Rethinking Healthy Aging: The Self-Perception of African American Older Adults ()
1. Introduction
Using a psychosocial developmental framework, this generic qualitative inquiry examined the aging experience among African Americans aged 65 and older. The application of the eighth stage of development, as proposed by Erick Erikson, provided precise theoretical guidance to this study’s research question and design. According to Erikson, aging individuals’ experiences are related more to the idea of a sense of integrity, which can be described as satisfaction, fulfillment, completeness, and meaningfulness, or as aging marked by a sense of despair, which is associated with regret, resignation, dissatisfaction, and meaninglessness (Erikson, 1968; 1984; 1998). The study’s findings reported that adults in this stage might experience physical decline, reestablish an identity distinct from earlier adult roles, and continue questioning life’s meaning or resolving the psychosocial crisis of ego integrity and despair.
While the literature on perceptions of aging generally exists, it is yet unknown how older African Americans perceive their aging process within the context of the psychosocial phase of ego integrity or despair, as explored using Erikson’s theoretical framework (Erikson, 1968; 1984; 1998) and as empirically studied (León et al., 2020; Sekowski, 2022). An earlier study on the perceptions of aging among African Americans in their later life found that a conscious perception and understanding of one’s aging process is a crucial determinant of successful aging (Ejim, 2020). This report reviews the procedures employed to develop coping strategies for healthy aging, aligning with Erikson’s psychosocial theory.
With limited studies on the aging experiences of African Americans as empirically documented (Bigonnesse & Chaudhury, 2022; León et al., 2020), it is to be highlighted that African Americans are underrepresented in scholarly publications. This report explored the aging perceptions of community-dwelling older African Americans in retirement homes. The garnered data revealed a blend of historical and intergenerational influences on participant’s perceptions, which manifested in their psychosomatic, psychosocial, physical, and socio-cultural dimensions.
It is well documented that older adults suffer more from depression and discrimination in their aging process, and this is corroborated in many studies that identified the impact of depressive vulnerability among older adults (Chen et al., 2021; He et al., 2021; Marques et al., 2021). Employing the psychosocial framework to examine the perceptions of older African Americans supports the assertion of Erikson et al. (1986) that an individual’s life cycle involves challenges and personal experiences that play valuable psychosocial functions in one’s quality of life. This inquiry adds to the unique experiences of African Americans, their ethnic differences, story sharing, affirmative acceptance of lifestyle, and resilience in understanding the aging process of African American older adults.
In this report, Ejim (2020) further explored Erikson’s framework, describing despair as a state in which an aging individual does not find satisfaction in their life as they grow older. Other scholars, including those from The National Institute on Aging, characterized aging as a process that alters individuals in various ways, including biological, physiological, environmental, psychological, behavioral, and social aspects. Therefore, aging is a process of growing old, which is associated with changes in the lives of an organism (Bigonnesse & Chaudhury, 2022; Erikson, 1984; León et al., 2020; Sekowski, 2022). This report establishes that the aging process is a uniquely individualized experience shaped by self-esteem, lifestyle choices, personality traits, family relations, and social connections.
2. Literature Review
By exploring the aging perceptions of older African American adults, there is a differentiation between discrimination and perceived discrimination as an internal negative stereotype that could potentially interfere with healthy aging (Foster & Walker, 2021; Saliba & Barden, 2021). The narrative experiences of participants contribute to the existing body of gerontology research by identifying the factors that impact physical and subjective health, socialization, healthy cognition, self-evaluation, and adjustment for African American older adults. In exploring the gap in gerontology studies among African Americans, this inquiry focuses on how psychosocial indices and active aging contribute to improving the quality of life of older adults. Accordingly (Erikson, 1982, as in Bigonnesse & Chaudhury, 2022; León et al., 2020), it is to be noted that the eighth stage of psychosocial developmental factors such as aging narratives, lifestyles, environmental factors, health disparities, individual differences, and family have impacts on the aging perceptions of African Americans. Many scholars have noted that racial inequalities lead to delayed health interventions in some African American communities (Bindra et al., 2024; Hinton et al., 2024). For this purpose, the study reports that healthy aging entails functioning and maintaining individuals’ psychological, mental, and social well-being in later life.
Research on aging perceptions has shown that how people feel about their aging process helps inform professionals about the essential needs of aging individuals. It helps to re-evaluate aging policies and amplify coping strategies that protect family structures and improve the quality of life for all aging individuals. According to studies, active aging is imperative as it impacts geriatric individuals’ culture, environmental adjustment, and family support (Foster & Walker, 2021; Saliba & Barden, 2021). Active aging decreases depressive mood by increasing well-being and robust mental health.
Empirical studies have revealed that psychosocial aging influences not only one’s physical abilities and competence but also the adjustment to life transitions and subjective health (Chen et al., 2021). Thus, it is essential to enhance and support the aging elders to make a healthy transition into the older adult stage of life (Foster & Walker, 2021; Saliba & Barden, 2021) through social activities which are predictors of less social isolation, more functionality, and independent living. On the contrary, loneliness has increased health risks, less social integration, less social engagement, and the inability to build resilience (Foster & Walker, 2021).
Erikson’s psychosocial developmental theory (Erikson, 1984; 1998; León et al., 2020; Sekowski, 2022) identifies eight human developmental stages: basic trust versus mistrust, autonomy versus shame/doubt, initiative versus guilt, industry versus inferiority, identity versus confusion, intimacy versus isolation, generativity versus stagnation, and ego integrity versus despair. He proposes that if individuals successfully transition through the stages of identity formation and crisis resolution, they may achieve psychosocial maturity and life accomplishments or regret lost opportunities in later stages of life.
Studies on healthy aging reveal the importance of emotional support, cognitive engagement, spiritual and environmental connectedness as effective ways to stay and remain active while aging (Duvauchelle, 2021; Pengpid & Peltzer, 2021). Research on healthy aging suggests that adults do encounter challenging environmental factors in their aging process. It is important to recognize that Erikson’s theory does not fully elaborate on the external factors that influence individual development. Therefore, there is a need to expand on how mental health, health risks, discrimination, mistreatment, racism, culture, and religiosity impact individuals as they age. According to Degenholtz (2021), providing adequate health awareness and promotional services for older adults is crucial, as this can be perceived through social support, which sees psychosocial adjustment as a significant factor that enables aging individuals to function appropriately in their environments. Proponents of social support view health awareness as an essential and non-negotiable component of comprehensive support for older adults. Additionally, other scholars highlight factors such as an individual’s lifestyle, perceived good health, professional status, family’s annual income, leisure, and self-reported spirituality as essential influences on health (Degenholtz, 2021; Duvauchelle, 2021; Pengpid & Peltzer, 2021).
Another study expounded the significance of social support to adjustment in old age, particularly as it pertains to suicidal ideations among older adults. It is to be noted that the mental health of aging individuals affects their worldview, perceived health, and medication adherence. This means that when older individuals express a low self-assessment of themselves, it can negatively impact their health and aging process in a fast-evolving society. Notably, the many effects of aging vary among individuals depending on their comparative age, generation, and adjustment mechanisms (Choquette, 2021; Dong et al., 2021; Jacobs & Holtzer, 2021).
To balance optimal health and well-being, Jacobs and Holtzer (2021) emphasized that social support could be considered a protective factor against the adverse effects of stress and a compensatory strategy for low-level functioning among older adults. Studies indicated the importance of acknowledging older adults’ struggles in their aging process. Majeski and Stover (2019) showed that to attain healthy aging successfully, older adults must maintain self-care, a positive attitude, and good humor. Personal adjustment was noted to be a factor that ensures positive developmental changes with an adaptive value that enables individuals to live well within their communities as social beings and accepted members, even when they are less active due to age.
The importance of social integration cannot be fluttered considering its significant impact on the mental, psychological, and physical health of the elderly. Unfortunately, many scholars have discovered that social isolation and loneliness are on the increase among older adults in the United States, noting that these deficits in feelings could result in an imbalance between desired social contacts and actual social contacts of the aging individuals (He et al., 2021; Tampi & Tampi, 2022). Concurring that loneliness is a subjective feeling of dissatisfaction in social relationships, research studies postulate that close social contacts or emotional ties are a challenging factor in the lives of older adults, especially after retirement. In their view, disengagement, withdrawal, and low commitment affect social networking. In other words, perceived social connectedness and living alone arrangements could increase the risk of mental health issues, poor cognitive function, and brain atrophy in the lives of aging individuals (Mahoney et al., 2021; Saligram & Murthy, 2022).
With a limited scholarship on the narratives of the aging process of African Americans, there is a need to address the gap in current knowledge about subjective aging experiences among African American older adults (Bigonnesse & Chaudhury, 2022; León et al., 2020). According to the literature review summary, it has been well-established that holistic health and well-being are paramount in the perception of aging experiences of older adults. See Figure 1.
The findings of this report indicated that subjective health is an essential component of understanding how older adults perceive and manage normative to chronic conditions associated with aging. According to psychosocial development theory, this exploration describes ego integrity as a phase of self-evaluation in which individuals become well-integrated people with extensive experiences, self-awareness, and potentially a sense of life satisfaction as they age. Consequently, an individual’s self-perception contributes to making meaning of one’s life, which includes understanding the impacts of external factors on the life of the aging individual. This also highlights the negative and positive aspects of life’s satisfaction and their impact on aging individuals as significant physical and psychosocial well-being predictors. It surmises that successful aging begins early in adulthood with three crucial phases of aging: preparation, preservation, and resilience (Escourrou et al., 2022; Siltanen et al., 2021). It follows logically that when individuals invest time to prepare for aging, they are better equipped to deal with the losses and changes accompanying aging.
Given the limited representation of aging experiences from African American older adults (Lamb, 2019), the findings of this investigation will hopefully guide policymakers, families, social workers, educators, mental health specialists, and medical professionals in providing compassionate care to the geriatric community. It will provide opportunities for motivation, self-appraisal, and maximization of healthy behaviors, which combat and moderate any aging stereotype. Relying on the available literature and their focus on mainly Caucasians or other communities outside the African American population, this research is important for all older adults but especially for the African American older population, whose historical and personal histories, events, and circumstances are not usually shared by other societal groups.
Figure 1. The literature review.
3. Methodology
A qualitative research methodology and a generic qualitative inquiry design were utilized to examine our subject and understand African American older adults’ subjective experiences, beliefs, attitudes, and aging perceptions. The semi-structured interview data were analyzed using thematic and constant comparison methods. In this case, a step-by-step comparative thematic analysis was employed to evaluate the respondents’ subjective opinions, attitudes, and values related to their aging process. A theme was considered to emerge when four or more similar ideas and experiences from participants were interconnected to the research question.
The data were collected from 10 community-dwelling African Americans 65 years and older. The ten participants were retirees who previously worked jobs requiring college and high school academic skills, as demonstrated in Table 1. The data collection technique involved a face-to-face semi-structured interview at the approved recruitment site, where the researcher received site permission to post flyers, along with an established private room where the interview was conducted. Interested individuals who responded to the flyer were earlier screened over the phone for eligibility, and thereafter, those who met the eligibility criteria were invited for a face-to-face interview.
Table 1. Demographic data of the participant.
Participants |
Age |
Sex |
Education |
P1 |
67 |
M |
Educated |
P2 |
66 |
F |
Educated |
P3 |
65 |
F |
Educated |
P4 |
72 |
F |
Educated |
P5 |
94 |
F |
Educated |
P6 |
67 |
M |
Educated |
P7 |
69 |
F |
Educated |
P8 |
70 |
M |
Educated |
P9 |
75 |
M |
Educated |
P10 |
75 |
F |
Educated |
4. Results of the Research
In answering the research question, this work combines similar ideas and experiences of the respondents as presented in the emergent themes and patterns shown in Figure 2. The research question was: What are the perceptions of aging among African Americans in late life from a psychosocial developmental perspective? While analyzing the data, only selected and prioritized themes that provided meaningful links to the question were selected.
The summary of the six themes and patterns identified in the study are: Autonomy: Six participants (P1, P3, P4, P8, P9, and P10) each described their experiences of aging as a natural process. They shared their narrations as times when they could focus on themselves and exercise control over their lives, free from external influences dictating the tone or format of their daily activities. Physical withdrawal and disengagement: P1, P2, P3, P4, and P5 expressed frustrations about being unable to engage in activities they once enjoyed due to physical decline and fatigue. Conversely, others indicated that their withdrawal stemmed from an unsupportive environment. Mental health, attitude, and lifestyle choices: The participants noted that a healthy lifestyle can reduce stress, which negatively impacts the body’s mechanisms and organs, ultimately leading to less cell damage. Reflection on life experiences: The study participants reported that aging prompts introspection, leading individuals to reassess and evaluate the significance of their life roles. Socialization and self-concept: The participants emphasized teaching younger generations to love and respect older adults. They acknowledged that aging as an African American can be challenging due to social influences. Religious effects and transcendence: The participants highlighted the issues of racial inequality in the distribution of health interventions and expressed their distrust of the medical care system. Instead of visiting a doctor’s office, many participants indicated a preference for avoiding medication and choosing to rely on their faith for healing.
Figure 2 summarizes the six themes and patterns, but a detailed description of the third and sixth themes will be analyzed in the next paragraph.
Figure 2. Summary of the research themes and patterns.
Theme 3: Mental Health, attitude, and lifestyle choices.
The theme of mental health was identified as participants mentioned that older African Americans are more likely to be diagnosed with depression, anxiety, and dementia than other races. Given the existing disparities in mental health treatment and the projected growth of the African American older adult population, a dire need for assessment and treatment that focuses on cultural perception of mental health is needed. According to Barnes (2022), African Americans are culturally disproportionate when given care among those suffering from Alzheimer’s disease and dementia. This study noted that race-based norms can be helpful in the clinical setting when erroneous and potentially harmful interpretations of underlying racial differences are addressed. The respondents noted that African American older adults experience significant health disparities and an increased risk of chronic health conditions such as hypertension, diabetes, dementia, stroke, and cancer than their counterparts. The participants highlighted racial inequality in health intervention distribution and distrusted the medical care system.
The report stated that without maintaining stable mental health, it becomes difficult for aging individuals to have autonomy as individuals acquire longevity. Healthy mental health is needed for aging individuals to be independent, creative, and have a sense of belonging while upholding moral independence and integrity in their aging process (Best et al., 2021; Liu et al., 2022). Despite age-related declines, this report reveals the roles of mental health, such as maintaining one’s autonomy, independence, and the ability to decide for themselves, along with the different phases of one’s life (Chen et al., 2021). The participants admitted that a healthy mental state enables one’s autonomy while facing the challenges of aging. According to some respondents, staying mentally healthy and active is a significant sign of reducing loneliness. This was echoed by P2, who indicated that aging is a little worrisome and challenging, especially in coping with the emotional and physical demands of activities of daily living. She mentioned that grandchildren and television shows keep her alert and less forgetful, as no other close family member relates to her. Research also has it that when people feel less valued, they feel less socially connected, which could, in turn, lead to isolation, loneliness, depression, less receptivity to social/emotional support, as well as loss of interest (Borghini et al., 2021).
Theme 6: Religious effects and Transcendence.
There is a relationship between aging and transcendence; this is where the patterns of trust, faith, optimism, and religion meet. In this theme, the participants expressed having a sense of purpose in life irrespective of their emotions, past and present, which were/are full of regrets, depression, and loneliness. The participants echoed some ideas of ego integrity by accepting themselves and their situations in life. Some respondents acknowledged that religion has a multidimensional paradigm that consists of behavioral, social, doctrinal, and denominational qualities. They concurred that religion/religiosity leads to how religion affects, shapes, and influences their development as African Americans. According to Hwang et al. (2022), a person-centered approach helps to identify the patterns of religious attributes that individuals make of themselves. For instance, older individuals tend to be more faith-based in their daily lives due to their upbringing at a younger age. A participant noted that, as an African American woman, she believed that with prayer, she could overcome anything because she grew up in a time where prayer was powerful. She acknowledged that her faith in God enables her to re-evaluate the concepts of fear, hope, love, dislike/hatred, longing/desire, joy, sorrow, appreciation/gratitude, compassion, and consideration for others. However, compared to the younger generation, it can be assumed that prayer is less likely to be the first thing the younger generation will do. For a large part of African Americans, God, culture, church, and religion have been a means of escape from a discriminatory reality. According to Erikson, ego integrity is an individual’s acceptance of the forces that have shaped their life and as a reflection of the experiences of life that have shaped them into who they are now (Erikson et al., 1986; Chen et al., 2021).
The participants stated that they were no longer interested in material things but focused on things that connect them to something more significant than the self. Some participants reported self-transcendent experiences that focused on having more interest in the amendment and personal relationship with God and a more conscious psycho-spiritual vision of life (Reischer et al., 2021). The theme of transcendence corresponds mainly with the idea that individuals 65 and older naturally tend to emphasize the spiritual, eternal, and non-materialistic aspects or dimensions of life during the resolution phase of life (Erikson, 1998; Chen et al., 2021). For instance, Participant 7 stated, “I’m 69, and I’m trying to grow old gracefully and spiritually.” P1 noted, “We are moving, and time is flying. You know I have a pension. I think God put it there for some reason,” Participant 2 added, “You can’t remain one way all the time. You know, as you age, you get wiser, and life’s clock keeps ticking.”
5. Discussion on the Results of the Research
The initial empirical study was consistent with and informed by the psychosocial developmental theory (Erikson et al., 1986; Erikson, 1998; León et al., 2020; Sekowski, 2022) with particular attention to Erikson’s eighth stage, ego integrity vs. despair, exploring the perceptions of community-dwelling older African American adults. Significantly, the findings bridge the historical barriers of help-seeking behavior both in seeking mental health support and empowerment of older African Americans as a contribution to empirical research on aging. The results are relevant in no small measure as they go a long way in helping to restore trust and diffuse the shame of exploitation, deception, and misconceptions about clinical studies, given the inequality of resources and advocacy to improve health literacy. The participants were realistic about their perceptions and appraisal of their aging process. Thus, they constitute a representative assessment of opinions, not necessarily by size but by the depth of capturing the views of older African Americans.
The participants confirmed that the aging process is a commonly shared experience comprising an individualized life experience focusing on self-esteem, lifestyle choices, personality traits, and family relations. They also noted that these perceptions form the fulcrum of human behaviors and attitudes, and undoubtedly, attitude impacts the aging process of individuals. Our research suggests that the aging mindset is essential, as it relates to increased social factors of positive attitude, resilience, and optimism to decrease its acceleration. Furthermore, optimism and confidence increase the likelihood of maintaining healthy aging, leading to quality of life (Kim et al., 2019; Liu et al., 2022). It is to be acknowledged that this study is significant for community and social policymakers, as well as for health and counseling professionals. The study is further substantial for gerontological counselors working in retirement homes and family and grief counselors.
On the theme of aging and mental health, the contemporary reality of older adults indicates that as one advances and grows old, there is a need for healthy mental health, which is required for the autonomy and independence of the aging person. Research opines that individuals must be independent and creative as they acquire longevity and maintain moral autonomy and integrity in their aging process (Liu et al., 2022). In other words, despite the apparent and manifestly challenging age-related indices of decline, older individuals are expected to maintain a sense of control, autonomy, independence, and the ability to decide for themselves.
It is, therefore, necessary for mentally healthy aging individuals to plan for adjustments as they age. The research highlighted the importance of making adequate retirement plans to combat confinement, which is an inherent factor for retiring professionals, as it leads to isolation and a decrease in social integration, whereby an individual maintains less contact with families, relatives, and the community which culminates in a lack of social integration (Borghini et al., 2021). The importance of mental and physical adjustments as one transition to old age cannot be overemphasized. Borghini et al. (2021) noted that negative attitudes about one’s aging process lower life expectancy and could lead to negative self-fulfilling prophecies, culminating in poor social and physical health conditions that may lead to depressive behaviors.
Our study also found that as people age and interact with others, they experience changes influenced by their attitudes toward aging. These attitudes are shaped by an individual’s moods, beliefs, and perceptions of reality. Consequently, some authors have noted that aging involves the ability of the individual to maintain self-awareness, contextualize social interactions, and remain grounded in their self-concept. An individual’s current self-perception regarding aging can significantly influence their future self-view (Butzbach et al., 2021; Gagliardi et al., 2021; Oosman et al., 2021).
Lastly, our study identified the connection between religiosity, aging, and transcendence. Many older adults view transcendence as a fundamental part of maturity, allowing them to reshape their perceptions of themselves, others, and the meaning of life. To varying degrees, transcendence helps older individuals find resolution in their aging process. This notion depends on how well or not they have internalized the earlier experiences of life (Chen et al., 2021; León et al., 2020; Sekowski, 2022). As people advance in age, they begin to adapt to the realities of life. Incidentally, respondents indicated that their trust in higher powers/God increased their gratitude for everything they had accomplished in life and decreased their mental health issues. These experiences correspond with the view that ego integrity is an individual’s acceptance of the forces that have shaped the individual’s entire life (Erikson et al., 1986; Chen et al., 2021; León et al., 2020; Sekowski, 2022). As such, since ego integrity denotes acceptance of where a person is now, this trait can be said to have been fully crystallized in the participants’ life experiences in this research. Many older individuals’ spiritual transcendence and faith are linked to resilience, hope, and optimism as factors for reducing stress.
6. Future Research Directions
Future research on resilience mechanisms that older adults employ in late life is recommended. To enable statistical generalization and replication of research results, a future study could use a quantitative survey to explore the well-being of aging individuals across the lifespan. Research can be conducted to identify the functions of social optimization and compensation (SOC) in relation to aging well-being, life satisfaction, and quality of life; social optimization and compensation (SOC) could provide adaptive processes for positive aging.
It is also to be acknowledged that this study had some limitations attributed to the sample size. Although the sample size for this investigation is consistent with a generic qualitative inquiry, it is presumed that a more significant number of participants could have been preferred. Nevertheless, Boddy (2016) stated that a research sample size does not necessarily imply statistical generalization but the expectation that the sample size will adequately answer the research questions. In this case, the sample size limitation for this study is inherently unavoidable and deters generalization; hence, future research is warranted.
7. Conclusion
Although the study needs further exploration, the community-dwelling participants of this research offered helpful information about the challenges of aging from the psychosocial developmental perspective. It was encouraging to listen and identify the many factors the psychosocial developmental framework plays in the lives of older African Americans. Such factors were mental health issues, internalized earlier experiences of life, discrimination, culture, religion, autonomy, and others. Evidently, those outside factors play a massive role in the psychosocial development of older African Americans. It is crucial to note that an individual’s ability to overcome developmental conflicts leads to positive adjustment, growth, and strength as one ages (Choquette, 2021; Dong et al., 2021; Jacobs & Holtzer, 2021).
Within the emergent themes, respondents acknowledged aging as a process of getting older with gradual physiological and mental changes. The participants recognized that aging brings significant bodily and physio-biological variations that do not necessarily imply the immediate cessation of living or non-continuity of exciting habits and lifestyle preferences. From this study’s perspective, aging is a gradual process of adjustment, growth, introspection, maturity, coming to terms with reality, and transcendence.
The research question was adequately answered based on the respondents’ personal experiences and professional interpretations of the above observations. Through the psychosocial exploration of older adults’ perception, thinking, and reflections, this study offers some viable understanding of the roles of self-concept among older adults. Although self-concept is one of older adults’ most significant challenges (Chen et al., 2021), it is acknowledged that self-esteem and perception of personal worth and values overwhelmingly impact the successful aging process. These experiences can be positive or negative, depending on one’s opinions. The problem is not necessarily the perception but its effects on later life stages. Unless changed or altered, self-concept shapes, makes, or breaks an individual’s entire worldview, even when non-consciously displayed (Bergeron & Lagacé, 2021). Having life satisfaction or dissatisfaction begins with one’s perception, which must be viewed from the cultural background of individuals. This study uncovered the idea that African American older adults cannot be separated from their socio-cultural realities. The extent to which an individual feels positive or negative about oneself reflects an individual’s subjective evaluation of self-worth and attitudes, which cannot be generalized.