Losing memory, losing meaning? Towards a deeper understanding of meaning in life in older adults with Alzheimer's disease

Within psychological science, the concept of meaning in life is understood as the subjective experience that one's life makes sense, has a purpose, and is worth living. Burgeoning empirical evidence shows the benefits of experiencing meaning in life for physical and mental health across different populations, including older adults. However, current views of meaning in life assume that complex cognitive abilities are needed to develop a sense of meaning. This triggers the question of how meaning can be understood for older adults who experience cognitive decline due to dementia. The current dissertation therefore provides an in-depth examination of meaning in life in older adults with Alzheimer's disease (AD). More specifically, we discuss how these older adults understand and experience meaning in life from a qualitative perspective (Part 1; Chapter 1-2), and how meaning in life and key aspects of psychological and cognitive functioning are related to each other quantitatively (Part 2; Chapter 3-7). In Chapter 1, we use a top-down directed content analysis approach to explore the correspondence between scholarly views on meaning in life and the lay conceptions of older adults with AD. The results show that the descriptions of participants with AD largely accorded with current views in the literature but also offer new insights for the conceptualization of meaning, such as the differentiation between felt and cognitive coherence and between future-oriented and fulfilled purpose, and the entanglement of the experience of meaning with aspects of hedonic well-being. In Chapter 2, in-depth interviews are analyzed using a bottom-up phenomenological reflective life-world approach. The essential meaning of the experience of meaning in life for older adults with Alzheimer's disease is formulated as 'continuing to participate in the dance of life as oneself.' This essence is further illuminated by describing its intertwining constituents: feeling connected and involved with others and the world, continuing normal everyday life as yourself, calmly surrendering and letting go, and desiring freedom, growth, and invigoration. Chapter 3 focuses on sources of well-being for older adults with and without AD in nursing homes. We find that for both groups, personal growth is related to higher levels of meaning in life and family is related to higher life satisfaction. For the older adults with AD, society and community is also related to meaning in life. In Chapter 4, we show using cross-sectional data that nursing home residents with AD who endorse higher levels of meaning in life also report lower levels of depressive symptoms and higher levels of life satisfaction, while controlling for demographics, cognitive status, and clustering within nursing homes. Chapter 5 focuses on the relation between quality of life and cognitive functioning for nursing home residents with AD. The results show that residents rate their own quality of life higher than their professional caregivers do. Furthermore, the residents' self-reports are not related to their cognitive status. In contrast, caregivers give lower quality of life ratings to residents who have lower cognitive status. In Chapter 6, we examine the relations between purpose in life, subjective memory beliefs, and memory performance. As a background investigation to the following chapter, this study focuses on a large sample of adults in middle to late adulthood without dementia using two-wave longitudinal data. Cross-lagged panel analyses show that adults with higher sense of purpose are more likely to have higher subjective memory beliefs nine years later. In Chapter 7, finally, we examine the longitudinal relationship between meaning in life and psychological and cognitive functioning in nursing home residents with AD over three waves. Cross-lagged panel analyses show that older adults who report higher levels of meaning in life are more likely to have less depressive symptoms one year later. We find no evidence for a strong relation between cognitive functioning and meaning in life, challenging the strong cognitive assumptions of current psychological conceptualizations of meaning in life. In sum, this dissertation highlights the relevance of meaning in life for older adults with AD, as their personal accounts as well quantitative analyses show the importance of meaning for their psychological health.status: publishe