Meaning and Purpose in Life in Aging: A Scoping Review

Sentido e Propósito de Vida na Velhice: Uma Revisão de Escopo

ABSTRACT

The feeling that life has meaning or purpose is essential for human beings. Absence of meaning can lead to an existential vacuum. Purpose in life, akin to meaning in life, derives from the humanistic psychology theory of Frankl, and they are considered synonymous. Other scholars, however, regard the two constructs as distinct. The objective of the review was to map both concepts in the gerontological literature, examining how they manifest in aging. The review of the databases was carried out between January 2019 and March 2020. Thirty articles were included. In the context of aging, results were conflicting. The literature review yielded evidence to affirm that meaning and purpose in life are distinct concepts, despite sharing the same existential-philosophical roots.

KEYWORDS:
aging; psychology; review; purpose in life; meaning in life

RESUMO

O sentimento de que a vida tem sentido ou propósito é essencial ao ser humano. A ausência de sentido pode levar a um vácuo existencial. Propósito de vida, a exemplo de sentido, também deriva da psicologia humanística de Frankl, sendo considerados sinônimos. No entanto, há estudos que propõem distinção entre os dois construtos. A revisão tem por objetivos mapear ambos os conceitos na literatura gerontológica, examinando-os à luz do envelhecimento. O levantamento nas bases de dados foi realizado de janeiro de 2019 a março de 2020. Foram incluídos 30 artigos. No contexto do envelhecimento, os resultados foram controversos. A literatura revista apresentou evidências para afirmar que sentido de vida e propósito são conceitos distintos, apesar da origem filosófico-existencialista comum.

PALAVRAS-CHAVE:
envelhecimento; psicologia; revisão; propósito de vida; sentido de vida

The feeling that life has meaning or purpose is one of the greatest emotions a human can experience (Frankl, 1959; Yalom, 1980). Absence of meaning can lead to an existential vacuum, promoting unfavorable psychological outcomes such as anxiety and depression (Frankl 1958, 1959, 1966). The experience of meaning is a protective factor in promoting resilience against the adversities which older adults may face (Ryff & Singer, 1998). A multidimensional construct defined in various ways (Brandtstädter, 2012), meaning in life derives from the philosophical-humanistic theories of Frankl (1969), who described the quest for meaning as the primary motivation of human existence.

Purpose in life, akin to meaning in life, also derives from Frankl´s humanistic psychology, and is considered a synonym of meaning in life (Frankl, 1963, 1969 ). Some scholars, however, regard the two constructs as distinct (Yalom, 1980; Wong & Fry, 1998). In terms of psychological well-being, the definition of purpose is couched in motivational terms, life goals which guide decisions and choices (Ryff, 1989).

Both meaning and purpose in life have bearing in the context of aging; well-being of older persons stems from the experiences of meaning and purpose in life (Tornstam, 1997). Meaning has implications for quality of life (Moody, 1986) and successful aging (Krause, 2005), promoting longevity and well-being (Takkinen & Ruoppila, 2001). Successful older adults cherish life and have a clear sense of meaning and purpose (Wong, 2000), including positive life and death attitudes (Ardelt & Koenig, 2007). Meaning in life has shown to be a way to ease older adults to engage in regular physical activities (Ju, 2017). Studies have shown correlations between meaning in life, physical health, emotional adjustment (Isaia et al., 1999) and depression in older adults (Volkert et al., 2019). Moreover, meaning is life is found to be a significant moderator of the associations between hopelessness and passive suicide ideation among older people (Beach et al., 2020). Greater purpose in life is associated with a number of psychological outcomes, such as more positive outlook on life, happiness, satisfaction and self-esteem (Ryff & Keyes, 1995). Purpose in life has been shown to be associated with biological markers of health and well-being (Mezick et al., 2010; Boyle et al., 2012, Kim et al., 2019, Kim et al, 2020,), and also with risk of mortality (Hill & Turiano, 2014).

Some studies suggest it can be hard to maintain a strong sense of meaning in old age (Hupkens et al., 2018; Krause, 2004). Physical, social and psychological losses that typically accompany the aging process can deprive older adults of important sources of meaning in life, leaving an existential vacuum (Baumeister, 1991). However, with advancing age, meanings become reexamined in the light of experiences, and new meanings can be constructed despite the losses inherent to age (MacKinley, 2002). The search for meaning allows old people to cope with challenges that come along the years.

Due to the implications of meaning in life for mental health and longevity, it is necessary to map both meaning and purpose in life in gerontological literature. Additionally, given the dearth of studies exploring the interchangeability of the concepts of meaning and purpose in life, the objective of the present review was to map the concepts of meaning and purpose in the gerontological literature and to investigate whether they can be considered as synonyms. Results of further searches from the analysis of the articles included in the review have also been charted.

Objectives

The objectives of this review were as follows: a) to map the concepts of meaning and purpose in life as reported in the gerontological literature and b) to investigate the possible distinctions between the two constructs. The questions to be addressed by this review are: a) can meaning and purpose in life be considered interchangeable constructs? and b) how do levels of meaning and purpose in life manifest in aging?

Method

A scoping review or mapping review is commonly used to clarify definitions and conceptual boundaries regarding a particular field or area when an extensive body of literature is heterogeneous in nature and not amenable to accurate systematic review (Arksey & O´Malley, 2005). A scoping review does not seek to analyze the methodological quality of the studies included, but to map them. Based on a synthesis of the available knowledge, various types of study design are then incorporated to comprehensively summarize and synthesize the scientific evidence, disclosing practices, programs and policies, as well as providing guidance for future searches (Colquhoun et al., 2014; Peters et al., 2015). We followed the Prisma Extension for Scoping Reviews (PRISMA ScR) to guide this work (Tricco et al., 2018).

Search strategy

The review of the studies was carried out between January 2019 and March 2020. The following databases were searched: BVS, PUBMED, AGELINE, CINAHL, COCHRANE, EMBASE, PSYCARTICLES, PSYCINFO, SCOPUS, and WEB OF SCIENCE.

The search strategy used was “Aging” AND “Purpose in Life” OR “Meaning in Life” AND (Aged OR “Aged, 80 and over” OR “old people” OR “old adults”), based on title and abstract. No constraints were applied regarding publication date of articles. The search strategy for each database is given in detail in Chart 1.

Chart 1
Database strategy

Database	Search strategy
PUBMED	(((((((Aging[MeSH Terms]) OR Aging[Title/Abstract]) OR Senescence[Title/Abstract]) OR “Biological Aging”[Title/Abstract]) OR “Aging, Biological”[Title/Abstract])) AND ((“purpose in life”) OR “meaning in life”)) AND (((((Aged) OR Elderly)) OR ((((((((((Aged, 80 and over[MeSH Terms])) OR (“Aged, 80[Title/Abstract] AND over”[Title/Abstract])) OR “Oldest Old”[Title/Abstract]) OR Nonagenarians[Title/Abstract]) OR Nonagenarian[Title/Abstract]) OR Octogenarians[Title/Abstract]) OR Octogenarian[Title/Abstract]) OR Centenarians[Title/Abstract]) OR Centenarian[Title/Abstract])) OR ((“old people”) OR “old adults”))
PUBMED PMC	(((((((Aging[MeSH Terms]) OR Aging[Title/Abstract]) OR Senescence[Title/Abstract]) OR “Biological Aging”[Title/Abstract]) OR “Aging, Biological”[Title/Abstract])) AND ((“purpose in life”) OR “meaning in life”)) AND (((((Aged) OR Elderly)) OR ((((((((((Aged, 80 and over[MeSH Terms])) OR (“Aged, 80[Title/Abstract] AND over”[Title/Abstract])) OR “Oldest Old”[Title/Abstract]) OR Nonagenarians[Title/Abstract]) OR Nonagenarian[Title/Abstract]) OR Octogenarians[Title/Abstract]) OR Octogenarian[Title/Abstract]) OR Centenarians[Title/Abstract]) OR Centenarian[Title/Abstract])) OR ((“old people”) OR “old adults”))
BVS / BIREME MEDLINE LILACS CUMED IBECS INDEXPSI	((“Propósito na vida” OR “purpose in life” OR “propósitos en la vida”) OR (“sentido na vida” OR “meaning in life” OR “sentido de la vida”)) AND (aging OR envejecimiento OR envelhecimento) AND ((aged OR anciano OR idoso) OR (“Aged, 80 and over” OR “Anciano de 80 o más Años” OR “Idoso de 80 Anos ou mais”) OR (“old people” OR “old adults” OR ancianos OR “personas mayores” OR seniores)) AND (instance:”regional”)
CINAHL - The Cumulative Index to Nursing and Allied Health Literature	(MH “Aging”) OR “Aging” OR Aging OR Senescence OR “Biological Aging” OR “Aging, Biological” AND (MH “Life Purpose”) OR “purpose in life” OR “meaning in life” AND (Aged OR Elderly) OR (“Aged, 80 and over” OR “Oldest Old” OR Nonagenarians OR Nonagenarian OR Octogenarians OR Octogenarian OR Centenarians OR Centenarian ) OR ( “old people” OR “old adults” )
SCOPUS	(TITLE-ABS-KEY (aging OR senescence OR “Biological Aging” OR “Aging, Biological” ) ) AND ( ( ALL ( “purpose in life” ) OR ALL ( “meaning in life” ) ) ) AND ( ( ALL ( aged OR elderly ) ) OR ( ALL ( “Aged, 80 and over” OR “Oldest Old” OR nonagenarians OR nonagenarian OR octogenarians OR octogenarian OR centenarians OR centenarian ) ) OR (ALL ( “old people” OR “old adults” ) ) )
WEB OF SCIENCE	TÓPICO: (Aging OR Senescence OR “Biological Aging” OR “Aging, Biological”) Índices=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Tempo estipulado=Todos os anos AND TÓPICO: (“purpose in life”) OR TÓPICO: (“meaning in life”) Índices=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Tempo estipulado=Todos os anos AND TÓPICO: (Aged OR Elderly) Índices=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Tempo estipulado=Todos os anos OR TÓPICO: (“Aged, 80 and over” OR “Oldest Old” OR Nonagenarians OR Nonagenarian OR Octogenarians OR Octogenarian OR Centenarians OR Centenarian) Índices=SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI Tempo estipulado=Todos os anos OR TÓPICO: (“old people” OR “old adults”)
EMBASE	(aged OR elderly OR 'aged, 80 and over' OR 'oldest old' OR nonagenarians OR nonagenarian OR octogenarians OR octogenarian OR centenarians OR centenarian OR 'old people' OR 'old adults') AND ('aging'/exp OR 'aging'/syn) AND ('purpose in life'/exp OR 'purpose in life'/syn OR 'meaning in life'/exp OR 'meaning in life'/syn)
AGELINE	DE “Aging” OR Aging OR Senescence OR “Biological Aging” OR “Aging, Biological” AND DE “Purpose in Life” OR “Purpose in Life” OR “Meaning in Life” AND (Aged OR Elderly ) OR ( “Aged, 80 and over” OR “Oldest Old” OR Nonagenarians OR Nonagenarian OR Octogenarians OR Octogenarian OR Centenarians OR Centenarian ) OR ( “old people” OR “old adults” )
COCHRANE LIBRARY	MeSH descriptor: [Aged] in all MeSH products OR MeSH descriptor: [Aged] in all MeSH products AND (“purpose in life”) OR (“meaning in life”) AND (Aged OR Elderly) OR (“Aged, 80 and over” OR “Oldest Old” OR Nonagenarians OR Nonagenarian OR Octogenarians OR Octogenarian OR Centenarians OR Centenarian) OR (“old people” OR “old adults”)
PSYCINFO	((Any Field: (Aging) OR Any Field: (Senescence) OR Any Field: (“Biological Aging”) OR Any Field: (“Aging, Biological”)) OR (IndexTermsFilt: (“AGING”))) AND ((Any Field: (“purpose in life”)) OR (Any Field: (“meaning in life”))) AND ((Any Field: (“old people”) OR Any Field: (“old adults”)) OR (Any Field: (“Aged, 80 and over”) OR Any Field: (“Oldest Old”) OR Any Field: (Nonagenarians) OR Any Field: (Nonagenarian) OR Any Field: (Octogenarians) OR Any Field: (Octogenarian) OR Any Field: (Centenarians) OR Any Field: (Centenarian)) OR (Any Field: (Aged) OR Any Field: (Elderly)))
PSYCARTICLES	((Any Field: (Aging) OR Any Field: (Senescence) OR Any Field: (“Biological Aging”) OR Any Field: (“Aging, Biological”)) OR (IndexTermsFilt: (“AGING”))) AND ((Any Field: (“purpose in life”)) OR (Any Field: (“meaning in life”))) AND ((Any Field: (“old people”) OR Any Field: (“old adults”)) OR (Any Field: (“Aged, 80 and over”) OR Any Field: (“Oldest Old”) OR Any Field: (Nonagenarians) OR Any Field: (Nonagenarian) OR Any Field: (Octogenarians) OR Any Field: (Octogenarian) OR Any Field: (Centenarians) OR Any Field: (Centenarian)) OR (Any Field: (Aged) OR Any Field: (Elderly)))

Inclusion criteria and Exclusion

Studies satisfying the following criteria were selected: 1) investigating samples of community-dwelling older adults aged over 60; 2) involving older adults without signs suggesting dementia or diagnosed mental disorders; 3) with qualitative and quantitative designs addressing important conceptual discussion on the variables of interest, namely, purpose and meaning in life among older adults; and 4) published in Portuguese, English or Spanish. Books, theses and dissertation were excluded.

Study selection

The search of the databases described led to the initial retrieval of 3,382 studies. After exclusion of 1,079 duplicates, 2,303 entries were selected for analysis of title and abstract, with inclusion of articles containing one of the terms: “aged”, “aged, 80 and over”, “anciano”, “idoso”, “old people”, “old adults”, “ancianos”, “personas mayores”, “seniores”, “aging”, “envejecimiento”, “envelhecimento” plus one of the terms “purpose in life”, “propósitos en la vida”, “propósito de vida”, “sentido na vida”, “sentido de la vida” and “meaning in life”. A total of 1,698 studies were excluded, giving 605 for full reading. Using the software program “Rayyan QCRI” (Ouzzani et al., 2016), articles were labeled after reading, aiding the process of exclusion for different reasons. Thus, 232 studies were excluded for providing a poor theoretical explanation of the variables of interest, 172 for involving samples aged < 60 years, 13 for being in other languages, 12 were excluded for involving older adults with cognitive impairment suggesting dementia, 13 for including older adults with mental disorders, 7 for including institutionalized older adults, 32 theses/dissertations and 46 books were excluded, while 44 articles were unavailable. Thus, a total of 30 articles were included in this review. The flow diagram of the scoping review process is depicted in Figure 1:

Figure 1
Flow Diagram of the Scoping Review (Source: PRISMA)

Results and Discussion

Description of studies

Of the 30 articles included, 29 were published in English and 1 in Portuguese. The fact that only one study in Portuguese was included in this review points to the fact that there are few studies addressing meaning and purpose in Brazilian older adults. Regarding study design, 16 were cross-sectional, 7 longitudinal, 6 were review studies and 1 a meta-analysis. Publication year ranged from 1992 to 2019. The characteristics of the included studies are given in Table 1 (see supplementary material).

Tabele 1
Characteristics of selected studies

Author/year	Country	Sample	Design	Conceptual discussion	Main results
Boyle, Barnes, Buchman, et al. (2009)	USA	1,238 community-dwelling older adults	Longitudinal	Purpose in life in existentialism line.	High level of purpose in life was associated with reduced risk of mortality.
Burbank (1992)	USA	81 community-dwelling older adults	Cross-sectional	Meaning in life in existentialism line	The majority of the sample (89%) reported having something so important that it gave their lives meaning. The categories that most gave life meaning were, in descending order: relationships, religion, service, activities and others such as living/growth, home, health and learning.
Czekierda, Banik, Park, et al. (2017)	USA (Poland)	66 studies	Systematic review and meta-analysis	Meaning and purpose as synonymous Meaning in life in existentialism line	Weak to moderate association between meaning in life and physical health. Concept of meaning, health status and age were not moderators of these associations. Health operationalization moderated the relationship between meaning in life and health.
Duppen, Machielse, Verté, et al. (2019)	Belgium (Netherlands)	121 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	Socially frail older adults experience meaning in life in different dimensions: purpose, moral worth, competence, self-worth, coherence, connectedness and excitement.
Guttmann (2001)	Israel	---	Review	Meaning in life in existentialism line	Meaning can be obtained through work, hobbies or volunteer activities, through attitudes taken toward fellow human beings and God.
Hedberg, Gustafson & Brulin (2010)	Sweden	189 community-dwelling older adults	Cross-sectional	Purpose and meaning as synonyms. Purpose in life in existentialism line.	The study indicates that the very old people studied were feeling indecisive about their purpose in life and that feelings are linked with poorer psychological health.
Hedberg, Brulin, Aléx, et al. (2019)	Sweden	30 community-dwelling very old women	Cross-sectional	Meaning and purpose as synonymous Meaning in life in existentialism line	Very old women experience purpose in life in daily life activities and in contact with the spiritual world. Some of the participants saw their lives in terms of simply existing, and did not experience purpose in life.
Hoeyberghs, Verté, Verté ,et al. (2019)	Belgium	16,872 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	Financial security, meeting basic needs and personal relations play an important role as sources of meaning in life.
Hupkens, Machielse, Goumans, et al (2018)	Netherlands	44 studies	Integrative review	Meaning in life conceptualized in several ways	Older persons find meaning in life through different processes. Meaning in life is associated with the circumstances old persons live in.
Irving, Davis, & Collier (2017)	Australia	31 studies	Systematic review	Purpose and meaning as synonyms. Goal-oriented purpose	Research outcomes suggest that greater reported purpose is related to a range of better health and well-being outcomes for older adults.
Jewell (2010)	England	535 community-dwelling elders	Cross-sectional	Purpose and meaning as synonyms. Purpose in life in existentialism line	Purpose in life is positively related to a collaborative religious coping style, an approach-lefted death attitude, intrinsic religiosity, and spiritual transcendence.
Jonsén, Norberg, & Lundman (2014)	Sweden	10 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	The sense of meaning in life in the oldest old was linked to regarding oneself as having a mission to carry out and to finding beauty, joy and happiness in life. The sense of meaning involved transferring to coming generations what earlier generations had left and having a deeply rooted faith in being taken care of from birth to the afterlife.
Ju (2017)	South Korea	239 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	Physical activity was positively associated with meaning in life and subjective vitality. The relationship between physical activity and vitality was partially mediated by meaning in life.
Koren & Lowenstein (2008)	Israel	180 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	Widowhood in older ages can cause loss of sense of meaning. Married couples have a higher level of meaning in life than widowers do.
Krause (2004)	USA	1,518 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	The findings suggest that life events arising in roles that are valued highly are associated with less favorable health ratings.
Krause (2005)	USA	1,313 community-dwelling elders	Longitudinal	Meaning in life in existentialism line	Emotional support reduces the effects of trauma on meaning, whereas negative inter-personal contacts tend to intensify the pernicious effects of trauma on meaning in life.
Krause (2007a)	USA	959 community-dwelling elders	Longitudinal	Meaning in life in existentialism line	Negative interaction lowers an older person’s sense of meaning in life. Increased early support was associated with a greater sense of meaning in life and was more strongly associated with changes in meaning over time than other measures of social support.
Krause (2007b)	USA	988 community-dwelling seniors	Longitudinal	Meaning in life in existentialism line	The results suggested that a sense of meaning in life declines at an accelerating rate with progressively higher levels of difficulty with thought suppression.
Krause (2009)	USA	1,361 community-dwelling elders	Longitudinal	Meaning in life in existentialism line	Old people with a strong sense of meaning were less likely to die during the follow-up period of the study than those who did not have a strong sense of meaning. Having a strong sense of meaning was strongly associated with mortality.
Krause (2010)	USA	1,011 community-dwelling elders	Longitudinal	Meaning in life in existentialism line	People with a strong sense of God-mediated control are more likely to find a sense of meaning in life and be more optimistic than individuals who do not have a strong sense of God-mediated control. People who are optimistic and who have a strong sense of meaning in life will rate their health more favorably over time than individuals who are not optimistic, as well as individuals who have not found a sense of meaning in life.
MacKinlay (2002)	Australia	24 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	---
Melo, Eulálio, Gouveia, et al. (2013)	Brazil	210 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	The influence of stress on quality of life was significant for the group with low meaning in life, where this was not the case for the group with high meaning.
Moore, Metcalf & Schow (2000)	Canada	---	Literature review	Meaning in life in existentialism line	----
Neville, Adams, Montayre, et al (2018)	New Zealand	614 community-dwelling elders	Cross-sectional	Meaning and purpose as synonyms. Purpose in life in existentialism line	Having poor mental health and lower purpose in life were indicators of loneliness. Old people with low levels of purpose had higher rates of loneliness than those with higher or neutral purpose.
Nygren, Jonsén, Gustafson, et al. (2005)	Sweden	125 community-dwelling elders	Cross-sectional	Meaning and purpose as synonyms. Purpose in life in existentialism line	The correlation between scores on the different scales suggests that the scales measure some dimension of inner strength and that the oldest old have this strength at least in the same extent as younger adults
Pinquart (2002)	Germany	70 studies	Meta-analysis	Meaning and purpose as synonyms. Purpose in life in existentialism line	Purpose in life showed a strong association with social integration, and with relational quality in particular. In addition, high purpose in life was related to better health, higher everyday competence, higher socioeconomic status, being employed, and being married.
Ryff, Heller, Schaefer, et al. (2016)	USA	---	Review	Goal-oriented purpose	The results showed declining scores for purpose in life and personal growth with aging, but also underscore the notable variability among older persons in these patterns.
Takkinen & Ruopilla (2001a)	Finland	55 community-dwelling elders	Longitudinal	Meaning in life in existentialism line	The space of functioning provided a novel and illustrative approach to functioning as a multifaceted behavioral competence with meaning in life as an integral part of it.
Takkinen & Ruopilla (2001b)	Finland	559 community-dwelling elders	Cross-sectional	Meaning in life in existentialism line	The interactions between the various measures of meaning in life showed that having a sense of coherence and zest for life were factors related to the sense of meaningfulness in life. Meaning of death was not related to other measures.
van der Vaart & van Oudenaarden (2018)	Netherlands	02 organizations	Cross-sectional	Meaning in life in existentialism line	The outcomes indicate that the long-term care organizations had little active policy on dealing with existential questions; also, personnel had few specific tools except listening closely.

The definitions of meaning and purpose in life, together with the way in which they manifest in older adults, are outlined below. The main study outcomes found in studies from the gerontological literature involving meaning and purpose are compiled in Table 1 and described below.

Meaning in life - concept and importance in aging

Meaning is a complex multifaceted construct involving physical, psychological, social and religious dimensions (Krause, 2010). This construct is addressed in studies conducted in the fields of philosophy, sociology, psychology, anthropology, gerontology and theology (Burbank, 1992). However, consensus among authors on a definition for meaning in life is lacking. The concept for meaning has been defined variously to denote coherence in one´s existence (Battista & Almond, 1973; Reker & Wong, 1988), ontological meaning in life based on subjective experiences (Crumbaugh & Maholick, 1964) and also orientation towards goals and aims (Ryff & Singer, 1998).

There are different definitions in the literature for meaning in life. According to Frankl´s existentialism theory (1969), each one constructs its own meaning in life. The author did not go as far as proposing a strict definition, but suggested meaning is associated with the belief that life is full of meaning, which transcends material reality (Melo et al., 2013). According to Frankl, the most important aspect is the quest for meaning, as opposed to the end result of this search. Thus, humans are not creatures at the mercy of their fate, but creators of it. It is precisely this search for meaning that distinguishes humans from other species (Frankl, 1971). The primary motivation of life is the search for meaning which comprises choices and commitments that transcend personal interests, irrespective of sex, age, intellectual ability or religious orientations (Frankl, 1959, 1967). Without meaning in life, man may experience feelings of worthlessness, frustration, and lack the will to live, referred to as an existential vacuum (Frankl, 1958). This author´s clinical work and the method derived from it called logotherapy (therapy through search for meaning) were heavily influenced by his experiences in Nazi concentration camps, and later in treating survivors of the Holocaust. From these experiences, the author derived the belief that people can find meaning in life even in situations extremely adverse to dignity and survival. In addition, prisoners who had a sense of meaning in life had better chance of survival (Bar-Tur & Prager, 1996). However, Frankl´s existentialist theory failed to consider the metaphysical decision-making on whether life has a goal or not. He predominantly seeks a goal for human existence (Bondevick & Sokstad, 2000). Given the fact there is no single meaning shared by all humans (Frankl, 1965), each individual should be responsible for developing their own meaning (Battista & Almond, 1973).

Frankl was the pioneer in defining the concept in the literature, but other authors later proposed alternative definitions. From a semantic perspective, Yalom (1980), based on a broader existentialist line than that of Frankl (1959), defined meaning as a sense or coherence, holding that meaning can be divided into cosmic or personal. Cosmic meaning denotes a certain magical or spiritual order of the universe, whereas personal (or earthly) meaning can be defined as the purpose or function to be fulfilled. Baumeister (1991) proposed four different needs of meaning: need for purpose, moral value, self-esteem and control. Subsequently, Derkx (2013) added further three needs to those described by Baumeister: the need for comprehensibility, connectedness and transcendence. According to Reker (1988), meaning in life can be defined as “cognizance of order, coherence, and purpose in one's existence, the pursuit and attainment of worthwhile goals, and the accompanying sense of fulfillment”. It is associated with a purpose, a direction and a reason for existence, representing a multidimensional construct which has cognitive, motivational and affective components. The cognitive aspect is related with beliefs and interpretations of the world; motivational refers to the system of values of each person that influence the attainment of personal goals, while the affective aspect involves life satisfaction, i.e. the conception that life is worthwhile (Reker, 1997). The search for meaning and the reason why people seek meaning can vary because individuals have different lifetime experiences (Reker et al., 1987). The model proposed by Park and Folkman (1997) describes the global and situational level of meaning, where the former refers to the belief about life and the latter to interaction between global meaning and life circumstances. Meaning can be conceived as perception that guides decisions and actions, providing life with coherence, interlacing past, present and future, shaping patterns of behavior related to life events (Simmons, 1998). Steger, Frazier, Oishi and Kaler (2006) defined meaning as one´s nature or existence. Brandtstädter et al. (2012) defined meaning as one´s understanding, belief or perception about life or activity, as well as the value and importance conferred to it.

Some authors highlight the stable nature of meaning over time, although sources can change through the course of the life span (Zika & Chamberlain, 1992; Yalom, 1980); others hold that stressors can erode sense of meaning, especially in advanced age (Krause, 2004). Certain physical, social and psychological losses which accompany older adults can deprive them of important meaning in life (Baumeister, 1991). Bereavement, retirement, widowhood and physical disabilities can erode and undermine the meaning of life, creating an existential vacuum among older people (Frankl, 1958, 1959). The experience of meaning is crucial for all humans, but this holds especially true among the older population (Hedberg et al., 2011), particularly the older old (Martens et al., 2005) Attaining meaning is a cognitive process driven by life´s adversities (Czekierda et al., 2017), and is a challenging complex process in elderly that involves multiple functions, such as focus, concentration and control (Krause, 2004). In aging, meanings in life are reexamined in the light of experiences, enabling older individuals to construct new meanings through wisdom (MacKinley, 2002). In a context of social, physical and cognitive losses, a meaningful life can favor the transformation of personal adversities into moments of human growth, converting anguish and hopelessness into well-being (Drageset et al., 2017). From this perspective, meaning in life can act as an important self-regulating mechanism, guiding individuals so that, by drawing on psychosocial resources, they may overcome the adversities of everyday life (McKnight & Kashdan, 2009).

With regard to sources of meaning in life, there appears to be overall agreement among researchers. According to Burbank (1992), the most important source of meaning in life is human relations, besides religion (beliefs), service, growth, work and health, maturity and personal growth, participating in hedonistic activities and acquiring material possessions were more important for the young-old than the old-old group. The studies of Hedlund and Birren (1984) and Anchoo and Levi (1995) affirmed the major sources of meaning as being: personal relationships, personal growth, success, altruism, hedonism, creativity, religion and legacy for future generations. Burbank (1992) found that the categories which conferred more meaning among community-dwelling older adults were (in descending order): relationships, religion, service and activities, followed by living/growth, home, health and learning. Guttman (1999), borrowing from Frankl (1958, 1959), proposed 3 ways of finding meaning in life: a) through an activity (doing or creating); b) experiencing values through relationships with others; and c) through unavoidable suffering. In aging, sources of meaning are associated with doing things for others, and being a grandmother/grandfather (Martos et al., 2010). An integrative review (Hupkens et al., 2018) found that human relationships are the main source of meaning for older persons, whereas other sources can vary with age and culture. Financial security, recognition of basic needs and relationships were found to be important sources for community-dwelling older people (Hoeyberghs et al. 2019). Amongst community-dwelling the oldest participants, meaning was associated with having a mission to carry out and finding joy, happiness, and beauty in life (Jonsén et al., 2014). Socially frail older adults appear to experience meaning through purpose, moral concern, competence, self-worth, coherence, connection and excitation, whereas purpose encompassed connection of life in the present with something positive in the future (Duppen et al., 2019).

In gerontological research, there are numerous associations of meaning in life with physical and psychological health. Meaning in life was positively associated with subjective vitality and self-reported health in older adults (McMahan & Renken, 2011). Reker (1997) found that personal meaning was a predictor of less depressive symptoms in elderly. Physical activity was found to increase depth of meaning in life (Hooker & Masters, 2016), while strong experience of meaning can lead to existential satisfaction (Van der Vaart & Van Oudenaarden, 2018). Meaning was associated with a series of outcomes, such as happiness, satisfaction with life, psychological well-being and recovery from bereavement (Zika & Chamberlain, 1992), outlining the importance of meaning in life as a strategy for successful aging, besides selection, optimization and compensation (Bates & Carstensen, 2003) and socioemotional selectivity theory (Carstensen et al., 2003). The existential domain is based on the search of meaning in life, which occurs through lifetime. As life goes on, spirituality seems to be central to help older people to find meaning and purpose to cope with stress, losses and difficulties that may have occurred (Miranda et al., 2020). Through the aging process, strengthen meaning in life appears to have essential contributions to longevity and mental health in older adults, which directly hinders their way of lives (Miranda et al., 2020).

Many authors of the studies included in the review examined an existential-philosophical line of meaning (Burbank, 1992; Czekierda et al., 2017; Duppen et al., 2019; Guttman, 2001; Ju, 2017; Hoeyberghs et al., 2019; Hupkens et al., 2018; Jonsén et al., 2014; Koren & Lowenstein, 2008; Krause 2004, 2005, 2007a, 2007b, 2009, 2010; MacKinlay, 2002; Melo et al, 2013; Moore et al., 2000; Reker, 2002; Takkinen & Ruoppila, 2001a, 2001b; van der Vaart & van Oudenaarden, 2018).

In the studies reviewed, meaning in life was associated with physical health (Czekierda, 2017), attitudes towards others and God (Guttmann, 2001), physical activity (Ju, 2017), living with others, high socioeconomic level, personal relationships, activities and religion (Hupkens et al., 2018), trauma in young adults (Krause, 2004), social support (2007a), thought suppression (Krause, 2007b), mortality (Krause, 2009), sense of control (Krause, 2010), sense of coherence, and with enthusiasm for life (Takkinen & Ruoppila, 2001b). Meaning was shown to moderate the relationship between stress and quality of life in community elderly (Melo et al., 2013). Another study found that married individuals had higher levels of meaning than widow(er)s (Koren & Lowenstein, 2008). Older adults with high cognitive functioning were more prone to engage in a new activity, which conferred meaning to life than individuals with average cognitive functioning (Takkinen & Ruoppila, 2001b) (Table 1).

Purpose in life - concept and importance in aging

The purpose concept, akin to meaning in life, has its origins in Frankl´s humanistic psychology theory (1959). According to Frankl (1963, 1969), the search for purpose is the true driving force of human experience, where finding a goal in life is fundamental for all individuals, irrespective of religious orientation. This search is neither abstract nor general, but a very real task.

Ryff and Keyes (1995), revisiting the structure of psychological well-being, defined purpose as one of six dimensions comprising the multidimensional model of well-being, together with autonomy, environmental mastery, personal growth, positive relations with others and self-acceptance. Purpose, one of the most important dimensions of psychological well-being, along with personal growth, can be defined as the comprehension of life´s purpose, a sense of directedness and intentionality, centering on establishing life goals and taking decisions based on personal resources (Ryff, 1989). This is an orientation which drives people to undertake tasks that sustain social life, making life meaningful (Ryff, 1995); it is a defining characteristic of mental health, where the experience of purpose is an essential part of positive mental health (Ryff & Singer, 1998). Sense of purpose enables an individual to have objectives, energy and envisage positive outcomes for the future (Mitchell & Helson, 2016). This is underpinned by a range of psychological states (such as positive emotions) and by personality attributes (such as competence), which are associated with health and well-being (Boehm & Kubzansky, 2012).

With regard to sources of purpose, the literature suggests that relationships, social roles, work, family, personal objectives, independence, generativity, community engagement and participation in meaningful activities can promote purpose (Kim et al., 2013, Irving et al., 2017). Being unemployed, being married, having high level of competence to perform activities of daily living, having quality personal relationships, enjoying good health, having high socioeconomic level, high educational level and religion are considered sources of purpose in life among older adults (Pinquart, 2002). Very old people can experience purpose through activities of daily living and connection with the spiritual world (Hedberg et al., 2019).

When vulnerable to the aging process (Ryff et al., 2016), finding purpose can be far more difficult for older adults than younger adults and youths (Ryff & Singer, 1998; Wong, 1989). The social, cognitive, physical, relationship and sensory losses that accompany aging can hamper engagement in activities that confer more purpose to life. Of the stressing events that older people face, widowhood and retirement appear to play an important role in reducing purpose in life among elderly (Pinquart, 2002). However, there appears to be a single pattern for individuals, where some older adults can maintain a high level of purpose with advancing age (Springer et al., 2011). Purpose can serve as a source of psychological protection, with objectives and goals reexamined and reorganized in the face of losses. A deep sense of purpose can lead the elder to select objectives and coordinate processes on how to achieve these, maximizing potential in response to challenges (Brandtstädter & Renner, 1990). In aging, this important self-regulation process that involves maximizing gains and minimizing losses, becomes fundamental given the decline in cognitive functions, emergence of physical disabilities and social losses (Baltes & Smith, 2003).

Associations between purpose and biological, social and psychological aspects are well documented in the literature. Purpose in life can promote positive outcomes for health and well-being in that it optimizes resilience resources in response to stress (MacKnight & Kashdan, 2009), increases level of satisfaction with life and reduces depression symptoms (Etezadi & Pushkar, 2013). A systematic review (Irving et al., 2017) showed that purpose has been associated with better immune system functioning, greater neural and cognitive reserve (Boyle et al., 2012), faster cortisol recovery after social event stress (Fogelman & Canli, 2015), greater optimism, positive affect (Kim et al., 2013) and lower depression risk in older adults (Koenig et al., 2014; Pinquart, 2002). Other studies showed association of purpose with longevity and fewer negative health outcomes such as Alzheimer Disease, mild cognitive impairment (Boyle et al., 2010), acute myocardial infarction (Kim et al., 2013) and mortality (Hill & Turiano, 2014). Purpose also predicts greater probability of preventive health care behaviors (Kim et al., 2014).

In terms of definition of the concept, purpose has been defined as intentionality toward objectives and life goals (Ryff, 1989; Ryff & Keyes, 1995) by some authors included in the review (Boyle et al., 2009; Irving et al., 2017; Pinquart, 2002; Ryff et al. 2016).

Among the articles analyzed, purpose was found to be associated with intrinsic religious orientation (Ardelt & Koenig, 2017), lower mortality risk, age, education, happiness, satisfaction, self-esteem (Boyle et al., 2009), psychological health (Hedberg et al., 2010), better health and well-being outcomes (Irving et al., 2017), religious coping, balanced death attitude, intrinsic religiosity, spiritual transcendence (Jewell, 2010), sense of coherence, resilience (Nygren, 2005), social integration, quality of relationships, psychological well-being, depression symptoms, health, daily competence, socioeconomic level, being married and being employed (Pinquart, 2002). Higher purpose scores were found in women versus men, and in whites versus blacks (Boyle et al., 2009). A systematic review showed that purpose declined with age (Irving et at., 2017). With respect to levels of purpose, community-dwelling older people with low purpose had higher rates of loneliness than those with higher purpose (Neville et al., 2018). A meta-analysis study revealed that high purpose was associated with better health, greater daily competence, higher socioeconomic level, being employed and being married (Pinquart, 2002). Purpose was shown to predict better health and longevity (Ryff et al., 2016) (Table 1).

Meaning and purpose in life as synonyms in the literature

For many researchers, meaning and purpose in life have been used as synonyms, with both terms representing a set of attitudes and views which make the world intelligible (Haugan, 2014). Grounded in existential-philosophical theory, Frankl (1963) regarded meaning and purpose in life as synonyms. Meaning in life can be described as deep existential meaning and includes elements or dimensions such as purpose and coherence (Frankl, 1966; Reker, 1992; Antonovsky, 1979, 1987); in this context, the phenomenon of transcendence is related to both concepts.

Authors deeming the two concepts interchangeable, generally draw on the work of Frankl (1958, 1959, 1963) to define meaning and purpose. Reker (1997) defined sense of personal meaning as “having a purpose and pursuing objectives in life”. Another definition by the same author redefined meaning as “cognizance of order, coherence, and purpose in one's existence, the pursuit and attainment of worthwhile goals, and the accompanying sense of fulfillment.” According to this conception, meaning in life is associated with a purpose, direction and reason for existence, constituting a multidimensional construct involving cognitive, motivational and affective components. Park and Folkman (1997) referred to meaning as “one´s goals and purpose”; Ventegodt et al. (2003) described purpose as “the meaning in life that creates a connection between our inner depths and the outer world”, showing the interchangeability of the concepts. The literature reviewed appears to suggest that meaning in life is a broader construct than purpose, encompassing fewer constructs within which purpose belongs. In this context, Derkx (2015) distinguished seven dimensions of meaning in life: purpose, moral worth, self-worth, competence, comprehensibility, connectedness and excitement. A distinction between the two constructs was proposed by Wong and Fry (1998), who held that purpose denotes intention in terms of attaining personal goals in life, whereas meaning in life encompasses establishing coherence in one´s existence. Both Derkx (2015) and Wong and Fry (1998) drew on the study by Yalom (1980) to describe meaning as associated with a sense of coherence, justifying the concept based on the existentialist line, and associating purpose with clear goals and aims in life.

In the literature, meaning (or purpose, with no distinction between the terms) can be associated with spirituality (Vachon et al., 2009), a proactive intentional characteristic of well-being and essential component of positive mental health (Ferguson & Goodwin, 2010). Representing correlated constructs, they are both related with order, fairness, coherence, values, faith and belonging (Hupkens et al., 2018).

Some articles included in the review demonstrated the interchangeability of meaning and purpose (Czekierda et al., 2017; Hedberg et al., 2010, 2019; Jewell, 2010; Neville et al., 2018; and Nygren et al., 2005). Among the studies reviewed, investigations on meaning and purpose in life showed some outcomes common to both concepts, such as health (Ju, 2017; Pinquart, 2002), mortality (Krause, 2009; Boyle et al., 2009), sense of coherence (Takkinen & Ruoppila, 2001; Nygren et al. 2005) and religion (Hupkens et al, 2018; Jewell, 2010).

In summary, the review of the studies yielded sufficient evidence to affirm that meaning and purpose in life are distinct concepts, despite sharing the same existential-philosophical roots. As pointed out by Heisel and Flett (2014), when confusing meaning and purpose in life, reductionism can take place upon defining the constructs, leading to the identification of meaning in life as strictly associated with a functional sense, overlooking a more significant deep existential line of the concept. If the concepts are construed by means of questions, perhaps a solution for distinguishing between them can be found. The answer to the questions “what is the meaning in life?” can be considered in terms of tasks, functions, roles and goals in life. The question “what is the meaning of my life?” cannot be interpreted by enquiring “what does my life mean?”, but rather, “what lends or confers meaning to my life?” or even “what makes my life significant and meaningful?” (Krause, 2004). Through these questions, the two concepts can be distinguished, considering purpose as orientation to goals and aims (Ryff, 1989) and meaning as coherence and sense of fulfillment (Reker & Wong, 1988), underpinned by psychological well-being and existentialist-philosophical theory, respectively.

Conclusion

In gerontoly, meaning in life has been studied under distinct perspectives: physical and mental health, well-being and religiosity (Sommerhalder, 2010). Finding meaning is an important strategy to help older adults to deal with losses and difficult times in life. By reviewing the data from gerontological research, this study addressed known gaps in the literature: the existence of few scientific articles discussing the concepts of meaning and purpose in life and distinguishing between the two.

The literature review yielded sufficient evidence to affirm that meaning and purpose in life are distinct concepts, despite sharing the same existential-philosophical roots, and that sense of purpose is invariably described as a subcomponent of meaning in life, with the latter consisting of a broader multidimensional concept. Distinguishing the terms, purpose denotes orientation to goals and aims in life, whereas meaning in life conveys coherence and one´s sense of fulfillment.

In the context of aging, study results were conflicting. Both depth of meaning and purpose can be diminished by social, cognitive and physical losses inherent to the aging process. However, some researchers affirm that sense of meaning in life remains stable or can even be bolstered in the face of adversities, despite erosion of its sources by stressing events. Contradicting this notion, review studies have highlighted that purpose in life generally declines over time, proving more susceptible to external factors brought on by aging compared to meaning in life, which appears to be more stable over time.

Further studies examining the way some older individuals can maintain a high sense of purpose in life in the face of adversities such as bereavement, coping with diseases, and both social and cognitive losses should be conducted. How individual differences may result in a singular pattern of purpose in life has not yet been widely explored in gerontological studies. Gaps in knowledge on the way interpersonal relationships can create meaning in life are also avenues for future research. Public policies might be able to raise projects that build meaning in life through Logotherapy and Existential Analysis in older people. Moreover, healthcare workers should be able to prepare older adults to seek meaning in their lives. Additionally, there is a need for more studies involving Brazilian older adults and meaning in life.

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Publication Dates

• Publication in this collection
  28 Aug 2023
• Date of issue
  2023

History

• Received
  18 Apr 2021
• Accepted
  11 Sept 2021