In this chapter, we explain our selection of forty cases for individual study from members of the Southampton Ageing Project (1977–8 to 2002–3) and briefly comment on their general characteristics. We then survey the self-descriptions that were provided over the first ten and more years of the study. This is followed by an account of the methods we followed in the final ten years in assembling and analyzing material to produce detailed individual case studies. Finally, we provide an introduction to our present accounts of the cases in the subsequent chapters.

Participants included in the case analysis

Although we only received concentrated funding for case study analysis in 1995, we began to identify and interview in depth selected members of our sample from 1990 onwards, when the sample was all aged over seventy-seven years. In 1995–6, we were able to complete case study accounts on each of the twenty-eight remaining participants. Together with those cases that we had begun beforehand and who had died in the intervening years, we succeeded in composing a total of forty case analyses (twenty-three women and seventeen men). In most cases, we conducted a further interview in which we checked our written conclusions with the participants and invited their comments. Later interviews were also conducted with surviving members of the sample by the first author as well as by the second or third author who had interviewed them regularly over the preceding years.

Brief descriptive details on each case, including year of birth, principal occupation, age at leaving full-time education and age at death, are provided in the Appendix. Pseudonyms replace the original names in the Appendix and throughout the text. The majority of the sample (twenty-seven of forty) were still married when we first interviewed them in 1977–8, and all had been married at one time in their lives. Three persons were divorced or separated.

Becoming frailer is central to the meaning of ageing. Whereas the presence of disability can be lifelong but also unchanging, the essence of frailty is fragility, a liability to further deterioration. A person who becomes frail is more vulnerable to illness and sudden death. There is a sense of being constantly at risk, of encountering a serious accident or fatal change in bodily condition, whether through incurring infection, becoming weaker or remaining too long in life-threatening conditions of exposure and isolation. Disabled persons and those around them can adapt more easily to a stable situation of need, but frailty requires a different type of adjustment. Regular or constant monitoring often becomes necessary.

Frailty is of course a relative matter, as is the need of personal monitoring. We are all vulnerable to gradual or sudden changes in bodily, environmental or social conditions, and in modern societies, we have become even more dependent on others to provide certain essential daily services for us. But there comes a point in most people's later years when the probability of damaging change occurring increases, particularly because of a decline in physical and mental abilities. Various negative outcomes become more likely: injury as a result of falling, weakness from failing to maintain adequate nutrition and inability to manage the household, competently carry out personal care tasks or move outside the house safely without fear of hurt or becoming lost.

In this and the following chapter, we consider the lives of those members of our sample from the time in our study that they began to become noticeably frailer. This usually implied that their continuing survival and welfare was dependent on the support provided by other people, generally their spouse or child(ren) (or both), and in some cases social care services. In fact, most of our sample became very frail before they died, if only in the last weeks or months of their lives.

In this chapter, we present the rationale for collecting the material reported in this book and describe the actual processes involved in the study on which it is based. As in all research projects, the data we sought reflected the particular interests of the investigators and the key theoretical concepts and health and welfare concerns that were influential at the time the research was being planned. Our project originated in a multidisciplinary longitudinal study of ageing initiated by the Departments of Geriatric Medicine and of Psychology at the University of Southampton in the later 1970s. There were two distinct stages of data collection. The interviews conducted in the first ten years included clinical assessment as well as questionnaires, whereas a more focused investigation of psychological well-being involving in-depth interviewing was undertaken in the latter ten and more years. After a brief description of the history of the main study, we continue with a reflection on the main theoretical ideas and observations that inspired our investigation into identity and well-being in later life. We close with a consideration of our reasons for conducting detailed case studies on our surviving participants in the second part of the project.

Southampton Ageing Project

The original Southampton Ageing Project sample comprised 340 persons aged over sixty-five years (born before 1914) recruited in 1977–8 from two general medical practices in Southampton. The participants were originally recruited as part of a two-year double-blind trial of an early ‘anti-ageing’ pharmaceutical product, Gerovital (KH3; comprising principally procaine/haematoporphyrin) on the processes of ageing – in particular, on cognitive functioning and mood (Hall et al., 1983). Some small beneficial effects were found in regard to grip strength, as well as avoidance of incontinence and decline in cognitive performance, but there was no observable impact on depressive symptoms. However, the generous nature of the funding allowed for substantial clinical, social and psychological data to be collected on each occasion, and thus the possibility of longitudinal as well as cross-sectional analysis.

Every one of the twelve women whose pathways through frailty we described in the last chapter was living alone at the point when frailty became an important element in their life. By contrast, one-half (six of twelve) of the sample of men whom we interviewed at this stage of life were still living with their wives. If this were a large and representative sample, it would illustrate a huge difference in gendered experience of ageing. In fact, we do know that the difference in men's and women's likelihood of widowhood in the United Kingdom has been and remains substantial (Bennett, 1997). Reviews also suggest men fare worse after their spouses’ deaths. We did not collect enough evidence to justify this conclusion, but the different nature of male reactions to growing frailty could be illustrated from our case accounts. As with the women, we consider the men in order according to the age at which physical frailty first intruded noticeably on their lives.

Becoming frailer before eighty years of age

As we saw in Chapter 4, Fred Hobson had a major heart condition when he entered our study at age sixty-seven years. This was already preventing him doing the heavy work around the house, like decorating, which he had been previously used to doing. His health continued to deteriorate, and he suffered a succession of three heart attacks over the following ten years. When he was interviewed at age seventy-seven, shortly after his wife died (see Chapter 5), he was experiencing a combination of problems when walking, feeling both unsteady and breathless. Some months later, aged seventy-eight years, he also suffered a stroke that resulted in him being in hospital for a period of three weeks.

He was interviewed again at age eighty years. By this time, he considered that he had overcome the problems relating to the stroke, including difficulties with speech and paralysis in his side and left hand.

Bereavement has remained a neglected aspect of the study of ageing, even as its significance in later life has increased. In economically prosperous societies with high standards of health care throughout life, bereavement of spouse has become more concentrated among the older part of the population. Nevertheless, there is a widespread assumption that adjustment to bereavement becomes easier with age. In some respects, this may be true – older couples have had longer to prepare for the inevitability of death – however, it is insufficiently acknowledged that the loss of a partner, particularly someone who has shared most of one's life experiences, is probably the most crucial blow to identity and quality of life that people receive in their lifetime. It is hard to imagine recovering an equivalent relationship. Bereavement of spouse thus becomes a major contributor to loneliness and depression in late life.

For many older people, the experience of ageing involves learning to live alone after many years of living together. Some of those currently old may never have lived alone in their lives, having moved as a young adult from living with parents to living with spouse. Even after the initial period of adaptation, there is a long process of learning to be undergone, not only learning of new skills but finding new ways to motivate oneself to continue to be active, to undertake tasks that previously were more externally driven. Circumstances of course vary greatly between bereaved individuals; but for current generations of older women and men in whom gender-role differentiation was more marked, women often have to learn to cope with financial matters and practical repairs, men with housework and food preparation. But more important – and more demanding of inner psychological resources – is finding a new focus in life, or maintaining a previous one on one's own, after years of being together in partnership.

Our case studies provided a rare opportunity to investigate spousal bereavement longitudinally.

With few exceptions, our sample of older persons still living with spouses in their later seventies and older appeared happily married. This might also suggest difficulties in differentiating among our sample. As the famous first sentence from Tolstoy's Anna Karenina proposes: ‘All happy families are more or less like one another; every unhappy family is unhappy in its own particular way’. Certainly at first analysis, there were many similarities in our participants’ accounts of their married life. Nearly all the married women, for example, described their husbands as providing sources of enjoyment and comfort but also of a sense of importance and of a meaningful role in life, most obviously in caring for them.

However, it is possible to look beyond the obvious similarities to see ways in which the sources of self and meaning that older married people referred to in describing their lives differed from one another. A self-description exclusively based on family interactions and commitments might predict a different future from one that also included external involvements.

We start our account by providing a brief portrait of the one male and female married couple who were both participants at the outset of the Southampton Ageing Project and who survived to be part of the second phase of the project. Both enjoyed a high quality of life up to eighty-five years, and we were able to interview them in depth in their later years.

We then consider married men and married women separately, beginning with the larger group of men who were still married at age seventy-five years when our case analyses began. We describe their lives through their later seventies and into their eighties until either their spouse died or they became significantly frail and dependent on help from their spouse or others. The subsequent story of their lives is continued in the following chapters.

Our forty case studies of persons growing old in the last quarter of the twentieth century indicate something of the variety of different trajectories possible in later life. However, these accounts may be already too distant in life experience and expectations to constitute comparable models for ageing in Britain in the twenty-first century. The physical realities of biological ageing including its variability across individuals may remain similar for the foreseeable future, but the social, psychological and spiritual resources at older persons’ disposal in coping with physical and mental decline are already noticeably changed. It is these resources that largely determine how we experience the later period of ageing, whether as a welcome new stage of life with positive characteristics of its own despite the increasing limitations or as a potentially long trial to be resisted, endured or terminated as soon as possible.

Research in social gerontology has expanded considerably in the ten years and more since we completed interviews with the remaining participants of our longitudinal study. Within the United Kingdom, results have been published of two major government-funded research programmes on ageing, the first of which examined factors related to quality of life in later life including issues of identity and meaning (Walker, 2005). However, recent North American studies have paid more explicit attention to the subject of existential meaning (e.g. Krause, 2009; Hill and Turiano, 2014). These have highlighted the significant role played by perception of meaning and purpose in life in a person's continued flourishing and survival throughout adulthood and into old age. They indicate the importance of correctly identifying and sustaining sources of meaning in a person's life.

In this final chapter, we present our own thoughts on what we have learned from studying individual older people's lives and in particular how self and meaning are maintained in the process of growing older. We note those aspects of ageing that have made the most impression on us as investigators.

This book was composed much later than we originally expected. There are many reasons for the delay, not least the increasingly competing pressures of academic life. But as a result we have found ourselves writing what is essentially an historical account of a previous generation's experience of later life. However, most studies of human development, and certainly longitudinal studies such as this, eventually become works of history. Particularly in a fast-changing society, each generation's experience of the life course is clearly different from the previous one, and what constitutes an age cohort of similar social experiences increasingly narrows. Even a five-year age difference can have substantial implications in terms of a person's social attitudes and expectations.

Nevertheless, there is still much to learn from the experience of those who have lived before because fundamental human needs do not change that quickly. This applies especially to the existential challenges and dilemmas posed by ageing, how, for example, to respond to the loss of one's life partner, the onset of physical and mental frailty, and the steady approach of one's own death. Considering how previous generations faced the kind of issues that we will all one day probably encounter is of perennial interest.

There are many people to thank for the possibility of producing what we consider to be a rather unique study of ageing based as it is on detailed case studies of forty people interviewed regularly over the last twenty and more years of their lives. First, there are those who devised the original Southampton Ageing Project, especially Michael Hall, holder of the founding chair in Geriatric Medicine at the University of Southampton, and Don Marcer in the Psychology Department; we also thank Schwarzhaupt of Cologne, the generous first sponsor of the initial data collection and analysis over the years 1977–80. Many contributed to this first exercise in conducting a longitudinal study of ageing in Southampton including Roger Briggs, Peter Coleman, Fiona Everett, Ros Gray, John Harris, Terry McEvoy, Bill MacLennan, Joan Punnett, Maureen Robinson, Mary Scarborough and John Timothy.

Living beyond ninety years is not always seen so positively, and a number of our cases described in the last two chapters have illustrated how fragile life can be as one enters the tenth decade. At least twenty-five of our sample of forty cases reached age ninety years. Many of them were by then in poor health, ten of them dying within two years. Nevertheless, there were others who continued to flourish beyond ninety years and even beyond ninety-five years. The latter could be said of at least eleven of our cases, more than one-quarter of the whole sample. In this chapter, we describe the lives of the six persons, three women and three men, in the sample whom we were able to interview up to and in some cases beyond their middle nineties. Did awareness of their exceptional longevity influence the way that they perceived meaning in their lives?

The oldest women

One of the most remarkable stories in our sample of forty cases was that of Elsie Darby, whom we first mentioned in Chapter 4. In Chapter 7, we described her life in a residential care home where she came to live at age eighty-six after a difficult period in which she was in a stressful relationship with her third husband, whom she subsequently divorced, and also suffered a heart attack. Yet Elsie succeeded in leaving residential care five years later at age ninety-one and returning to sheltered housing, where she lived a further six years. How did she manage it? She herself later said that she had been spurred to leave the home by a visitor who had said to her that she was ‘taking someone's place’! Elsie had the good fortune that all her furniture had been kept in store at no cost by friends of the family. Therefore, it was relatively easy for her to set up home again.

In this chapter, we introduce the fifteen participants in our study who were already living alone when they entered our case study sample in their later seventies. These were predominantly women. In fact only one woman among our twenty-three female cases (Dora Meadows, see Chapter 4) predeceased her husband. In contrast, eight of our seventeen men predeceased their wives. As already mentioned in Chapter 3, all of our participants had been married at some point in their lives. In fact, it is possible to differentiate between them in terms of the period of their life when their spouses died or in a few cases separated from them. A significant minority of our women had begun living alone well before the standard age of retirement, sometimes even in early adulthood.

Widowhood has been a common experience for women in European and other societies, and concern for the financial plight of widows in particular has been a prominent feature of the work of religious bodies in earlier historical periods and for welfare organisations in modern times. Nevertheless, support from children has always been and remains the major resource widowed older people can draw on. But with smaller families and the greater mobility of children, the family has become a declining resource for supporting persons in old age. Our participants, born mainly in the early twentieth century, varied considerably in the size and spread of the families they had generated, and the consequences are evident in the character of their contacts in later life. Some of those ageing alone lived lives that were closely interrelated with that of their children's families and received strong practical as well as emotional support from them after their spouses died. There were others whose lives remained in practical matters at least independent of children or other members of their family.

The greater part of the chapter therefore deals with eleven older women who had been living alone since before age seventy-five years.

The ageing of the world's population has become one of the major concerns of the twenty-first century, yet it is sad that attitudes of ‘concern’ seem to outweigh the satisfaction that should arise from present civilization's achievement in enabling more and more people to live to the advanced ages that previously were reserved for a small minority of the population. The concerns are understandable in that they relate primarily to the frailties, physical and mental, that increase in the ninth and tenth decades of human life. Despite the advance warnings of demographers over the past fifty years, society has begun to adapt only slowly to the implications of an ageing population. In particular, it has failed to make the huge quantitative and qualitative changes to social care provision that the situation requires. As a result, individual ageing is beginning to seem almost an unwanted burden even after a life of considerable economic contribution. Contemporary culture seems more youth focused than ever in the innovations it encourages, the media representations of different age groups and the values and goals it prescribes. Ageism and ageist language remain firmly embedded in Western culture despite some recent advances in legislation to combat discrimination, and are even influencing other world cultures that were previously more respectful of age.

Robert Butler, a physician, psychiatrist and founding director of the US National Institute on Aging, addressed these issues forty years ago in his book Why Survive? Being Old in America (Butler, 1975). Since then the question of the meaning of living a long life has become more acute, as conditions for the oldest among us appear to be deteriorating rather than improving. If contemporary people were to choose the age at which they would die, would they decide to live to an advanced age with the likely implications of increasing frailty and sense of burden? Certainly many younger people appear not to want to survive to this state of being.