Making Sense of Extreme Longevity: Explorations Into the Spiritual Lives of Centenarians

Abstract

As the population grows older and more individuals live into advanced age the oldest-old segment will continue to increase in size. This qualitative study analyzes data gathered using in-depth interviewing and explores the spiritual saliency for sixteen centenarians. Results illustrate the importance spirituality has for older adults over the lifecourse, particularly those in advanced age. Our findings indicate that spirituality is key factor of support, an important resource in late life, and maintains continuity over the lifecourse for the centenarians. Additionally, spirituality serves as critical component in the everyday lives of the participants and provide a framework for helping older adults make sense of having lived a very long life. The findings reported here support the need for researchers and practitioners to consider the importance of spirituality in late life, particularly for those in their last decades.

As the population ages greater numbers of people are reaching advanced ages, and this is particularly true for the oldest-old segment of the population. With increased life expectancy rates and the extension of the lifecourse, we are confronted with understanding new life stages that are unique to late life. Individuals who live to 100 years of age are survivors and have outlived many family members and peers (Archer, Brathwaite, & Fraser, 2005; Smith 2003). The oldest-old are human “longevity outliers,” advancing well past the average life expectancy rate of 78 years in the United States (Smith, 2003). Centenarians are a unique and continually growing sub-population within the general aging population. Thus, the realities of living well into advanced age necessitate careful exploration by gerontologists and other social scientists.

Centenarians

Research on centenarians is increasing; to date a considerable amount of existing scholarship seeks to measure and quantify the experiences and situations of centenarians (Hensley, Martin, Margrett, MacDonald, Siegler, & Poon, 2012; Randall, Martin, MacDonald, & Poon, 2010). Few studies qualitatively explore the nature of what it means to older adults to have lived such long lives, and even fewer are existing studies that explore the spiritual lives of centenarians. The Georgia Centenarian Study and The New England Centenarian Study are two extensive, longitudinal studies in the U.S. and have contributed greatly to what is known about centenarians. Both studies primarily represent a focus on genetic and lifestyle-related factors that contribute to extraordinary longevity, while also considering health, cognitive and functional capacities (Martin, 2002; Martin, Baenziger, MacDonald, Siegler, & Poon, 2009; Martin, Poon, & Johnson, 1996; Perls, Kunkle, & Pucca, 2002; Poon, Bramlett, & Holtzberg, 1996). More recently there has been a surge in research investigating the biological, environmental, and genetic domains and their implications on longevity in centenarian populations (Doty, Petersen, Mensah, & Christensen, 2011; Lapasset, Milhavet, Prieur, Besnard, Babled, Aït-Hamou, & … Lemaitre, 2011).

Common knowledge within gerontology is the lack of an overarching factor that contributes to successful or advanced aging, and the existence of a host of variables (demographic, social, physiological, and biological) that impact longevity (Archer, Brathwaite, & Fraser, 2005; Perls, Kunkle, & Pucca, 2002; Poon, Bramlett, & Holtzberg, 1996). Qualitative research exploring these characteristics of centenarians is sparse (Archer, Brathwaite, & Fraser, 2005). Less frequently found in the literature is research with a focus on the everyday lived experiences of centenarians, their spirituality, and the meaning-making centenarians may engage in when considering their extraordinarily long lives. As interest in centenarians increases, it is important that researchers carefully explore the accumulation of experiences leading to a varied old-old age, and what it means to be a centenarian, and what factors contribute to longevity (Johnson & Barer, 1993). Thus, this study further investigated the nuanced lives of centenarians, while paying careful attention to spirituality. This study involved a secondary analysis of data generated from a qualitative study, and explored the lives of 16 centenarians (3male, 13 female) living in the Mid-western region of the United States.

Spirituality and Aging

It is important to understand how elders are responding to both late life challenges and opportunities (e.g., death of a spouse, the loss of physical functioning, or the change in role as one enters into retirement). Focusing on older adults’ spiritual experiences is part of this larger understanding. Spirituality has been found to provide a framework that guides some, but not all, individuals through painful, as well as joyful events, often facilitating the discovery of the positive from the negative (Ardelt, Ai, & Eichenberger, 2008). Consequently, spirituality is also a potentially powerful resource in late life providing certain older adults with the ability to adapt to changing individual needs.

Spirituality has the potential to be a major resource for some, but not all, older adults as they age and as they expand their consciousness. Living longer and approaching death inevitably evokes contemplative thought regarding the meaning of life (Hillman, 1996; Tornstam, 1997). Atchley (2009) argued that spirituality is salient, or potentially salient, in the lives of many older adults. Research has indicated that certain older adults (those for whom religion and spirituality are important) demonstrate resilience in their narratives about life and the meaning they attribute to living long lives (MacKinlay, 2006; McFadden, 2005; Nelson-Becker, 2003a). Furthermore, previous research has suggested that spirituality and religiosity serve as coping tools for some individuals as they age, indicating that spirituality has utility in late life and is functional (Ardelt, Ai, & Eichenberger, 2008; Nelson-Becker, 2003a).

The findings we present here illuminate the experiences and voices of centenarians. As the findings make clear, spirituality and religion are more than constructs for participants. Spirituality, in particular religion, is a way of being in the world that affords these elders connection and meaning. Paying careful attention to our definitions as researchers is important, but more important is providing an understanding of a phenomenon and the meaning it may have for people, meaning as it is told by the individuals living that experience. For the purpose of this research, we explore the spiritual dimensions of the participants; that is, we seek to discover how spirituality informs what it means to having lived so long. In this research, we use Atchley’s (2009) definition of spirituality as a “realm of human experience encapsulating an intense awareness of the present; transcendence of the personal self; and/or a feeling of connection with all of life, the Universe or a Supreme Being” (p. 2).

This conceptualization of spiritualty encompasses religion. Spirituality is concerned with the individual phenomenon, such as personal experiences of the transcendent (beyond worldly concerns and verbalized thought), identified with an answering of life’s questions regarding the meaning of existence. Religion, including individual and institutional components, is instead more closely associated with specific behavioral, social, doctrinal, and denominational characteristics, often more narrowly identified with religious institutions, prescribed theology, and rituals (Seidlitz, et. al, 2002).

Methods

In this qualitative study, we used a grounded theory approach (Glaser & Strauss, 1990) to theorize the relationship between spirituality and aging for the participants. Specifically, as researchers we engaged in a retrospective interpretation of the original data intentionally to explore a research question that had not been previously asked during the initial data collection and analysis (Hinds, Vogel, & Clark, 1997; Radina & Downs, 2004). We engaged in further analysis of original data from a previous study examining the life experiences of centenarians to investigate: “How does spirituality matter in advanced age, and to what extent is spirituality important, if at all, in the lives of these centenarians?”

Original Study

The data used for this analysis were generated during a larger study funded by the xxx (blinded fore review) General Assembly, through the xxx and the xxx Long-Term Care Research Project (xxxxx, 2008). Once IRB approval had been obtained, centenarians from urban and rural areas were recruited for the project. For this larger study, participants were recruited using snowball sampling and word-of-mouth techniques. This resulted in a sample population of 16 centenarians located in the Midwest. Interviews were held in the place of residence of each centenarian. Three of the centenarians interviewed were African-American. The remaining participants were white. Living arrangements of the participants included independent homes within the greater community, living with a child, and also residence in facilities providing varying service levels of long-term care.

For the larger study, an interview design approach was used as an extension of the basic research question “What is it like to have lived such a long life?” Further avenues of inquiry included the challenges of very old age, reflections of the past, thoughts about the future and “typical day” experiences. In addition to the interview guide, a basic demographic data sheet was created to capture information such as date and place of birth, family history, education and work history, as well as the need for and use of formal and informal support. The face-to-face interviews lasted approximately 1 to 2 hours with one exception in which the interview lasted approximately 6 hours. After the initial sample of 16 centenarians was recruited, interviews were completed and transcribed. Data from all 16 interviews were analyzed using a grounded theory approach (Glaser & Strauss, 1967; Lincoln & Guba, 1985). Findings from the study are reported elsewhere (xxxx, 2008). A key theme that emerged from the original study was the frequency that centenarians’ discussed their spirituality and religion. This theme was not explored in the initial study; we revisited this theme for the purposes of the research presented here. One researcher from the original study was involved in this study and was integral to the analysis process of the original transcripts.

Secondary Analysis

For the purposes of the study reported here, the transcripts of the 16 participants represent the complete dataset of the original study for the purposes of further data analysis. Once IRB approval was obtained, a research team was involved in the secondary analysis of the original data to ensure contextual validity through inter-coder reliability. Using Atlas.ti, we returned to the codes from the original study and explored how the participants discussed their spiritual lives. In addition, we re-analyzed the transcripts asking new questions of the data. In this secondary data analysis, we pulled on the expertise of our researcher from the original project as we returned to the data for further analysis and continued investigation of the centenarians’ spiritual lives. The sample description is identical to the original sample described in the above section. Qualitative researchers and methodological experts suggest that secondary data analysis is useful and appropriate when employed to strengthen bodies of social knowledge and to pursue interests distinct from the original study (Glaser & Strauss, 1967; Hinds, et al, 1997).

Analysis of these data involved a grounded theory approach of the original dataset. We performed as a secondary data analysis technique within two years following the initial collection and analysis of the original data. This analysis was performed using codes from the primary data collection and analysis, and also from codes that emerged when the data were further analyzed using our research questions (Hinds, et al, 1997; Thorne, 1998). We used grounded theory techniques of coding and comparing data, progressing from “open coding” to a second iteration of “selective coding” (Straus & Corbin, 1990). The codes that emerged in the secondary data analysis phase of this study were God, church, life philosophy, resilience, moments of transcendence, purpose, and inner strength. Findings generated from this secondary analysis are presented here. Through constant-comparison analysis, interpretations, and syntheses of the emergent themes, as well as taking into consideration the existing literature on centenarians, spirituality and aging, three main findings emerged: the importance of divine support, spirituality as vital resource and key aspect of resilience, the continuity of spirituality over the lifecourse for these centenarians.

Results

Our findings indicate that spirituality is key factor of support, an important resource in late life, and contains aspect of continuity over the lifecourse for participants. Additionally, spirituality serves as critical component in the everyday lives of the participants, while providing a framework for helping older adults make sense of having lived a very long life. These emergent and major themes are illustrated in Table 1.

Table 1.

Significant Findings

Themes	Concepts of Meaning-Making and Spirituality	Categories
The Importance of Divine Support	Relationship with and connection to God as important	Belief in God seen as protective factor God as important and mattering most over the lifecourse
Spirituality as a Vital Resource and Promoter of Resilience	Spirituality contributes the process of resilience and helps centenarians cope with life adversity.	Spirituality as a central component to well-being Spirituality as coping tool for helping them live with acceptance of living to an old age
The continuity of spirituality over the lifecourse	Spirituality has remained a constant in the lives of these centenarians and a vehicle for making sense of living long lives	Participants deviated little from their religion or faith tradition acquired as children Few participants narrated about spiritual struggles and losing faith

The Importance of Divine Support

As these centenarians discussed their spirituality, they narrated about their relationship with God and the importance of prayer. Spirituality as having divine support or having a close, personal relationship with God emerged as a major theme when participants were asked to describe what mattered most about being an old person (George, Ellison, & Larson, 2002). One centenarian reflected on her relationship with God as an important part of her life as a centenarian. Rose explained:

Well he’s in my life [God]. What could you do without him? I just feel he’s there with me. And I always say thank you for this new day and help me with whatever I do. Here I am, living this long life. I have survived nearly everything.

Another centenarian, Betty, explained how God is an on-going and key aspect of her life:

The important part of my history is God’s been in my life all the time. From the time I was 2 years old I was taught that there was a God, that that was who I should look to for my health and my strength. My mother taught me that. So, all the time that was I was taught the Bible. My bible is so wore out now it’s funny looking.

For these centenarians, spirituality has remained an important part of their identity and their relationship with God has been intricately linked with their perceived strength. Gloria reflected:

God has brought me through it all. He’s been with me every day and brought me through everything that I had to go through. That’s the big thing in my life.

When asked about being an old man and dealing with hardship in life, Herman described his faith as an essential component of having lived so long. In doing so, he was moved to tears:

I love God so much, so much that I have this feeling in my heart. We’ve been together for such a long time and have been through so much. That’s the secret to my long life – being with God and my faith.

These centenarians, when asked what it means to live such a long life and about having experiences that left major impressions on them, discussed their spirituality, faith, and connection to God. Their narratives reflected that their spirituality was interwoven with their everyday lives and has been important to their development over the lifecourse. For these centenarians, spirituality has also served as a resource and has remained essential as they navigate the terrain of late life.

Spirituality as a Vital Resource and Promoter of Resilience

The centenarians in this study demonstrated resilience in their narratives about life and the meaning they have attributed to having lived so long. Participants were explicit about how their spirituality served as coping tools for them, and how their belief in God has provided a buffer of support when dealing with hardships. Specifically, centenarians in this study discussed how faith, their connection with God, and the practice of Christianity have served as support mechanisms in advanced age. Nora explained how reading the biblical texts and contemplating spiritual meaning has provided her with strength:

I read the Bible every morning. After they get me dressed or when I’m able to dress myself, that’s the first thing I do. After my breakfast I get the Bible and read the lesson and then I’m ready for the day and I feel like it’s my strength. It gives me strength to do the things that I need to do.

Lucile discussed how she conceptualizes God as a personal resource that helps her cope with the realities of dependency and hardship:

You learn what you can and what you can’t do and who and what you can depend on and I have one source I can depend on, I can depend on God every day of my life because he promised never to leave nor forsake me and he never has through the toughest days in my life, I could almost reach out and touch him.

The centenarians disclosed experiences illustrating that their faith is tool that has helped them accept what life brings and the experiences, both positive and negative, they have had over the lifecourse. One centenarian reflected on the difficulties living into advanced age potentially presents and how she has relied on her faith as a means for practicing acceptance. She claimed, “A deep faith helps me to accept. And you sure have to accept a lot of things in this life.”

The Continuity of Spirituality over the Lifecourse

For the participants in this study, spirituality has remained important throughout the lifecourse and this continuity is reflected in their narratives. Present in the literature is the understanding that as people age they search for a framework to help them deal with and accept the uncertainties and hardships associated with end of life (Wink, 2003; Zinnbauer & Pargament, 2005). The data collected from these centenarians illustrate that spirituality has remained a constant over their lifecourse and continues to be present force in their lives as centenarians. However, as these older adults age, they are not searching for a spiritual framework to help them make meaning as they near completion of their lives. Rather, they are utilizing a spiritual framework that has remained consistent and mostly constant for them over the lifecourse. For example, the practice of going to church for these participants once was and continues to be important. None of the participants discussed spiritual struggles or moments of doubting their faith or questioning spirituality. This most likely reflects the nature of the questions asked during the interviews. Although some of the centenarians discussed issues related to mobility and transportation and how this has restricted their ability to attend spiritually related activities as they once used to, such as worship services and church events, the practice of being in a congregation and part of a community remains constant over the lifecourse.

Lorna reflected on how her spirituality was instilled at an early age and continues to part of her belief system:

From the time I could talk, I was taught to love and trust God and as you’re taught that, it grows on you. It just does so much for you. It helps you to live and makes you live better and it makes you want to help somebody to do something that’s worthwhile that they want to do.

Being part of a religious community at one time was an extremely important ritual for the individuals in in this study. They reflected on the meaning that being an active church member once provided them. One centenarian explained, “I take pride in that and I used to take the drapes down at the church and wash them and put in decorator pleats and hang them. We used to do so much for the church.” Marjorie reflected on how going to church gave her a routine and was part of her life weekly, “On Sundays it was the same. Every Sunday was the same.” Although church attendance for the centenarians in this study declined, the elders articulated an identity with the religious community and their respective spiritual communities. For many of them church has become portable and now they worship in their homes because they are unable to attend church services due to comprised mobility or transportation. Regina explained, “I don’t go [to church] because I’m afraid to get in the crowds because somebody may bump me and I may fall. So they come to me on Sunday and bring me communion.” Beulah commented on the difficulty of going to church, but recognizes how important this religious community of practice is for her based on previous experience:

I haven’t been going to church for a few years now… it’s just so hard to get away to go now since they moved our church. Our church was not far from here, but they moved our church way out on and it’s a good way out. I’ve not been many times out there, but [earlier] I went every Sunday and took my kids. It was a staple in my life. The beliefs are still there, even if I can’t make it to church every Sunday.

A spiritual life and community is important and emerged as salient aspects regarding the spiritual lives for participants. Their narratives illustrate that church as a place was once and continues to be an important part of their spiritual development. Edna explained:

I don’t hear well. And I have a hard time getting up from the pew when I’m there. It’s also hard for me to hear the sermon. I have to think all to myself and it’s pretty…I’m pretty worn out by the time the service is over with. But of course I love going to church – I have it enjoyed it all my life. But now when it comes to my church, they know it’s hard for me to be there, but every week I still manage to get a bulletin and I feel they still consider me one of their members.

Issues related to access was another theme that emerged from the data. These centenarians have relied on their spirituality as a source of coping and a tool for strength. Church attendance is an expression of this religiosity and spirituality. These centenarians reflect on how church attendance has been important to them over the lifecourse and articulated that despite issues related to access, belonging to a church and sharing a community of practice has remained important to them. Betty illustrated this point:

I’ve got four cards already from different people for my church and I’ve sent them cards. But they come from -- my son works on Sunday by the way, so that’s bad that he has taken time off. He ushers two months of the year and up until this last year, I went with him on those two months that he ushered, but this year the parking lot has a lot of gravel on it and you have to walk around in here to get into here Listen, one of those little -- on a walker, one of those little pebbles you know could throw you and you can’t help a person on a walker hardly. So I’ll think I’ll stay put.

Spirituality has remained important for the participants as evidenced in the aforementioned quotations. It has served as a source of meaning making over the lifecourse. Additionally, spirituality has provided the centenarians with a sense of belonging and continuity. As Vernice pointed out, “I’ve been started going to that church when I was 25 years old – that’s 75 years I’ve been a part of that church!”

Discussion

Spirituality is a powerful resource for some, but not all, individuals in late life. In this research we found that centenarians placed considerable importance on the divine support in their lives, or their belief in a Christian God. Narratives indicated also that for these centenarians there exists an interconnectedness of spirituality with religion, or in other words these two constructs are interchangeable in practice and lived experienced. Also, we found that spirituality is a vital resource and key aspect of resilience for participants, and that spirituality maintained continuity of spirituality over the lifecourse for these centenarians. This emphasis on the importance of God, religion, spirituality, and faith is most likely a reflection of the sample being Christian. Additionally, key themes encourage consideration of the larger implications regarding the inaccessibility of church for elders with functional decline and limitations. Furthermore, our findings suggest that spirituality and religion have the potential to provide some older adults with the ability to adapt to changing individual needs. Our findings suggest suggests that spirituality not only serves as a tool for coping and adaption in late life, but is also a critical pathway to quality of life, life satisfaction, and subjective well-being for individuals for whom spiritual is important. We suggest with our research presented here that spirituality is more than development, identity and utility, but it is a mechanism to assist certain people in positive growth (Fagin & Pargament, 2010).

For most humans living to 100 years of age is plausible yet surprising reality, but with certainty we can make assertions and predictions that many more people will live to age 80, 100, and beyond. There is little disagreement that current cohorts of older adults are living longer than those of previous cohorts, and will continue to do so in the near future; however, there is a debate about the quality of lives being lived by those in advanced age (Finch, 1998; Rowe & Kahn, 1987). With this demographic shift, many existing social and cultural realties impacting the lives of older adults are being further explored. Spirituality as development, identity, and meaning-making serves as an example of a complex social, psychological, and cultural phenomenon. Spirituality for many older adults remains important at the end of life and is reported as having significance. As McFadden (2005, pg. 172) posits, “for many, but certainly not all older people, faith communities, religious beliefs and experiences of the sacred will contribute to life quality and meaning.” This has implications on the spiritual development of older adults who are actively exhibiting “characteristics of curiosity, inquisitiveness, wonderment, puzzlement, and craving for understanding” as ingredients warrant investigation – the significance spirituality has for individuals at the end of life necessitates further study (Ardelt, Ai, & Eichenberger, 2008; Atchley, 2009; Nelson-Becker, 2003a).

Our research investigated the salience of spirituality for a sample of 16 centenarians. The elders in our study maintain a sense of spirituality that is embedded in their everyday lives, and cultivate a relationship with God that is essential to the meaning they make of extreme longevity. In addition, these centenarians are frank in their discussions of how their spirituality has served as a resource for how they cope with certain trials and tribulations associated with age. Although this finding illuminates the contextual validity of the research presented here, we know that not all older adults rely on spirituality as resource. These elders came of age at a time when many Americans were highly and openly religious, and illustrate the importance for them of lifelong engagement with a faith tradition and faith communities. How might this change for future cohorts of older adults with an increasing secular society and focus on individualism? Our research also illustrates that there is no last-ditch effort or desperate final attempt in later life to align oneself spiritually. Rather, there exists a spiritual continuity for these centenarians and this is characterized by spirituality as having always been an important part of their lives. They are spiritually confident as they embark on the last decades of life.

Conclusion

For the centenarian in this study, spirituality is discussed in the context of religiosity, church attendance, and how their affiliation and beliefs remain continuous over the lifecourse. This conversation was very much rooted within a Christian context. The elders in this study are products of the longevity revolution and articulate the importance spirituality and religion has had for them over the lifecourse. Surviving great odds and challenges, these centenarians are old, and for most of them it is surprising. They are living in what Johnson and Barer (1997) describe as an aura of survival. They are in awe that they have lived this long. Regardless of surprise or disbelief, they make meaning of old age; they do so with their spirituality and religiosity. When asked about how and why they have lived so long, they reflect on their relationships and understanding of the Transcendent, or God as articulated by the participants, the forces in the universe that are greater than them.

The results of our research must be understood in the context of where the research was conducted. The centenarians in this study reside in the Midwest region of the United States, in places that are traditionally more conservative with stronger linkages to spiritual and religious communities. These centenarians were raised and reside in geographic locations closely tied to and defined by religion. Accordingly, spirituality is important to the elders in this study. Their conceptualizations of spirituality emerged from interviews and are interwoven throughout their narratives about life, indicating that spirituality maintains saliency over the lifecourse. Previous research and the research presented here indicate that spirituality remains important in advanced age and continues to develop over the lifecourse.

Our findings also suggest it is important that researchers further examine spirituality as a phenomena within the aging populations in order to understand exactly how elders are conceptualizing and utilizing it within the context of aging (Nelson-Becker & Canda, 2008). Additionally, further research is needed to better understand the changing role churches as spiritual communities may play for some elders. Further research can address how do churches change to meet the new needs of an aging congregation? Furthermore, knowing what spirituality is and how elders are potentially using it can have possible practice implications resulting in the development of interventions and programs that are spiritually based. More knowledge needs to be gathered in addressing spirituality in the public realm: what ethical guidelines are to be assumed in direct practice, how should institutions of education be addressing spirituality, how are different disciplines utilizing spirituality, and identifying where spirituality fits in with macro level service and public policy (Nelson-Becker & Canda, 2008). Spirituality has the potential to provide some elders with peace, comfort, connectedness, and strength. It is our job as researchers and practitioners to support those elders by integrating their spiritual experiences and practices into our research.

Limitations and Future Research

Lastly, we should note the limitations regarding sample population and methods for this study. Because a portion of the data analysis was secondary, a member-checking technique was not employed, indicating the findings and representations of voice were not checked with the participants to ensure contextual validity. Another limitation in this study is the convenience sample. Ideally, centenarians would have been interviewed from various other regions and maximum-variation would have been the sampling technique used to recruit participants. Furthermore, we did not have data on religions affiliation or attendance. We surmised, based on evidence in the transcripts, that the Centenarians were primarily Christian. It would have been helpful to know more about their religion backgrounds. Given the nature and scope of this project, we as the researchers find this sample population and what we did know about them to be appropriate.

Furthermore, the work presented here assumes that spirituality can be a positive experience with positive outcomes with the potential of promoting subjective well-being in late life. For many individuals, spirituality and religion can be sources of negative experiences and have negative outcomes over the lifecourse. This should be considered regarding future work on spirituality and aging. Additionally, further work needs to examine the complex role and function spirituality has in the lives of older adults. Regardless of these shortcomings, we hope the findings from this study encourage further research into the experiential dimensions of spirituality and the relevance these experiences have for all older adults. As the literature on spirituality and aging reveals, exploring these factors may provide valuable insight into the elements that shape resilience, health, and well-being throughout the lifecourse.