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Gerotranscendence: A Critical Review

The theory of gerotranscendence, a developmental theory of positive aging was proposed by Lars Tornstam in 1989. It was based on the empirical researches done by him in late 1970s and early 1980s [4] and work of other theorists [5,6]. Tornstam began to explore aging with a phenomenological qualitative approach. 50 participants aged between 52 to 97 years were interviewed after a lecture by Lars Tornstam on the early concepts related to gerotranscendence [4]. The theory of gerotranscendence was also elucidated by quantitative studies including a retrospective study in which 912 Danish participants aged 74-100 were asked about gerotranscendence related developments in life [7]. This study was complemented by another cross-sectional research with participants aged between 20 to 85 years to describe the level of gerotranscendence at different ages [8]. The theory of gerotranscendence was also based on the former theories by Jung and Erikson [9-11].


Description of the theory of gerotranscendence
The theory of gerotranscendence, a developmental theory of positive aging was proposed by Lars Tornstam in 1989. It was based on the empirical researches done by him in late 1970s and early 1980s [4] and work of other theorists [5,6]. Tornstam began to explore aging with a phenomenological qualitative approach. 50 participants aged between 52 to 97 years were interviewed after a lecture by Lars Tornstam on the early concepts related to gerotranscendence [4]. The theory of gerotranscendence was also elucidated by quantitative studies including a retrospective study in which 912 Danish participants aged 74-100 were asked about gerotranscendence related developments in life [7]. This study was complemented by another cross-sectional research with participants aged between 20 to 85 years to describe the level of gerotranscendence at different ages [8]. The theory of gerotranscendence was also based on the former theories by Jung and Erikson [9][10][11].
Tornstam's earlier work on aging revealed that aging is a natural developmental process towards maturity and wisdom [12][13][14]. This advancement in age is accompanied by a gradual shift in meta-paradigm of an aging person, which Tornstam termed as Gerotranscendence [8,13,15]. Gero refers to 'old' and transcendence means 'rising above' [16]. According to Tornstam [14], "It is a shift in meta-perspective from a materialistic and rational view of the world to a more cosmic and transcendent one, normally followed by an increase in life satisfaction" [14].

Three dimensions
This shift in the perspective occurs in three dimensions; the cosmic dimension, the self-dimension and the social and personal relationship dimensions. The themes such as redefinition of time, connection with earlier generations, decreased fear of death, mysteries in life, and transcendental sources of happiness in gerotranscendence are subsumed under the cosmic dimension [3,4,9,17]. The dimension of self includes the themes of selfconfrontation, decrease in self-centeredness, self-transcendence and ego-integrity. Self-confrontation theme refers to the discovery of the hidden aspects of personality which Jung calls the shadow [, 3,4,9,17,18]. The theme of ego-integrity resembles to Erickson's eighth stage of the personality development [19,20]. The importance of social contacts during different phases of life, social masks, emancipated innocence, reduced interest in material assets and wisdom were the themes under the dimension of social and personal relationships [3,4,9,17,18].
The aging individual growing into gerotranscendence experiences redefinition of time space and objects. It is also characterized by a communion with the spirit of the universe with an increased preference towards meditation. Aging person becomes more aware of the higher self and seeks spiritual enlightenment [3,4,17]. The total flow of life becomes more significant than individual self. Fear of death is less and the affinity with the earlier, existing and imminent generations is greater [8,14].

Primary assumptions
The theory is based on several assumptions which are identified by Tornstam himself.
I. He stated that the research is influenced by the values of the investigators and the society [4].
II. He has mentioned that the gerontological research is predominantly influenced by positivistic paradigms [4,16].
The positivistic values that influence research in gerontology include effectiveness, productivity and rationalism. It is based on these values that withdrawal in old age is regarded as negative rather than a natural process [4,15,20]. Furthermore, these values have caused the prevailing misconceptions in the gerontological research. The term successful aging is a classic example of the influences of these values.
III. Assumption in the theory is that the prevailing paradigm on aging can be reversed by confirming the resource perspective with the experiences of elderly people [4,16]. IV. Tornstam assumes that gerotranscendence is a natural phenomenon and living in accord with the natural laws will lead to gerotranscendence [4,16]. On the contrary, he stated that the cultural norms and societal ideologies such as an inclination towards productivity might prevent this natural process towards gerotranscendence [4,20].

Strengths and limitation of the theory
The strengths of the theory are tied to the empirical evidences presented by Tornstam. He has tested the theory through research and has found that the theory of gerotranscendence: i. Relates to the real experiences of older adults [7,8,[12][13][14]17].
ii. Shows the relevance of the theory in old age experience.
iii. Provides a new prospect on the developmental and situational shift in the lives of the older people [21].
iv. Another strength of this theory is its applicability into practice. Guidelines for nursing practice have been developed using the theory of gerotranscendence as a framework [10,11].
v. It is very relevant to nursing as it provides nurses with an understanding of the transcendent behavior in old age and provides them with a frame of reference to promote positive aging in older adults [16].
The theory also has some of the limitations such as a) Tornstam fails to provide a definition of gerotranscendence. He has explained its characteristics but this term needs to be more explicitly defined.
b) Tornstam has limited the transcendence to old age whereas, Reed [22] has claimed it to be prevalent in all ages and not only limited to old age.
c) Furthermore, the theory explains the state of affair at individual level and doesn't include the broad social factors which might influence the aging experience.

Utilization of the theory in the research
Researchers have started to note the importance of gerotranscendence [5,16,23,24]. It has been studied across different cultures as Tornstam claims that the theory is not cultural bounded and rather a natural process. The theory has been studied in Iranian, Turkish [25] Chinese [26] and Swedish [12,14] population. The theory of gerotranscendence was adopted by Wadensten [5,6,27] and studied in various settings.
Interpretation of the theory of gerotranscendence by nurses found that some of the nurses interpreted the transcendent signs in old as pathological and the theory provide them with a interpretative framework to accept these signs as part of normal aging. It enabled them to develop a positive attitude in approaching older people [23]. Guidelines based on this theory were developed to guide nursing practice [24]. It has also been utilized to study the experiences in reminiscence groups [28].
Wang [29] studied the Bio-psycho-socio-spiritual factors that influence the development into gerotranscendence. Weiss [30] has explored the intersection of post-traumatic growth and gerotranscendence. He found similarities between the two paths in the process of personal transformation with the difference being traumatic events and normative later life experiences between the post traumatic growth and gerotranscendence respectively [30]. The theory of gerotranscendence have provided framework for a number of researches. It is also related to the broader concepts of positive aging and has a potential to help in the understanding of mental health issues, and retirement and volunteerism in old age.

Positive aging
As per Tornstam, theory of gerotranscendence is a developmental theory on positive aging. It was proposed as a result of mismatch between the prevailing theoretical paradigms in gerontological research and the empirical evidence [4,14,15]. It presents aging from a resource perspective and unveils the potential of old people to grow into gerotranscendence. Gerotranscendence is the final stage of natural progression towards wisdom and maturation [12][13][14].
A transcendent view of life in old age enables a person to see his life with a larger perspective with a meaningful interpretation of past experiences. Lewin & Thomas [25] found a positive relationship between gerotranscendence and Life satisfaction. An individual become more transpersonal in later life and therefore less likely to feel lonely [9].
People who face crises in their lives are more likely to achieve a higher level of gerotranscendence than those who had not experience any crises [3,14]. There is a significant correlation between the cosmic transcendence and feeling of coherence and meaning of life [31]. Transcendence in life promotes health, harmony, healing and meaningfulness in life of older adults [29,32]. Studies have also attested the fact that people who find meaning in life tend to experience better physical health [33,34].

Gerotranscendence and mental health issues
The theory of gerotranscendence sketches aging process as merelya positive experience as opposed to Erickson's eighth stage which affirms two opposite possibilities for an aging individual namely ego-integrity and despair [19]. This positive or resource perspective of aging as Tornstam labels it, fail to explain the mental disorders in general and depression in particular among the old members of the society. According to a systematic review by Djernes [35] in 2006, the prevalence of depression in old age is upto 49% and the figure reaches to 90% for those living in long term care setting [36].
Tornstam has mentioned that there are factors that can promote or hinder the process of growing old into gerotranscendence. However the statistics affirms that depression is the most common mental illness among individuals aged more than 65 years [35]. These figures questions Tornstam's claims that gerotranscendence is a natural process and everyone has a potential to grow into gerotranscendence. There are alternate explanations available for the above mentioned figures such as depression is related to biological changes in the body, some physical disorders are also related to increased prevalence of depression such as coronary artery diseases [37] and stroke too mention studies [38][39][40]. Depression is also associated with personality types, coping and life experiences. Nonetheless, Tornstam asserts that negative life experiences are associated with higher levels of gerotranscendence [4]. Therefore, there is a need to explore this mismatch between the theory and statistics.
Presenting a purely positive prospect on aging limits the theory to a certain group of people experiencing a positive change. Inability to provide an explanation for the miserable experiences in later life and accompanying dissatisfaction with life limits the Tornstam perspective. Depression and other mental health issues may not be considered a normal part of aging but the fact that these disorders are common in old age population cannot be ignored. It has been documented that withdrawal in gerotranscendence is different from depressive symptoms as there is no correlation between the gerotranscendence scale and depression scale [4]. Tornstam's explanation of the mental disorders in late life as a result of being hindered of hindering themselves in their developmental process needs to be studied extensively.

Work retirement and volunteerism
The theory of gerotranscendence focus on the micro level i.e. individuals facing retirement in later life rather than elucidating it at a macro level i.e. socio demographic factors and policies that influence retirement process. The theory asserts that in later life, an individual loses his interest in material and rational view of life [4,7,14]. As they transcend, they are less concerned about their future in the material world therefore, retirement doesn't have a negative impact on their satisfaction with life.
Retirement is conceived as a positive milestone accompanied by a reduction in social activities and increased introspection with an increased perceived quality of life [4,41]. There are various research studies in different population to study the effects of retirement among elders. Scarce resources and poverty are dealt with a rich spiritual life and empowering relationship with God [42]. Another study in China shows that pursuing transcendence fortifies the resiliency in retirement in spite of the associated challenges [26].
Aging adults also involve in altruistic activities contributing to increased self-worth and healing [14]. These activities help them in transcend their worries and concerns related to aging, facilitate satisfaction in life, and build a context for learning the hidden self and their world [22]. This explains the increase in volunteer activities with aging. Purposeful volunteering is found to be associated with increased happiness, motivation and wellbeing among retired elders [43].

Conclusion
In a nut shell, theory of gerotranscendence presents a positive view on aging. Tornstam has supported his perspective with various qualitative and quantitative research studies. The theory has also been adopted by many scholars and applied in a number of contexts. Many research studies verified the postulated put forward by Tornstam. However, there is a need to further explore this theory in old age people suffering from depression and identify ways to promote gerotranscendence in them.