As elderly people approach the last stages of life, they are likely to face numerous questions regarding their past and future. Late life is typically associated with depression, since not all elderly individuals are capable of adjusting to the new conditions of life. Nurses are uniquely positioned to organize life review activities with elderly patients. The current assignment provides an overview and analysis of a life review interview conducted with an older adult.
Introduction of Older Adult
G.V. is a 71-year-old woman who uniquely combines the elements of the Irish and German ethnicity. She was selected for a life review interview, because she has been a friend of our family for quite a long time. One of her brightest features is that she is always beautiful, neat, and properly dressed, presenting herself as an intelligent and nice woman. V.G. is an elderly woman who has been with her husband for 40 years. She was born in Long Island, New York. V. G. is the oldest of nine children. She spent her childhood in a small house. The woman never managed to finish high school. She found a job as a housekeeper but hurt herself at work. Her personal life had been equally painful, until she met her second husband. G.V.’s first husband was an alcoholic and a gambler. She regretted her decision to marry him, since she never knew when he would be nice or aggressive towards her. The woman had to think twice before she agreed to marry her second husband. Now she admits that the years she spent with him were the happiest in her life.
Overall, G.V. confesses that her life was not as good as she wanted. She still regrets her failure to become a high school graduate. She has lost her father and grandmother. The two events have shattered her life. Nevertheless, the woman is optimistic about her future. She is sexually active and stays at home. She has a number of health concerns but still dreams of celebrating her 80th birthday in good health. The woman does not want to end her life in a nursing home, as she does not think she deserves to be isolated from the world. The life review interview has become a good opportunity for G.V. to look into her past and the future that is possibly awaiting her.
Analysis of the Life Review Interview
The concept of life review was developed on the basis of Erikson’s stages of psychosocial development and Butler’s work on reminiscence in the elderly (Shilling, 2014). Reminiscence is a naturally occurring process, particularly in older adults. The primary goal of a life review is to enable elderly patients to look into their past experiences and resolve their past conflicts (Shilling, 2014). Such activities speed up patients’ reintegration into major life activities (Shilling, 2014). One of the benefits of a life review is that it empowers older adults to remember and emphasize their past accomplishments in ways that create a balanced perspective of their present and future life (Shilling, 2014). More importantly, it is through a life review that older adults have better chances to complete all stages of Erikson’s psychosocial development (Shilling, 2014). Finally, life review interviews favor and encourage patients’ emotional self-expression, which protects them from the physical consequences of continued stress (Jenko, Gonzalez, & Seymour, 2007). Apparently, many elderly patients hold traumatic memories that increase the risks of adverse physical outcomes (Jenko et al., 2007). In this sense, a life interview can be treated as a therapeutic approach that assists elderly patients in dealing with their life stressors, thus enhancing their ability to reach the goals of the last stage of life.
A life review is often compared to reminiscence. The principal similarity between them is that they facilitate memories’ recall (Haber, 2006). Both reminiscence and life review rely on the principles of remembering and storytelling. Nevertheless, it is wrong to use the concepts of reminiscence and life review interchangeably. According to Staudinger (2001), a life review is a complex concept that incorporates the elements of self-reflection and self-analysis. It is much broader than simple reminiscence, which is spontaneous and passive (Haber, 2006). Unlike reminiscence, a life review is intentional, active and well-structured. It does not occur spontaneously. In most cases, it is limited to several major life themes, such as family development or personal life (Haber, 2006). Its purpose is to highlight the most essential points in the life of an elderly person and relate them to end-of-life decisions. Its nature is more evaluative than that of reminiscence (Haber, 2006).
The concept and meaning of a life review are intricately related to Erikson’s stages of psychosocial development. The last, eighth stage of Erikson’s developmental scale embodies a major distinction between ego integrity and despair (Haber, 2006). “Ego integrity is defined as a basic acceptance of ones’ life as having been inevitable, appropriate, and meaningful” (Haber, 2006, p. 157). A life review often becomes the best possible strategy for the elderly to achieve the desired level of ego integrity and reconcile with their own selves. To display a good level of ego integrity means to reconcile with the reality of life in older age. Unfortunately, not all older adults are happy with their past activities. Chances are high that they will spend their last years in despair than in peace and emotional stability.
On an ego integrity scale of 1-10, G.V. scores 8. According to Haber (2006), older adults come to terms with their realities by valuing good things and reconciling with difficult things. G.V. has reached a state of ego integrity that is high enough to guarantee her peaceful coexistence with the realities of life in older age. For instance, the woman says that she is not afraid of getting older, although she realizes that future health problems may force her into spending her last days in a nursing home. She looks forward to meeting her 80th birthday and celebrating it with her family. The woman implies that she is not depressed about her age and health. The woman has reconciled with the difficult thing of her first marriage. She is open and frank in her recognition of the best things in life – her husband, her children and the house she owns.
Nevertheless, G.V. is far from displaying a perfect level of ego integrity. She has lived through many difficulties, many of which are yet to be resolved. Here, G.V. talks about her sister, calling her a “whore” and describing the role she played in her family problems. It seems that the old woman has never resolved the conflict with her sister. Also, the woman regrets the fact that she never managed to finish high school and become a university graduate. Even though she earned good profits working as a housekeeper, she needs to shift her focus from the past towards her future. The woman’s tone suggests that she will hardly reconcile with the need to spend her last days of life in isolation. If her health becomes worse, the woman will not agree to be sent to a nursing home. These are just some of the few conflicts G.V. must address to eliminate the taste of despair in her memories and daily routines.
The value of the life review interview for G.V. can hardly be overstated. The woman has managed to uncover the hidden conflicts that had been haunting her during her life. G.V. recognizes that her participation in the life review has empowered her to look back into the past and make predictions about her future. Yet, the most significant part of the interview was G.V.’s answer to the question of what kind of life she had. In her opinion, her life was not good. Her answer can be interpreted as a sign of poor ego integrity and high levels of despair. However, G.V. can still develop a more positive view on her productive life.
The part of the interview devoted to adulthood was the most difficult one. G.V. shared the pain of her relationships with her mother and her first husband. Despite a huge amount of respect the woman shows towards her mother, she cannot reconcile with the fact that she never felt any love on her mother’s side. She believes that her mother was responsible for her father’s death. Also, G.V. feels that her mother was a huge obstacle on her way to maintaining closer relationships with her grandmother.
Overall, life review interviews have far-reaching implications for clinical practice. In the words of Wheeler (2010), a life review represents a positive technique for helping elderly patients to recall the major events of their lives. Any information that elderly patients provide during a life review interview can inform the development of future therapeutic practices (Wheeler, 2010). These practices will eventually help older people to understand who they are and how they can come to terms with their realities. As for personal legacy, G.V. does not seem to have accomplished anything that could make a difference in the lives of other elderly people. She has struggles heroically to improve her life and the lives of her children. She has managed to overcome numerous obstacles on her way to a happy and peaceful life. G.V. has also proved that reminiscence can be a good approach towards reconsidering past mistakes and paving the way towards a happier future.
A life review is gaining popularity among gerontological nurses. The latter should master quality therapeutic approaches to help their elderly patients come to terms with their end-of-life realities. The results of the current life review interview suggest that not all older adults feel depressed in the last stages of life. Nevertheless, many of them find it difficult to engage in productive reminiscence and resolve their past conflicts. G.V. displays high levels of ego integrity, but she still needs to improve her emotional wellbeing. The results of the interview will inform the development of new therapies to help the woman develop a more holistic understanding of her older self.