Research Article, J Aging Geriatr Med Vol: 1 Issue: 2

Do We Become More Spiritual with Age?

Bruce A Stevens^*

Wicking Chair of Ageing and Practical Theology, School of Theology, Charles Sturt University, Australia

*Corresponding Author : Bruce A Stevens
Wicking Chair of Ageing and Practical Theology, School of Theology, Charles Sturt University, Director of CAPS, Australia
Tel: +61-403529773
E-mail: bstevens@csu.edu.au

Received: February 15, 2017 Accepted: March 17, 2017 Published: April 21, 2017

Citation: Stevens BA (2017) Do We Become More Spiritual with Age?. J Aging Geriatr Med 1:2.

Abstract

Keywords: Ageing; Meaning; Spirituality; Gerotranscendence; Lars Tornstam; Qualitative research; Religious beliefs

Introduction

Lars Tornstam [1,2], with his model of gerotranscendence, has argued that we become more spiritual in the later years of life. He redefined the ageing process as a universal trend to spiritual fulfilment. This positive model of ageing has had considerable influence over the last two decades. This paper an attempt to respond to his understanding of gerotranscendence drawing on data from a qualitative study.

The Study

This study was based on interviews with 15 people. Participants were approached using the ‘snowball technique’ of sampling. This method of gathering a sample is also known as ‘chain referral’ which has limitations since it is not random selection but is useful to identify people with specific traits or interests. I provided information about the study and asked some contacts to forward an email outlining the project to people who might be interested. The sample was restricted to the following criteria:

(i) Aged 60-75

(ii) Not in residential care.

(iii) Not formally trained in theology.

Ethics approval was gained through Charles Sturt University, Australia. The 15 people were aged between 60 and 75 years old (mean = 67). The interviews were conducted by the author and lasted about 45 minutes. Each person chose a pseudonym to preserve anonymity. The following consented to be part of the study: Bill age 68 Agnostic, Nell age 72 Agnostic, Sarah age 62 Agnostic, Anselm age 75 Liberal Protestant, Hannah age 69 Liberal Protestant, Campbell age 70 Anglo-Catholic, Annie age 67 Anglo-Catholic, Rowan age 65 Anglo-Catholic, Jean age 67 Charismatic, Frances age 62 Charismatic, Anthony age 65 Charismatic, Ruth age 63 Charismatic, John age 69 Reformed, Elizabeth age 67 Reformed, and Susan age 66 Pentecostal.

The purpose of the general study was to investigate views associated with aging. The sample interviewed represented a range of perspectives: agnostic/atheist (3), Liberal Protestant (2), Anglo- Catholic (3), Reformed (2), Charismatic (4) and Pentecostal (1). These classifications are mine but generally reflect church allegiance if present. There was no attempt to include people of other faiths. The people in the study were well-educated, financially secure and living in Canberra, the national capital of Australia.

Four open ended questions were used to explore themes such as the influence of aging, meaning, significant or unusual events, and attitudes to luck. This study focused mainly on the first question. Data was gathered and then used for thematic analysis. The process included interviews, as described, which were transcribed, and the data was coded using NVivo 10. This was helpful to identify what might be considered micro-themes. However, I found this less useful than grouping general themes, followed by a ‘match and compare’ analysis of themes, memo writing and idea mapping with large sheets of paper. Themes tended to be large and it was better to visually represent ideas relevant to an individual’s beliefs. Since the study was exploratory it was only in the discussion that connections were made with current research with a specific consideration of the gerotranscendence model.

Results

I began this study with the question: Does growing older make a difference to an understanding of the meaning of life? The interviews highlighted differences between people but generally growing older did make a difference. Ageing seems to function like a catalyst. While it can be likened to a ‘chemical reaction’, the direction of change is far from certain.

An analysis of themes led to the following (note that some research participants raised more than one theme):

1. A catalyst that is largely unnoticed or hidden: Three people did not notice much difference while ageing. Hannah did not see any direct effect of being older, “No, no. Not at all. It’s because I’ve grown as a person that my God stuff has changed.” Anthony was similar in not noticing sudden changes, “I just think that my spiritual maturity has grown continually over the years. My understanding of God, my understanding of people, my empathy for people.” Both commented on a slow, natural process of maturing. Rowan retired early, “I was given a redundancy about 45.” But he did not see his perspective changing, “Yeah, always been that way. There hasn’t been a dramatic change.” He explained, “I suppose it was related to working out that I was gay but eventually … wondering why I didn’t want to do what other guys were doing and eventually just accepting, well, it’s not what I chose. God made me this way.” Rowan highlighted a gradual process of acceptance of points of difference. Ageing here was considered something of a constant, in the background, even hidden in influence and not always noticed except in retrospect.

2. A catalyst which brings an emergent process: In two participants change was noticed as cumulative effect. Campbell now had the time to notice, “I’m not given to abstract sort of thinking or philosophical thinking. I don’t sort of lose any time on that. I’m very embodied in the day to day small things of life and probably look through them to … the beauty of nature, the pattern of light on the trees out there, the movement of the breeze in the trees. I attend to those things and I see the glimpses of infinity and the glimpses of eternity, the beauty, just little reminders of the ultimate nature of reality and in that sense I have more time to smell the roses as they say.” Anselm saw value in opening up to experience, “The journey of learning, either through travel and visiting places or walking and reflecting on where you are or a little bit of contemplation … all those things built up a ‘me’… I think it’s the ‘me’ that I don’t yet fully understand.” He continued, “There’s a sense of what you’re becoming. I’m probably becoming a Christian but not a Christian in the (conservative) sense.” Here the person is very much agent. Ageing influences how the person interacts with life, he or she becomes more open and willing to embrace experience. This results in a more expansive self-experience for both Campbell and Anselm. Perhaps this describes a ‘ripening’ of experience which takes time – in this case decades of living.

3. A catalyst deepening the relationship with God: Six participants spoke of their sense of a deepening spiritual relationship. Annie saw her life “living out of that trust so that I have a sense of connection with a God who is intimate but also other than and far more mysterious than I can ever know fully.” Anthony explained, “Probably just coming to realise the nature of God a lot more, growing into that and realising that He’s more interested in relationship than anything else, so I think that has been significant.” Frances recalled, “I would look back on things that have happened in my life that at the time I thought were dreadful, were trials, but I can see that they have turned out in the long run, for good … I would say that the longer you go on the more you are sure that God can be trusted regardless.” Hannah attached less importance to beliefs she held earlier, but “I do have a sense of being looked after so this is part of my growing.” Ruth affirmed, “Oh, absolutely. I feel I have evolved if I can use the term. I think my understanding about God and my relationship with God has just grown deeper. I still read the Bible and think ‘Wow, I haven’t seen that before. That is so true.’ It is really a living thing that is true and speaks to me wherever I am. Yes, I just feel that my understanding has grown deeper.” Susan concluded, “Well, I think as I’ve walked with God over the years, the more I walked with Him the more I’ve got to know Him. It’s like a friendship. The more you spend time with your friend, the more you know your friend so your relationship with that friend deepens or doesn’t, depending.” There is a sense in which ageing functions as a catalyst, as these people reported, to a deepening spiritual relationship with God.

4. A catalyst that changes perspective: Eight participants tried to articulate a changing perspective. Ageing seemed to bring an opportunity to clarify what is important. This included values. Bill noted, “I think I probably think about these issues a little bit more now than I did 20 or 30 years ago. That’s probably true. I think you probably focus on things a little bit more of that nature. I mean one does, I think I do a bit more, yes.” He added, “I think it’s a more, for me, a more thoughtful process rather than something ... It’s reflective, yes.” Campbell recognized that he had, “become a little more philosophical in the clichéd sense I suppose. You know, when you get off the work train which I’m just getting off, you’ve got more time to think over things and to appreciate things.” Annie identified a greater sense of, “equanimity, I suppose there’s a bit more equanimity as I’ve got old … I look for where the initiative of God is in something. I did quite a lot of advocacy in my early days (as Social Worker) not that I’m saying they weren’t good things to do but it’s … yes, I think the shift is one of, it might seem like a subtle thing, but I think it’s actually a bit more detachment from the outcomes of something.” Annie has become, “more accepting. Yes, that’s right that’s perhaps the word I was trying to search for. And also the older I get the more I think well there’s more than one way to go about something.” Such comments reflect the different perspective that ageing brings. Perhaps something like ‘gaining wisdom’, but even this falls short of describing the richness of experience. Some previously urgent things are not as urgent, and what is really important becomes clearer.

This was also obvious in some of the comments of others. Anthony thought, “I think you have a greater maturity, a greater understanding of life and perspective and you know the relationship that God has.” Elizabeth identified positive changes, “I think I’m a bit wiser and maybe a bit more thoughtful about things and I think a bit more caring. I hope I’m a bit more caring anyway. Experience and walking with the Lord I guess and knowing Him better. Not being so blasé about it all, you know, now that I’m retired, not being quite so busy too. Having time to think.” But, “Yes, well it happened when I was just over 50, that real change that really enabled me to really grow.” Ruth has relaxed, “I don’t have to work anymore. I don’t have to strive in that (way) any more. And there’s a freedom.”

The catalyst of ageing does not always lead to a deeper faith, it can lead to a different way of seeing things. Nell looked back on stages she identified, “I was 15 and that (more conservative Christian belief) lasted me 30 years and that was the train that I followed. Then in my mid 40s I was uncomfortable, I was bored I think looking back about what was going on at church. It wasn’t challenging me. There was a time in the 1980s that was really good where we did a course with (Bishop) Bruce Wilson, the Eremos course and that was fantastic and that gave me a lot to think about and chew over. But then after that there was nothing happening at church for me and I was just finding things a bit stale and then we had this great upheaval with our local church and we ended up leaving.” Later Nell realized that she had lost the structure of her faith, “I thought I can’t call myself a Christian. What is a Christian? I kept saying ‘What is a Christian?’ If you don’t believe in the virgin birth are you still a Christian? And then I didn’t even believe in something that could incarnate so I thought I’ve got to let that go and I had to let church go. And that took, I would say, 12 years to get that out of my system.” No process is risk free. Beliefs, like clothes that no longer fit, can be discarded.

Anselm reflected on his experience of via negative, giving up beliefs, “That’s really what my life has been, well certainly for the last 25 years where I gave up believing things. I didn’t give them up, they just slipped away. But the idea of the spiritual side of life didn’t slip away, only the propositional side, you know. That’s all gone.” Anselm was selective. He gave up some beliefs but retained what still ‘fitted’.

5. A catalyst of awareness of limits: Death was mentioned. Jean thought this was relevant, “Well, it’s more imminent, more present, because when you’re young you don’t think about death and dying but when you get older you do. … A couple of my friend’s husbands have died in the last 12 months and you go to their funerals and you think about what they’ve done in their life and conversely, what have you done with your life?” Susan wanted to take every opportunity, “I think I’ve had more time to grow in the knowledge of God now and my purpose is more clarified because you have more time. So I’m very focused on making every day count. It’s not wasted.” John saw a bigger picture, “Looking forward, looking backward it’s a massive comfort, you can actually see there is a destiny that shapes us, how we will or whatever, and I’m absolutely certain of that.” He added, “The blessing comes from actually doing what the Lord wants you to do. That’s where meaning comes from.”

Frances placed her lifetime in the frame of eternity, “I guess, do I have a greater sense now that this time on this earth is short compared to eternity? Maybe? I’ve thought about that in terms of my body which is not as flash as I’d like it to be, in terms of its health. I’ve thought, ‘Well, this is not forever.’ And I think maybe you also … various things that you put your effort into what you can find hard, I think as you’re older maybe you can look at them and say that maybe this is for a season and I’m prepared to do it for a season whereas, would I have had that perspective when I was younger?”

But not all saw this in religious terms. Bill asserted, “You make our own meaning of life.” He looked back, “It’s a development thing over a long period of time … I’ve always had personal goals in life. I’m an academic so there are certain things I’ve done well in the scientific areas.” Time is finite, as Bill said, “I mean, you start to think you only have twenty years left, thirty years left, what’s that going to be like, what’s the quality going to be like? To what extent should I change what I’m doing? … I mean, life is going to finish for me in about, somewhere between 20 or 30 plus years.” This is the time left. It is a catalyst for making meaning.

6. Catalyst for generativity: Six of the people in the study recalled making a contribution. Anthony made this through his business and the services offered, “Yes, just knowing that I’m in a relationship with God, that’s the ultimate theme and you don’t have to be setting the world on fire.” Jean found her vocation, “A really positive thing that has happened in my life that gave me enormous meaning and let me find the real me and that was when I ‘fell into’ aged care.” Elizabeth had a ministry with a Bible study group. Anselm recalled, “We had a youth club and used to meet in our home and so on, but I’d done it also in a more formal youth club in St Johns but I realised that wasn’t what I was really into. What I was really into was this group of young people that just came to our house on a Sunday afternoon, spend the time with us.” Each have good reason for satisfaction with a life well lived.

Frances remembered, “We had at some point three shops and three children and certainly I worked myself very hard.” Frances thought about the succeeding generations, “That’s a perspective that you have in terms of the generations going on.” Susan considered her family, “I’m very content with my children, my grandchildren and the purpose I have in life.” She was satisfied that, “My time is useful and valuable and so what I do in terms of how I leave a legacy I guess in this life is having touched other people’s lives for good.” The legacy that remains.

7. Catalyst for integration: Growing older can bring a sense of integration. Annie recognized that, “The active presence (of God), if I didn’t assent to it and say ‘yes’ to it, then it’s very easy to fall into a fragmented scattering of my energy, very easy to fall into that and it (my faith) just centres me, reminds me that these roots are deep, they are true, they’re strong and to look to that, so I hope and pray to always do that.” Anthony saw a human similarity with God, “Our spirit has the attributes or part attributes of God so that’s why God wants to have intimacy with us because he is similar to us … that you are interacting with other people, whether they are Christians or not, their spirits are made in God’s spirit and so that interacting with other people is a reflection of our interaction with God.” This sense of integration is active. It demands a courageous response – to bring the pieces of a life together into a greater whole.

The idea of ageing as a catalyst identifies an active agent in the spiritual life of those growing older. There is an effect but it is not predictable. Ageing affects people in different ways and towards various ends.

Discussion

There is a lot of literature on the effect of ageing and how this might relate to spiritual attitudes. One study by Paul Wink and Michelle Dillon found an increase in spirituality from late-middle to older adulthood. This was a longitudinal study with a sample of N=130 [3]. While there was a definite trend towards being more spiritual with age, rates of practice were low. The rank order of the importance of spirituality tended to be stable over the years.

Perhaps the most influential model of spirituality in older adults was proposed by Lars Tornstam [1]. In a time where ageing was associated with emotional disengagement or physical and emotional decline, there was a need to see value in growing old. His idea of gerotranscence has been very influential and has generated many studies. According to Tornstam human ageing is characterised by a potential for gerotranscendence – a shift from a materialistic and rational view to a more cosmic and transcendent perspective.

There is considerable overlap in my findings with criteria for his model. I will first outline the similarities in terms of some of what he identified as being characteristic of gerotranscendence.

In the Cosmic Dimension, none of the participants specifically mentioned Time and childhood with what Tornstam characterised as a blurring of a sense of time. I identified generativity, so there was some overlap in Tornstam’s Connection to earlier generations. For Susan her children and grandchildren were important. Frances saw a legacy in “the generations going on”. There was an appreciation of time being limited as in Life and death, Jean saw death as more “imminent” and Bill had a sense of the years remaining. It was not clear that people were less afraid of death the closer they were to it, though Frances compared it to “eternity”. With Susan there was a sense of the urgency of time. There was an increased appreciation of the Mystery of life with less need to rationally explain everything. Frances saw the trials of life carrying meaning. Campbell was more “philosophical” as he aged. Bill found himself thinking more about issues. With a few people, perhaps achieving more gerotranscendence, there was a quality of Rejoicing in simple pleasures such as appreciating nature. Campbell and Annie mentioned such delight.

Tornstam also identified a dimension of The Self. He saw gerotranscendence as characterized by Self-confrontation through life-review, discovering hidden aspects of the self, and accepting both good and bad. Anthony spoke of a greater maturity. Elizabeth has become “wiser”. Rowan has become more comfortable in his identity as a gay person. Perhaps some might also be characterised by a Decrease in self-centeredness. The trend is to be less narcissistic and to have a more appropriate self-confidence. Annie described a feeling of “equanimity”; Ruth has found “freedom” and Elizabeth becoming “a bit more caring”. There was a broad expression of caring for others by participants which Anthony described as having a focus on people. Certainly there is some degree of Body transcendence in which an obsession with physical beauty passes, but there were no specific comments. Annie described being more “accepting” and this would include accepting the ageing process. Tornstam also described Self-transcendence with an emphasis on meeting the needs of others such as children and grandchildren. This was clear in a number of responses, for example Susan and Frances already mentioned. John has a sense of “destiny”. But it also included other forms of generativity with Elizabeth finding meaning in leading a Bible study, Anselm’s work with the youth group and Anthony leaving a business legacy. I described his Ego-integrity in terms of integration with a greater acceptance of life as coming together and forming a whole. Anselm described this as gaining richness of experience including “contemplation” and vividly by Annie drawing together “fragments scattered”.

In the realm of Social and Personal Relationships, Tornstam saw Changed meaning and importance of relationships in which people become more selective in their choice of relationships with a need for more solitude. There was some evidence of this but it was not overt. Generally, people found more time for spiritual development through a variety of means. Jean had found a vocation in working with the aged. Anthony has come to value relationships more. There was some Dealing with role playing in life when the self is understood beyond former roles. Bill valued his life as an academic, his search for truth and the need to ‘make our own meaning’. In Emancipated innocence there is a freedom to go beyond needless conventions, norms and rules. Jean illustrated this in resisting congregational expectations of her role as a pastor’s wife. Modern asceticism, as an idea, might have appealed to some in the study but renunciation was not a strong theme. Instead there was more of a sense of growing in relationship with God, valuing the unseen realm, and this came in comments of Hannah who trusts more, Annie who has found great intimacy, Ruth with a deeper experience of God, and Anthony with a spirit shared with God. Transcendent everyday wisdom described a transcendence of the right-wrong duality which is accompanied by broadmindedness and tolerance. This was evident with Jean who revised her moral views. What I found was a willingness in some participants to give up being identified with the Christian faith (Nell) or distinctive dogmas (Anselm).

While there are areas of overlap, as noted above, I am not sure the gerotranscendence model is fully adequate to explain what the participants expressed in this study. Some criteria seem to just be part of the ageing process, for example bodies change and mostly we accept this. Many of the other traits are not so much spiritual as simply a biological process such as giving up roles for which we are no longer capable. For example, Rajani in a factor analytic qualitative study found that people tend to accept these signs as part of normal aging [4]. Tornstam is perhaps amorphously spiritual and some of his writing reads like a New Age tract. I found the views of my participants more in line with traditional Christian faith, whether they accept or reject it, and they would not relate well to his understanding of cosmic consciousness. Indeed, Tornstam’s model does not necessitate belief in a higher power. All the participants in my study would either accept a personal and all-powerful God or reject the notion.

There have been writers who have appreciated Tornstam’s model. Some of them are eminent thinkers. The work of Erik Erikson has been very influential [5]. The last of his original 8 life stages was integrity or wisdom versus despair. His widow Joan later proposed a ‘ninth stage’ in her revision of his life stages for those facing the challenges of living into their 80-90’s. In each stage the issues faced need to be resolved in a fresh way. Joan saw benefit in the idea of gerotranscendence [5,6]. Yasuyuki Gondo and colleagues reviewed models of successful ageing [7]. They noted that gerotranscendence does not require cognitive resources and may be more applicable to oldest of the old.

In my study there was no indication of necessary growth towards a predetermined ideal. Some diversity is recognized by Tornstam, “far from everyone reaches high levels of gerotranscendence” with the process slowed down or blocked [8]. Solveig Hauge offered a careful analysis of Tornstam’s model [9]. We must be careful not to extend our mid-life ideals to old age; perhaps we can see a contemplative activity, rather than withdrawal and resisting outward activity. Dalby questioned whether the search for spirituality is universal. More universal is integrity, the bringing the past and present together, and it was considered important to find some sense of meaning beyond present losses of ageing [10]. Helen Black, in her study ‘Wasted lives’ (sample of N=150 men), found very little religious interest, spirituality was thought to be unimportant and got in the way of ‘living life’ [11]. What counted was attaining goals. The diversity of views in my study would support these findings. The catalyst effect is more random.

Gerotranscendence has been used to try to change the attitudes of older people. Barbro Wadensten introduced the ideas to a group of older people and generally participants recognized their experience in terms of the theory [12]. Jing-Jy Wang and colleagues looked at the benefits of a gerotranscendence support group [13]. There has been some cross-cultural research investigating the model [14,15]. Losses and other negative life events might be seen as contributing to spiritual growth, as indicated in a large longitudinal study (N=1569 with two surveys) [16,17].

Tornstam carried out a number of research projects, both qualitative and quantitative, to support his views. However, the methodology has not been consistently strong or especially persuasive. For example, the qualitative interviews were of 50 older people who had already expressed an interest in his theory and so compromised his study. I would note that the participants in this study were not selected because of an interest in gerotranscendence, but simply on the basis of being older and willing to discuss spiritual concerns. Arguably such a sample provides useful data on which to evaluate Tornstam’s model.

There have also been questions raised about the theory, Albert Jewell was critical and asked if gerotranscendence is really age related or universal or culturally or personality dependent? He wondered if there was confusion in the constructs and whether it added anything of substance to Erikson’s developmental theory [18]. Eisenhandler thought it was just disengagement theory in a new guise [19]. The views of Argen offered a ‘better fit’ explanation to the views of my participants [20]. Argen used a sample of N=129 and interviewed again those who lived to 92 (N=41). This author found seven patterns of adjustment from self-realization to withdrawal. The heterogeneity remained at 92, but body challenges led to a shortened time perspective and cognitive strategies of adjustment, losing interest in what could not be done any longer, and a balancing of good and bad life events “most distinguishing characteristics now were even deeper altruism, religiousness, reflecting and life satisfaction at 85” [14,20].

Tornstam made strong claims that his view of ageing was universal, and not culturally dependent. This has been challenged by various authors. Kristen Thorsen has argued that gerotranscendence should abandon its universalist claims because it is socially constituted. Also the aged vary widely both historically and geographically [21]. Sabrina Bruyneel and colleagues found that gerotranscendence was more correlated with spirituality and religious allegiance, attitudes to morality and death than age [22]. In their sample of N=467 (adults 17-91) they did a factor analysis of Tornstam’s scale and it did not match the three dimensions he proposed. They labelled the scales Transcendent Connection, Anxiety and Uncertainty and Active Involvement. They proposed that gerotranscendence is more associated with Transcendent Connection. Curiously they found a negative relationship between age and Transcendent Connection. These authors argued that young people can exhibit gerotranscendence as well as old.

Hakan Jonson and Jan Arne Magnussson were even more sweeping in their dismissal of the theory as empirically weak, with parallels to the New Age movement as well as romantic orientalism, and that it can be understood as an attempt to re-enchant aging [23]. Old people in this theory are meant to gerotranscend, but if they do not it are due to obstructive influences in Western mid-life performance orientation. However, they acknowledged the value in Tornstam’s critique of gerontology to move away from positivism to a phenomenological approach that focused on older people’s experiences and interpretation of their worlds. Instead of seeing ageing as a depressing and declining trajectory “ageing becomes a positive qualitative development towards a more profound and satisfying state of mind and being” [22,23]. The popularity of life review and reminiscence as tool for personal growth is another example of growth in old age [24]. They conclude that the theory is weak but positive. I can only agree that my findings and much of the discussion would support their conclusion.

A simpler model of spirituality with the aged has recently been advanced by Sarah Bachelard and Neil Miller [25]. They identify two seemingly contradictory movements in their understanding of vocation:

(a) A self-completion through becoming more aware of our individual story and fulfilment in who we have become. It is like Thomas Merton’s finding of a “true self” [26].

(b) A letting go of attachment to capacities, competencies, financial earning, health, relationships, and eventually life.

These two movements shine through the data used in this study. These are what has engaged the people in their process of ageing. Their model is also far simpler than the gerotranscendence model with extensive categorization and I think a better fit with the concerns expressed.

Conclusion

In this study the views of 15 people expressed their views about growing older. There was a diversity of opinion, naturally, and for many it was a spiritual journey, for all it was meaningful. This paper offers an evaluation of the gerotranscendence model through a literature review and comparison to qualitative data. There was some ‘fit’ with the model there was also a ‘lack of fit’. Tornstam’s model did not capture the core experience of many participants who found their relationship with God deepened. The model of Tornstam is more about cosmic consciousness than God, and in other ways as well it proved inadequate. In my view a better, simpler model, has been proposed by Bachelard and Miller [25].

The finding from my study is that ageing is like a catalyst somewhat random in outcome. Of course this is not highly descriptive, gerotranscendence does better for all its apparent faults, but this is a step along the way to perhaps developing a more comprehensive model. And every step counts.

Acknowledgement

This research has been funded by the J. O. and J. N. Wicking Trust, grant number 100469.

References

1. Tornstam L (1989) Gero-transcendence: A reformulation of the disengagement theory. Aging1: 55-63.
2. Tornstam L (2005) Gerotranscendence: A developmental theory of positive aging.Springer, New York.
3. Wink P, Dillon M (2002) Spiritual development across the adult life course: Findings from a longitudinal study.J Adult Dev 9:79-94.
4. Rajani F (2015) Theory of gerotranscendence: An analysis. Eur Psychiatr 30S1: 1467.
5. Erikson EH, Erikson JM (1997) The life cycle completed. W. W. Norton and Company, New York.
6. Verbraak A (2000) Gerotranscendence: An examination of a proposed extension to Erik Erikson’s theory of identity development. MSc in Psychology Thesis, University of Canterbury, New Zealand.
7. Gondo Y, Nakagawa T, Masui Y (2013) A new concept of successful aging in the oldest old: Development of gerotranscendence and its influence on psychological wellbeing. Annu Rev Gerontol Geriatr 33: 109-132.
8. Tornstam L (2011) Maturing into gerotranscendence. J Transpersonal Psychol 43: 176.
9. Hauge S (1998) An analysis and critique of the theory of gerotranscendence. Essay Nurs Sci 4: 98.
10. Dalby P (2006) Is there a process of spiritual change or development associated with ageing? A critical review of the research.Aging Ment Health 10: 4-12.
11. Black HK (1995) ‘Wasted lives’ and the hero grown old: Personal perspectives of spirituality by aging men. J Relig Gerontol 9: 35-48.
12. Wadensten B (2005) Introducing older people to the theory of gerotranscendence. J Adv Nurs 52: 381-388.
13. Wang JJ, Lin YH, Hsieh LY (2011) Effects of a gerotranscendence support group on gerotranscendence perspective, depression, and life satisfaction of institutionalized elders. Aging Ment Health 15: 580-586.
14. Wang J (2011) A structural model of the bio-psycho-social-spiritual factors influencing the development towards gerotranscendence in a sample of institutionalized elders. J Adv Nurs 67: 2628-2636.
15. Ahmadi FL (2001) Gerotranscendence and different cultural settings. Ageing Soc 21: 395-415.
16. Read S, Braam AW, Lyyra T, Dorly JH (2014) Do negative life events promote gerotranscendence in the second half of life? Aging Ment Health 18: 117-124.
17. Weiss T (2014) Personal transformation: Posttraumatic growth and gerotranscendence. J Humanistic Psychol 54: 203-226.
18. Jewell AJ (2014) Tornstam’s notion of gerotranscendence: Re-examining and questioning the theory. J Aging Stud 30: 112-120.
19. EisenhandlerS (2003) Keeping the faith in later life. Springer, New York.
20. Argen M (1998) Life at 85-92: A qualitative longitudinal study of how the oldest old experience and adjust to the increasing uncertainty of existence. Int J Aging Hum Dev 47: 105-117.
21. Thorsen K (1998) The paradoxes of gerotranscendence: The theory of gerotranscendence in a cultural and post-modernist outlook.Nor Epidemiol 8: 165-176.
22. Bruyneel S, Marcoen A, Soenens B (2005) Gerotranscendence: Components and spiritual roots in the second half of life.
23. Jonson H, Magnusson JA (2001) A new old age? Gerotranscendence and the re-enchantment of aging. J Aging Stud 15: 317-331.
24. MacKinlay E, Trevitt C (2006) Facilitating spiritual reminiscence for older people with dementia: A learning package. Canberra: Centre for Ageing and Pastoral Studies, Australia.
25. Bachelard S, Miller N (2016) Growing old: The vocation and practice of ageing. J Health Care Chaplain 4: 180-191.
26. Merton T (1961/2007) New seeds of contemplation. New Directions Publishing Corporation, New York.