Life as Experienced Within and Through the Body After the Age of 85 Years: A Metasynthesis of Primary Phenomenological Research

Introduction

Metasynthesis is a rigorous systematic approach to describe a “bird’s eye view” (Thorne, 2017, p. 11) of qualitative knowledge about a defined phenomenon. This metasynthesis seeks to reconceptualize the existing primary phenomenological knowledge of life after the age of 85 years, as experienced within and through the body. There are several compelling justifications for metasynthesis of knowledge in this area. Changing population demographics in this “age of ageing” (Magnus, 2009) suggest that living a long life is set to become a common global phenomenon (World Health Organization, 2018). In many countries, the 85-and-over cohort has been identified as the fastest growing, projected to increase worldwide by 351% between 2010 and 2050 (United Nations, 2018). Despite this, we know very little about the everyday lived experience of this relatively recent and historically unparalleled phenomenon of longevity.

Knowledge emanating from those living through this later stage of the life course is vital to support their present needs and to plan for future cohorts. Several primary phenomenological studies of those over 85 years of age have been published, however, as stand-alone data, and the impact of findings is limited (Erwin et al., 2011). A metasynthesis of the existing descriptions of lived experience after 85 years supports a conceptually comprehensive understanding, creating new interpretive pathways, identifying research gaps, and informing the development of further primary studies (Willig & Wirth, 2018).

The human body is the physical form we inhabit in the identifiable world (Engman, 2019). Arguably, the body—ever-present, yet often unacknowledged—is the medium for any and all human experiences (Gish & Vrkljan, 2016; Gubrium & Holstein, 2003a; Toadvine, 2018). Viewed in this way, the “flesh” is the fundamental ontological lens (Merleau-Ponty, 1945/1962, 1964/1968), and our physical form is not only the body I have, but the body I am (Sheets-Johnstone, 2015). Embodiment research explores the ways in which human experiences manifest, reveal, and conceal themselves in the body (Finlay, 2017). Beyond tangible physical and sensory experiences, it is within and through the body that we experience the social, emotional, cultural, temporal, spatial, and existential dimensions of life (Van Manen, 2011). Accordingly, it is within and through the body that we experience different stages of life, including life after 85 years (Clarke & Korotchenko, 2011; Todres, 2008).

Merleau-Ponty’s notion of embodiment is a fusion of existentialism and phenomenology, searching for meaning in everyday embodied experiences (Thomas, 2018). Wainwright and Turner (2006) describe the existing research on the aging body as “. . . ignoring the practical experiences of embodiment” (p. 238). Existing conceptualizations of aging and the aging body have been disparate and from narrow dualistic camps of theoretical thought (Martin & Twigg, 2018). Although the body is central to the understanding of aging (Clarke & Korotchenko, 2011), very little research has been done to ascertain and describe the embodied experiences of individuals over the age of 85 years. Metasynthesis of primary phenomenological research overcomes these shortcomings by describing nuanced accounts of everyday experiences using the voices of individuals over 85 years. Therefore, with the aim of reconceptualizing existing knowledge through the philosophical lens of embodiment, this metasynthesis sought to answer the following research question: How is everyday life over the age of 85 years experienced within and through the body?

Method

The typology of this review is metasynthesis, a systematic method of analyzing and reconceptualizing primary qualitative literature (Erwin et al., 2011; Ludvigsen et al., 2016). Metasynthesis involves analytical reinterpretation and integration of knowledge (Sandelowski & Barroso, 2007). Sandelowski and Barroso’s (2007) iterative method of metasynthesis was engaged, comprising the following steps: (a) formulating a review question and philosophical positioning, (b) conducting a systematic literature review, (c) appraising findings, (d) extracting and analyzing findings, (e) reconceptualizing and synthesizing findings, and (f) presenting findings.

Procedure

Primary phenomenological studies exploring the lived experience of individuals over the age of 85 years were considered for review. Further criteria for inclusion were that they were peer-reviewed, English language studies published after the year 2003. The following databases were searched: CINAHL Plus, PubMed, and Ebsco-host, including results from Medline Complete, Academic Search Premier, Allied and Complementary Medicine, PsycArticles, and PsycInfo. Google Scholar was also searched, where a PhD thesis of high relevance was obtained. Search terms were broad and organized into two sets, namely, “phenomenolog*” OR “lived experience” AND “85-years” OR “oldest old” OR “elderly” OR “nonagenarian” OR “centenarian”. The literature searches were conducted in December 2018.

Duplicates were eliminated and abstracts scanned for alignment with inclusion and exclusion criteria. Further studies were identified through screening of reference lists (Sandelowski & Barroso, 2007). Studies were read in full by Brianne van Rhyn, and preliminary study selection involved broadly regarding whether the body emerged as “story-teller” (Finlay, 2017) in the primary data, even if implicitly so. Studies that met this measure were then considered analogous with the philosophical positioning of the metasynthesis (Sandelowski & Barroso, 2007) and subsequently comprised the data that informed the metasynthesis. Once the primary studies for inclusion were chosen, initial analysis involved extracting direct quotations, or “significant statements.” Care was taken to preserve the context in which the experience was described in the primary study, as well as the original researchers’ interpretations (Lachal et al., 2017).

Through a reflective process guided by Maurice Merleau-Ponty’s (1945/1962, 1964/1968) philosophy of embodiment, initial impressions of how the data elucidated the research question, How is everyday life over the age of 85 years experienced within and through the body? were formed by Brianne van Rhyn. In collaborative peer review with more experienced researchers, Alex Barwick and Michelle Donelly, themes were identified as they relate to embodied experiences. Table 1 exemplifies the process of identifying embodiment themes. A total of 32 themes was identified, and these were then organized into four dimensions using Max van Manen’s (1990, 2011) reflective lifeworld existentials framework.

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Table 1.

Example of Identification of Themes.

Significant Statement	Initial Impressions	Theme
A 98-year-old man pointed to his foot and said, “that’s the problem look at that” (Clancy et al., 2015, p. 6)	Blaming, accusatory Body as fragmented/foreign Mistrust in body	Disembodiment
A woman over 85 years describes loneliness: “It’s an emptiness. I almost feel it in my chest, just a little heaviness. I’m not gonna cry, I’m not going to be outwardly sad, but I can feel it in my body . . . Like pressure . . . pressure in my chest. I probably wouldn’t think of it consciously unless I’m really just focusing on what’s happening to me” (Smith, 2012, p. 50)	Loneliness embodied as emptiness/heaviness Body part: chest No outward manifestation (tears, outward expression) Train of thought expression: pre-reflective	Abstract emotion embodied
A woman over the age of 85 years describes how she navigates the stairs at home: “I’ve worked it out. I really don’t stand up and walk up the steps. I kind of crawl up. I put my hands on a couple of steps up. I don’t touch my knees. I put my feet down. You can learn how to do something if you have to. I couldn’t go up stairs in public” (Hinck, 2004, p. 787)	Learning new ways Adaptation, resilience Limitation of navigating public spaces Specific cognitive-driven technique Loss of pre-reflective, habitual body	Bodily compensations Resilience Thinking before moving

Results

The database searches collectively produced 629 articles for consideration, including duplicates. A further four studies were identified through screening of reference lists. After duplicates were removed and abstracts were read, a total of 37 studies met the criteria on first assessment. The preliminary selected studies were then read in full by Brianne van Rhyn and appraised for quality utilizing the Critical Appraisal Skills Program (CASP; 2018) tool. Through this process, a further 18 studies were excluded for reasons pertaining to methodology, study participants, and presentation of findings. Reasons for exclusion included the age range of the participants was too broad, for example, 65 years and older, although exception was made if the majority of participants were 85 years or more; the study did not include direct quotations; if the study explored perspectives other than those of individuals over the age of 85 years, for example, their spouses or carers; and if no embodied experiences were explored or described.

As recommended by Sandelowski and Barroso (2007), no studies have been excluded based on quality, however, all findings will be considered within the context of the appraisal. Details of the appraisal findings can be viewed in the supplementary material. At the conclusion of the selection process, a total of 19 primary phenomenological studies, including a PhD thesis, were included in this metasynthesis. A flowchart of the selection process is presented in the supplementary materials.

Ontological Dimensions

Through analysis of the extracted data, themes were organized as ontological dimensions using Van Manen’s (1990, 2011) reflective lifeworld existentials framework (Figure 1). The four dimensions are being in a body (corporeality), being in time (temporality), being in place (spatiality), and being with others (relationality). Although these ontological dimensions serve to organize the lived experience, they are not to be viewed as independent from one another in any way. Instead, they are interwoven and overlapping aspects of the lifeworld (Rich et al., 2013). The participants’ words are italicized. If presented in the primary data, the participants’ gender and age are also stated.

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Figure 1.

Reflective lifeworld existentials framework.

Being in a Body

It was in the physical body where participants described some of the most pervasive ontological experiences of life after 85 years. Julia Pusztai (2015) describes these corporeal experiences as the “loud-speaking body” (p. 98), a body characterized by the loss of its previously taken-for-granted and pre-reflective nature (Leder, 1990; Merleau-Ponty, 1945/1962). Participants, such as this 88-year-old man, describe having to actively think about previously “second nature” tasks such as walking: “I’m aware now of taking steps, whereas before I didn’t think about walking, I just walked” (Pusztai, 2015, p. 139). The loss of the pre-reflective body was perceived as a threat to keeping safe, especially in relation to the risk of falls: “I’m a little more cautious when I go out that back door . . . That’s for sure. I take hold of the railing” (woman, Hinck, 2004, p. 787); “. . . I went over backwards at my son’s house, opened up my skull . . . never back up . . . turn around very slowly” (man, 100 years old, Pusztai, 2015, p. 142).

Consciously planned ways to mitigate the risk of falling was a common thread in the primary studies. This woman describes how she navigates the perilous trip to collect the mail:

. . . I go down my walk. There’s a steep place. I can go down it all right but coming back, that throws me off over in the grass. So I usually go down that way to the mailbox, but I come back the driveway. (Hinck, 2004, p. 788)

Many participants described similar ways of modifying activities to abate the risk of falling. One woman describes how she gets everything she needs for baking out of the cupboards, pantry, and fridge before starting the task to avoid having to move around the kitchen (Larsson et al., 2009, p. 105). Another, aged 93, says, “I can still walk around the block . . . I usually take my wheelchair and push it, then when I’m tired I sit down” (Pusztai, 2015, p. 130). Strategies to keep safe were a prevailing topic of conversation. When asked what she would take a picture of that symbolizes this time of her life, a 90-year-old woman says, “The walker . . . and the bath bench, and the grab bars” (Pusztai, 2015, p. 98).

Similar to the loss of the taken-for-granted and pre-reflective body is the loss of the habitual body (Fuchs, 2012), as this 93-year-old woman describes,

I used to knit and crochet, but my hands just won’t go anymore [laughs]. . . I just couldn’t make my fingers work. . . I lost whatever it takes to make it go! It was just awkward. I couldn’t seem to turn the yarn the right way. (Pusztai, 2015, p. 102)

Long-standing bodily truths such as limb-dominance are challenged, as the following 98-year-old woman describes in relation to buttoning a shirt: “. . . the right hand didn’t seem to want to button it . . . it took me a long time. It seemed so ridiculous. My right is supposed to be better than my left” (Pusztai, 2015, p. 100).

Many participants describe learning new ways, or “little tricks” (Hovbrandt et al., 2007, p. 81) to overcome bodily losses, for example, going up stairs: “I’ve worked it out. I really don’t stand up and walk up the steps. I kind of crawl up. I put my hands on a couple of steps up” (Hinck, 2004, p. 787). Similar accounts of compensations for functional losses were described throughout, for example, by these two women aged 90 and 97 years, respectively: “. . . we found, they’re little . . . toothpicks, but I use them better than floss . . . with my arthritic hands . . . floss is not good for me” (Pusztai, 2015, p. 98); “I have a rubber gizmo. . . that clamps onto it [jar] and shshhhh [it opens] . . .” (Pusztai, 2015, p. 134).

Some participants expressed experiencing their body as foreign, articulating discord between their changing body and sense of self: “. . . nothing’s right anymore” (Pardo et al., 2018, p. 12); “I will never be the person I was before. . .” (Bruun-Olsen et al., 2018, p. 6). In a study exploring older people’s experiences of recovery from a hip fracture, this woman describes her body as unfamiliar: “My body feels very cold, very warm, very eh . . . different” (Bruun-Olsen et al., 2018, p. 6). Similarly, two male participants, 98 and 89 years of age, respectively, blame their failing limbs for their fall. The first, accusingly pointing to his foot, says, “that’s the problem look at that”; the other, pointing to his legs, “that there is the problem” (Clancy et al., 2015, p. 6). This suggests incongruence between their unpredictable, unreliable body and their sense of self, in a tone of resentment. An Italian woman lifts her hand and says, “I can’t do anything. This shakes” (Pardo et al., 2018, p. 12). Revealing language, such as this hand and that foot, not my hand or my foot, indicates a disembodied experience.

Sometimes, this untrustworthy body presents itself gradually, as this 93-year-old man with several vertebral fractures describes:

It gives me a pain that can be compared with carrying a very heavy bag of cement on my shoulders . . . all day, anywhere and anytime. I wake up with it, I go to sleep with it . . . (Van Wijngaarden et al., 2015, p. 261)

To others, like this 90-year-old woman, the change is abrupt: “That morning . . . I couldn’t hardly get up . . . I couldn’t believe it. This is not me! What has happened to me?” (Pusztai, 2015, p. 103). In the same way, a 92-year-old man describes the sudden nature of changes in his body: “. . . my body began to talk to me. Almost one morning my knees were stiff . . . So it [the body] was mobile and it wasn’t” (Pusztai, 2015, p. 101). The changes experienced in their bodily function and mobility provoked existential questions, as this woman expresses: “Suddenly I feel old . . . Suddenly one starts to count the years . . . how many years do I have left?” (Bruun-Olsen et al., 2018, p. 6).

Tensions between “what I want to do” and “what I can do” were common, especially in the voices of women, who described their desire for leisure occupations such as singing, painting, crocheting, knitting, collecting, shopping, and reading. Deteriorating vision was mentioned as the most common obstacle to these pursuits, as the following women describe: “I’d like to read but my sight’s a bother” (Pardo et al., 2018, p. 12); “I used to collect stamps . . . but I don’t have the vision for that kind of stuff now” (Pusztai, 2015, p. 113); “The worst thing is not being able to see . . . I can’t do any sewing . . . or thread a needle” (Haggblom-Kronlof et al., 2007, p. 197). An 87-year-old woman in nursing care, previously an avid painter, describes how her advanced retinal degeneration has affected her:

You lose so much that you are no longer human . . . I see nothing, I see nothing but blackness . . . in spring, it’s so beautiful out here. That little pond with those trees and the daffodils all in bloom . . . the delicate green of the weeping willows . . . But now, it’s all black. (Van Wijngaarden et al., 2015, p. 261)

Being in Time

The philosopher Jan Baars (2012, 2017) describes the social, cultural, and individual constructs of time, beyond traditional chronometric notions. The changing meaning of time emerged as a significant ontological dimension in the lives of the individuals over the age of 85 years. A temporal paradox was described by several participants in that, as their bodies were perceived to move slower, time seemed to move faster. On one hand, doing things “has to take longer”; “you have to leave yourself plenty of time . . . everything is long-winded and slow” (Larsson et al., 2009, p. 106); “I’ve very much slowed down” (Pusztai, 2015, p. 113). On the other hand, “one feels that the day ends before it begins” (Fischer et al., 2008, p. 264); “the day just slips away” (Larsson et al., 2009, p. 106).

Participants described the additional time it takes to complete everyday tasks. This 93-year-old woman describes getting up from a chair: “It takes me a little longer, and I make sure my feet are down, you know . . . then I brace myself like this, and sometimes I grab a hold of there” (Pusztai, 2015, p. 108). Similarly, an 87-year-old woman describes the cognizant nature of doing things: “I have to . . . think of what I’m doing, and so it’s slower, a lot slower” (Pusztai, 2015, p. 109). Everyday examples include pruning: “I’ve got a shrub out there that needs to be trimmed. So I cut off one limb today. And then I quit. Tomorrow I will cut another limb off” (Hinck, 2004, p. 787); or getting dressed: “I’m up at 6.30 because getting on a dress shirt, and the tie, and the trousers, and coat . . . is a little more time consuming than it used to be” (93-year-old male, Pusztai, 2015, p. 107).

Several participants expressed a preference of doing things by-the-clock, deliberately seeking out patterns, routines, and “staying in old tracks” (Larsson et al., 2009, p. 104). This was often to negotiate bodily restrictions, as described by a 92-year-old man:

. . . because of my [condition], I’m limited . . . I have a fixed routine. I go up the pool, do some exercises, and go back down the pool. That takes four minutes. I do five of those . . . (Pusztai, 2015, p. 129)

Some did not have a clear reason for their time-bound routines, such as this 93-year-old man: “I wake up at six o’clock in the morning and start looking at the clock because I have some thought about getting up at 6:30, and why 6:30, I don’t know . . .” (Pusztai, 2015, p. 129); and this 85-year-old Brazilian woman: “. . . I need to get up early, I make very hot coffee, because I like very hot coffee . . .” (Caldas & Bertero, 2007, p. 380).

A man, aged 92, describes how seeking out patterns and routines is a changed aspect of his identity, which is unique to this later stage of life:

Most of my life . . . I tried to do something different. So if I got into a pattern, I consciously tried to change it. But now, I try to develop patterns that are the same . . . For example, I take Metamucil, and right now, I can look in the kitchen, and I know from where the jar is sitting that I had it this morning and I’m going to have it this afternoon. (Pusztai, 2015, p. 118)

Some participants pragmatically aligned their bodily functions to clock-time, such as this 91-year-old woman:

I try to drink my water early enough in the day so I reduce the bathroom trips as much as possible . . . my first trip is . . . about midnight to 2, the next one might be 4:30 to 5 . . . (Pusztai, 2015, p. 124)

In contrast to pursuing patterns and routines, some participants described their days to be “almost alike” (Larsson et al., 2009, p. 103) and that they found life to be “terribly monotonous” (Gudmannsdottir & Halldorsdottir, 2009, p. 322). A man receiving palliative care for incurable cancer articulates this tedium as it manifests in his everyday life:

I interfere in every small damn thing . . . And my wife says, hell, you have never cared about this before . . . I ask her if she has tried another dishwasher detergent as it seems cheaper than the other . . . often it is just because I have nothing else to do . . . what the hell am I going to do today? (Sjoberg et al., 2017, p. 5).

In contrast to previously described notions of time moving more swiftly, some participants felt that “. . . life has come to a standstill” (Sjoberg et al., 2017, p. 5).

An irony was expressed by several participants, in that although more free time is available to do things at this stage of life, the motivation to do them is waning: “In some ways I’ve got more free time, in other ways no. Because there are lots of things I don’t feel like doing. I used to be more interested. Life is winding down” (Pardo et al., 2018, p. 13). This was echoed by others: “I’ve got lots of things to do, but I can’t make myself do them and that’s the biggest problem” (Pusztai, 2015, p. 111); “when you get older, you don’t want to do things you did when you were younger. You just don’t care” (Hinck, 2004, p. 787).

Existentially, time refers to the subjective perception of the past, present, and future (Baars, 2012; Van Manen, 1990, 2011). The past was a source of comfort to many participants, who became animated when reliving memories (Clancy et al., 2015). Several participants explored the joy of reminiscing: “I have a great ability to sit in my armchair and meditate . . .” (Nygren et al., 2007, p. 1066); “I can sit and imagine . . . Sometimes I am swimming by the east sea coast” (Fischer et al., 2008, p. 264). Most participants lived in the present moment, with several expressing variations of the statement “taking life as it comes” (Nilsson et al., 2003, p. 352). The future is experienced as an arm’s-length extension of the present, rather than looking far ahead (Nilsson et al., 2003), as this woman describes in her upcoming plans:

. . . now I got my eye done [cataract surgery], [I thought] I’d start back [painting] . . . Maybe my paints may not be any good cause I haven’t looked at them for probably three years or so. I might buy me some new paints. (Hinck, 2004, p. 786)

Being in Place

As with time, place was perceived as significant to those over 85 years (Dekkers, 2011; Krasner, 2006). Spatiality refers to the various environments that we navigate with our bodies (Van Manen, 2014). Home is a particularly important place for the over 85-year cohort (Krasner, 2006; Zemke, 2004) and was frequently described by participants. Home represents the intersection of familiarity, independence, and autonomy, as well as ties to past memories and relationships: “. . . a precious place to be” (Hinck, 2004, p. 784). The concept of “at-homeness” (Molony, 2010; Saarnio et al., 2017) refers to home as both an actual and an existential place of feeling safe and centered, as this woman describes:

My home is the framework around my daily life . . . In your own home, you can shield yourself. I feel that I am the one who sets the agenda in my own home. That gives me a good feeling. (Bergland & Slettebo, 2015, p. 2167)

Referring to her “home base,” this widowed woman describes having to justify staying at home:

Shortly after my husband died, people started to ask . . . where do you live now? I live where I have always lived . . . It doesn’t get any larger just because there is only one person rambling around in it. (Bergland & Slettebo, 2015, p. 2167)

In contrast, another widow describes the symbolism and dread of going to functions and seeing “the empty chair” where her husband would have sat (Smith, 2012, p. 48). Some participants found solace in past memories associated with their home, as this widowed woman describes of life on the farm: “Sometimes living alone gets a little depressing. But if I get out and take a walk . . . ‘[c]ourse we lived here so long that I know what we grew in this field and that field” (Hinck, 2004, p. 784).

The loss of home and “at home-ness” (Molony, 2010; Saarnio et al., 2017) was described in despairing terms (Johnson & Bibbo, 2014), as articulated by this 89-year-old man: “I am finished, completely finished; I am stuck here at the nursing home” (Clancy et al., 2015, p. 6). A woman describes the loss of home as extending to a loss of autonomy and privacy:

After the fracture, my children decided that I had to sell the house and move out . . . Everything was well before the fracture. After the fracture the consequences was a disrupted life . . . suddenly I was under surveillance. (Bruun-Olsen et al., 2018, p. 6)

Beyond home, some participants described finding solace in nature: “. . . if I’m out in the garden I don’t feel lonely and even if I’m only seeing the birds, it’s enough company for me” (Ness et al., 2014, p. 5); “. . . the growth and the seasons changing and the wind whistling and storming sometimes and perfectly still sometimes, the moon shining so fantastically . . .” (Hovbrandt et al., 2007, p. 80). In a broader, existential sense of being-in-the-world, the perception of space was experienced in more abstract ways. One man feels as though he is “. . . looking through the wrong end of a pair of binoculars”—instead of things getting closer, everything appears to be distorted, moving farther and farther away: “It is like the end of a curve, a vacuum . . . Not my world anymore” (Van Wijngaarden et al., 2015, p. 261).

Being With Others

The ontological being shares its common world with others, distinct from the self (Van Manen, 1990). Relationality entails everyday social encounters, interactions, experiences, and relationships (Applebaum, 2012), as well as how the self is influenced by the presence or absence of others (Merleau-Ponty, 1945/1962). The participants describe others in various social capacities, from interactions with broader society to close relationships with friends, family, and partners.

Relationality, as described by Van Manen (1990, 2011), extends to the interpersonal space between people. A woman with impaired vision describes how she navigates crossing the road by means of spatiality and relationality through an urban societal lens:

I try to . . . slip in when others walk [laughs] . . . I feel when there’s someone standing beside me . . . I feel it . . . and when they walk then I roll along, I follow the pack . . . (Hovbrandt et al., 2007, p. 81)

Others, such as this 92-year-old man, describes being disconnected from society:

You have no effect on anything . . . The ship sets sail and everyone has a job, but you just sail along . . . I am cargo . . . That’s not easy . . . That’s not me! No, no, no, no, no! . . . I simply feel ignored, completely marginalized . . . side-lined in all areas. (Van Wijngaarden et al., 2015, p. 261)

Participants compared themselves with others in their age cohort. The majority expressed contentment when viewing their body in this relative way, describing themselves as typical “for my age” (Hinck, 2004, p. 785). Social comparisons contributed to acceptance of bodily issues: “I know a lot of my friends have different things wrong with them like arthritis, take cold pretty easy, have a lot of foot trouble” (Hinck, 2004, p. 785); “. . . one has a pacemaker, another one has pain in her legs, one has had a knee operation, another had an operation on her hip, and so on” (Larsson et al., 2009, p. 103). The normalization of bodily changes was sometimes expressed explicitly: “. . . I had a vertebra broke right in the lower part of my back. I guess at my age, it’s nothing unusual” (Hinck, 2004, p. 785); “When you get to 92, you are supposed to have . . . a pain here and a pain there” (Hinck, 2004, p. 785). However, some participants, such as this 90-year-old woman, describe a dissonance between how they perceive themselves compared with their social cohort: “I didn’t know I was old until I moved in here with all these gray-haired folks! Gray-haired OLD folks [stated with emphasis]! It just didn’t dawn on me. You’re old just like they are” (Pusztai, 2015, p. 103).

Participants described relinquishing previously held social norms and expectations, as this woman describes:

You may wonder why I don’t wear hose . . . I got to where it was just hard for me to get them over my foot. So I thought, what the heck, I’ll just go bare legged. I don’t care what people think about it. (Hinck, 2004, p. 787)

A 90-year-old woman describes, with humor, the multidimensional bodily losses that threaten social dignity: “I’m finding myself like when I eat, when I chew tobacco, it’d just be running down like this [laughs]. I’m slobbering . . . Then my eyesight is not able to check whether my clothes are soiled . . .” (Pusztai, 2015, p. 97). Others less humorously describe threats to their dignity as “an on-going humiliation” (Van Wijngaarden et al., 2015, p. 262). A 92-year-old man makes the following observation: “You know the phrase ‘it’s hard to grow old gracefully?’ . . . Well, it is . . .” (Pusztai, 2015, p. 99).

Personal relationships were complex, as older people navigate the fear of being a burden to others, especially their children, “because they have their own lives to live” (Hinck, 2004, p. 784). Some participants expressed feelings of abandonment: “You can’t expect them [his children] to be here every day to pat this old man . . . That’s the way it is now. You must not be too demanding” (Gudmannsdottir & Halldorsdottir, 2009, p. 323); others of feeling misunderstood: “. . . I know that the people around me do what they can for me, but they can’t be me” (Bruun-Olsen et al., 2018, p. 5). Relationality extended to pets, and several participants found companionship in animals, for example, this woman describes her cat as “. . . always there for me” (Smith, 2012, p. 48).

Hearing loss was a frequently expressed inhibitor to communicating with others: “. . . because of my hearing problem, my social interactions are limited” (Pusztai, 2015, p. 115). The quality of social interactions was also affected by hearing loss, resulting in frustration and withdrawal:

. . . this is a major handicap for me socially . . . when I go down to dinner, the noise level is so high . . . that is just extremely frustrating. So, I grin, and smile, and nod . . . ‘cause I know what the subject is, and from the inflections, I can tell when I’m supposed to respond. (Pusztai, 2015, p. 115)

“What I try to do is be gracious and say ‘I can’t hear you’ or ‘Would you speak more loudly?’ . . . I find myself just withdrawing from the conversation” (Smith, 2012, p. 49). The loss of hearing predisposes the older individual to social isolation, loneliness, and depression (Courtin & Knapp, 2017).

A life partner passing away was expressed as an embodied traumatic experience, with the grief of this woman losing her husband described as “. . . the hardest change in my life. My life was turned upside down. Everything, everything . . . I felt paralyzed . . . I was completely alone” (Pardo et al., 2018, p. 13). Another described the grief and absence with “. . . only half of me is here” (Smith, 2012, p. 50). Loneliness manifested in the body in different ways, for example, restlessness—“I squirm in my chair . . .” (Smith, 2012, p. 49); fatigue, feeling “limp, like a rag doll” (Smith, 2012, p. 50); emptiness, like a “vacuum”; or a heaviness “in my chest” (Smith, 2012, p. 50). A 94-year-old man who believes that life is no longer worth living, metaphorically describes his social isolation: “. . . I feel like a sawed-off tree. Completely sawed-off. But a sawed-off tree still has roots. I have no roots anymore, no strong bonds anymore, and no close connection to life anymore” (Van Wijngaarden et al., 2015, p. 260).

Discussion

This metasynthesis contributes new insights into the experience of life after 85 years. Four ontological dimensions were identified through extracting, analyzing, and reconceptualizing existing phenomenological data, through the existential philosophical lens of embodiment. The four ontological dimensions identified are being in a body (corporeality), being in time (temporality), being in place (spatiality), and being with others (relationality; Van Manen, 1990, 2011). These dimensions offer broad yet nuanced insights into how life is experienced within and through the body after 85 years. Merleau-Ponty’s embodiment philosophy challenges us to consider the body as the unwavering vantage point of perception (Thomas, 2018). In this way, the body tells the story (Finlay, 2017; Van Manen, 2011). Phenomenological data grounds the ontological expressions of this stage of the life course in everyday experiences (Smith, 2012). What we do in everyday life, within and through our ever-present body, is inseparably connected to an individual’s identity and meaning-making (Hasselkus, 2002).

To our knowledge, no prior phenomenological inquiry has exclusively explored the experience of life within and through the body in this age cohort. However, examination of existing phenomenological research of participants aged 85 years or more demonstrated that the body is, in fact, central to the everyday lives of this cohort. A large number of thinkers, drawing on Merleau-Ponty, contend that our bodies are “largely unproblematic and taken-for-granted” (Williams, 1996, p. 24) only becoming salient when disrupted (Lala & Kinsella, 2011; Leder, 1990). The previously unseen body intrudes on awareness when it experiences pain, discomfort, and, perhaps, when it ages (Clarke & Korotchenko, 2011; Shilling, 2012; Williams & Bendelow, 1998). Aging is, therefore, both a corporeal and existential reality in which the body may become more present in disquieting ways (Gish & Vrkljan, 2016). This embodied transition is described by some as gradual and by others as abrupt (Clarke & Korotchenko, 2011; Engman, 2019).

In this metasynthesis, we observed that participants in the primary studies describe the previously absent body as a significant presence in their everyday lives. The body is perceived as an obstacle (Haggblom-Kronlof et al., 2007), as foreign and unreliable (Bruun-Olsen et al., 2018; Clancy et al., 2015; Pardo et al., 2018), and as the cause of feeling trapped (Sjoberg et al., 2017) and isolated (Dickens et al., 2011; Smith, 2012). The perception of the body as an obstacle echoes Gilleard and Higgs’s (2018) reflections on the body as “betrayer” or “traitor” to the individuals’ sense of self. Loss of the habitual and taken-for-granted body (Fuchs, 2012) is one of many losses experienced by older people. Multidimensional losses extend to loss of health and mobility (Hinck, 2004; Hovbrandt et al., 2007; Larsson et al., 2009; Pusztai, 2015), of meaning and purpose (Sjoberg et al., 2017), of independence and autonomy (Bruun-Olsen et al., 2018; Gilleard & Higgs, 2010), of dignity and the will to live (Van Wijngaarden et al., 2015), of home (Johnson & Bibbo, 2014; Saarnio et al., 2017), and of friends and loved ones (Ness et al., 2014; Pardo et al., 2018; Smith, 2012). This culmination of losses can result in existential pain and suffering (Gudmannsdottir & Halldorsdottir, 2009).

In several studies, these multidimensional losses amounted to a crisis, which required the older persons to adapt and to find a new way forward. This was sometimes achieved by modifying practical tasks or the physical environment (Caldas & Bertero, 2007; Hinck, 2004; Hovbrandt et al., 2007; Larsson et al., 2009; Pusztai, 2015), however, some suggest that it requires a complete reshaping of the individual’s sense of self and identity (Bergland & Slettebo, 2015; Haggblom-Kronlof et al., 2007; Kaufman, 1986, 1993; Ricoeur, 1992). The idea of evolving identity at this stage of the life course lends support to Erikson and Erikson’s (1998) theory of development, wherein the last stage of life is characterized by looking back and evaluating a life lived. This process of sense-making is deeply existential (Dahlberg et al., 2009; Frankl, 1988).

The majority of phenomenological accounts explored in this metasynthesis resonate with aspects of Baltes and Baltes’ (1990) model of selective optimization with compensation. This model proposes that an older individual selects and optimizes their best abilities while compensating for declines and losses; in simple terms, “doing the best one can with what one has” (Baltes & Smith, 2003; Carpentieri et al., 2017). With a few exceptions (Bruun-Olsen et al., 2018; Clancy et al., 2015; Smith, 2012; Van Wijngaarden et al., 2015), participants describe, without resentment, the necessity of finding new ways of doing, or being, at this stage of life. In addition to compensating for losses, existential reflection and adjustments to the individual’s sense of self contributed to resilience at this stage of life (Browne-Yung et al., 2017; Moyle et al., 2010; Ramsey, 2012). Carver and Scheier (2002) reflect on how strength can be found in both perseverance and in relinquishing—and the crux lies in knowing when to choose one position or the other.

Similar tensions are described throughout the phenomenological data. This is well captured in the title “embracing opposites” (Fischer et al., 2008) where simultaneous contradictory experiences are described—weakness in body and strength in spirit (Caldas & Bertero, 2007; Nygren et al., 2007; Pardo et al., 2018; Pusztai, 2015), regret and reconciliation (Fischer et al., 2008; Haggblom-Kronlof et al., 2007; Ness et al., 2014), connectedness and loneliness (Bergland & Slettebo, 2015; Fischer et al., 2008; Smith, 2012), independence and dependence (Bruun-Olsen et al., 2018; Nygren et al., 2007). Here, a salutogenic orientation (Antonovsky, 1985, 1987) is analogous with the lived experiences of older individuals, in that well-being is defined by their sense of coherence, coping, and balancing the dichotomies of the aging experience (Bergland & Slettebo, 2015; Fischer et al., 2008; Hinck, 2004; Ness et al., 2014; Nygren et al., 2007).

Temporal perception was an existential dimension where paradoxes and distortions were prevalent for those over 85 years of age. It is evident that time—both chronometric clock time, as well as linear perceptions of the past, present, and future—are experienced in a different way compared with other stages of the life course (Caldas & Bertero, 2007; Haggblom-Kronlof et al., 2007; Larsson et al., 2009; Nilsson et al., 2003; Nygren et al., 2007; Saarnio et al., 2017; Shin et al., 2003). Tornstam’s concept of gerotranscendence postulates a “redefinition of time” in later life (2011, p. 168), particularly a decreased distinction between the past, present, and future. The complexity of subjective temporality has been studied by scientists and philosophers alike (Baars, 2012; Van Manen, 1990). It is accepted that time is culturally constructed (Janca & Bullen, 2003). However, there is a paucity of empirical research of this phenomenon in individuals over 85 years, indicating a gap in knowledge and an opportunity for future research.

Phenomenological philosophers including Levinas, Heidegger, Sartre, and Merleau-Ponty describe the lifeworld as it relates to spatiality (Dekkers, 2011). The places we inhabit are one of the cornerstones of the lifeworld (Forsund et al., 2018; Van Manen, 2011). Todres and Galvin (2010) write about ontological dwelling as extending beyond the environment we are in, to a larger Heideggerian notion of Gegnet—a wholeness, a sense of belonging, and being at home in the world. In this way, place becomes a source of existential meaning (Molony, 2010; Tornstam, 1989). Home and “at-homeness” have a significant bearing on well-being (Bruun-Olsen et al., 2018; Clancy et al., 2015; Gudmannsdottir & Halldorsdottir, 2009; Hinck, 2004; Saarnio et al., 2017; Sjoberg et al., 2017). These findings have implications for policy makers and planners to enable resources to support older people who wish to remain at home for longer, as well as designing nursing homes, care spaces, and public living areas to accommodate older individuals’ sense of belonging in place (Nettleton et al., 2018).

Metasynthesis of existing phenomenological data found that within each ontological dimension and between dimensions are tensions and contradictions. These reflect the complexity of the lived experiences of those over the age of 85 years (Gubrium & Holstein, 2003b). The findings provide evidence of the heterogeneity of aging (von Humboldt & Leal, 2012) and support the view that diversity grows, rather than diminishes, as age progresses (Martin, 2012). For this reason, qualitative inquiry is beneficial when researching this cohort, as it serves to combat reductionist, narrow, and binary accounts of aging and the aging body (Twigg & Martin, 2015). Knowledge emanating from the voices of the older individuals themselves is, therefore, vital to support their needs and desires (Larsson et al., 2009). Future researchers could use the findings of this metasynthesis as a basis upon which to further promote the diversity in the experience of aging.

In terms of practical application, a better understanding of the lived experiences of individuals over the age of 85 years can enable greater empathy, promote genuine curiosity, and avoid generalized assumptions and stereotypes. This metasynthesis hopes to foster respect for the rights and dignity of those over 85 years, combating agist views and discrimination. The knowledge of the ontological experiences of older individuals has potential to manifest in real-world settings as improved quality in the standards of health care, welfare, aged-care delivery, as well as in broader societal changes in culture, acknowledging the diversity, worth, and potential of individuals in this group (Galvin & Todres, 2009; Kontos & Naglie, 2009; Todres, 2008). Simone de Beauvoir (1908–1986) wrote aptly that “there is one form of experience that belongs only to those that are old—that of old age itself” (De Beauvoir, 1970/1996, p. 381), which is a sentiment that may guide future researchers contributing knowledge to this field.

Although the body emerged as central to the everyday lived experiences of those over 85 years, research methodology explicitly exploring embodiment in this cohort is lacking. Many questions remain about how the body is experienced and, in turn, how experiences are embodied at this stage of the life course. Not just in terms of the physical body, but in its metaphysical and existential relation to time, space, and others. Thorarinsdottir and colleagues (2017) describe Merleau-Ponty’s unique composite of phenomenology and existentialism as the ideal instrument for exploring “real life” (p. 220). The philosophical underpinnings of this metasynthesis allowed for an exploration of meaning-making within the transcendental, everyday experiences of life after 85 years. This method may be useful for future primary research seeking to explore the body as storyteller (Thomas, 2018; Van Manen, 2011).

Conclusion

The results of this metasynthesis add new insights to the experience of life within and through the body after 85 years. Reconceptualization of primary phenomenological data revealed rich, heterogeneous, and often dichotomous, ontological experiences of the body, time, place, and others. Regarded through the philosophical lens of embodiment, the participants’ experiences, in their own words, reveal that the body can be viewed as a storyteller. Participants describe their body as more of a presence in everyday life, as opposed to the previously taken-for-granted nature of their physical being. Their perception of time, both chronometric and in reference to the past, present, and future, is altered and sometimes experienced as distorted. Home and a sense of belonging to a place were described as being particularly significant contributors to well-being.

Participants encounter multidimensional losses, including the loss of loved ones, health, and independence. Resilience in navigating these losses requires physical compensations, but also existential reflection and an evolving sense of self. In this way, the physical experience is inextricably linked with metaphysical meaning-making. This metasynthesis contributes greater understanding of the lives of individuals over 85 years, however, the complexity of their experiences highlights the importance of further research into the corporeal, temporal, spatial, and relational transitions unique to this stage of the life course.

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