Dr. Chung is Emeritus Professor, and Dr. Kim, Dr. K.-S. Choi, Dr. Kwon, Dr. Park, Dr. M.-H. Choi, and Dr. Yom are Professors, Department of Nursing, College of Medicine, Chung-Ang University, Dongjak-Ku, Seoul, Korea.
This project was funded by the Nursing Science Research Institute at Chung-Ang University. The authors acknowledge Donna Schwartz-Barcott, PhD, in guiding the research; Carol Kaufman, for editorial assistance; and Kum Sook Oh for photography.
Address correspondence to Kyung-Hee Kim, RN, PhD, Professor, Department of Nursing, College of Medicine, Chung-Ang University, 221 Huksuk-Dong, Dongjak-Ku, Seoul, Korea; e-mail: firstname.lastname@example.org.
Aging is a process that everyone undergoes throughout life. However, this process tends to take on different meanings as individuals undergo a variety of changes. Researchers have found that as older adults undergo the aging process, they tend to experience decreased self-esteem, and a sense of isolation, alienation, and worthlessness becomes likely, leading to various physical, mental, sociopsychological, and spiritual problems that must be addressed (Beaver, 1983; Ha et al., 1995; Jeong, 1994; Kang, Go, Lim, & Lee, 1993; Shin et al., 2002; Shim, 2005; Yoon, 1991).
Older adults in Korea, especially those who go through multifaceted problems of aging, belong to a generation that experienced both World War II and the Korean War in the 1940s and 1950s, as well as numerous changes brought about by the cultural, political, economic, industrial, and educational upheavals that took place in most Westernized societies during the past 50 years. As a result, this generation underwent rapid changes in terms of personal relationships and social structure (Chang et al., 2007; Choi, 1994).
These rapid alterations in Korean society have brought about the coexistence of a traditional conservative value system and a newly accepted, Western one. The difference in social, cultural, and moral standards between the conservative older generation and the younger generation with its Western value system is the most serious problem in Korean society today (Ahn, 1997; Choi, 1994).
The core of all human relationships in traditional Korean society was the family unit, which connected all family members and relatives. This family-oriented collectivism was a fundamental characteristic of Koreans and their social structure, for both individuals and families (Choi, 1994). However, this family-centered value system, which was like a religion in Korea, has been altered due to a reduction in family size, changes in family structure, an increasing number of women joining the workforce, and the prevalence of individualism. In addition, the relationships among family members have changed, and with this change has come a weakening of the sense of obligation to support older family members.
Older adults in Korea face various problems caused by the confusion and conflict arising out of the different values that exist between the old and the young, as well as by the mental and physiological changes that accompany the aging process. There is a need for a comprehensive approach in working with such multifaceted problems of older adults, especially to help them lead quality lives by using their existing resources. In addition, it is necessary to clearly and accurately understand how older adults in Korea perceive and respond to the aging process and to conflicts in their lives as they get older. Such conflict, or han, a unique Korean term, deserves special attention. Han, experienced mostly by Korean older women, is an emotional conflict that accompanies grief, resentment, and remorse, and which often involves the psychosomatic distress of heartburn (Kim, 1991; Oh, 1995; Yang & Choi, 2001).
Relationships among family members have changed, and with this change has come a weakening of the sense of obligation to support older family members.
The literature documents various attempts to gain an understanding of older adults’ knowledge and awareness of aging, especially their attitudes toward this process. There have also been many studies focusing on older adults’ functional life, life satisfaction, and personal relationships (Ahn, 1997; Baltes, 1997; Baltes & Carstensen, 1996; Choi & Paek, 2002; Fisher, 1995; J.S. Kim, 1998; Martin, 1991). In addition, since 1990, there has been an increase in studies qualitatively examining the viewpoints of older adults (Choi & Kim, 1996; Futrell, Wondolowski, & Mitchell, 1993; S.Y. Kim, 1998; Kim, 2005; Mitchell, 1990; Rendon, Sales, Leal, & Pique, 1995; Traynor, 2005; Trice, 1990; Wondolowski & Davis, 1991). However, very few qualitative studies have examined the Korean experience of aging.
This study was an attempt to fill this gap, and Strauss and Corbin’s (1998) grounded theory approach was used to describe Korean older adults’ perceptions of the aging process. A theoretical framework is proposed and can be used to uncover approaches that will support older adults in aging successfully.
An approach based on grounded theory as proposed by Strauss and Corbin (1998) was applied to discover a framework with which Korean older adults’ adaptation to aging may be understood and explained. Because theoretical sampling is the recommended strategy for applying the grounded theory approach, the most important criterion used for the recruitment of the sample was that participants be older adults who either reside at home on their own or with their grown child’s family or who visit the senior center during the day. The researchers recruited the sample by first identifying possible participants through personal contacts and then extending invitations directly to the identified older adults. The participants were initially contacted via telephone, except for those at the senior center, who were visited by the researcher, who explained the purposes and procedures of the study and made initial interview arrangements.
Saturation was achieved with a total of 18 participants. They were between ages 65 and 80, and 12 resided at home. The rest spent their days at the senior center. Eight were men, and 10 were women. Nine were married, 7 were widowed, and 2 were single. Eight lived with their children, 8 lived with their spouses, and 2 lived alone. Thirteen participants were relatively well educated, and 12 were financially comfortable. Three had jobs. Twelve had chronic diseases such as hypertension, rheumatoid arthritis, and diabetes.
Participation was voluntary, and participants were informed that the data would be used only for the purpose of this study and that their privacy would be protected. At the time this research was conducted, the participating university did not have an established ethical committee for research; therefore, only written informed consent was obtained from every participant.
Interviews were conducted over a 10-month period. To collect data for open coding, a pool of participants was considered, and the researcher (K.-H. Kim) selected someone who fit into as many categories as possible in connection with the topic of research to be the first participant. Each subsequent participant had different backgrounds from the previous participant.
Each person was interviewed after being briefed about the purpose of the study. Hoping to establish an amicable relationship with the participants, the researcher (K.-H. Kim) began with casual conversations about the weather or daily life. After establishing a friendly relationship, the researcher began intensive interviewing for data collection. The questions in the interview were along the lines of “What is the meaning of getting old?”, “What kinds of feelings or thoughts do you have as you get old?”, “How do you manage the feelings you have as you get old?”, and “What do you feel after you manage your feelings about getting old?”.
The venues for the interviews were quiet coffee shops, houses, or nursing homes. Efforts were made to conduct the interviews in comfortable and interruption-free surroundings.
The equipment used to collect data consisted of a portable cassette recorder and a field notebook. Interviews lasted between 40 and 90 minutes each, with the number of interview sessions per person ranging from one to three. To accurately quote material collected from the interviews, the researcher always audiorecorded the sessions, with permission from each participant.
The processes of data collection, coding, and analysis were carried out concurrently; that is, data analysis was done by transcribing the researcher’s field notes and audiorecorded interviews immediately following data collection, and the results of the analysis were reflected in the questions for the next participant. This was done to make comparisons and to check whether a concept brought up by one participant might appear in conversations with subsequent participants. If the concept did not appear in an interview, questions were asked to discover the reason and context for its absence. This process continued until the categories were saturated and no new themes or concepts emerged from the data (Strauss & Corbin, 1998). The above process was used to promote the reliability and validity of the qualitative research.
Conceptual Ordering. Conceptual ordering classified events and objects along various explicitly stated dimensions (Strauss & Corbin, 1998). During conceptual ordering, data were broken down into discrete parts and were closely examined and compared for similarities and differences. From this procedure, 182 distinct concepts were identified (Table). These concepts were classified based on the feelings they evoked when examined comparatively and in a particular context. They were named either directly from the words of respondents themselves or by the researchers. For example:
Table: Conceptual Ordering of Data
Participant: Whenever I offered my opinion to my children, they didn’t understand me [no understanding]. They didn’t pay attention to my opinion because they were sure that it was not suitable to the situation. I think this causes generation gap [generation gap].
Participant: When I felt sorry, I tried to stop feeling sorry for myself. I tried to think positively [autosuggestion].
These concepts were reexamined for similar properties and grouped into 35 subcategories, according to their similarities, and then further reduced to 15 more abstract and inclusive categories (Table). For example, concepts such as feeling sick; being in pain; feeling weak; experiencing numbness in the hands; feeling cold, tired, and sluggish; experiencing a lack of strength; experiencing tingling in the joints; and having difficulty breathing were grouped into Being Weak, one of the 35 subcategories. Subcategories such as Being Weak, Being Ineffective, Being Disconnected, and Perceiving Signs of Aging were grouped into Declining, one of the 15 categories. The above process continued until the categories were saturated and a consensus was reached by the researchers in team meetings.
Analysis of Patterns. This study had 15 distinct categories based on the conceptual ordering of the data. After the categories were determined, the data were analyzed to show how the categories varied dimensionally along those properties. The data were compared according to properties and dimensions inherent within the incident or event, grouping like with like. This process of qualifying a category by specifying its particular properties and dimensions is important to formulate patterns, along with their variations. Through this analytical process, five patterns were identified (Figure). Thus, these data analyses were the foundation and initial structure for theory building.
© 2008/Yuka Kisugi/ailead//Amana Images/Getty Images
Through a series of data analyses such as the process of open coding, constant comparison of data, and selective sampling of the data, a paradigm model for this study was developed (Figure). The central phenomenon in Korean older adults’ perception of aging was the process of Generating, Expressing, and Transforming Growing Futility. As the participants observed the aging process, they realized their various internal and external situations had declined. In response to these declines, they felt Uneasy, Futile, Depressed, Subject to Fate, or Weary, which led them to experience feelings of futility.
It is necessary to seek methods of helping older adults to be recognized by people in their surroundings and to have an independent lifestyle.
The extent of the experience depended on actions and interactions within a set of contextual and structural situations and, therefore, differed in degree from person to person. Once a sense of Growing Futility was generated, the participants chose strategies to cope with their given situation. At this time, the interactive process between the degree of futility and intervening conditions, such as Direction in the way of thinking and Self-Acceptance, affected the strategies that the participants chose for coping with increasing frustration. This sense of frustration was transformed into Adjustment, Wryness, or Despondency, according to the selected strategies of Acceptance, Negotiation, Imputation, or Rejection. When Growing Futility was handled with Acceptance, participants were able to cope with other people comfortably and keep themselves strong, even in adverse situations. However, when Growing Futility was handled with Imputation or Rejection, participants seemed to blame and reject others, to be displeased with their sad feelings, and to experience loss by feeling frustrated. In such cases, Growing Futility was transformed into Wryness or Despondency.
Well-Rounded Type. There are five patterns or ways in which the participants went through the aging process. In the first pattern, which involved 4 participants, individuals felt a weak degree of Growing Futility, expressed Acceptance, and were able to adjust or overcome their negative feelings. This pattern was named Well-Rounded Type.
For example, participants 2, 3, 9, and 14 lived with their respective spouses in a small family unit. They had intimate emotional relationships with their children and also good husband-wife relationships. Their children respected them and discussed important issues with them. With a stable financial foundation, they were independent and participated positively in daily activities. Although they had health problems, they were not burdened by hospital fees, so even when their children showed a deep interest in them, the participants visited health care providers by themselves. In situations that elicited futility, they comforted themselves and tried to enjoy leisure activities and volunteer work in an effort to boost their own morale. Therefore, they kept themselves satisfied with positive attitudes, still considering other people’s difficulties and comforting them as is expected of typical Korean older adults.
Declining Type. In the second pattern, which involved 4 participants, individuals felt a strong degree of Growing Futility, exhibited Negotiation, and were Wry about their sense of Growing Futility. This pattern was named Declining Type.
For example, participants 1, 4, 5, and 8 had spouses who had passed away, and they lived with their children. They did not have close familial relationships, and communication was lacking. They would go to a senior center in the morning, stay there for the whole day, and return home in the evening. They felt bored with the repetitive pattern of their lives. They were financially dependent on their children and felt sorry when the children did not care about their health condition. However, they comforted themselves, and out of consideration for their children, complied with them silently by assuming that they were doing whatever they could. When they believed the children were rejecting them, however, they looked back on their “good old days,” and felt upset, displeased, mistreated, and sorry for themselves.
Erupting Type. In the third pattern, which involved 4 participants, individuals felt a strong degree of Growing Futility, expressed Imputation, and were Wry about their sense of Growing Futility. This pattern was named the Erupting Type.
For example, participants 11, 12, 16, and 18 had resigned from their workplaces, and their spouses were deceased. They lived alone because they did not want to face the task of understanding their children’s mentalities and intentions, and they felt estranged from them. They often felt empty, comparing the present with the past, when they had a meaningful working life. They felt unhappy about their children’s indifferent attitudes but lived alone, as they were healthy and financially independent. When they felt unhappy about their feelings of futility, they sometimes would loudly rebuke other people. They felt unsatisfied and unfortunate when they compared their current situations with their past situations.
Avoidance Type. In the fourth pattern, which involved 4 participants, individuals felt a strong degree of Growing Futility, used Negotiation, and were Wry about their sense of Growing Futility. This pattern was named the Avoidance Type.
For example, participants 10, 13, 15, and 17 lived in a small family unit and had an intimate relationship with their family members. However, they were constricted by the past and lacked confidence. They were hesitant and reluctant to do anything. They tried to overcome their anxiety but blamed themselves for their incompetence, thinking their opinions were not accepted. They had financial independence and were in fairly good health. But psychologically, they were ambivalent about their relationships with their children.
Collapsing Type. In the fifth pattern, which involved 2 participants, individuals felt a strong degree of Growing Futility, expressed Rejection, and were Despondent about their sense of Growing Futility. This pattern was named the Collapsing Type.
For example, participants 6 and 7 lived with their children but spent most of their time alone and were financially and physically dependent on their families. Because they were sick and frail, they found it inconvenient to live alone, but they also believed they were burdening their children by living with them. They felt rejected by their family members and rarely communicated with them. When they reflected on their past, they felt a sense of han. Complaining that there was no hope for them, they became indifferent to their surrounding situations and felt sad, grief stricken, and resentful of everything. They said they were simply waiting for death, wishing to die whenever they saw their aging faces in the mirror.
This study analyzed the evolving stages of the phenomenon Growing Futility, in which five patterns were confirmed. These five patterns are similar to the five kinds of adaptation characteristics for older adults identified by Richard, Livson, and Peterson (1962):
- The first pattern found in this study was compatible with the The Mature, who accepts his or her aging process, is satisfied with his or her life, and actively goes through each day developing human relationships.
- The second pattern of this study was similar to The Rocking Chairman, who avoids complicated human relationships and social activities and lives a very passive life.
- The third pattern of this study corresponded to The Angry Man, who believes he has been mistreated in the past and rejects reality.
- The fourth pattern of this study was similar to The Armored, who tries to escape from psychological anxiety and conflict caused by the aging process.
- The fifth pattern of this study was compatible with The Self-Hater, who self-abuses, becomes pessimistic, and tends to try to commit suicide.
In this study, Korean older adults’ experience of aging can be understood as the process of Generating, Expressing, and Transforming Growing Futility. The causal conditions of Growing Futility were Being Weak, Being Ineffective, Being Disconnected, and Perceiving Signs of Aging, which had made aspects of the participants’ lives different from the way they had been in the past. Living with weakened health, older adults struggled with their new status of incapacity and diminished sense of purpose. Many previous studies also point out that such physical changes interact with social ones, resulting in complicated problems for older adults (Beaver, 1983; Choi, Kim, Byon, & Won, 1990; Ha et al., 1995; Jang, 2006; Park, 1985; Shim, 2005; Shin et al., 2002; Song, 1993).
The Growing Futility generated by the causal condition Declining was expressed as Being Weary when situations had changed from what they had been in the past; however, older adults tried to accept the new reality as natural when they found themselves Being Ineffective and experiencing a feeling of Being Depressed because of their sense of the futility of life.
The contextual conditions in which such Growing Futility is generated include the participants’ relationships with others, their influence on their surrounding situations, and their lifestyle. The relationship concept in this study implies social relationships and relationships with family members. The fundamental axis of Korean families is still family idealism (Song, 1995). Therefore, the evolving sense of Growing Futility is greatly influenced by older adults’ relationships combined with family idealism. This can be understood in the context of the Korean sociocultural structure in which people identify themselves in a relationship frame and respond sensitively to the feelings of others.
In addition, the older adults in this study showed that they chose the Acceptance strategy when they felt a strong sense of influence and maintained an independent lifestyle; the Negotiation strategy when they had weak influence and a dependent lifestyle; and the Rejection strategy when they had weak influence and an independent lifestyle.
The data analysis of this study showed that Korean older adults’ influence of and lifestyle toward their surroundings are important factors in selecting strategies when perceiving Growing Futility. Previous studies (Jang, 2006; Park, 1993; Sung, 1997) also reported that older adults’ function of perception affected their emotional state; therefore, this emotional state may have an influence on selecting strategies in perceiving Growing Futility.
The ultimate goal of caring for older adults is to help them live a quality life by maximizing their independence and maintaining welfare levels worthy of their dignity. In this vein, the results of this study suggest it is necessary to seek methods of helping older adults to be recognized by people in their surroundings and to have an independent lifestyle. This study shows that the economic and health status of older adults are the essential factors for maintaining an independent lifestyle. Older adults who were financially independent did what they wanted to do, without conflict with their children. They went to the hospital when they needed health care, and they enjoyed hobbies.
On the other hand, older adults who were not financially independent spent most of their time in senior centers every day, constantly conscious of the reaction of their children. According to Ha et al. (1995), Jang (2006), and J.S. Kim (1998), one of the characteristics typical of Korean older adults is financial difficulty. Some of the most common reasons for conflicts between older adults and their children are negligence by the children, a sense of alienation, and questions about pocket money.
Mehata (1993) claimed that an important factor contributing to loss of independence among older adults is their reduced functional health status. This study also found that participants who were financially and physically dependent were often simply waiting for death. These results were also compatible with the claim that when older adults with a reduced capacity for coping with physical, psychological, and social stress are repeatedly exposed to such stresses, their motivational, perceptional, and emotional aspects are damaged, which eventually results in feelings of helplessness, depression, and despair. In short, it is a vicious cycle of self-destruction (Jeon & Suh, 2004; Kim, 2006; Miller, 1983; Yoon, 1991).
In the contexts above, the intervening conditions that provoked or restricted participants’ strategies toward Growing Futility were the direction of their way of thinking and self-acceptance. The participants’ direction of thinking also formed a basic framework for determining how Growing Futility was expressed.
The results of data analysis in this study show that the participants’ direction of thinking was expressed as future-oriented thinking, which involves hopes, goals, and a planned life, and past-oriented thinking, which dwells on the past. When the participants had a future-oriented outlook, their Growing Futility transformed positively.
These results are also supported by Kim (1995), who reported that when their thinking is hopeful, people predict the results of their actions, have expectations about their future, understand the actions required by social norms and cultures, and accept their social roles. Erikson (1963) emphasized that older adults need to acquire a potential capacity for maturity and wisdom, which is an inner struggle rather than an external adaptation. The data analysis in this study also shows that internal self-acceptance affects Growing Futility in intervening conditions. Ha et al. (1995) stated that when older adults review their life and accept it, they feel self-integrated; otherwise, they feel regret and despair that it is too late for them to choose an alternative lifestyle.
With these actions and interactions between structural situations and contexts, Growing Futility transformed into Adjustment, Wryness, or Despondency, depending on the specific set of conditions. When the participants accepted Growing Futility, they became Adjusted, and when they imputed or rejected Growing Futility, they also became Wry or Despondent. Interestingly, the presence of han, a unique Korean term, was found in this study. Participants who felt a strong degree of Growing Futility and were Despondent by their sense of Growing Futility became sad, had profound grief, and experienced a sense of heartburn.
This study attempts to propose a theoretical framework that will contribute to developing practical and effective approaches for treating the many problems faced by older adults in Korea. The central phenomenon in Korean older adults’ perception of aging was the process of Generating, Expressing, and Transforming Growing Futility. The direction in which the participants’ Growing Futility developed depended on actions and interactions in a set of conditional structures. The results of this study showed that individual and sociocultural factors, including relationships with others, influenced the participants’ surrounding situations, lifestyles, direction of thinking, and self-acceptance.
Without understanding the aging process from older adults’ perspectives, nurses cannot help them make successful adjustments to this stage of life. It is expected that the theoretical model presented in this article will help enhance nurses’ understanding of Korean older adults’ perception of aging and will thereby promote the development of therapeutic relationships and communication between practitioners and patients. A more refined theoretical development of the study of the aging process will be needed, especially when a comparative study becomes available through cross-cultural qualitative research.
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Photo Credit: Kum Sook Oh.
Figure. A Paradigm Model of the Aging Process.
Conceptual Ordering of Data
|Feeling sick, weak, cold, tired, sluggish; having difficulty breathing; being in pain; lacking in strength; experiencing numbness in hands, tingling in joints||Being Weak||Declining||Causal Conditions: Declining|
|Feeling stiffness, malaise, decline; having difficulty moving; being absent minded||Being Ineffective|
|Experiencing a generation gap, no communication, no understanding, no place to go, nothing to do, difference of opinion with others||Being Disconnected|
|Having weak sight, weakened hearing, wrinkles, gray hair, dark spots on the skin; losing teeth, memory||Perceiving Signs of Aging|
|Feeling surprised, bewildered, impatient, worried, agitated, anxious, restless, scared||Being Uneasy||Growing Futility||Central Phenomenon: Growing Futility|
|Feeling futile, solitary, isolated, lonely, sad, empty; being useless, confused; appearing pitiful, poor, melancholy||Feeling Futile|
|Having a bleak outlook, gloomy prospects, lack of capacity; being burdensome, dependent, unbearable, disappointing, envious; feeling hopeless, vague, insufficient, pushed around||Being Depressed|
|Experiencing naturalness, inevitability, obligation, submission, generational shift, passage of time||Being Subject to Fate|
|Feeling overwhelmed by time, that one is killing time, limited, bored, that growing old is tedious, that one has too much time||Being Weary|
|Having activities, participating, having human contact||Connectedness||Relationships||Contextual Conditions: Relationships, Influence, Lifestyle, Health Status|
|Feeling resigned, living alone||Alienation|
|Being intimate, feeling estranged||Relationships with Children|
|Having conflicts, character differences, good relationships||Husband-Wife Relationships|
|Being consulted, asked for help, needed for help; having the right to make decisions||Accepted State||Influence|
|Feeling neglected, rejected||Neglected State|
|Having a small family, an extended family, a life of sharing; living as sole family member, being single||Family System||Lifestyle|
|Having a “giving” life, a dependent life||Financial Status|
|Having good health, disease||Health Status||Health Status|
|Living in a caring environment, making contributions, keeping in practice, achieving||Future Oriented||Direction||Intervening Conditions: Direction, Self-Acceptance|
|Experiencing tenacity, retrospection||Past Oriented|
|Experiencing self-consolation, self-control, independence, generosity||Being Positive||Self-Acceptance|
|Experiencing self-condemnation, self-abuse, self-hatred, desperation||Being Negative|
|Having determination, courage, patience, exertion, enjoyment, self-control, compassion; autosuggestion; controlling desires; being careful; taking care of oneself; suppressing painful memories||Being in Control||Acceptance||Strategies: Acceptance, Negotiation, Imputation, Rejection|
|Enjoying hobbies, enjoying leisure, doing volunteer work, babysitting, job seeking, getting along with one’s peer group||Getting Along|
|Being agreeable, appearing to comply, avoiding negative reactions, demanding attention||Compromising||Negotiation|
|Nagging, interfering, scolding, complaining, blaming||Blaming Others||Imputation|
|Shaking off responsibilities, standing back, rejecting others, showing disinterest, feeling alienated||Turning Back||Rejection|
|Exhibiting consideration, understanding, sharing, caring, caressing||Embracing||Adjustment||Consequences: Adjustment, Wryness, Despondency|
|Feeling comfortable, calm, relieved||Being Careless|
|Achieving, being resolute, dominating, showing off, justifying, being open minded||Standing Firm|
|Feeling empty, meaningless, deplorable, wretched||Being Self-Piteous||Wryness|
|Feeling unsatisfied, annoyed, bothered, irritated, mistreated, hateful, vexed; complaining, blaming||Anger|
|Feeling deflated, overwhelmed, frustrated||Frustration||Despondency|
|Feeling distracted, messy, atrophied, hesitant||Disorientation|
|Feeling sad, grief stricken; having grudges, spite, rancor, han (heartburn)||Resentment|