Spirit-Health Connections

Is the idealized post-retirement "leisure lifestyle" really all that great? Are there any alternatives to it?

Purpose and Power in Retirement

The Alternative

Is there an alternative to retiring to a life of leisure, self-absorption, inactivity, and separation from others, leading to boredom and mental and physical decline? Of course there is. The alternative—on which this book is based—is to find a sense of worthy purpose and direction for the retirement years. Maintaining purpose and meaning is so important because it is key to effective adaptation to the stressful life events that typically occur during this period—changes in social roles and status, loss of loved ones through death or relocation, and eventually, the onset of physical illness and disability.1 I examine here the alternative to an inactive retirement and discuss new sources of purpose in later life, the importance of having a "vision" for one's retirement years, and the need to plan for an active retirement that is productive and fulfilling. I also review medical research that has looked at the effects of having "purpose" on mental and physical health.

MAKING THE BIG DECISION

Wil Rose, cofounder and president of the National Heritage Foundation, once said, "Live each day as though it were your last—for one day you will be right." How many people have a direction, purpose, and goal for the remaining years of life so that every day can be lived as if it were their last? At what target do most retired people aim their arrows of time, talent, and financial resources? Many want to do something in their last years that will give life meaning and leave a mark on the world. Retirement presents opportunities like never before to make a difference in the lives of others that will last far into the future. There is something better than spending this precious time pursuing recreation and leisure and seeking fulfillment focused on the self—the harder that happiness is sought in those directions, the more quickly it flees. As Nathaniel Hawthorne once said, "Happiness in this world when it comes, comes incidentally. Make it the object of pursuit, and it is never attained." How does happiness come about incidentally in retirement? Part of the answer has to do with having purpose—especially, the right purpose.

This does not mean turning to a life of asceticism and self deprivation, completely void of pleasure or enjoyment. In fact, the very opposite is true. Recreation and a little self-indulgence are definitely part of the picture. The difference is that they are not at the center of the picture, the focus of ultimate concern. More like a dessert than a main course. It is only when our attention and our focus—our purpose—are outside ourselves that pleasure can be fully savored. This pleasure is long lasting, not something that disappears when desperately grasped, as does self-centered pleasure.

THE IMPORTANCE OF PURPOSE

Phillips Brooks, one of America's greatest preachers during the nineteenth century, said, "Sad will be the day for every man when he becomes contented with the life he is living, and there is no longer some great desire to do something larger which he knows that he was meant and made to do." Purpose is the great desire that helps structure time and resources so we can make progress toward meaningful goals during retirement. Having a purpose helps to motivate and energize people. Purpose helps us establish priorities that are worthwhile and life-enhancing. Purpose provides momentum to overcome the obstacles, challenges, and stressful circumstances that occur with aging. In addition, as people look back during the process of life review, accomplishments and progress toward worthwhile goals will be satisfying and contribute to their sense of integrity. When people have no direction or goals, they wander aimlessly through life, fail to realize their full potential, and sometimes look back with despair over wasted time and opportunities.

The Jewish psychiatrist Victor Frankl, one of the few who survived the horrors of the Nazi concentration camps, emphasized the importance of finding meaning and purpose. He said that it was the key to survival when his choices were few and the future appeared hopeless.2 He and other camp prisoners who maintained a sense of meaning or purpose in life were the ones able to transcend the dismal surroundings and desperate physical circumstances of the camps and ultimately got through the horrific experience, while those who could not ended up dying. Frankl attributed his own and others' survival to the power of having a sense of purpose that kept their eyes on meaningful goals ahead. Purpose can help us survive retirement as well, and more than just survive, actually live triumphantly as worthy goals are reached and a difference is made in the world.

The purposes of young adulthood or middle age, however, are often not sufficient for the retirement years. With age, wisdom, and experience, people sometimes realize that earlier priorities, values, and goals have been misplaced, shallow, or otherwise less important when looking back from the standpoint of adult maturity. There are also different needs to fulfill in this last life stage, which is characterized by a struggle between "integrity versus despair."3 This means that old goals will have to be set aside or modified and that new, more substantial and meaningful goals for this last life stage will need to be identified and pursued. Letting go, however, is never easy.

SAYING GOODBYE

Deciding to have a new purpose for the retirement years requires acceptance of change. Change is inevitable—it comes whether we want it or not—especially with aging. Change can be resisted and fought, or accepted and used to begin something new. Leo Tolstoy said, "Everybody thinks of changing humanity but nobody thinks of changing himself." On the one hand, many people resist change. People crave continuity—to remain the same, to continue with the usual routines. On the other hand, they cannot stand sameness or lack of change. Monotonous routine results in boredom, restlessness, and a desire for something different or new.

Life is all about change—the changing seasons from spring through winter, the changing weather, the changing temperature, the changing position of the sun throughout the day. Change characterizes our interactions with family and friends. It can't be helped. People also enjoy change—they want something different to eat at each meal, different programs and news to watch on television, different stories in the newspaper each day. Humans require change and contrast. If they don't have it, as sensory deprivation experiments have shown, they become stark raving mad. For example, if a person is immersed in water at body temperature and all light and sound are cut off, scientists have found that he will soon begin to hallucinate—his brain will produce change on its own with no outside input. Change is necessary—and yet it is often difficult.

Retirement is a time to say goodbye—goodbye to old sources of purpose and meaning. But how does a person know what to let go of and what to hang on to? What are the characteristics of things to let go of? Some things have to be let go whether you want to or not—for example, the routines of an old job, your identity as worker or boss or supervisor, perhaps your role as instructor, nurturer, and protector of your children as they leave to establish their own families. There are some hard goodbyes that many will have to say, particularly as advanced age sets in. Goodbye to loved ones as they become sick and die, goodbye to friends and neighbors when they move or relocate, goodbye to vigorous health and independence when sickness or disability strike. Remember that the old must end before the new can begin, as fall and winter precede the springtime.

It is important to prioritize among the things you willingly say goodbye to. Deciding on a purpose for your retirement years will help you determine what to hold on to and what to let go. Since time and resources are limited, these choices should be made strategically and consciously in line with your purpose. Often this is done unconsciously. Each person has priorities, spoken or unspoken, consciously chosen or unconscious. It is important to take time to consciously choose a worthy purpose for retirement, given the role it will play in setting your future priorities.

SAYING HELLO TO NEW PURPOSE

Retirement (and preferably, well before retirement) is when a new purpose should be chosen. That purpose will then direct your activities and structure your time during this final one-third of life—that may last forty years or more for some. Given the length of time now spent in retirement, it is truly almost enough to start a second life. What an exciting opportunity—to start life over, but to begin this time with all the wisdom and experience gained over the years.

So what are your options? What are the characteristics of sources of purpose that have potential? In other words, what kinds of goals can be set for retirement that will be energizing, motivating, and enjoyable as one strives toward them? Remember, it's not about arriving, but about the journey. Here are some suggestions.

Choose a purpose that takes advantage of your strengths and abilities.

Choose a purpose that takes into consideration your current strengths, talents, capacities, and resources. For example, a person with poor vision, no flying experience, and on a limited budget would not decide to borrow money to purchase an airplane and then pilot it to make food drops to starving people in Afghanistan. No, that would be silly. First, make a thorough inventory of your talents—your natural abilities, training, and experiences. Second, ask yourself what kind of work you performed when you were employed and what were you particularly good at. Is there an area about which you are especially knowledgeable—medicine, law, business, gardening, or cooking? Do you have a particular skill, like playing a musical instrument, making crafts, doing plumbing, electrical work, or carpentry?

Third, what kind of personality do you have? Extroverts enjoy talking and interacting with people. Introverts are stressed out by people and happiest when carrying out projects alone or with a few close friends. Do you tend to be a leader, organizer, or manager, a take-charge kind of individual, or do you prefer to follow directions and complete specific tasks that are assigned by someone else? Do you take pride in being logical, rational, and able to find solutions to problems? Or do you see your strength in being caring, compassionate, and nourishing, a good listener and encourager? Do you tend to be patient and long-suffering, or alternatively, impatient, easily irritated, and wanting to see results quickly?

Fourth, what do you enjoy doing? What kinds of activities have you enjoyed in the past? What activities give you pleasure, so that you look forward to doing them? What kinds of things have you spent hours and hours doing when time just seemed to fly by? What kinds of activities excite you and energize you, rather than bore you and drain your strength?

Finally, what are your limitations? How is your physical health and endurance? Are you disabled in some way? Do you have difficulty walking and moving about, trouble hearing, problems with vision, or difficulty with coordination? Do you have chronic lung disease or chronic congestive heart failure that limits physical activity? What about financial resources? Are you able to live comfortably on your present income and assets, or do you need to work in order to live from day to day? Do you have sufficient money put away that will last during your retirement years? How much disposable income is there each month? What about time? How much free time is available? Do you have other responsibilities to family members, community organizations, your church, or volunteer groups that need fulfilling?

Choose a purpose that has flexibility.

Goals must be flexible in terms of your future abilities. They should be achievable regardless of the changes you are likely to encounter up ahead. The reality is that older adults experience health problems that limit and restrict them, and they are hard to predict. Financial problems may arise because of hospital bills or other unanticipated expenses. These new restrictions may prompt a modification of goals or at least a change of the pathway to pursuing goals. Purpose, however, need not be affected. Remember that purpose is the motor, the engine that drives us toward our goals. If someone is driving along and encounters a tree across the road on the way to his destination, he will not give up and go back home. Instead, he will get out a map and look for alternative routes to that destination. His car's motor remains unaltered as the power source that will take him over different roads to where he decides to go. The same is true for purpose as it moves a person toward chosen goals. What determines the power in purpose, of course, is the worthiness of the goals.

Your purpose should have the potential for significant impact.

Your purpose ought to have some kind of impact in the world; it should make a meaningful difference for at least one other person. If your effort has little impact or if its impact is entirely self-directed, then the worthiness of the goal must be questioned. For example, a person may choose to drive from New York to Los Angeles and back to New York again. The sights would be interesting and new things might be discovered, but if the effects were entirely confined to the person taking the journey, then the journey's potential for impact would be relatively low. The world wouldn't be much different as a result of the trip. If, however, she sought by the trip to affect even one other person in a positive way (or to rejuvenate or educate herself so that she could make an impact after her return), the impact would increase substantially.

Impact need not be defined on a large scale or by the number of people who are affected. Someone might, without expectation of reward, expend a great deal of effort and resources to improve the circumstances of one other person. Such efforts might be associated with considerable impact and could have consequences hard to predict. For example, the single person affected might help someone else, who in turn might help someone else, and so on, until a wave of generosity spreads out as a consequence of the initial deed. The world is often changed through the accumulated effects of many small kindnesses. The following true story illustrates this point.4

In the 1890s there was a very important inventor by the name of Whitcomb L. Judson who worked hard to create a revolutionary transportation system for Chicago. This was a huge contribution that placed Judson's name into the history books because of his accomplishment. One day, Judson learned that a father of a friend had severe arthritis in his fingers that made it difficult for him to manipulate the many tiny hooks that held people's clothes and shoes on in those days. The friend asked Judson if there was anything he could design that would make it easier for his father to fasten his shoes than the tiny hooks. Despite the fact that Judson was preoccupied with his enormous transportation project, he chose to take time to help his friend. As Whitcomb tried to figure out a way to keep shoes on easier, he invented a little contraption known as the zipper. During Judson's lifetime, very little attention was paid to the zipper and he didn't sell many of them. After he died, however, the zipper soon became enormously popular, as it remains to this day. When he designed the zipper for his friend's father, Judson had no intention of discovering something that would make him famous and rich—he just wanted to help a man with painful fingers to keep his shoes on. The consequences of that kind act, however, changed the world for the better. Which one of Judson's accomplishments had more impact? It's hard to say.

Albert Einstein said, "Only a life lived for others is a life worthwhile." There are not many actions that have true significance and meaning if no one else is affected. The effects that our actions have on others establish them as worthy. For example, if a person expends a great deal of time and resources climbing a mountain and is successful, while he may experience a feeling of satisfaction and accomplishment, the action affects no one else in a significant way. The action is entirely self-centered. Don't get me wrong—there's nothing wrong with climbing mountains or performing actions that one alone benefits from. In my younger years, I myself was a mountain climber and solitary explorer. However, if your action does not benefit others, either directly or indirectly, then your focus is still solely on yourself. It is important to focus on yourself at times, but if your goal and motive in life is self-fulfillment only, it won't provide you with much purpose.

The altruistic nature of an action is important; in other words, the action is not performed with the sole intention of receiving a reward or having one's own personal needs met. For example, suppose a man decides to perform an act of kindness by visiting a disabled homebound widow in the neighborhood. His intention would be to relieve the widow's loneliness and make her feel loved and cared for. If, however, he makes the visit because it is known that the widow is very wealthy and might provide a handsome reward for such attention, his good action is entirely self-centered. This is an extreme example, but it illustrates the point that for actions to serve a worthy purpose, they must be truly other-directed and not entirely self-directed. Having purpose that gives real power requires a focus on others or at least on another. As Ralph Waldo Emerson said, "The purpose of life is not to be happy. It is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well."

Your purpose should have a spiritual aspect.

If your purpose has a spiritual dimension, the power to reach your goals increases enormously. In addition, having a spiritual dimension magnifies the intrinsic rewards as you strive to fulfill that purpose. By spiritual I mean having some connection with God and God's will. Having a spiritual aspect, then, means that actions are in some way performed to further God's purposes. While it may be difficult to determine exactly what God's purposes are, and there are many different understandings of God that might influence that determination, common principles exist that are found in all major religious teachings. Chief among these common principles are to love and care for your neighbor and to attend to the needs of others, in contrast to being focused on your own comfort and pleasures. Western religions also place a particular emphasis on action. The universe is constantly moving and changing. To keep up, a person needs to be action-oriented. God has given people free will to determine their destiny. God has given power, dominion, and authority to humans as part of creation. But it is up to us to choose to take action.

ACTIVITIES THAT FULFILL PURPOSE

Only certain kinds of actions guide a person toward goals that are worthy enough to provide sustained purpose. On the one hand, say someone determines that his goal in retirement is to make as much money as he possibly can so that he can have control and power over others. This may provide great purpose as he takes action to strive toward that goal. Aging, however, usually leads to limits on one's earning capacity and to limited opportunities with regard to gathering wealth. It is likely, then, that the goal to earn a lot of money will be frustrated by one circumstance or another and could quickly lead to disillusionment. Even if our retiree succeeds, given that the goal is entirely self-centered, it is not clear how much fulfillment he will actually experience. On the other hand, say he chooses to seek to improve the lives of others by helping to meet their physical, psychological, social, or spiritual needs, with little expectation of reward. In this case, many activities can be engaged in to achieve the goal and any actions taken are quite likely to succeed and be fulfilling, especially if motives are "right."

So, what kinds of purpose-filled activities can a retired person get involved in? For those needing to draw a small amount of income to make ends meet, who still wish to invest in the lives of others in meaningful ways, there are the Foster Grandparent Program, Senior Opportunities for Services Programs, and Operation Mainstream. These government programs provide earnings at the federal minimum wage. If income is not needed, there are numerous government-sponsored volunteer activities such as the Retired Senior Volunteer Program (RSVP), Peace Corps, Service Corps of Retired Executives (SCORE), Volunteers and Service to America (VISTA), and International Executive Service Corps (IESC). Many other formal and informal kinds of helping and volunteer activities exist that I will discuss further in chapter 5.

PURPOSE WITH PHYSICAL ILLNESS

Physical illness and disability present real challenges. They do so by taking away independence and making inaccessible those things that provided purpose and meaning when we were younger and more able. I know this for a fact, given my personal battle with pain and disability from arthritis for the past twenty years. When your way of life is dramatically changed by illness, it sometimes stimulates a search for new sources of meaning. People with chronic illness are by no means excluded from experiencing purpose and power. One of the great advantages of purpose is that it is not limited by circumstances. In fact, difficult circumstances often represent the fertile soil of opportunity—opportunity for new direction and purpose that can have more impact than ever before. When a person is well and healthy, he or she can be entrapped by goals that have little ultimate meaning or significance. Illness often forces people to reevaluate and shed previous dreams and goals. Failing to redirect purpose and redefine goals in such circumstances can result in depression, despair, and loss of usefulness—and often does.

Rather than being focused on acquiring more possessions, more influence over others, or more self-centered pleasures, being unable to do so any longer because of illness forces attention toward higher, more important goals. The type of illness that one has may contain clues for that new purpose. It is the illness and limitations brought on by illness that can point the way.

For example, a person with arthritis and chronic pain may find that his or her suffering provides insight, compassion, and motivation to help others who also experience pain.5 Similarly, a woman diagnosed with breast cancer may join a support group to encourage and support other women with breast cancer. A homebound elderly person may decide to relieve loneliness by calling other homebound persons on the telephone and offering support, encouragement, and companionship. A person with chronic depression may decide to reach out to others who are disheartened and without hope, offering companionship that will lessen the burden of suffering.

The physically ill person may also, in desperation, seek spiritual solace. This may involve renewing a relationship with God or with a spiritual community. As a result, he or she may experience a new calling to serve others in some small way, still within his or her ability. For the spiritual person, opportunities for fulfilling God's divine will abound everywhere, especially in circumstances that would otherwise appear dismal. Disabled and dependent people can serve, if only by their attitudes of gratefulness and appreciation for the care they receive from others. The spiritual person can be a missionary to everyone she meets, sharing God's kindness, love, and truth in whatever circumstance arises, and praying for others when physical actions are no longer possible. Those in nursing homes and other institutional settings are no exception. The spiritual person in a nursing home may decide to give the gifts of friendliness and companionship by engaging in conversations with other residents, offering time to listen, and, if needed, supplying encouragement and hope. Serving in this way energizes and empowers the sick, gives them vision and purpose, and, while not guaranteed, may even lead to better physical health for some. As lives take on new meaning and purpose, the body's natural healing mechanisms may be invigorated (for example, immune function may be boosted).

HEALTH CONSEQUENCES OF PURPOSE

Plenty of scientific research shows the difference having a life's purpose makes on well-being and health. This is especially true for research that has examined the relationship between purpose and mental health in later life.

Purpose may be especially important for those recovering from addictive disorders like alcoholism.6 Purpose in the setting of chronic alcoholism has been shown to interact with spiritual practices to increase the length of sobriety. For example, Stephanie Carroll examined the relationship between spirituality and recovery from alcoholism in a sample of one hundred alcoholics participating in Alcoholics Anonymous.7 In that study, spirituality was defined as the extent to which the subject practiced Step 11—involving prayer and meditation—of the twelve-step program. The investigator found significant positive correlations between the practice of Step 11, "purpose in life" scores, and length of sobriety. Greater purpose in life was also associated with more Alcoholics Anonymous meetings attended, which was in turn associated with greater length of sobriety. The author concluded that a sense of purpose in life is associated with higher scores on spiritual activities like prayer and meditation, and that these together may assist in the maintenance of longer sobriety.

Having purpose in life influences the risk of experiencing depression, regardless of age. For example, Lisa Harlow and colleagues examined the relationship between purpose in life, negative emotions, and substance abuse in a sample of 722 adolescents.8 They found that purpose and meaning in life helped to block the vicious cycle of self-derogation, depression, substance abuse, and suicidal ideation in this population.

British investigators examined the relationship between purpose in life and both positive and negative measures of psychological well-being.9 They found a strong association between purpose, meaning in life, and well-being, which they were able to replicate in two different samples of people. Purpose in life was found to be more strongly related to positive well-being than to indicators of negative mental health. This finding suggests that having purpose in life may be particularly important in bringing about positive emotions like joy and happiness, rather than simply protecting from negative ones like depression or anxiety.

Not surprisingly, activities like volunteering are especially associated with greater purpose and well-being after retirement. In a study of forty retirees, those who volunteered more than ten hours a week scored significantly higher on a "purpose in life" test than did those who volunteered ten or fewer hours per week. In that study, a significant negative correlation was found between degree of purpose in life and proneness to boredom.10 Having a sense of purpose also predicts less worry about death and dying among older adults.11 This may have to do with the impact that purpose in life has on their sense of personal control and autonomy.

As noted earlier, having a sense of meaning and purpose is especially important in the setting of medical illness. Carol McWilliam and colleagues explored factors other than medical ones that influenced the discharge experiences of twenty-one medical patients.12 Included in the study were 22 informal caregivers and 117 professionals involved in their care. Investigators found that lack of purpose in life contributed to a disempowering process. Even in the face of threats to independence imposed by a biomedically oriented paternalistic health care system, patients with a sense of direction and purpose in life were less likely to experience a threat to autonomy. Researchers concluded that future attention should be placed on empowering patients with a sense of purpose and meaning to help maintain autonomy in the face of the threats imposed by illness and treatment settings.

In another study of medical patients, E. J. Taylor examined factors associated with meaning and progress among seventy-four persons with recurrent cancer.13 She found significant negative correlations between sense of purpose and symptom distress, social dependency, and length of time since diagnosis of recurrence. Adjustment to illness was clearly associated with greater purpose and meaning. She concluded that a sense of purpose was integrally related to the physical and psychosocial consequences of metastatic cancer, and that health professionals should seek to enhance the patient's sense of purpose and meaning.

Not only is purpose associated with better mental health, then, but as the above study implies, it may also be associated with better physical health. Note that having strong purpose was associated with a longer time since diagnosis of recurrence, suggesting that purpose may have delayed the recurrence of the cancer. Consider also the work of Karen Hooker and Ilene Siegler, who examined the relationship between having life goals (i.e., purpose in life) and perceptions of physical health and vigor.14 These investigators found that individuals who reported greater achievement of life goals perceived their health as substantially better than those who reported less fulfillment of purpose. Similarly, a study by A. Grand and colleagues found that purpose (feeling useful and having many projects to accomplish) predicted better physical health and vigor regardless of age.15 In a study of three hundred persons at five developmental stages from young adulthood to the old-old, George Reker and colleagues found that purpose in life increased with increasing age and predicted greater psychological and physical well-being.16

There is also evidence that having purpose predicts a longer life span.17 In one study, investigators followed 6,274 subjects for three years. During the three years, 449 people died. Among the 3,891 women in the study, predictors of survival were younger age, less disability, fewer memory problems, regular health examinations, and greater purpose in life. Thus, purpose in life was an independent predictor of longevity, regardless of age or level of physical disability.

Having a sense of purpose and meaning may also influence the health and well-being of family members who care for sick loved ones.18 In one study, researchers examined the effect of having purpose on spouse caregiver health.19 Studying sixty-five spouse caregivers of persons with advanced cancer, they found that sense of purpose was a significant predictor of better caregiver health status. Thus, it appears that those who have strong purpose in life can endure even the most difficult of circumstances and survive—both mentally and physically.

CONCLUSION

There is an alternative to retiring to a life of self-absorption, leisure, and inactivity. That alternative involves identifying a new and higher purpose that can give life meaning and significance, while at the same time accepting the changes associated with advancing age and retirement. Only certain kinds of purpose have the potential to be empowering, so being deliberate about choosing the right goals is essential. Empowering sources of purpose are especially important for persons with acute or chronic medical illness and for loved ones who provide care for them. Having purpose and meaning in life is associated with better mental health, better physical health, and greater longevity. Purpose, then, adds not only years to life, but life to years.

Notes

  1. E. Payne, S. Robbins, and L. Dougherty, "Goal Directedness and Olderadult Adjustment," Journal of Counseling Psychology 38, no. 3 (1991): 302-308.
  2. Victor Frankl, Man's Search for Meaning (New York: Pocket Books, 1959).
  3. Erik Erikson, Vital Involvement in Old Age: The Experience of Old Age in Our Time (New York: Norton, 1994).
  4. Christopher Ian Chenoweth, "Make a Small Difference in a Big Way," Daily Inspiration (29 November 2001); available from http://www.positivechristianity.org.
  5. Harold G. Koenig, Chronic Pain: Biomedical and Spiritual Approaches (Binghamton, N.Y.: Haworth Press, 2002).
  6. Jodie L. Waisberg and J. E. Porter, "Purpose in Life and Outcome of Treatment for Alcohol Dependence," British Journal of Clinical Psychology 33, no. 1 (1994): 49-63.
  7. Stephanie Carroll, "Spirituality and Purpose in Life in Alcoholism Recovery," Journal of Studies on Alcohol 54, no 3 (1993): 297-301.
  8. Lisa L. Harlow, M. D. Newcomb, and P. M. Bentler, "Depression, Self-derogation, Substance Use, and Suicide Ideation: Lack of Purpose in Life as a Mediational Factor," Journal of Clinical Psychology 42, no. 1 (1986): 5-21.
  9. Sheryl Zika and Kerry Chamberlain, "On the Relation between Meaning in Life and Psychological Well-being," British Journal of Psychology 83, no. 1 (1992): 133-45.
  10. Lawrence Weinstein, X. Xie, and C. C. Cleanthous, "Purpose in Life, Boredom, and Volunteerism in a Group of Retirees," Psychological Reports 76, no. 2 (1995): 482.
  11. Herbert Rappaport, Robert J. Fossler, Laura S. Bross, and Dona Gilden, "Future Time, Death Anxiety, and Life Purpose among Older Adults," Death Studies 17, no. 4 (July-August 1993): 369-79. notes for chapter 4 + 185 186 + notes for chapter 5
  12. Carol L. McWilliam, J. B. Brown, J. L. Carmichael, and J. M. Lehman, "A New Perspective on Threatened Autonomy in Elderly Persons: The Disempowering Process," Social Science & Medicine 38, no. 2 (1994): 327-38.
  13. E. J. Taylor, "Factors Associated with Meaning in Life among People with Recurrent Cancer," Oncology Nursing Forum 20, no. 9 (1993): 1399-405.
  14. Karen Hooker and Ilene C. Siegler, "Life Goals, Satisfaction, and Self-rated Health: Preliminary Findings," Experimental Aging Research 19 (1993): 97-110.
  15. A. Grand, P. Gorsclaude, H. Bocquet, J. Pous, and J. L. Albarede, "Predictive Value of Life Events, Psychosocial Factors, and Self-rated Health on Disability in an Elderly Rural French Population," Social Science and Medicine 27 (1988): 1337-42.
  16. George T. Reker, E. J. Peacock, and P. T. Wong, "Meaning and Purpose in Life and Well-being: A Life-span Perspective," Journal of Gerontology 42, no. 1 (1987): 44-9.
  17. Yukako Honma, Y. Naruse, and S. Kagamimori, "Physio-social Activities and Active Life Expectancy, Life Expectancy in Japanese Elderly," Japanese Journal of Public Health 46, no. 5 (1999): 380-90.
  18. Carolyn Milne, C. Saccco, G. Cetinski, G. Browne, and J. Roberts, "Correlates of Well-being among Caregivers of Cognitively Impaired Relatives," Canadian Journal of Nursing Research 26, no. 1 (1994): 27-39.
  19. Kathleen M. Stetz, "The Relationship among Background Characteristics, Purpose in Life, and Caregiving Demands on Perceived Health of Spouse Caregivers," Scholarly Inquiry for Nursing Practice 3, no. 2 (1989): 133-53.

From Harold G. Koenig, M.D., Purpose and Power in Retirement: New Opportunities for Meaning and Significance ( Philadelphia: Templeton Foundation Press, 2002), 54-70. 

 
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