Attitude to the meaning of life and life satisfaction of elderly and senile people

Ermakova Natalia Georgievna ORCID: 0000-0002-3015-8488 Doctor of Psychology Professor of the Department of Clinical Psychology and Psychological Assistance, Herzen State Pedagogical University of Russia 191186, Russia, Saint Petersburg, nab. Moika, 48 nataliya.ermakova@yandex.ru Zashchirinskaia Oksana Vladimirovna ORCID: 0000-0002-2666-3529 Doctor of Psychology Associate Professor of the Department of Clinical Psychology and Psychological Assistance, Herzen State Pedagogical University of Russia; Professor of the Department of Pedagogy and Educational Psychology, St. Petersburg State University; 191186, Russia, Saint Petersburg, nab. Moika, 48 zaoks@mail.ru Sakovsky Igor' Vsevolodovich ORCID: 0000-0001-8947-1463 PhD in Medicine Associate Professor of the Department of Clinical Psychology and Psychological Assistance, Herzen State Pedagogical University of Russia; Associate Professor of the Department of Clinical Medicine and Psychology, St. Petersburg Medical and Social Institute 191186, Russia, Saint Petersburg, nab. Moika, 48 igor.sakowsky@yandex.ru Denisova Kristina Eduardovna ORCID: 0009-0004-6290-9073 Psychologist, Master of Psychology, Company LLC" Omega", 195267, Russia, Saint Petersburg, 114 Grazhdansky ave., office building 1 107772@mail.ru

Frolova Nina Dmitrievna ORCID: 0009-0003-2709-2355 Graduate student, Department of Pedagogy and Educational Psychology, Saint-Petersburg State University 199034, Russia, Saint Petersburg, nab. University, 7-9 frolovanina.dm@mail.ru

Introduction.

 The steady increase in the share of older people in society is a global trend, due to the development of healthcare and an increase in life expectancy ^[1]. In old age, there are changes in the functioning of all body systems, and the presence of age-associated diseases (decreased muscle mass, osteoporosis, sarcopenia), decreased sensory and cognitive functions that affect the quality of human life ^[1,2].Changes in the lives of older people are associated with retirement, with a change in social status, loss of professional skills interpersonal relationships and financial stability, the presence of health problems and in the family, which leads to a change in values and meanings of life, and is accompanied by emotional experiences ^[3,4]. Social frustration is one of the factors of mental maladjustment ^[5,6].

Society faces the need to solve the tasks of specialized care for the elderly (medical, social, psychological) aimed at preventing maladaptation, prolonging their functional and cognitive independence ^[2,6].

The strategic document for the implementation of the program of systemic support and improvement of the quality of life of older citizens is the national project "Demography", as well as approved in 2016.The Government of the Russian Federation "Strategy of actions in the interests of older citizens in the Russian Federation for the period up to 2025" ^[2].

The biopsychosocial approach in medicine and medical psychology is currently clearly established as a fundamental research model that involves the study of a person in his integrity, unity of the ratios of biological, psychological and social characteristics ^{[5, p.9]}. When adapting a person to changing conditions, the attitude of a person to his health, to the environment, to the meaning of his existence and the assessment of his life path plays a crucial role ^[5].

Describing the stages of the life cycle, E. Erickson designates the last stage of life - the stage of late maturity, in which the psychological conflict can be resolved favorably, with the preservation of the integrity of the personality (recognizing satisfaction from his life) or despair (if the passed stage of life is assessed as a series of missed opportunities) ^[7]. V. Frankl, noted that everyone has the opportunity for both progressive and regressive development. Depending on the choice made by an elderly person, his further life and activities will be aimed either at preserving his personality, or at isolation and individualization. The difference between the two strategies affects the quality of life and its duration^[8]. Krasnova O.V., Leaders A.G. considering the features of the psychological crisis of the elderly, noted that in the late age period there are difficulties of identification, as well as a lack of willingness to create new social connections ^[9]. The loss of friends and the narrowing of the social circle leads to alienation, aggression, a decrease in emotional mediation and apathy. The authors note that compensation in the form of participation in various forms of creativity (hobbies) in interest groups can be a significant mechanism of re-socialization.

It should be noted that many studies are aimed at studying and correcting the cognitive functions and emotional state of older people ^[4.10], while little attention is paid to the study of the personality relationships of older people, especially senile age, to the meaning and values of life. At the same time, the presence of the meaning of life in the period of old age and old age is an opposition to extinction, as noted by Rubinstein S.L. ^[11], and a stable system of values and life meanings are mechanisms for overcoming crisis situations ^[5]. As noted by a number of authors, along with basic needs for financial and medical care and social protection, older people have needs for communication, self-development and self-realization ^[12], and employment can be considered as one of the factors of mental well-being ^[13].

Physical and cognitive abilities as a result of the progression of age-associated diseases differ in elderly and senile people ^[2], it can be assumed that personality attitudes to values, meaning of life and life satisfaction may also differ, and therefore this study is relevant.

The purpose of the study is to identify the peculiarities of the attitude of the personality of elderly and senile people to the meaning of life and life satisfaction, and to identify the orientation of psychological assistance.

The subject of the study is the relationship of the personality of elderly and senile people to the meanings of life and life satisfaction. The general philosophical approach of the study is the principle of determinism, which allows us to assess the influence of previous stages of mental development on subsequent ones; as well as the principle of development, taking into account actogenesis, ontogenesis and historiogenesis. The methodological basis of the research is the biopsychosocial approach, as a fundamental research model in medicine and medical psychology, involving the study of a person in the systemic unity of the ratios of biological, psychological and social characteristics

                   Materials and methods of research.

The study involved 93 people aged 60 to 88 years; 82 of them were women and 11 men. They were observed at the day care department of the integrated center for social services of the Vyborgsky district of St. Petersburg. Elderly people were sent to the center by the therapist of the district polyclinic. The inclusion criteria were the ability to actively move and self-serve, age over 60 years. The group did not include people with severe cognitive decline and with significant motor impairments. All patients gave informed consent to participate in the study. We divided the study participants into 2 age groups: from 60 to 75 years old - the elderly according to WHO criteria ; and from 75 to 88 years old - the senile age according to WHO criteria ^[2] . The first group included 51 people (48 women and 3 men); the second group included 42 people (34 women and 8 men).We paid attention to a detailed description of socio-demographic characteristics, including the gender composition of the two groups to objectify the comparison of indicators; they differed only in terms of age. The study was conducted in 2018 - 2019.

The day care department carried out a set of activities aimed at improving socio-psychological adaptation: physical therapy and Nordic walking; occupational therapy (various crafts), isotherapy, computer literacy; cultural and leisure activities (concerts, lectures, excursions), legal advice. Psychological assistance was provided by psychologists individually and in the group of correction of higher mental functions.

Research methods. The method of theoretical research: analysis, generalization and systematization of literary data. Methods of empirical research: observation, conversation, testing.

Research methods. A structured interview was used; D.Leontiev's "Life Orientations" ^[14]; "Life Satisfaction Index" (ZHU), adapted by N.V. Panina ^[15]; Hospital Anxiety and Depression Scale HADS (Hospital Anxiety and Depression Scale); "Clock Drawing Test" ^[16].

Methods of mathematical statistics were used to process the data of our study. The nonparametric Mann-Whitney U-test was used for comparative analysis, correlation analysis was carried out using Spearman's rank correlation coefficient, and the computer program Statistics ver.10 was used.

                   The results of the study

Analysis of the interview results. During the interview, questions were used about well-being, family composition, education, interests, hobbies, as well as about the values of life.Family composition: live alone in group 1 27 (52.9%),in group 2 17(40%), live with a spouse in group 1 10(19.6%), in the second 8(19.1%), with children in group 1 10(19.6), in group 2 14(33.3), live with other relatives in group 1 4 (7,9), in group 2 3 (7,1). Life has made its own adjustments, and at an older age, many patients tend to live with relatives due to reduced functionality.

The presence of chronic diseases in the 1st younger group is 40 (78.4%), in the 2nd older group 40 (95.2%) representatives are noted ; health care (taking medications, measuring blood pressure, dieting)  more attention is paid in the older group (100%) than in the younger (82.4%), which indicates a greater number of somatic problems in the older group, but also the desire to preserve their health. The need for outside help in everyday life is more indicated in group 2, 10 (23.8%), in group 1, 6 (11.8%) people. According to the level of education, secondary specialized and higher education are equally represented in both groups.

When ranking the values of life proposed in the interview in 1st place, representatives of both 1 and 2 groups indicated the value of "health" (54.9% and 69.05%), then "children" (21.5% and 11.9%) and then "feelings" (15.7% and 7.1%) in importance.), moreover The need for them is greater in the younger group than in the older one. Such values of life as "good food, money, hobbies, ecology" remained without special attention in both groups.

According to the interviews, representatives of the younger group have more willingness to interact with relatives and friends, more involvement in emotionally meaningful contacts with their children's family. Representatives of the younger group, according to interviews, provide all possible assistance in raising grandchildren, tend to attend fitness, cultivate indoor flowers, take care of pets, do gardening, attend interest classes (choir, drawing, local history).Many patients of group 1, having mastered the computer, find educational games, learn English, travel virtually to museums and enjoy these activities. After retirement, they found new values and meanings of life for themselves.

  While the patients of the older group had fewer contacts with relatives and friends, which was confirmed by the interview data ("grandchildren have grown up", "children have their own lives"). Group 2 patients have less willingness to attend concerts, theaters, and museums ("they have less energy for communication and travel", "they don't like noisy places and fuss in transport"), fewer friends and buddies (passing away), less desire to do needlework ("eyesight decreased, hands work worse") There is a restraint of feelings, there is a narrowing of the social circle. The main concerns of the representatives of the 2nd group are manifested in household chores (going to the grocery store and cooking, keeping the house in order), visiting a polyclinic; from classes mainly watching TV shows, in some cases reading, walking. Representatives of the older group are not inclined to master the computer ("it's too difficult, the eyes get tired," etc.).

The results of comparing the indicators using the "Life sense orientations" method of the first and second groups are presented in Table No. 1.All indicators are within the average norm ^[14].

Table 1. Comparison of the average indicators of group 1 and 2 according to the method of "Life orientations".

M is the average; S is the standard deviation; p<0.05 is the level of significance of the differences

When comparing indicators using the SOE methodology, significant differences are observed in the parameter "Locus of control - I", which reflects a person's ability to control his life, self-confidence. The "locus of control - I" is significantly higher among representatives of the 1st (younger) group, which indicates their more active participation in life situations (interaction with children, grandchildren, friends), in decision-making in the family.Representatives of the older group depend more on relatives when making decisions in the family, which is confirmed by the interview data. Other indicators: "purpose of life", "process of life", "effectiveness of life", "locus of life control", "meaningfulness of life" do not have significant differences in patients of groups 1 and 2, which can be regarded as similarity of problems (deterioration of health, termination of work, difficult family relationships, financial insecurity ).

The results of comparing the indicators of the hospital anxiety and depression scale (HADS) of the two groups did not reveal significant differences. The norm is from 0 to 7 points, the subclinical severity of the sign is from 8 to 10 points, the clinical severity of the signs is from 11 or more points.^[16].  Indicators of anxiety of group 1 (6.84 ±3.5) and group 2 (5.64 ±3.4); and indicators of depression : in group 1 (5.59 ± 3.4) and in group 2 (5.74 ±2.78) are within the normal range (less than 7 points), which indicates a relatively prosperous emotional state of the elderly, which The interview data is also confirmed.

No significant differences were found in both groups when comparing the indicators of the "Life Satisfaction Index" (IIA) methodology (Table No. 2).The maximum number of points on each IU scale is 8, the total IU score is a maximum of 40 points^[15]..

Table 2 - Comparative analysis of the indicators of group 1 and 2 using the "Life Satisfaction Index" method.

M is the average; S is the standard deviation

According to such indicators as: "Interest in life, " Consistency in achieving goals", "Consistency between set and achieved goals", "Positive assessment of oneself and one's own actions", "General mood background", there are average values (maximum score of 8) in groups 1 and 2, as well as in the general indicator according to the IJU methodology (the maximum score is 40 points), which can be regarded as relative life satisfaction by the study participants in both groups.

To assess the cognitive functions of the representatives of groups 1 and 2, a "Clock Drawing Test" (maximum score of 10 points) was conducted^[16]. Indicators of cognitive functions are significantly higher (p<0.01) in representatives of group 1 (9.647 ±1.016) than in group 2 (older) (8.643 ±1.62). The results may indicate a more pronounced decrease in visual memory and opto-spatial functions in representatives of the older group, which is a target for psychological correction.

We conducted a correlation analysis of the average values of indicators in groups 1 and 2 using Spearman's rank correlation coefficient.(Asterisks indicate the reliability of the relationships, and the numbers in the columns indicate the closeness of the correlation itself).(Table No. 3 and Table No. 4 )

Table 3.- Interrelations of indicators of CSF, IU and HADS in the first group (60-73 years old). (P<0,001***;P<0,01**P< 0,05*)

According to the results of the correlation analysis of group 1, the indicator of "Meaningfulness of life" has many positive links with indicators: "Sequence of goals" (+0.354), "Interest in life" (+0.329), "Positive self-assessment", "General indicator of life satisfaction" (+0.389), a negative relationship with the indicator depression HADS (-0.636). The results show that the meaningfulness of life ("what I do and for what") in older people of the younger group is directly related to the sequence of goals, which leads to positive self-esteem, interest in life and satisfaction with life itself. The higher the meaningfulness of life and personal control over the situation, the less depression. The indicator "Locus of control- I" in group 1 has fewer relationships.

According to the results of the correlation analysis of group 2, the indicator of the "Locus of control"I" has many relationships.All significant correlation coefficients are presented (Table No. 4).

Table 4 -The relationship between the indicators of CSF and IU and HADS of group 2 (75-88 years). (P<0,001***; P<0,01**; P< 0,05)

The indicator of the "Locus of control"I" has relationships with the indicators: " Consistency of goals" (+0.525), "Consistency of goals" (+0.423), "Positive self-assessment" (+0.321), "General mood background" (+0.414), "Interest in life (+0.449) and "General life satisfaction" (+0.577).Thus, it is important for representatives of the second group, first of all, to recognize their personal participation in the implementation of goals. Representatives of the older group have lower control over the situation in joint events with relatives, and therefore it is so important to recognize their personal participation.

While representatives of the younger group participate in joint family activities (buying and choosing a gift for a grandson or helping to partially pay for a trip to the camp, etc.), which gives meaning to life by participating in a common cause, without focusing on personal Ego.

                   Discussion of the results.

In a comparative study of elderly and senile people, a positive assessment of the emotional state and life satisfaction was noted, which indicates a relatively prosperous state of self-esteem, assessment of life meanings and values in both groups.

When comparing indicators of life-meaning orientations, the indicators of the "Locus of Self control", control over the situation, and indicators of cognitive function are significantly higher in the younger group, whose representatives are more involved in activities in society, which gives them a sense of meaningfulness of life. A number of authors note that involvement in and satisfaction from activities brings a sense of well-being^[12,17,18], and the formation of new skills and hobbies can be regarded as one of the factors of mental well-being^[12,13].

Representatives of the older group distance themselves from the noisy society  due to the decrease in physical and cognitive capabilities, they are focused more on personalized participation in the situation, while maintaining the integrity of self-perception and life satisfaction. Smith J.L.,et al. It is recommended to teach older people to develop the ability to contemplate, to pay attention to positive experiences ^[17,18]. Jopp D, Rott C. It is noted that a positive attitude can bring life satisfaction to people over 80 years old ^[19]. Wiles J.L., et al. They note the importance of environmental safety for the elderly with reduced mobility and cognitive functions, write about the need to rebuild the space at home (handrails in the bathtub, and a convenient passage to the kitchen, etc.)^[20].

 Psychological assistance should be aimed at correcting cognitive functions, at forming new values and meanings of the life of older people, accessible to their capabilities and control (computer development, bibliotherapy, audiobooks, coloring pictures by numbers, etc.), which will be available to people and the older age group. At the same time, it is necessary to conduct classes on the development of communication skills.

Comprehensive care for the elderly in day care centers is an important measure aimed at improving the socio-psychological adaptation of the elderly, which is confirmed by a number of authors ^[2,6,21,22].

                            Conclusion.

The biopsychosocial approach to medicine and medical psychology involves the study of a person in his integrity, the systemic unity of the ratios of biological, psychological and social characteristics ^[5], which was also described in the works of B.G. Ananyev ^[23]. Psychosocial factors can contribute to the formation of adaptation disorders, which makes it important to identify the characteristics of the personality relationships of older people. These methodological approaches contributed to solving the problems of this study.

 The scientific novelty of the study lies in the fact that empirical data have been obtained on significant differences in the life orientations of elderly and senile people.

 If the representatives of the elderly (from 60 to 73 years old)  the meaningfulness of their lives is associated with sufficient social activity, while representatives of senile age (from 75 to 88 years old) distance themselves from social contacts and unexpected situations, demonstrate a desire for autonomy, wanting to maintain a measured lifestyle, which is protective in nature, at the same time, life satisfaction remains.

 It can be assumed that the desire of older people for social isolation, which was described by Krasnova O.V., Leaders A.G. in 2002 ^[9], in the modern world has shifted along the time axis to an older age group, to representatives of senile age, while representatives of a younger group with the development of new modern computer technologies have become more socially mobile.

                                      Conclusions.

1. For the elderly, there is a sense of meaningfulness in life, which is directly related to a high Locus of Self-control and social activity, which brings a sense of satisfaction with life

2. In the group of senile people, there is social distancing, a decrease in the locus of life control and a decrease in cognitive functions, which requires a differentiated approach when creating psychological assistance programs.

3. Psychological assistance to the elderly can be aimed at the formation of new values and meanings of life, the correction of cognitive functions, as well as the development of communicative interactions in society.

4. The results obtained may be useful for medical and social workers involved in working with the elderly.