Skip to main content
×
×
Home

Reflections on wisdom at the end of life: qualitative study of hospice patients aged 58–97 years

  • Lori P. Montross-Thomas (a1) (a2) (a3), Jamie Joseph (a2), Emily C. Edmonds (a2), Lawrence A. Palinkas (a4) and Dilip V. Jeste (a2) (a3) (a5)...
Abstract
Objective:

Wisdom is a complex trait, and previous research has identified several components of wisdom. This study explored the possible impact of a diagnosis of a terminal illness on the conceptualization and evolution of wisdom while facing the end of life.

Design and Participants:

Semi-structured qualitative interviews were conducted with 21 hospice patients aged 58–97 years who were in the last six months of their life.

Methods:

Hospice patients were asked to describe the core characteristics of wisdom, as well as how their terminal illness might have impacted their understanding of this concept. The interviews were audiotaped, transcribed, and coded by the research team using a grounded theory analytic approach based on coding consensus, co-occurrence, and comparison.

Results:

Broad concepts of wisdom described by the hospice patients align with the extant literature, thereby supporting those general conceptualizations. In addition, hospice patients described how their life perspectives shifted after being diagnosed with a terminal illness. Post-illness wisdom can be characterized as a dynamic balance of actively accepting the situation while simultaneously striving for galvanized growth. This delicate tension motivated the patients to live each day fully, yet consciously plan for their final legacy.

Conclusion:

The end of life offers a unique perspective on wisdom by highlighting the modulation between actively accepting the current situation while continuing the desire to grow and change at this critical time. This paradox, when embraced, may lead to even greater wisdom while facing one's own mortality.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Reflections on wisdom at the end of life: qualitative study of hospice patients aged 58–97 years
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Reflections on wisdom at the end of life: qualitative study of hospice patients aged 58–97 years
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Reflections on wisdom at the end of life: qualitative study of hospice patients aged 58–97 years
      Available formats
      ×
Copyright
Corresponding author
Correspondence should be addressed to: Dilip V. Jeste, M.D., University of California San Diego, 9500 Gilman Drive, Mail Code #0664, La Jolla, California 92093-0664, USA. Phone: +1-858-534-4020. Email: djeste@ucsd.edu.
References
Hide All
Ardelt, M. (2004). Wisdom as expert knowledge system: a critical review of a contemporary operationalization of an ancient concept. Human Development, 47, 257285. doi:10.1159/000079154.
Baltes, P. B. and Smith, J. (2008). The fascination of wisdom: its nature, ontogeny, and function. Perspectives on Psychological Science, 3, 5664. doi:10.1111/j.1745-6916.2008.00062.x.
Bangen, K. J., Meeks, T. W. and Jeste, D. V. (2013). Defining and assessing wisdom: a review of the literature. American Journal of Geriatric Psychiatry, 21, 12541266. doi:10.1016/j.jagp.2012.11.020.
Bellizzi, K. M. (2004). Expressions of generativity and posttraumatic growth in adult cancer survivors. The International Journal of Aging and Human Development, 58, 267287. doi:10.2190/DC07-CPVW-4UVE-5GK0.
Boyatzis, R. E. (1998). Transforming Qualitative Information: Thematic Analysis and Code Development. London; New Delhi: Sage Publications.
Carstensen, L. L., Isaacowitz, D. and Charles, S. T. (1999). Taking time seriously: a theory of socioemotional selectivity. American Psychologist, 54, 165181. PMID:10199217.
Chochinov, H. M. (2007). Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ, 334, 184197. doi:10.1136/bmj.39244.650926.47.
Clayton, V. (1975). Erikson's theory of human development as it applies to the aged: wisdom as contradictive cognition. Human Development, 18, 119128.
Damon, W. (2000). Setting the stage for the development of wisdom: self-understanding and moral identity during adolescence. In Understanding Wisdom: Sources, Science, and Society (pp. 339360). Philadelphia: Templeton Foundation Press.
Dedoose (2015). Web Application for Managing, Analyzing, and Presenting Qualitative and Mixed Method Research Data. Los Angeles, CA: SocioCultural Research Consultants, LLC.
Depp, C. A. and Jeste, D. V. (2006). Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. The American Journal of Geriatric Psychiatry, 14, 620. doi:10.1097/01.JGP.0000192501.03069.bc.
Diamond, L. M. and Aspinwall, L. G. (2003). Emotion regulation across the life span: an integrative perspective emphasizing self-regulation, positive affect, and dyadic processes. Motivation and Emotion, 27, 125156.
Erikson, E. H. (1950). Childhood and Society, revised 1963. New York, NY: Norton.
Glaser, B. G. and Strauss, A. L. (1967). The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago: Aldrine Publishing Company.
Glück, J., Bluck, S., Baron, J. and McAdams, D. P. (2005). The wisdom of experience: autobiographical narratives across adulthood. International Journal of Behavioral Development, 29, 197208. doi:10.1177/01650250444000504.
Hammarskjöld, D., Auden, W. H. and Sjöberg, L. (1964). Markings ["Vägmärken"] by Dag Hammarskjöld. Translated by Leif Sjöberg and W.H. Auden, with a Foreword by WH Auden. New York, NY: Ballantine Books.
Happé, F. G. E., Winner, E. and Brownell, H. (1998). The getting of wisdom: theory of mind in old age. Developmental Psychology, 34, 358362. doi:10.1037/0012-1649.34.2.358.
Jeste, D. V. and Vahia, I. V. (2008). Comparison of the conceptualization of wisdom in ancient Indian literature with modern views: focus on the Bhagavad Gita. Psychiatry, 71, 197209. doi:10.1521/psyc.2008.71.3.197.
Jeste, D. V., Ardelt, M., Blazer, D., Kraemer, H. C., Vaillant, G. and Meeks, T. W. (2010). Expert consensus on characteristics of wisdom: a delphi method study. The Gerontologist, 50, 668680. doi:10.1093/geront/gnq022.
Kierkegaard, S. (1843). Journalen JJ. In Søren Kierkegaards Skrifter (vol. 18, p. 306). Copenhagen: Søren Kierkegaard Research Center.
Kross, E. and Grossmann, I. (2012). Boosting wisdom: distance from the self enhances wise reasoning, attitudes, and behavior. Journal of Experimental Psychology: General, 141, 4348.
Lerner, R. M. (2008). Spirituality, positive purpose, wisdom, and positive development in adolescence: comments on Oman, Flinders, and Thoresen's ideas about “Integrating spiritual modeling into education”. The International Journal for the Psychology of Religion, 18, 108118.
Meier, E., Gallegos, J. V., Thomas, L.P., Depp, C.A., Irwin, S. A. and Jeste, D. V. (2016). Defining a good death (successful dying): literature review and a call for research and public dialogue. American Journal of Geriatric Psychiatry, 24, 261271.
Montross-Thomas, L. P. (2015). What are the most loving moments of your life? Journal of Palliative Medicine, 18, 398. doi:10.1089/jpm.2015.0006.18.5.
Morley, J. E. (2004). The top 10 hot topics in aging. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59, M24–M33. doi:10.1093/gerona/59.1.M24.
Morse, J. M. (1995). The significance of saturation. Qualitative Health Research, 5, 147149. doi:10.1177/104973239500500201.
Murray, S. A., Kendall, M., Grant, E., Boyd, K., Barclay, S. and Sheikh, A. (2007). Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management, 34, 393402. doi:10.1016/j.jpainsymman.2006.12.009.
NHPCO (2015). Facts and Figures: Hospice Care in America. (vol. 2016, p. 7). Alexandria, VA: National Hospice and Palliative Care Organization.
Niebuhr, R. (2015). Major works on religion and politics. In Sifton, E. (ed.), The Library of America. New York, NY: Literary Classics of the United States, Inc.
Pasupathi, M., Staudinger, U. M. and Baltes, P.B. (2001). Seeds of wisdom: adolescents' knowledge and judgment about difficult life problems. Developmental Psychology, 37, 351361. doi:10.1037/0012-1649.37.3.351.
Pinder, M. M. and Hayslip, B. Jr. (1981). Cognitive, attitudinal, and affective aspects of death and dying in adulthood: implications for care providers. Educational Gerontology: An International Quarterly, 6, 107123. doi:10.1080/0380127810060201.
Smith, J. and Baltes, P. B. (1990). Wisdom-related knowledge: age/cohort differences in response to life-planning problems. Developmental Psychology, 26, 494. doi:10.1037/0012-1649.26.3.494.
Sternberg, R. J. (1990). Wisdom: Its Nature, Origins, and Development. New York, NY: Cambridge University Press.
Strauss, A. L. and Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage.
Takahashi, M. (2000). Toward a culturally inclusive understanding of wisdom: historical roots in the East and West. International Journal of Aging and Human Development, 51, 217230. doi:10.2190/H45U-M17W-3AG5-TA49.
Thomas, M. L. et al. (2017). A new scale for assessing wisdom based on common domains and a neurobiological model: the San Diego Wisdom Scale (SD-WISE). Journal of Psychiatric Research, 1–8. doi:10.1016/j.jpsychires.2017.09.005.
Vachon, M., Fillion, L. and Achille, M. (2009). A conceptual analysis of spirituality at the end of life. Journal of Palliative Medicine, 12, 5359. doi:10.1089/jpm.2008.0189.
Willms, D. G. et al. (1990). A systematic approach for using qualitative methods in primary prevention research. Medical Anthropology Quarterly, 4, 391409. doi:10.1525/maq.1990.4.4.02a00020.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed