The Late Stage of Life: How Can People Live a Good Life in Old Age?

Germany’s inhabitants are getting older and older. But although the very old are the fastest growing segment of the country’s population, we know very little about how they live. A representative survey wants to find out more about the diversity of life in old age. Its findings may challenge widespread assumptions about aging. 

by Andreas Kirchner

Rosemarie Rohr loves the theater. It is where she goes to meet friends, to keep fit, to contemplate herself and her life. Developing new plays, rehearsing once a week at the Freies Werkstatttheater (Free Theater Workshop) in the south of Cologne, and, of course, being on stage, applauded by the public – she cannot imagine a life without theater. 

Already as a little girl, Rosemarie Rohr wanted to become an actress. Today she is 84 years old and lives close to Barbarossaplatz, »just across from the Blue Shell bar.« She even has a new boyfriend. A house cleaner comes once a week, but she does not need nursing care. Her daughter moved to Madeira and would love for her mother to join her, but Ms. Rohr prefers to live among all the young people in Cologne’s »Kwartier Latäng« – the so called Latin Quarter. And if you ask her, it is going to stay that way. 

We know very little about the very old

This passionate actress is just one out of a million very old people currently living in North Rhine-Westphalia (NRW). Demographically, people belong to the group of the very old – or old-old – if at least half of their birth cohort has deceased. Although no other segment of the population is growing as fast as the old-old, from a scientific point of view they are still an »unknown group« and mostly underrepresented in socio-scientific surveys. Existing studies such as the Deutscher Alterssurvey (German Old-age Survey) or the Heidelberger Hundertjährigen-Studien (Heidelberg Studies on Hundred-year-olds) provide insights into the living conditions and quality of life of very old people. But many of these surveys have a sample size that is too small to reliably account for a specific age cohort. Others focus on a specific birth year, a specific social group or specific health issues. In short: existing studies do not draw a comprehensive picture of the living conditions of very old people. An interdisciplinary research team at ceres, the Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health hopes to change this. The survey NRW80+ is headed by project coordinator Dr. Roman Kaspar. Over the course of three years, the researchers will analyze information provided by 1,800 randomly chosen respondents over 80 years of age. The focus of the project is on people’s personal quality of life and their subjective well-being. 

In light of current demographic trends, the necessity to conduct a representative survey on very old people is undisputed. Political decision makers lack reliable information, hence there is no basis for the planning of target-group-specific policies for senior citizens. NRW80+ is trying to make a difference in three ways. First, the survey collects detailed information on the life options and life achievements of very old people in NRW. Then it identifies possible reasons for differences in quality of life. And last but not least, it analyzes how the survey’s findings modify widespread images of old age. On the basis of these findings, the study’s authors would like to contribute to the critical discourse on quality of life in late life and develop recommendations for policy makers and other actors in the field. »We are confident that, together with practitioners and political decision makers, we will be able to initiate some new action strategies that address the needs of very old people and improve their quality of life in the long run,« says Kaspar. 

People age individually

People are not only getting older, today the lives of the very old are also surprisingly diverse. In former times, the grandparents lived with their family and its members provided the necessary care. Nowadays, there is a great variety of care and residential models, among them multigenerational homes, retirement and nursing homes, living alone in one’s flat or sharing a flat with other senior citizens. 

Where people live in old age largely depends on their health and their social resources. »Unfortunately a long life does not necessarily mean additional years spent in good health. Especially the old-old often suffer from physical and mental impairments over a longer period of time, which in some cases makes it impossible for them to live independently,« Kaspar explains. 

Oftentimes physical and mental impairments lead to a decline in the social and cultural participation of the very old: »Here at the senior citizen theater, everybody is sane,« Ms. Rohr observes. »Otherwise they would not be able to memorize their text.« She is certainly aware that she is in a privileged situation: »I know that there are lots of old people who are not as well as I am and who do not have the ability to organize their leisure time as actively as I do.« 

Theoretical and methodological groundwork

In surveys of the old-old, the theoretical and methodological groundwork is extremely important. The first task is to assess to what degree established concepts of quality of life can be transferred to the very old, and where adjustments have to be made. Factors such as people’s economic situation or their social environment are certainly also important in regard to this group. But as Kaspar points out, the emphasis changes and new elements emerge: »Surely health plays a more important role than it does for younger people. Also, questions surrounding the meaning and approaching end of one’s life, or intergenerational relationships become important. One thing that is special about our theoretical concept is that it is not limited to subjective well-being as a marker of quality of life. Instead, we try to account for individual ways of living in our theory.« 

When dealing with the old-old, the research design can also be quite a challenge. In principle, it is certainly possible to reach very old people. But are they willing, in practice, to participate in a scientific study that addresses fundamental and highly sensitive issues? Apart from that, how can the study ensure that respondents are capable of supplying accurate information? Conducting an interview with a person who has a legal guardian or lives in a long-term care (LTC) facility is particularly demanding. In these cases, it is sensible to give relatives, care-givers and nursing staff the possibility to participate in the survey. By conducting so called »proxy interviews « with closely related or intimate persons, the researchers can ascertain essential aspects of the personal circumstances and way of living of respondents who are unable to provide this information themselves. This is a significant departure from the established practice of focusing only on groups of persons who can speak for themselves. 

Extensive preliminary studies This research process requires a lot of finetuning – from the theoretical and methodological framework, via conducting the representative survey and assessing its results, to the formulation of recommendations for decision makers and practitioners. 

In the preparations for the representative survey, a social research institute was commissioned to carry out a feasibility study to identify central aspects necessary for planning: »How can older people and their environment be approached in way that also encourages more encumbered individuals to take part? How many very old people have to be contacted in total to realize the targeted number of 1,800 interviews? Who is available to support the interview or answer for the respondent if necessary? These are only some of the questions the feasibility study is concerned with,« says Kaspar. At the same time, the research team is conducting test interviews in advance to assess the questionnaire’s practicability and its applicability to the needs of very old people. 

More complex perspectives on aging

The representative survey will be carried out after the methodological consolidation phase, and it will take approximately twelve months. It will certainly yield interesting – perhaps even surprising – results. Our ideal of a self-determined and healthy aging process, which we hope for for our family members, our friends and ourselves, will be confronted with extensive empirical data. At least one thing seems clear already: even though it is encouraging and inspiring to meet people like Ms. Rohr, it would be inappropriate to reduce old people’s quality of life to participation in cultural, social or political activities. Instead, we have to develop new concepts of quality of life beyond popular notions of mental sanity and physical fitness in old age. These new concepts should do justice to the actual wishes, needs and desires of very old people. But in order to do so, we need to find out what they are. 

NRW80+
Quality of Life and Subjective Well-Being of the Very Old in NRW

Project board:
Professor Christian Rietz,
Professor Michael Wagner,
Professor Christiane Woopen,
Professor Susanne Zank

Research team:
Dr. Roman Kaspar(coordinator),
Luise Geithner,
Anna Janhsen,
Michael Neise,
Carolin Kinne-Wall

Contact:
nrw-80plusuni-koeln.de
www.ceres.uni-koeln.de/en/forschung/nrw80