What gets you out of bed in the morning?
It’s a deceptively simple question, and useful shorthand for helping us pinpoint something vitally important: our sense of purpose. No matter what stage of life we are in–young or old, in school or employed, married or not, healthy or sick — having a purpose is what makes us human and makes us who we are.
In fact, purpose is vital to our health and well-being, from childhood to old age and even at the end of life.
What is Purpose?
Purpose is one of six recognized dimensions of wellness. (The other five are self-acceptance, environmental mastery, positive relations, personal growth, and autonomy). The concept of purpose is derived from the field of positive psychology. It is conceptualized as reflecting a person’s sense of meaning and direction in life and manifests in terms of a person’s goals for the future and feeling that life is worth living. Its benefits include greater optimism, resiliency, self-esteem, and sexual enjoyment, as well as less depression, loneliness, and even less fear of death.
Purpose Has Health Benefits
A sense of purpose may seem like a tiny footnote in the biomedical canons as to what is important for health and wellness, but the list of its associated health benefits may surprise you.
Similarly, a sense of purpose protects brain health. A study from the Rush Memory and Aging Project found that people with higher scores on a scale measuring purpose were 2.4 times less likely to develop Alzheimer’s disease.
Purpose is also related to people’s engagement in preferred and meaningful actions or activities. Helping people remain engaged and reconnect has been shown to improve their appraisals that life is worth living, which in turn reduces depression.
The reverse is also true: otherwise healthy older people who feel that they are not needed and useful are more likely to develop a disability, feel depressed, or die prematurely–a finding that has been replicated in several studies and countries.
Based on his experience as a prisoner in Auschwitz, the psychiatrist Viktor Frankl believed that having a purpose was so profound that it would see people through even the most traumatic experiences. As he wrote in his 1946 masterpiece, Man’s Search for Meaning, “[a man who] knows the ‘why’ for his existence … will be able to bear almost any ‘’how.’”
Scope Does Not Matter
Some people may define their sense of purpose on a grand scale: changing the world, ending homelessness, or curing cancer.
Purpose can also be much more grounded to daily life, rooted in family ties, beloved hobbies, or social roles like being a faithful parishioner, devoted pet owner, trusted friend, loving caregiver, or nurturing parent or grandparent. Everyone has to find his or her own path; what’s wonderful is that the therapeutic effects are consistent regardless of one’s purpose.
Maintaining a Sense of Purpose as We Age
What makes us get up in the morning will change as we age, and will be related in part to where we are in our life course. However, maintaining a sense of purpose can be challenging as we get older, and in old age. Previous roles and activities that gave us purpose may no longer be possible. Careers and work roles may end, children may have grown up, and cognitive and physical limitations and the home environment may shape what can be done, diminishing our sense of purpose and changing what gave us purpose in previous years.
Ageism is another obstacle to maintaining a sense of purpose in old age. Robert Butler, MD, the pioneering aging researcher who coined the term “ageism,” put it this way in his 1972 book Why Survive?: Being Old in America:
“In America, childhood is romanticized, youth is idolized, middle age does the work, fields the power and pays the bills, and old age, its days empty of purpose, gets little or nothing for what it has already done.”
Given the growing number of older people and the very long lives that most of today’s children will live, helping people young and old continuously find and maintain a sense of purpose is critical to physical and mental health.
Making Purpose a Renewable Resource Throughout our Lives
As having a sense of purpose is essential to health and well-being, we cannot ignore it. We need to make “purpose” a renewable resource and part of our approach to supporting health and wellness throughout the life span, particularly for older adults aging with functional or cognitive challenges.
Imagine what would be possible if we helped everyone identify their preferences and find and adapt meaningful activities to achieve their sense of purpose for every age, starting with:
- People in transition, facing changes like unemployment and retirement. In our career-obsessed culture, the end or loss of work can cause painful social and emotional dislocation, loss of identity, and even, in one study of early retirees from Shell Oil, premature death.
This is a strongly American cultural phenomenon; in many other countries, identity is not linked to work and many other life roles are honored. We could learn a lot there.
Dan Buettner, who has explored places around the world where people consistently live the longest, healthiest lives (“Blue Zones”) says that, “in all Blue Zones, people have something to live for beyond just work,” and posits that “knowing your sense of purpose is worth up to seven years of extra life expectancy.”
- Healthy older people. As people age, they may have a hard time staying involved, particularly after a retirement. Meaningful activities such as volunteering, tutoring, or mentoring younger people are often popular among older people, as these activities help to fulfill the need for “generativity,” coined by the psychologist Erik Erikson to refer to the need to give back what one has learned to the next generation. Generativity is an important source of purpose.
- Children, who must be adequately prepared for lives (and retirements) that may be twice as long as they were for their great-grandparents. This will mean changing the way we educate children and the expectations we inculcate in them for employment, family life, civic and community engagement, and old age.
- People living with dementia. Losing one’s social role and sense of identity can be one of the most painful aspects of cognitive decline. People living with dementia may need some help finding and maintaining a sense of purpose, yet the challenge is fundamentally the same for all of us.
Meaningful activities can help restore a sense of irreducible “personhood” and research has proven that people living with dementia enjoy learning new things, particularly goal-oriented activities.
One study of art therapy showed that people living with dementia who drew a greeting card intended for someone else felt a greater sense of purpose than those who did free drawing. Other research has consistently shown that helping people living with dementia engage in activities that are tailored to their abilities and interests improves their daily functioning and quality of life.
Helping persons living with dementia find purpose through engaging in meaningful activities can also be accomplished by instructing older volunteers to provide these activities. For example, the Senior Companion Program of Weber Human Services in Ogden, Utah, directed by Ms. Karyl Chase, engages older adults in serving elders in the community who are isolated and at risk for losing their independence. Through a new grant from the Corporation for National and Community Service, occupational therapists will be trained in the Tailored Activity Program (TAP), then instruct these older volunteers in how to use meaningful activities during their visits with people living with dementia. In turn, families will also gain opportunities for respite.
The Culture Change We Need to Promote Purpose
Helping people of all ages maintain a sense of purpose should be a priority when designing activities for them as part of home, community, and long-term services and support in all settings. This key element of person-centered care requires culture change, and, importantly, the ability to elicit and understand what people’s preferences actually are.
A new measure to help identify people’s preferences has been developed by Kimberly Van Haitsma, PhD, Director of the Program for Person-Centered Living Systems of Care at Penn State College of Nursing and Katherine Abbott, PhD, Assistant Professor of Gerontology at Miami University. As this video explains, this information in turn informs and strengthens person-centered care: video: “People flourish when they are doing things that they prefer to do and that are meaningful to them. Person-centered care promotes choice, purpose, and a greater sense of connection.”
To sum up, purpose is essential to who we are. It gets us up in the morning and gives us small and big goals that are essential to our well-being and defining who we are and want to be. It provides a sense of meaning and connectivity and, well, basically it is essential to our survival.
Thus, this should be integrated in our health care systems — asking people questions related to their purpose and strategizing ways to strengthen their connectivity to what is important to them. Knowing this, we as individuals, our health care and education systems, and our whole society should look for ways to take far greater advantage of the role of a sense of purpose. That’s a goal worth getting out of bed for.