Journal of Gerontological Nursing

Feature Article 

“It May Be a Bit Uncertain But It's Never Boring”: Thematic Analysis of a Blog About Engaging With Aging

Yan Su, MS, RN; Shumenghui Zhai, MPH; Boeun Kim, MSN, RN; Christina E. Miyawaki, PhD, MSW; Janet Primomo, PhD, RN; Basia Belza, PhD, RN, FAAN

Abstract

Online blogs about healthy aging written by health care professionals and others are increasing. The purpose of the current study was to analyze a first-person narrative blog about engaging with aging (EWA), with a goal of better understanding the process used to manage daily life and inform healthy aging for older adults. Using a thematic analysis approach, 67 blog posts written by a nonagenarian, retired nursing professor were analyzed. Emergent themes revealed the identification of age-related changes (e.g., physical, cognitive, functional, social, societal, psychological), characteristics of the age-related changes process, responses to age-related changes (e.g., feelings, attitudes), approaches and strategies to addressing age-related changes (i.e., the use of internal and external resources), and the outcomes of the approaches. The EWA blog posts help understand the aging experience from the perspective of an older adult, especially functional changes and how they affect daily life, as well as strategies used to adapt to changes. [Journal of Gerontological Nursing, 45(12), 21–27.]

Abstract

Online blogs about healthy aging written by health care professionals and others are increasing. The purpose of the current study was to analyze a first-person narrative blog about engaging with aging (EWA), with a goal of better understanding the process used to manage daily life and inform healthy aging for older adults. Using a thematic analysis approach, 67 blog posts written by a nonagenarian, retired nursing professor were analyzed. Emergent themes revealed the identification of age-related changes (e.g., physical, cognitive, functional, social, societal, psychological), characteristics of the age-related changes process, responses to age-related changes (e.g., feelings, attitudes), approaches and strategies to addressing age-related changes (i.e., the use of internal and external resources), and the outcomes of the approaches. The EWA blog posts help understand the aging experience from the perspective of an older adult, especially functional changes and how they affect daily life, as well as strategies used to adapt to changes. [Journal of Gerontological Nursing, 45(12), 21–27.]

To optimize older adults' functioning and quality of life and meet the anticipated societal need, the American Geriatrics Society recommends advancing knowledge on healthy aging (Friedman et al., 2019; Jacobs, 2019). Healthy aging is a lifelong, ongoing process including optimizing opportunities to achieve health, independence, a successful transition in life-course, and personal and community security; maintain an active role in society; and adherence to attitudes and behaviors known to promote health (Browning, Thomas, Kendig, & Ory, 2015). These ideas address compensatory or adaptive aging strategies used by older adults to cope with health problems as well as normal age-related changes and seem to play a role in maximizing functional capabilities and facilitating well-being.

Research on healthy aging has a focus on geroscience (i.e., the biology of aging) and clinical interventions that slow the aging process and promote a healthy and longer life, with a rationale that slow aging will lead to fewer diseases and bring better quality of life (Kaeberlein, Rabinovitch, & Martin, 2015). The Evidence-Based Geriatric Nursing Protocols for Best Practice is also based on biological and physiological aging (Smith & Cotter, 2016). There is a need to learn from older adults' own aging experience and how older adults themselves adapt to the impact of age-related changes experienced in day-to-day living.

Even less is known about how relatively healthy nonagenarians adapt to the impact of age-related changes. First-person internet blogs are a source of qualitative data that can be used to study this phenomenon (Hookway, 2008; Jones & Alony, 2008). The “Engaging with Aging” (EWA) blog provides an opportunity to examine how one older adult maintains self-sufficiency and well-being.

What facilitates older adults to thrive? What can be learned from resilient, functional, independent older adults? And how might that knowledge be applied to others to promote healthy aging? The aim of the current study was to conduct a thematic analysis of one person's blog about the aging experience. The objectives were to: (a) analyze and identify themes of a blog authored by a nonagenarian on EWA; and (b) identify the implications of the findings. This study is an exploratory first step to extend the knowledge about how older adults experience and manage their day-to-day age-related changes.

Method

Setting and Sample

The blogger is a nonagenarian, retired nursing professor and scholar. While in her 50s, she published textbooks on nursing care of older adults (e.g., Carnevali & Patrick, 1993). While in her mid-90s, her own aging prompted her to write about her first-person knowledge of aging, which she contrasted with the theories and perspectives written by those who were not yet old. She admitted that the content of the blog might not be relevant to others. She hoped that readers would consider her posts as a point of departure for how others might think about their own adaptation to the impact of age-related changes (Carnevali, 2019). The University of Washington Institutional Review Board (IRB) was consulted and they determined the study was a biographical scholarship or a study of one person and/or her works to characterize her, and as such, no IRB approval was needed.

The blogger started writing the blog in 2017 and publishes, on average, one blog post per week. Each post stands alone and has a specific subject. This analysis included 67 blog posts published online between August 2017 and February 2019. Only sentences regarding the blogger's own experiences, discoveries, and insights were included in the analysis. Sentences that had citations, photographs and graphics, and comments posted by readers were excluded. Titles were also excluded from analysis, as most titles were abstract, and the study authors wanted to minimize the potential to distort the meaning and intention of the blogger.

Data Analysis

A thematic analysis approach was chosen to organize key features and insights (Braun & Clarke, 2006; Nowell, Norris, White, & Moules, 2017). Blog posts were analyzed based on the six-phase approach of Braun and Clarke (2006): (1) get familiar with the data; (2) generate initial codes; (3) search for themes; (4) review themes; (5) define and name themes, and (6) produce the report.

All blogs were coded and analyzed in ATLAS.ti version 8. A total of three dyads (six team members) created the initial codebook based on five randomly selected blog posts. During team meetings, all six team members compared their team codes and developed a codebook based on consensus about concepts, descriptions, and quotations. The first (Y.S.) and second (S.Z.) authors independently coded a subset of data (n = 13 posts), and the codes and codebook were reviewed and refined by all team members. The same two authors separately coded the remaining data and the codes were cross-checked with one another. Patterns in semantic content related to the research questions across the entire dataset were extracted as themes. The six-phase method was an iterative and reflective process that required moving back and forth between phases rather than a linear and sequential process.

Trustworthiness

Trustworthiness criteria (i.e., credibility, transferability, dependability, and confirmability) by Lincoln and Guba (1985) and a practical guide for thematic analysis to meet the trustworthiness criteria (Nowell et al., 2017) were used to ensure rigorous and relevant thematic analysis. For credibility, prolonged engagement with the blogger, peer debriefing, and member checking were used.

For peer debriefing, biweekly research meetings were held to share and examine one's own and team members' thoughts and reflections regarding all processes, such as coding and extracting themes. All members reviewed the description of a conceptual framework of EWA written by the blogger (Carnevali, Primomo, & Belza, 2019) to understand her meaning and clarify the study objectives. For prolonged engagement, two team members met monthly with the blogger to review the evolving ideas and interpretation of the data. For transferability, a description of the setting and sample was provided. For dependability and confirmability, the researchers' triangulation of coding and decision making and an audit trail of codes and themes were documented throughout the study. For member checking, a near-final draft of a manuscript was reviewed by the blogger.

Results

The current thematic analysis of 67 blog posts on EWA revealed five major themes: (a) Identification of Age-Related Changes; (b) Responses to Age-Related Changes; (c) Approaches and Strategies to Addressing Age-Related Changes; (d) Outcomes of the Approaches and Strategies to Age-Related Changes; and (e) Characteristics of the Age-Related Changes Process. Related quotes are presented in Table 1.

Emergent Themes and Subthemes in 67 Blog Posts About Engaging with Aging

Table 1:

Emergent Themes and Subthemes in 67 Blog Posts About Engaging with Aging

Identification of Age-Related Changes

Physical. Physical changes in the body included, but were not limited to, reduced vision, impaired hearing, and joint deformity. Physical age-related changes seemed to play a decisive role in aging well.

Cognitive. Cognitive changes included a decline in short-term memory, thinking, and decision-making. “…I not only avoid or delay decision-making, I'm actually distracted, even dithering, in the way I'm functioning” (Post 59).

Functional. Functional changes included a progressive decline in stamina and energy; reduced efficiency and increased lag time; changes in muscle strength and joint flexibility; and a waning sense of balance, limited mobility, and limited living domain. Tasks such as personal hygiene were affected by functional changes.

Role Changes in Society. Changes in the blogger's societal role included the actual or perceived loss of that role: “We become ‘ex-.’ Ex- in our job titles, and relationships. Even with the family members, perceptions and role relationships are altered” (Post 5). Along with role losses, there was also an expression of adopting other social roles.

Dependency and Loss. Aging process adversities included those associated with illnesses, trauma, loss of loved ones, loss of control (meaningless efforts), dithering, and ease of falling. “[I am feeling…] increasingly dependent with concomitant loss of control and privacy” (Post 9). “Also, I found that my aloneness had weakened my willpower” (Post 32).

Responses to Age-Related Changes

Blog posts contained negative and positive feelings toward age-related changes. Negative feelings included frustration, desperation, helplessness, embarrassment, disappointment, being out-of-date, lowered self-esteem, undervalued (when facing ageism), and futility. Genuine sadness was described in regard to the loss of a loved one. Self-confidence changed based on accompanying physical changes as former skills diminished. Fears were noted related to falling, losing a role in society, or having to give up treasured items. Worrying about losing privacy was evident. Positive feelings included relishing solitude and enjoyment in writing a blog. There was a value associated with age-related changes, such that change is inevitable and there is need for adaptation.

Attitudes captured in the blog posts included being positive and holding a strategic stance and being grateful. A strategic stance included inventing a new way to compensate for a limited ability (e.g., scared but trying) and reprioritizing. For the blogger, well-being and happiness became a top priority in life. The blogger expressed a desire to not repeat a bad experience, maintain dignity, maintain independence, be grateful (not blame others), contribute to society, find meaning and motivation in life, and trust in people and equipment.

Approaches and Strategies to Addressing Age-Related Changes

The approaches and strategies used to address age-related changes included the use of internal and external resources. Internal resources included accepting the age-related changes as normal or natural; acknowledging one's capacity; conducting a self-evaluation; finding opportunities to use existing talents; appreciating others who identify talents and provide opportunities; being resourceful, resilient, and relevant; and finding a balance between demand and capacity. Another strategy was identifying alternative methods for solving problems, setting reasonable goals, and motion efficiency (i.e., conserving energy to compensate for limited capacity). There was a need to rely on and trust others, let go of control, and be open-minded. The blogger noted the need for ongoing adaptation and rewarding oneself for learning new ways to adapt. External resources were mentioned, such as one's home, family members, neighbors, friends, and colleagues, but there was less focus on external compared to internal resources.

Outcomes of the Approaches and Strategies to Age-Related Changes

There were physical and psychological beneficial outcomes from strategies for dealing with age-related changes. Physical outcomes included a higher level of energy, increased social participation, improved performance (e.g., better balance), and improved cognitive capacity. Psychosocial outcomes were increased pleasure, enhanced security, being in control, and a focus on the mind rather than the body.

Characteristics of the Age-Related Changes Process

The age-related changes process was persistent, dynamic, and variable: “Change is the name of our game” (Post 21). Aging led to loss and the process being out of one's control. The speed of change was not constant but increasing: “With the growing accumulation of age-related changes and a seemingly faster pace of occurrence, whatever balance I can maintain is going to have to occur at lower levels” (Post 11). The nature of the age-related changes and their impact on daily living include uncertainty about what might happen next. The impact is unpredictable and cumulative. Recuperation takes longer. There was a close physical body–daily living linkage as the aging body triggered attention and emotions.

Change in Age-Related Changes Over Time

The blog posts analyzed were published over a period of 18 months. It is likely that the blogger's experience with and understanding about EWA changed over time. Patterns in the foci of the posts are noted in Figure 1. The terms “changes” and “challenges” were used more frequently over time, whereas the words “resources,” “activities,” and “balance” used to represent EWA strategic approaches were mentioned less frequently over time.

Changes over time of frequency of certain terms used in the blog.Note. In the x-axis, 1 contains Posts 0 to 10; 2 contains Posts 11 to 20; 3 contains Posts 21 to 30; 4 contains Posts 31 to 40; 5 contains Posts 41 to 50; 6 contains Posts 51 to 60; and 7 contains Posts 61 to 67. The y-axis refers to the frequency of the specified words. Change includes change(s) and changing; challenge includes challenge(s) and challenging; resources includes resource(s); activity includes activity and activities; balance includes balance(s) and balancing; engage refers to engage(s) and engaging.

Figure 1.

Changes over time of frequency of certain terms used in the blog.

Note. In the x-axis, 1 contains Posts 0 to 10; 2 contains Posts 11 to 20; 3 contains Posts 21 to 30; 4 contains Posts 31 to 40; 5 contains Posts 41 to 50; 6 contains Posts 51 to 60; and 7 contains Posts 61 to 67. The y-axis refers to the frequency of the specified words. Change includes change(s) and changing; challenge includes challenge(s) and challenging; resources includes resource(s); activity includes activity and activities; balance includes balance(s) and balancing; engage refers to engage(s) and engaging.

Early in the blog, the blogger focused on physical changes. Over time, the focus shifted to intellectual changes: “Now I find myself anticipating time for solitude where insights about being and living with aging materialize, further develop and become distilled” (Post 24). The blogger expanded connections with friends and colleagues when physical issues increased: “My physical world is seriously contained as fits with my current status, but my vicarious world is completely safe, amazingly wide-ranging and continuously, newly fascinating” (Post 33). “My physical world remains highly circumscribed, but my personal world is widening and deepening by the day” (Post 45).

In summary, these emergent themes presented the changes in different age-related changes and how the blogger engaged with age-related changes by developing strategies and eventually explicating the positive outcomes from using those strategies. Characteristics of the age-related changes, the change in age-related changes over time, and the outcomes of strategies for age-related changes supported the idea that the aging process was ongoing, dynamic, and challenging, but for this blogger, strategies helped maximize her functioning as she aged. Member checking with the blogger confirmed that the current authors' understanding of the blog posts was correct.

Discussion

Although many themes were reflected in the literature about healthy aging, findings suggested additional dimensions that inform our understanding of how older adults adapt and grow. Normal age-related changes described in the literature supported the first theme. Age-related changes related to physical and biological functioning (Jopp et al., 2015; Kusumastuti et al., 2016), cognitive functioning (Cho, Martin, & Poon, 2015), and social and psychological functioning (Tkatch et al., 2017) were noted in the literature. In comparison to other age-related changes, functional age-related changes were the most prominent, as they were most frequently experienced by the blogger.

Responses to age-related changes included feelings and attitudes, similar to dimensions of successful aging: acceptance, a positive outlook, inquisitiveness, and self-affirmation (Browning et al., 2015; Jopp et al., 2015). Some feelings and attitudes related to age-related changes indicated the loss of roles that accompanied age-related changes. Based on the current analyses, it appears that some negative feelings and attitudes are normal responses to age-related changes, but the blogger managed to transition her attitudes to strategic responses to age-related changes.

Strategies for adapting to age-related changes have been documented and were reflected in the EWA blog. Personal resources (e.g., resilience) (Jopp et al., 2015; Tkatch et al., 2017; Woods et al., 2016), active engagement in life (e.g., volunteering), and cognitive activities (Cho et al., 2015) motivated older adults to strive for balance, remain active, and validate their own strengths (Rush, Watts, & Stanbury, 2013). Within the blog, ongoing exploration and experimentation with alternative methods to compensate for decreased ability due to age-related changes were found. Using social and/or external resources, a component of successful aging (Cho et al., 2015; Jopp et al., 2015), was mentioned less frequently than internal resources in the EWA blog. This may be due to the fact that the blogger wanted to focus on proactive and self-directed strategies that might be used by older adults to achieve self-sufficiency in day-to-day living at home.

Outcomes of approaches and strategies used to manage age-related changes describe positive aspects of the aging experience (e.g., feeling in control, restoring balance, continuing to learn and grow). Similarly, in a study of centenarians and octogenarians, Cho et al. (2015) examined successful aging and developmental adaptation models noting that age-related physical and functional changes may be modified and compensated for in part by use of psychological and social resources, resulting in positive well-being. Furthermore, Nguyen, Leanos, Natsuaki, Rebok, and Wu (2018) argued that older adults have the potential to adapt to functional changes associated with aging by learning new skills and subsequently maintaining independence. This notion of growth potential in older adults was reflected in the current analysis of the EWA blog.

Characteristics of the age-related changes process were vividly described in the EWA blog as dynamic, variable, and unpredictable; accumulative; and having their own pace of change. In addition, the physical body–daily living link suggested that the physical body plays an indispensable role that cannot be replaced by other factors in daily living for older adults. The two points are nuanced aspects of age-related changes and do not appear to be documented in the literature.

Over time, the blogger seemed to focus more on the outcomes of strategies such as pleasure from writing blogs, sharing knowledge, and pleasure from achieving positive outcomes. The blogger's insights appeared to be deepened by the writing process and focused more on the thinking process and gaining pleasure, which might explain why words of resources, activities, and balance were used less frequently. This shift in thinking may provide insight regarding the developmental stages of older adults.

Limitations

There are several study limitations. First, the sample is the blog of one person. The narration is only as rich as the blogger's insight, bias, and honesty. The current results cannot be generalized to all older adults. However, this blog analysis contributes to healthy aging as an example that promotes citizen science and citizen health. In citizen science, the public is encouraged to collaborate or is seen as being in charge to solve a scientific question (Den Broeder, Devilee, Van Oers, Schuit, & Wagemakers, 2018). The current blog analysis is an example of “extreme citizen science,” a term that means the citizen is in charge of knowledge development (Den Broeder et al., 2016, p. 507). Second, the blogger wrote for an audience rather than a personal journal, which may lead to low validity of the blog content (Hookway, 2008). However, this stance—being aware of the audience's reactions to her blog—can potentially limit biases because the blogger may consider public reaction toward her expressions (Jones & Alony, 2008). Finally, there may be coding bias. Two coauthors coded the blogs. However, the coders regularly checked in with the team. In addition, prior to submission of the manuscript for review by the editorial team, it was reviewed by the blogger.

Implications

Comparison of the different age-related changes showed the variable rates of changes. The blogger's experience highlighted the importance of the functional and physical aspect and how functional and physical age-related changes closely affected daily living. Negative feelings were expressed regarding age-related changes and the impact on daily living; however, the implementation of strategies made a difference, as the blogger noted. Upon further investigation with a larger sample, nurses can take note of these strategies and encourage older adults, including nonagenarians, to use them in similar situations.

The characteristics of the age-related changes process illustrated the ongoing, accumulative, and increasing pace of age-related changes. However, with the implementation of strategies, beneficial outcomes resulted such as restored balance, compensated functioning, and more control of uncertainty. With increasing and accumulative age-related changes, there is an ongoing adaptation and shift from self-target interventions to more reliance on others, such as nurses. It is important for nurses to find a balance between assisting older adults and encouraging them to undertake activities independently.

This blog analysis promotes the legitimacy of the findings in other nursing fields, such as ageism. Although aging experts emphasize the possibilities and capacities of aging, the public holds negative aging attitudes (Sweetland, Volmert, & O'Neil, 2017). The current blogger with an “insider” viewpoint and professional background allows the public to see the normative changes of aging and the potential to manage the impacts on daily living; inspires the public to rethink the aging process and the way they expect to age; and challenges their stereotyping schema that aging is deteriorating.

Conclusion

The current thematic analysis of a first-person narrative online blog written by an independent-living nonagenarian about her day-to-day experiences adds to the knowledge base about the impact of age-related changes and approaches and strategies used to adapt to changes, outcomes, and characteristics of process- and age-related changes. The EWA blog provides an insightful insider's perspective and illuminates what an older adult experiences day-to-day. Further study is warranted on characteristics of the age-related changes process to unveil a clearer picture of age-related changes and their impact on older adults. The current study contributes to the growing body of knowledge about the feasibility of using blogs as data sources; provides older adults with a window into how this older adult thinks about and engages actively with her own age-related changes; and inspires health care professionals to deploy strategies that promote healthy aging.

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Emergent Themes and Subthemes in 67 Blog Posts About Engaging with Aging

Theme/SubthemeSample Quote
Age-Related Changes (ARCs)
  Physical“None of my joints need replacing any time soon, but I do get twinges in my right hip that may be foreshadowing future surgery” (Post 49).
  Cognitive“I still was fortunate to have choices to make, but my comfortable deciding process was eroding. Instead of automatically deciding and doing, I was increasingly dithering, delaying and distressing.” (Post 27)
  Functional“Everything takes much longer as I have to make mini-calculations about how to do every little thing from putting on clothing in the morning to how I remove them at night” (Post 44).
  Social“It was only in my 80s and then with the death of my husband that I really began to experience my personal autonomy in reverse” (Post 5).
  Societal“Life keeps changing and I continue to be green about so many things as I engage with my aging” (Post 31).
  Psychological“I was clumsy, forgetful, messy, made missteps. As it was all going on, the idea began to emerge that there were ARCs that were changing my former skill and confidence” (Post 60).
Responses to ARCs
  Feelings“I truly mourned the loss of and my changing self-image” (Post 5).
  Attitude“And I knew that I would need to think specifically and concretely to be most effective” (Post 11).
Approaches and Strategies to Addressing ARCs
  Internal resources“I imagined myself standing in the middle balancing a pan with daily living demands on the one side, and my resources for meeting those demands on the other” (Post 11).
  External resources“I'm so fortunate that caring and willing family members as well as a small circle of friends of a younger generation (or two) live geographically close” (Post 63).
Outcomes of the Approaches and Strategies to ARCs“Instead, my brain seemed to take advantage of the absence of external stimuli and began to generate activities of its own” (Post 24).
Characteristics of the ARCs Process“Each ARC we experience has substance, it accumulates, and has its own pace of change” (Post 51).
Authors

Ms. Su is PhD Student, Ms. Zhai is PhD Student, Ms. Kim is PhD Candidate, and Dr. Belza is The Aljoya Endowed Professor of Aging, School of Nursing, University of Washington, Seattle, Washington; Dr. Miyawaki is Assistant Professor, Graduate College of Social Work, University of Houston, Houston, Texas; and Dr. Primomo is Associate Professor Emeritus, School of Nursing & Healthcare Leadership Program, University of Washington Tacoma, Tacoma, Washington.

The authors have disclosed no potential conflicts of interest, financial or otherwise. Partial funding was provided to Ms. Su as a predoctoral de Tornyay Scholar. Dr. Miyawaki is also partially supported by the Aljoya Endowed Professorship.

The authors thank Nancy Woods, PhD, RN, FAAN, for her insightful comments on the manuscript.

Address correspondence to Yan Su, MS, RN, PhD Student, School of Nursing, University of Washington, Box 357266, Seattle, WA 98195; e-mail: yans23@uw.edu.

Received: June 06, 2019
Accepted: September 06, 2019

10.3928/00989134-20191105-03

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