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Theses, Dissertations, and Other Capstone Projects
2018
Differences in the Perceptions of
Gerotranscendence Between Certified Nursing
Assistants and Older Adults
Amanda Perera
Minnesota State University, Mankato
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Perera, Amanda, “Differences in the Perceptions of Gerotranscendence Between Certified Nursing Assistants and Older Adults”
(2018). All Theses, Dissertations, and Other Capstone Projects. 794.
https://cornerstone.lib.mnsu.edu/etds/794
Running head: DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
Differences in the Perceptions of Gerotranscendence Between Certified Nursing Assistants and
Older Adults
By
Amanda M. Perera
A Thesis Submitted in Partial Fulfillment of the
Requirements for the Degree of
Master of Arts
in
Clinical Psychology
Minnesota State University, Mankato
Mankato, Minnesota
May 2018
Running head: DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
April 6, 2018
Differences in the Perceptions of Gerotranscendence Between Certified Nursing Assistants and
Older Adults
Amanda M. Perera
This thesis has been examined and approved by the following members of the student’s
committee.
________________________________
Advisor
Jeffrey Buchanan, Ph.D.
________________________________
Committee Member
Donald Ebel, Ph.D.
________________________________
Committee Member
Eric Sprankle, Psy.D.
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
1
Abstract
Many theories of aging have been proposed within the field of gerontology to explain
both psychological and social changes that occur during the aging process. One of the theories is
the theory of gerotranscendence, which explains that as individuals age they develop a new
perspective on life that allows the aging individual to shift their conceptualization of the world,
from a materialistic and rational view to a more transcendent and universal view. Previous
research suggests that some behaviors associated with gerotranscendence have been
misinterpreted as pathological. The purpose of this current study was to examine whether there
are significant differences in the perceptions of gerotranscendence between younger adults
working as certified nursing assistants (CNA) and older adults who live in long-term care
facilities. A total of 81 participants (i.e., 40 CNAs and 41 older adults) were recruited and given
a set of three vignettes and a short story questionnaire. Each of the vignettes included behaviors
indicative of gerotranscendence and described the life of an elderly gentlemen living in an
assisted living facility. After reading each story, participants were asked to rate each of these
behaviors in terms of how unusual, similar, or concerning they were. Across the three
dimensions of gerotranscendence that were measured, significant age differences were found on
only one subscale (i.e., older adults found behaviors on the self-dimension less unusual
compared to the CNA sample). Therefore, the results of this study were inconsistent with those
from previous studies, and do not support the hypotheses that there are significant differences
between how older adults and CNAs perceive the behaviors associated with gerotranscendence.
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
2
Table of Contents
Introduction……………………………………………………………………………….3
Method……………………………………………………………………………………19
Results……………………………………………………………………………………25
Discussion…………………………………………………………………………….….28
References………………………………………………………………………………..34
Appendices
A. Consent Form…………………………………………………………………….38
B. Older Adult Demographics Form…………………………………………………41
C. Gerotranscendence Survey……………………………………………………….42
D. Certified Nursing Assistant Online Survey Consent Form……………………….61
E. Certified Nursing Assistant Demographics Form………………………………..62
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
3
Introduction
As the social paradigm of aging changes and more individuals live past their eighties, it is
of paramount importance that the aging process, as well as the perceptions of aging are explored.
According to the United States Census Bureau, as of 2015, across the world it was reported that
there were 617.1 million individuals aged 65 years and older, approximating 8.5% of the world
population (He, Goodkind, & Kowal, 2016). In the United States alone approximately 14% to
20.9% of the population is aged 65 years or older. Projections for the year 2050 show that the
older adult population is expected to increase to 16.7% of the world population (He, Goodkind,
& Kowal, 2016).
Increase in Older Adults Living in Assisted Living Facilities
A growing percentage of the older adult population is receiving care provided by
professional caregivers in settings outside the home. For example, in 2014, approximately nine
million older adults in the United States were provided long-term care services by about 67,000
paid providers (Harris-Kojetin et al., 2016). Data collected in 2014 by the Centers for Disease
Control and Prevention’s National Center for Health Statistics reported that there were 1,369,700
residents in nursing homes, 835,200 residents living in residential care communities, and
282,200 residents enrolled in adult day service centers (Harris-Kojetin et al., 2016). In
comparison, data from 2012 indicated that long-term care facilities served about eight million
older adults in the United States (Harris-Kojetin, Sengupta, Park-Lee, & Valverde, 2013). Data
collected from 2012 also indicated lower numbers of residents living in each long-term care
setting with 1,383,700 residents living in nursing homes, 717,300 residents residing in residential
care communities, and 273,200 individuals enrolled in adult day service centers (Harris-Kojetin
et al., 2013). Overall, data between the years of 2012 and 2014 indicated that the number of older
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
4
adults receiving long-term care services increased by approximately one million and there was
an increase of 8,800 paid, regulated long-term care facilities.
Interaction Between Certified Nursing Assistants and Older Adults
With the rising numbers of older adults living in residential care settings such as assisted
living facilities, direct care is increasingly being provided by professional caregivers. Direct-care
staff members, such as certified nursing assistants (CNA) provide eight out of every ten hours of
paid care that is received by older adults who reside in long-term care facilities (Dawson &
Surpin, 2001). Research conducted by Squillace et al., 2009, aimed to introduce the first National
Nursing Assistant Survey, which provided a rich resource in the data available about CNAs. Data
included in the survey were CNAs working in nursing homes that participated in the National
Nursing Home Survey (NNHS). These CNAs worked to assist residents with activities of daily
living, were paid for their services, and were certified by the state to provide either Medicare or
Medicaid services. From the 3,017 CNAs who were sampled from 582 facilities, data indicated
that the median age for CNAs was 37.48 years old, with the vast majority being women, and on
average worked at the same facility for approximately five years. Given these numbers, it is clear
that significant age gaps between staff and residents of long-term care facilities frequently exist.
One concern related to this age difference is how younger employee relate to and understand the
behavior of the older individuals for whom they provide care.
Generational Impact
The question as to whether current CNAs are able to relate to and understand the
behaviors and motives of the older adults they assist stems from the fact that these two groups of
individuals come from different generations. While current CNAs in their early to late 30’s fall
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
5
into either the Generation Xers or Generation Nexters cohort, older adults, typically fall into the
Baby Boomer Generation. While being part of a different generation may not seem significant in
understanding whether or not the groups of individuals will be able to understand each other, the
differences in how these generations perceive others and the world around them is key. Various
generations have a collective field of emotions, attitudes, preferences, and embodied practices
which they use to create their own persona, traditions and cultures (Schewe & Nobel, 2000;
Strauss & Howe, 1997). Each generation is known for their unique and differing values and
motivations, which can be created given the defining moments the cohort experienced
throughout their lives. Conger (2001), explained that “generations are a product of historical
events that leave potent emotional memories that shape feelings about authority, institution, and
family.” Similar to this explanation, a comprehensive study conducted by Schuman & Scott
(1989) showed that individuals from the same generation had the same collective memories,
especially from their formative years of adolescence and young adulthood. When defining each
generation, one must take into consideration not only the values of each cohort, but also the
important events which have defined and shaped the groups. In their work, Strauss & Howe,
1997 described values, stereotypes, and important events that occurred within each of the
generations, including the Baby Boomers, generation Xers, and generation Nexters. Baby
Boomers who were born between the years of 1944 and 1960 are known for their optimism,
personal gratification and growth. The generation Xers, who were born between 1961 and 1980,
are said to value diversity, techno literacy, fun, and informality. Lastly, those born between 1981
and 2000 fall into a generational cohort which has been given many names including, generation
Nexters, millennials, and the internet generation. These individuals are stereotyped as being
optimistic, confident, and valuing civic duty. When looking back at a few of the defining
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
6
historical moments in each of these generations, such as the civil rights and women’s
movements, Rodney King, the 9/11 terrorist attacks, and boom of computers, it is evident that
these moments have played a crucial part in molding the characteristics and values which are
found within the generational cohorts.
Wyatt (1993) outlined six ways that a generation is constituted, including a traumatic or
formative event, such as the assassination of a leader, a dramatic shift in the demography which
may influence the distribution of resources within a society (e.g., the size of the baby boomer
generation), a privileged interval which connects a generation into either a cycle of success or
failure (e.g., the Great Depression), the creation of a sacred space that may sustain a collective
memory (e.g., Woodstock), the work of individuals who know and actively support each other
(e.g., Bill Gates and Steve Jobs), and mentors that give voice by their work (e.g., Martin Luther
King). Seeing the difference in the ways Baby Boomers grew up, compared to the individuals
who fall into the generation Nexters cohort, it would seem plausible that these two groups see the
world differently, and may not understand the behaviors of the other group. This
misunderstanding between the younger and older adults brings into question how effectively a
younger adult, working as a CNA, can aid and care for an older adult who they may not
completely relate to and understand.
Theories of Aging
Currently, within the field of gerontology there has been a significant effort to understand
how individuals change psychologically as they age. More specifically, how older adults change
their perception of themselves over time, how frequently they socialize with others, and whether
they are engaging in “optimal” amounts of activity have been discussed (Buchanan, Lai, & Ebel,
2015). Throughout time there have been numerous theories used to understand aging, or more
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
7
specifically understand “optimal aging” or “successful aging.” These theories have including the
activity, pathological, disengagement, continuity, and selection, optimization, and compensation
(SOC) perspectives.
One of the most prominent perspectives in understanding aging has been activity theory,
which assumes that all types of activities, such as social and physical activities are beneficial for
aging individuals. This theory also posits that older adults have the same psychological and
social needs as they did when they were younger (Buchanan, Lai, & Ebel, 2015; Tornstam, 2005;
Kelly, 1993; Hooyman & Asuman Kiyak, 1988). However, although their needs remain the
same, as individuals age and begin to enter older adulthood society itself begins to withdraw
from the aging individual, causing the individual to set aside roles they once had, such as an
occupation they held. Giving up these roles may lead to older adults experiencing a loss of
identity, isolation, and low self-esteem (Buchanan, Lai, & Ebel, 2015). According to the activity
theory, due to the loss of roles in society the only way for the aging individual to experience
optimal aging is to remain productive in their communities and to increase their amount of social
interaction. Given this perspective of how to reach optimal and successful aging, older adults
who avoid activities or fail to socialize with others around them are viewed as being maladjusted.
The continuity perspective, like the activity theory focuses on preserving life as it was in younger
and midlife (Havens, 1968; Atchley, 1999; Tornstam 2005). While the activity perspective
expounds that the aging individual has the same psychological and social needs as when they
were younger, the continuity perspective believes that the aging individual maintains the natural
urge to continue their lifestyle and identity as they previously were in midlife. Due to this
perception, any older individual who is shifting, and redefining their self and the world around
them may ultimately be identified as a deviant (Tornstam, 2005).
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
8
Similar to the activity theory, the disengagement perspective focuses on the aging
individual’s loss of roles and functions in society (Cumming & Henry, 1961; Cumming, 1963).
This theory also assumes that as individuals age there is an inherent drive for them to disengage
both mentally and socially from the society they are living in (Tornstam, 2005). However, in
contrast to the activity theory, which perceives that society withdraws itself from aging
individuals, the disengagement perspective conceptualizes that society, along with the aging
individual withdraw from each other mutually. As the aging individual gives up their roles and
functions in society they gradually pass on their roles to younger generations. Although this
process of losing roles within the society is inevitable, it is viewed as a positive progression. The
overall assumption of disengagement theory is that in order to obtain successful aging, one must
be able to effectively complete the disengagement process (Buchanan, Lai, & Ebel, 2015;
Tornstam, 2005).
The SOC (i.e., selection, optimization, and compensation) perspective holds that the
behaviors of an aging individual are due to the attempt to cope with the process of aging and old
age itself (Baltes & Baltes, 1990; Tornstam, 2005). The “selection” aspect of this theory refers
to an aging individual increasing restrictions in their life due to fewer domains of functioning. It
is believed that the restriction itself occurs because the process of aging leads to a loss in the
range of adaptive potential. It is implied within the selection aspect that the aging individual
adjusts their own expectations so that they will have a subjective experience of satisfaction along
with personal control. Next, the “optimization” element refers to the view that the aging
individual can still engage in behaviors that may enrich their chosen life courses. Lastly, the
“compensation” piece of the SOC perspective, similar to the selection aspect, results from a
restriction in range of adaptation potential. Meaning that the onset of compensation occurs when
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
9
the behavioral capacity of the individual is either entirely lost or reduced from previous adequate
functioning. Once behavioral capacities are reduced, compensation may occur from aspects of
the mind, or through technology. An aging individual, to compensate for a reduction in
behavioral capacity, may use aspects of their mind, such as creating mnemonic strategies when
their internal memory mechanics become insufficient. Furthermore, technology, such as a
hearing aid may also be used in instances where an aging individual begins to lose auditory
functioning.
The SOC may help explain the presence of specific behaviors in older adults that may
appear concerning to a younger care provider. For example, a caregiver may assume that an
elderly individual is not partaking in social activities because they are unable to or perhaps are
depressed and withdrawn. The older adult, in reality may be capable of participating, but choose
not to socialize because they would rather be alone and spend time contemplating other things,
such as their life and family. More specifically, while an older adult spending more time by
themselves may be pathologized by other individuals, this behavior could be explained by the
SOC perspective as understandable. Specifically, the older individual may be redirecting their
goal hierarchy due to the loss in domains of functioning and they may begin to focus on more
important goals, such as reflecting on their past (i.e., selection). In order to achieve their desired
outcomes in the selected domains, the older individual may invest most of their time and energy
into the acquisition of that goal (i.e., optimization). The older individual may also begin to
activate internal or external resources to pursue their desired goals (i.e., compensation), such as
spending time alone sitting quietly so that they can better reminisce.
Unlike the “selection” aspect of the SOC perspective, which holds that behaviors of the
aging individual occur due to old age itself, the pathological perspective tends to equate aging
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
10
with disease and interprets behaviors that are manifested in old age as pathological or disordered
(Tornstam, 2005). Therefore, an aging individual who refrains from socializing with others or
limits their engagement in activities may be viewed as being depressed or exhibiting signs of
other disorders. When considering all the theories of aging discussed above, it is evident that an
individual who is operating from one of these perspectives may view behaviors of an older adult
as pathological or abnormal. This further brings into question what perspective younger adults
working as CNAs may be operating from, how these perspectives differ from those of the older
adults they serve, and what the implications of these differences in perspectives are for the
caregiver-older adult relationship.
Theory of Gerotranscendence
Finally, the theory of gerotranscendence was proposed by Lars Tornstam as an alternative
way to conceptualize the aging process. Tornstam believed that the process of living into old age
is characterized by a general potential towards gerotranscendence (Tornstam, 1997). The theory
of gerotranscendence, as defined by Tornstam is a “shift in meta-perspective, from a materialistic
and pragmatic view of the world to a more cosmic and transcendent one” (Tornstam, 1997). To
better understand the theory of gerotranscendence, it can be broken up into three dimensions;
cosmic, self, and social/personal relationships.
Cosmic dimension. Older individuals who are progressing toward gerotranscendence
may experience a redefinition in their perception of time, space, and objects. Their perception of
objects may change in a way that eliminates the boundaries of “you,” “me,” “us,” and “them,” so
that there is an impression of being “one” (Tornstam, 2005). Due to this perception of being
“one,” individuals may in turn become less self-centered. Factors that are included in the cosmic
dimension include, feeling a closer connection to other generations, a change in the concept of
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
11
life and death, addressing the mystery of life, and transcending happiness (Tornstam, 2005;
Tornstam, 2011; Wadensten & Carlsson, 2001; Wadensten & Carlsson, 2007; Wadensten, 2007;
Degges-White, 2005). When experiencing gerotranscendence, an individual may begin to feel as
though they are part of a larger context, and that they themselves are no longer as significant. In
the cosmic dimension, individuals may begin to refine their conceptualization of time, and may
begin to feel a closer connection between the past, present, and future. This connection between
the past and the present can be exemplified by interviews that were conducted with older adults.
During the interviews, the interviewer stated, “Some people say that they have gradually come to
a concept of time that is different from the one they had before. They say that, in early life and
adulthood, they had a very clear idea of what is today and what belongs to yesterday, but that it
has changed, and they feel like they are able to be in two time periods at once” (Tornstam, 2005).
When asked if they recognized this experience, many respondents answered “yes” and then
explained how their childhood has now come more alive in their older age. Many have also
referred to this closer connection with earlier or future generations as a “coiling genetic chain,”
or a link in a chain of generations, wherein the chain (i.e., life) is the important aspect, not each
individual link (i.e., each person).
As individuals begin to experience gerotranscendence, fears of death may change such
that one may still be afraid that death will be painful, but they no longer fear being dead
(Tornstam, 2005). To some, this attitude of not fearing death came suddenly, however, others
have experienced the onset of this perception as gradual over the course of life. The mystery of
life is also addressed within the cosmic dimension. Those who begin to enter gerotranscendence
have focused on accepting the mysteries of life, and no longer feel the need to define, explain, or
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
12
understand everything. Lastly, an individual may begin to find joy in commonplace, subtle
events and experiences, such as listening to the birds outside, or watching a thunderstorm.
Self-dimension. Older adults moving towards gerotranscendence may also begin to
experience a redefinition of their perception of life and death, which may decrease their overall
fear of death. The self-dimension addresses the ability of an individual to confront themselves,
decreases in self-centeredness, self-transcendence, and ego-integrity (Tornstam, 2005; Lin,
Wang, & Wang, 2015; Tornstam, 2011; Tornstam, 2005; Wadensten, 2007; Wadensten &
Carlsson, 2001; Wadensten & Carlsson, 2007; Degges-White, 2005). Unlike other theories, the
theory of gerotranscendence assumes that individuals are constantly changing and developing. In
an interview conducted with older adults as previously exemplified, interviewers also asked
individuals whether they have recognized that over the years they have begun to discover sides
of themselves that they had not known before (Tornstam, 2005). Many of the respondents stated
that during their elderly years they have discovered both negative and positive aspects about
themselves, such as discovering a characteristic of being cheerful, or being driven by anxiety.
While rediscovering themselves, many older adults also experience a new awareness that they
are not the center of the universe, whereas their younger selves may have been more egocentric.
This shift from egoism to altruism has been known as “self-transcendence,” where an individual
begins to focus on others well-being, rather than focusing on themselves and self-interest
(Tornstam, 2005). Older adults, experiencing transcendence typically focus less on their outward
appearance or body image. While they still care about their bodies, they develop a new
awareness of how to take care of their bodies without obsessing over it.
Interpersonal dimension. Lastly, older individuals may experience a decrease in the
interest of maintaining superfluous relationships and social interactions, and a decrease in the
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
13
interest of material possessions. The social and personal relationships dimension addresses the
importance of social contacts, emancipated innocence, and attitudes toward material assets
(Tornstam, 2005; Lin, Wang, & Wang, 2015; Tornstam, 2011; Tornstam, 2005; Wadensten,
2007; Wadensten & Carlsson, 2001; Wadensten & Carlsson, 2007; Degges-White, 2005). While
other theories (e.g., activity theory) have proposed that as adults age they should maintain their
lives as they once did during midlife, in such ways as staying connected with friends and
socializing, the social and personal relationships dimension explains that solitude and
selectiveness may lead to greater happiness in older adults. As an individual transcends, they
may become more selective in their choice of companions, and with who they surround
themselves. Rather than continuing to participate in superficial socialization as they once did
during their younger days, older adults may instead choose to spend time with close relations and
friends. They may also find the need for positive contemplation solitude, meaning that they have
an increased desire to spend time alone, reflecting. Additionally, older adults develop an
understanding that answers can rarely be given as concrete right or wrong statements, which
consequently is accompanied by increased tolerance of ambiguity and broadmindedness. While
younger, individuals may feel the need to stick with the status quo, older individuals may begin
to be able to break away from social conventions, which allows them to express important
feelings or questions without the feeling of embarrassment or self-consciousness. Lastly, older
adults, as they age may develop an understanding between themselves and the roles they played
in life. They find an importance in the need to be their genuine selves, and may even begin to
understand how important the roles (e.g., parent, employee, friend) they played in life were.
Overall, gerotranscendence, the shift in meta-perspective is described as being accompanied by
an increase in life satisfaction for the aging individual.
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
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Relevant Literature
Existing research, although, limited, has suggested that the perceptions and experiences
of gerotranscendence is correlated with age (Buchanan, Ebel, Garcia, Vandenest, & Omlie, 2016;
Buchanan, Lai, & Ebel, 2015; Wadensten & Carlsson, 2001). Specifically, older individuals
report having more experiences consistent with gerotranscendence compared to younger
individuals. This may be due to the increase of potential life crises that occur as one grows older.
Crises that occur, such as the death of a family member or friend can accelerate the speed at
which an individual experiences gerotranscendence by challenging and questioning the
foundation of one’s reality (Tornstam, 2005). When a tragic death occurs, an individual is likely
to question reality, and notions such as “it won’t happen to me” are challenged. This may lead to
individuals realizing that it is never too late to change, therefore replacing old assumptions with
newfound perspectives (Tornstam, 2005). In a cross-sectional study conducted by Lars
Tornstam, which aimed to answer questions on whether gerotranscendence might be related to
age, gender, life circumstances and life crises, it was discovered that there was a positive
correlation between scores on the cosmic dimension and ego-integrity under the self-dimension
of gerotranscendence (i.e., known as coherence in the study) and age, meaning that cosmic
transcendence and degree of coherence were higher in the higher age categories (Tornstam,
2005). More specifically, in the cosmic dimension, 31 percent of individual who were the oldest
(i.e., 75-85) scored the highest on the cosmic dimension. Individuals who scored the lowest on
cosmic transcendence were men, between the ages of 20 and 44 years of age, who had not
experienced any life crises in the past two years. The results indicated that women, as well as
those who during previous two years had experience one or more life crises scored higher on the
cosmic dimension. In terms of gender differences, a difference was seen in men and women who
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
15
cohabitate. The gender difference between men and women was seen to decrease with age up the
65 to 75 years old age category, and then between the ages of 75 and 85 split, so that women
continue to increase in cosmic transcendence, while men decrease. In terms of coherence, results
indicated that women showed a slightly higher degree of coherence than men, and those who
experienced rises or disease had lower coherence values.
One potential implication of these findings is that behavior consistent with
gerotranscendence can be misinterpreted by younger individuals who provide care (e.g., family
members, nursing assistants) to older adults. A small body of empirical literature has explored
this question. For example, Buchanan, Lai, & Ebel (2015) approached both undergraduate
college students and older adults from various senior community centers to examine whether
these two groups had varying perceptions on behaviors of gerotranscendence. For this study,
participants were given three vignettes to read about an older adult who resided in an assisted
living facility. Dispersed in each vignette were behaviors that were indicative of
gerotranscendence. After reading each of the vignettes, participants were asked to rate whether
they considered each behavior unusual, similar to what they have experienced, or whether they
thought someone should be concerned about the behavior. Results from this study indicated that
there was a significant difference between older adults and college students on the items that
regarded how “unusual” and “concerning” the behavior was perceived to be across numerous
dimensions of gerotranscendence. Specifically, behavior one of story one (i.e., changed
perception of time and space) indicated that there was a significant difference in the perception
of the older adults and college students in how unusual and concerning the behavior was. The
older adults were less likely than the college students to rate the behavior of “experiencing
memories in great detail” as unusual, as well as less concerning. Similarly, for behavior four of
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
16
story two (i.e., having a new perspective on social contacts – Mr. Smith now goes to lunch in
sweatpants, a t-shirt, and baseball hat because he doesn’t need to impress anyone anymore ),
results indicated a significant in perceptions of how unusual and concerning the behavior was.
The older adult sample were less likely to rate the behavior as unusual and were also less likely
to rate the behavior as concerning. Lastly, behavior one of story three (i.e., withdrawal from
social activity and the preference for solitude – Mr. Smith is not visiting with his friends and
socializes little within the facility), behavior two of story three (i.e., withdrawal from social
activity and the preference for solitude – staff let Mr. Smith know when activities are in the
facility, but Mr. Smith prefers solitude), and behavior three of story three (i.e., having a new
perspective on social contacts – Mr. Smith prefers to spend time with people he knows and likes,
instead of making new friends) indicated that older adults were significantly less likely to rate
the behaviors as unusual or concerning compared to the college students.
Similarly, a study conducted by Buchanan, Ebel, Garcia, Vandenest, & Omlie (2016),
examined age differences in perceptions of the specifically the cosmic dimension of
gerotranscendence. In this study, younger adults aged 18 to 31 were compared to older adults
aged 65 years and older. Again, like the previous study discussed, vignettes describing the life of
an older adult who was experiencing aspects of gerotranscendence were given to participants.
After reading the vignettes, participants were asked to rate whether the behaviors were unusual,
similar to what they have observed, or whether they thought someone should be concerned about
the behavior. Results from this study showed that there was indeed a difference between the age
groups. Older adults were more likely to rate the behaviors indicative of gerotranscendence as
less concerning and unusual compared to the younger adults.
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
17
As stated previously, younger adults may view behaviors consistent with the theory of
gerotranscendence as abnormal or pathological. Older adults, especially, those who reside in
long-term care facilities, mainly interact with others in the facility as well as the nursing stuff
that work within the facility itself. Research has been conducted to assess the perceptions of
nursing staff, regarding behaviors of gerotranscendence. Tornstam and Törnqvist (2000),
interviewed nine nursing staff and five care aids who worked in a Swedish independent living
facility. During the interview, each of the 14 individuals were asked whether they have noticed
behaviors indicative of gerotranscendence in the residents, and if they did how they interpreted
these behaviors. Of the 12 behaviors that were inquired about in the interview, five of the
behaviors were viewed as negative or pathological, including “Transcendence of time,”
“Increasing need for solitude,” “Rejoicing in small events,” “Modern ascetism,” “and “Self-
transcendence.” Four behaviors, such as “Rediscovery of the child within,” “Connection to
earlier generations,” “Ego-integrity,”, and “Disappearing fear of death,” were viewed as positive,
and apart of another aging perspective, like the activity perspective or continuity perspective.
Two of the behaviors, “Self-confrontation,” and “Body transcendence” were interpreted as part
of the neutral continuity theory perspective. Lastly, one behavior, “Everyday wisdom” was
noticed by two staff members, who thought that older adults were more condemning than broad-
minded, however, their perception of the behavior could not be placed into a theoretical
perspective.
Much like the study discussed above, Wadensten and Carlsson (2001) investigated
whether nursing staff who worked with older individuals could recognize signs of
gerotranscendence and how they interpreted these signs. Nursing staff were given qualitative
interviews, in which they were asked whether they had recognized certain signs of
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
18
gerotranscendence and to provide their interpretation of the meaning of each of the signs. Staff
were also asked how they cared for the older individuals who were exhibiting these signs. The
results from the interviews indicated that all the staff members included in the study had noticed
signs of behaviors that were indicative of gerotranscendence. Many of the staff had deemed
some signs, such as having a greater capacity to find pleasure in the small things and
withdrawing from social activities as pathological. However, other behaviors of
gerotranscendence, such as thinking about their childhood and not caring as much about their
bodies, were interpreted by the staff as normal. When asked how they cared for individuals who
were exhibiting these signs, the most common manner was to listen passively, or to try and
activate older adults who did not want to engage in social activities. Overall, the studies
previously discussed provide evidence that behaviors indicative of gerotranscendence may be
interpreted as pathological or undesired by younger to middle-aged adults.
Purpose of the Study
The purpose of this study was to extend the work discussed previously that examined the
perceptions of gerotranscendence between a population of younger adults (i.e., college students)
and community-dwelling older adults. The current study is novel in the sense that it used a
quantitative analysis to compare the perceptions of behaviors indicative of gerotranscendence
between younger adults who worked as certified nursing assistants (CNA) and older adults living
in long-term care facilities. Older adults living in these facilities may be more familiar with
behaviors of gerotranscendence, either through observing the behaviors in others around them or
experiencing the behaviors in themselves. In contrast, younger adults working in these facilities
may deem behaviors of gerotranscendence as peculiar or symptomatic of a disorder such as
depression. Therefore, significant differences in the perceptions of gerotranscendence between
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
19
these groups is expected to occur. Based on previous research, it is hypothesized that the older
adults in the study would be less likely to perceive the gerotranscendent behaviors described in
the survey vignettes as concerning or unusual compared to Certified Nursing Assistants.
Additionally, it is hypothesized that the older adults will be more likely to perceive the behaviors
of gerotranscendence as familiar.
Method
Settings
Participants in the study were recruited from long-term care facilities in a small
Midwestern city and the surrounding area. Five assisted living facilities were visited for data
collection. Although all recruitment was conducted at senior care facilities within the same
region, each of the five assisted living facilities slightly differed in terms of size of community,
and recruitment method. Across the five senior living facilities the total number of apartments
available ranged from approximately 57 to 117, indicating that at some facilities there were more
residents compared to others. Most of these communities not only included services for assisted
living but also for memory care, and independent living. All facilities were also for-profit
organizations.
Participants
Two samples of individuals were recruited to participate in this study: Older adults living
in long-term care facilities and individuals working as nursing assistants. In order to be eligible
to participate in the study, individuals needed to be 65 years of age or older and not experiencing
cognitive impairment. The absence of cognitive impairment was ensured by asking facility staff
to recruit only individuals who did not have a diagnosis of a condition that caused dementia in
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
20
their medical chart. In cases where participants were directly recruited at resident meetings, staff
were asked if individuals who signed up for the study had a condition that caused dementia.
Participants were not excluded from the study if they were unable to read or write. In the case
that participants were unable to read due to limited vision, or were unable to write, the researcher
read the consent form, demographics questions, instructions, introduction, and three stories to the
participant. The researcher also read the survey questions to the participant and filled in answers
based on responses given by the participant themselves. In total, there were 41 older adults
between the ages of 71 and 101 who completed the survey. The sample included 17.1% male,
and 82.9% female. Regarding ethnicity, 100% of the older adults identified themselves as
Caucasian/White. Many of the participants, 73.2% identified that they were Protestant, 24.4%
followed the Catholic religion, and 2.4% identified that they had an alternative religious
preference (i.e., Christian). When answering how long they have resided in their current facility,
63.4% had living in the facility for more than one year, 19.5% had resided in the facility between
six month and one year, and 17.1% had lived in the facility for less than six months.
In addition to the older adult population that were surveyed, a total of 40 Certified
Nursing Assistants(CNA) between the ages of 18 and 67 with a mean age of 40.55 also
participated. The sample was 12.5% male and 87.5% female. Regarding ethnicity, 95.0% of the
sample were Caucasian/non-Hispanic White, 2.5% were Asian, and 2.5% were Hispanic or
Latino. The majority of CNAs (42.5%) identified themselves as being Protestant, 27.5%
identified themselves as being Catholic, 10.0% stated that they did not have a religious
preference, and 20.0% identified that they followed another religious preference. Lastly, when
asked to indicate the number of years of work experience they had working with older adults, on
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
21
average the CNAs indicated that they had 12.71 years of work experience with older adults, with
a range of work experience spanning from one year to 42 years.
Procedures
Recruitment. Recruitment of older adults was conducted in regional long-term care
facilities, such as assisted living facilities. Recruitment methods varied slightly depending on the
community that was being visited. While at some of the communities that were visited the
researcher was able to attend resident meetings to recruit for the survey study, at other facilities
activity directors took it upon themselves to search for residents who would be interested in
completing a survey and being part of a study.
The sample of certified nursing assistants were also recruited from long-term care
facilities. The researchers attended staff meetings and individuals were asked to add their name
and email address to a sign-up sheet if they were interested in participating. Those individuals
who expressed interest in the study were sent a link to access an online version of the consent
form, demographics form, and the gerotranscendence survey.
Informed Consent. Data collection was completed at a location convenient for
participants, typically a commons area in the facility in which the participant resided. Prior to
beginning the study, all participants were given an informed consent form to read through. If
participants were unable to read for any reason, the researcher was available to read the consent
form fully. This form included information about the purpose of the study, the procedures which
would take place, risks and benefits of the study, confidentiality, the voluntary nature of the
study, how to address any questions that may come up after the study is completed, and a
statement informing the participant that signing the form indicated that they were deciding to
DIFFERENCES IN PERCEPTIONS OF GEROTRANSCENDENCE
22
participate in the research study, that they had read the form, understood it, and understood that
they would receive a copy of the consent form for their own records.
Nursing assistants read an online version of the consent form. Continuation to the survey
portion of the study indicated the individual consented to participate in the study.
Demographics form. Upon obtaining informed consent, each older adult participant
completed a demographics form which included information about the participants gender, age,
ethnicity, length of time residing in the facility, and religious affiliation. Nursing assistants also
completed a demographics form that asked about gender, age ethnicity, job title, years of
experience working with older adults, and religious affiliation.
Gerotranscendence survey. After completing the demographics form, a
gerotranscendence survey was given to the participants. This instrument has been utilized in
previous research investigating age differences in perceptions of gerotranscendence (e.g.,
Buchanan, Ebel, Garcia, VandeNest, & Omlie, 2016; Buchanan, Lai, & Ebel, 2015). Participants
were first asked to read a set of instructions which described how the survey was to be
completed. This brief statement explained that the participant would be reading a set of three
short stories about an older adult who lives in a senior care facility, and then answering questions
about their opinions of behaviors that were indicated within each of the stories. Next, participants
were asked to familiarize themselves with the main character portrayed in each of the three short
stories that were to follow. The participants were introduced to a man named Mr. Smith, an
elderly resident residing in an assisted living facility. The two-paragraph introduction described
Mr. Smith’s social, occupational, and health history. A copy of the survey is included in
Appendix C.
