of friends and social networks had two different aspects. First, joy and connectedness provided by friends and participation showed how crucial it is to maintain social ties. Second, STV has the potential to serve as a platform for forming new relationships.
Those participants who were still able to attend activities found that connectedness with other people brought content to life. For instance, Maria (aged 83) narrated her congregational attachment as follows:
Christian values have been significant to me for all my life. The chance to take part in congregational activities keeps me lively … I have many service tasks and mission work is close to my heart.
The church gave Maria the opportunity to continue meaningful activities regularly. Even with her changed physical capacity, friends from the church made sure that she was able to attend. From the perspective of meaningfulness, it was important that she was able to follow her spiritual conviction when her physical capacity had decreased. Congregational activities provided meaningfulness in terms of both horizontal and vertical self-transcendence (see Schnell, Reference Schnell2009). It was quite common that the participants were involved in the Evangelical Lutheran Church in Finland and they were used to taking part in church activities. The veterans’ association was an important network for some participants: they could choose either to be an active member and organise events for others or to attend regular events and excursions.
The Red Cross brought comfort to Veikko (aged 93) as he had a volunteer friend visiting him regularly. He explained the importance of talking to this volunteer by saying:
Somehow, I try to scrape together someone to talk to … The representative of the Red Cross can come every week if needed, to spin a yarn … When he/she comes, we'll have a cup of coffee and a good chat. So my use of language doesn't fully seize up.
For Veikko, it was meaningful to have someone to share with frequently and always be looking forward to something eagerly. Besides in-person visits like this, befriending phone calls have also been found to be effective in reducing older people's experience of social loneliness (Crewdson, Reference Crewdson2016).
Older people get along fairly well with technological tools that enable connection to others (Wessman et al., Reference Wessman, Erhola, Meriläinen-Porras, Pieper and Luoma2013; Kettunen and Sääskilahti, Reference Kettunen and Sääskilahti2016). With the assistance of technology, the participants formed social groups to exercise, see others and chat about everyday matters. For some, STV had provided a new platform for relationships, as illustrated by the following discussion:
In our STV group, we have formed real close relationships with each other. Even though we are different and there are different events [in our lives]. Veikko and we all, Kyllikki, we have become, I feel that we are the same family. I could say that we have a really good connection. I believe we can all endorse that. (Sylvi, aged 91)
Yes, it can be endorsed [returns to the discussion on individual ways of saying goodbye to a deceased loved one and shares a personal story of touching the cheek of his lady friend who has passed away]. (Veikko, aged 93)
This small dialogue exemplifies how crucial it is to have groups and close people with whom to share life. Not only did the participants agree that they had formed a family-like community, they also shared their deepest moments of pain and misery. The benefit of STV and similar technologies is that it can bring people together despite changing physical capacity or geographical distance, as was the case for the group of Sylvi, Kyllikki and Veikko. However, technology is not always sufficiently flexible. It was noted in the other groups that after personal connections were made, it was handier to phone each other as STV demands that televisions are on and set to a certain channel before the devices can be linked. Even though some of the participants felt that STV needed too much preparation, the platform served as a connection to form friendships.
The first group of participants wished to discuss memories of their youth. This discussion seemed to promote connectedness between participants as they were eager to share their memories, especially of life after the war. For instance, Helena (aged 91) said:
After the war in the countryside, we had those evening get-togethers but dancing was forbidden. Yet it started to appear that people began to dance after the get-together for one hour. But a bit later we reached the point that it was only about dancing. So at least I danced a lot in my youth.
Helena continued to explain about listening to music in the forest after the war, as dancing and music were forbidden by law at the time. Further, she told us with amusement how the police were trying to calm the youth down. Anneli (aged 83) had very similar memories of youth activities. Participants shared glimpses of joy from their youth. The existence of war was the reality of their childhood and youth. After discussing and laughing about their memories, they briefly moved on to the rough parts: the reality of war and being evacuated, working hard and not getting an education. Still, the atmosphere of this meeting was cheerful and participants seemed to have strong mutual understanding of how life was back then and how the world had changed rapidly. From the viewpoint of meaning, it is notable that participants choose to share stories of joy, freedom and cherishing time spent together. This is an example of how people need to find meaningfulness in life even in the middle of difficulties. The urge to discover meaningfulness is strong (e.g. Yalom, Reference Yalom1980).
These results are in line with previous findings that STV gives older people an experience of belonging and activity (Wessman et al., Reference Wessman, Erhola, Meriläinen-Porras, Pieper and Luoma2013; Laitinen and Uotinen, Reference Laitinen and Uotinen2015) and that STV is a meaningful part of daily living for older people (Laine, Reference Laine2010; Pietikäinen, Reference Pietikäinen2013; Kettunen and Sääskilahti, Reference Kettunen and Sääskilahti2016). There is evidence that virtual connections (face and voice) decrease the experience of social loneliness and social isolation among older people. Teaching older people to use the technology is important and motivates them to use this apparatus in their daily lives (Crewdson, Reference Crewdson2016). Yet, the families of older people have raised their concerns that technology cannot be the only route to provide care for ageing family members (Piau et al., Reference Piau, Campo, Rumeau, Vellas and Nourhashémi2014; Kauppinen, Reference Kauppinen2015).
Conclusions
In this paper, the authors have shown how strongly meaning in life is embedded in a network of relationships. Opportunities to connect, belong, share and be cared for all reinforce the experience of meaningfulness. Vulnerability, being hurt, feeling different from others and longing for dead loved ones all contribute greatly to loss of meaning. Relationality and meaning in life were found to be closely intertwined, as relationality directly contributed to experience of meaning. Woodward and Kartupelis (Reference Woodward and Kartupelis2018: 37) frame this by writing: ‘Confrontation with questions of ultimate meaning in life and death is, for some, an everyday experience.’ Still, older people are not used to sharing ideas on their personal beliefs and commitments; therefore, these discussions should be encouraged. Silence around the topics of meaning and beliefs should be understood as ‘lack of practice’ in sharing rather than a sense of intrusion into private ideas. In most cases older people would be willing to share and discuss more than what they are asked about (Coleman, Reference Coleman and Coleman2010: 160). As older people are not often invited to true dialogue on issues of meaning, we do not truly understand issues of meaning and spirituality for older people. As the world has changed quickly, generational differences between older people and carers (in health care, pastoral care and ministry) challenge younger generations to grasp the sources of meaning for the older generation (MacKinlay, Reference MacKinlay2017).
This article showed that older people often see their autonomy as relational. They count on their relations and safety nets to get support to make decisions and plans for the future. This aspect of relational autonomy leads us to see that preparing for old age with one's family supports autonomous ageing. By identifying and following aspects of relational autonomy, the meaningfulness of ageing is supported in fragile old age. The fear of losing capabilities often becomes reality as people get older. For older people, close home-like relationships can form a network of sharing in this quest and therefore trusted relationships form the foundation of holistic wellbeing (Woodward and Kartupelis, Reference Woodward and Kartupelis2018: 76).
From the viewpoint of wellbeing, all people, older people included, have a need to feel valued, affirmed and loved. People have an intrinsic need to have hope that goes beyond this life and have faith either in something or in someone. People have a need to experience tranquillity through security and peace. These spiritual needs can be religiously oriented or without any religiosity. In all cases, these needs can be only met through and within personal relationships (Woodward and Kartupelis, Reference Woodward and Kartupelis2018: 38).
When an individual loses physical capacities, it becomes increasingly important for them to find new ways of belonging and of sharing the big questions of life. The authors have shown that STV can promote meaningfulness for older people as it can support the formation of relationships. Technology does not alleviate the need to meet family members, but offers an alternative platform to find friends to share the joys and pains of life.
As death is an inevitable part of life, these discussions with older people should not be avoided, but rather, encouraged (Coleman, Reference Coleman and Coleman2010: 159). In the last stages of one's life, one can encounter approaching death with a calm mind if one has discovered peace with the lived life in the past and present (Kimble, Reference Kimble and Seeber1990). This type of coherence of life was described as ego integrity by Erikson (Reference Erikson1994): coherence in old age forms when one has been able to negotiate events of life as a meaningful and acceptable ensemble (see Ganzevoort, Reference Ganzevoort2010). From the viewpoint of existential wellbeing, it is crucial to identify that an individual is always more than a ‘psychosomatic organism’: the need to find meaning in life – even in death and misery – is strong (Kimble, Reference Kimble and Seeber1990; Baumeister, Reference Baumeister1991; Schnell, Reference Schnell2009). It can be concluded that STV and similar technologies constitute an additional (barely utilised) channel through which to provide existential care, counselling and social support in ageing.
Limitations of the paper and future research
The authors recognise that this paper provides only one angle on the results. For instance, physical changes were discussed from the viewpoint of autonomy; yet, participants shared so many descriptions of their physical reality of life that a separate paper could have been written on the subject. The same goes for appearance of religiosity and complexity of relationships, as well as thoughts on encountering death and dying. Still, with this one paper, the authors have tried to show how many facets are related to finding life meaningful in old age, so we included all the main themes.
If we were to do anything differently, we would include the theme ‘memories of youth’ in all group meetings. It was clear that it was moving for the participants in the first group to have this opportunity to share incidents that they did not even remember before someone else brought it up. As a group of researchers trying to achieve the ‘optimal’ number of meetings and not to create extra work for the hospital staff, we were unable to recognise the value of this meeting while running the groups. Further, even though the analysis was data-driven, the topics for meetings were selected based on previous research. The discussion topics impact on the results. We found that fruitful discussions were shared. For the future, it might be interesting to give the participants more of a free hand to come up with themes for discussion: for instance, the hosts of the meetings could have half of the themes ready and participants could choose the other half.
As the technology seems to give older people alternative opportunities to share and be cared for, it is important to consider some ethical aspects. The participants mentioned that phone calls do not replace the need for meeting the family members, and it could be suggested that the same goes for technical-assisted care in general. With different types of connections, it is possible to bring elements of joy, meaningfulness and belonging to the lives of older people; yet, this is not likely to be the same as meeting people in real life. In the future, studies should measure whether existential discussion groups and existential care provided using technology have an impact on the self-rated wellbeing of an individual. If technology is considered as a form of providing existential care in general, studies should compare the effectiveness of care face-to-face and online.
Acknowledgements
The authors thank Professor Auli Vähäkangas, Professor Marjaana Seppänen and doctoral candidate Sofia Sarivaara for the support and insights during the project, as well as Dr Kate Sotejeff-Wilson for the language editing.
Author contributions
S-MS and AM-P-L gathered and analysed the data. RP took part in designing the study. All authors contributed to the writing process and the order in which the names appear indicates the input in the paper.
Financial support
This work was supported by the Church Research Institute, Evangelical Lutheran Church of Finland (S-MS) during the data-gathering process; and the Osk. Huttunen Foundation and Kone Foundation during the analysis process.
Ethical standards
The Ethical Review Board in the Humanities and Social and Behavioural Sciences at the University of Helsinki reviewed the research plan. In addition, the board of the collaborating hospital reviewed and accepted the research plan.
Open access
