Research on existential questions among the elderly yields fruitful collaboration

In practice, social workers find it difficult to respond to the life questions of elderly people. Based on this experience, Windesheim set up a valuable research project in which social workers, students, researchers and elderly people work together.

Which practical question prompted this study of existential questions? 
The practical question that prompted this study into existential questions among the elderly came from a social worker in Meppel. She came to us with the following question: is it possible to set up a long-term collaboration on existential questions among the elderly? She noticed that the elderly sometimes have questions about life that she found difficult to anticipate. And her colleagues were also struggling with that problem, she said. Some found it difficult to recognize the signs, while others picked up on them but
did not know how to follow them up. I then started making an inventory, asking myself whether this indecision on how to respond also existed in other organizations. When this turned out to be the case, the ball started rolling and we launched a study with financial support from the SIA steering committee. The focus is on the social worker and the question: Are you sensitive to the life questions that may come up and do you know how to follow up on them by means of discussions, practical support or a referral?

Why do social workers want to learn to deal with these questions differently?
Social workers like to work towards solutions and are good at it. As soon as contact is made with an elderly person, the professional starts the conversation very openly, but often with the solution in mind, such as a drop-in activity or a visit from a volunteer. However, social workers notice that these solutions do not always adequately address the questions that the elderly have and that they sometimes stop coming to an activity after a few times, or otherwise drop out soon. In such cases, it may be that the question behind the question has not been sufficiently brought to the surface, or that it concerns an existential or life question that requires a slightly different approach, or slightly different interviewing techniques.

This solution-oriented mindset, thinking in terms of options on offer - which, incidentally, is also based on municipal policy - sometimes gets in the way of social workers. Especially with existential questions, there is often no immediate practical solution. Moreover, the term 'existential' has a highly charged meaning. In our exploratory PROZINS study, we discovered that social workers use two meanings: existential in terms of meaningful in daily life but also existential questions about the greater meaning of life in general. They often use the first meaning for themselves but the second meaning for their clients: the emotionally charged meaning that may concern matters such as loneliness and the proximity of death. The weight attached to the term 'existential' makes it difficult to use and is also our challenge: how can we make the term less emotionally charged and more open to discussion? One of the things that are important in this respect is for professionals to discover what existential questions they themselves have.

What existential questions do social workers have to deal with in practice?
Social work is a very broad field and social workers come into contact with elderly people in many different ways. The way in which these existential questions are raised therefore varies a great deal. They usually have to do with major life events such as the transition from work to retirement, illness, the loss of a partner, family problems, a move. For example, I have a case of an elderly person who is himself a carer for his partner with dementia. He sees the relationship with his partner change dramatically and this raises the question: Where do I get the support that I used to get from my partner? How can I get involved in meaningful activities besides caring for my partner? How do I keep control of my own life? This is a good example of a signal that a social worker must be able to pick up. The next question is: how do you deal with it? A first step can then be that you, as a professional, help to organize someone's thoughts around such a question. In this case, the assistance of the social worker in sorting out his thoughts gave the elderly person so much insight into his situation that the next step was no longer necessary. The whole range of instruments of home visits, (drop-in) activities and counselling are of course available, but looking for the solution among the options on offer does not really work if underlying questions of meaning continue to slumber'.

What do you personally find valuable about this study?
I think this study is a very good example of how you can do research based on a practical question with a clear goal. It also ties in nicely with our model of 'Living a Better Life', which we have developed in our professorship. You can also see it as part of the movement of positive health, which looks at people as a whole and focuses more on underexposed aspects such as existential questions. I think it's great that people from the field know how to find us and also indicate that they really enjoy working with students and want to continue doing so. The way in which we cooperate with students, the professional field and the elderly themselves in this study makes it very valuable. The multidisciplinary background of the students is an added bonus. Nowadays, we increasingly approach neighbourhood issues starting from the question: Who has which role, because every professional has his or her own perspective. The idea is that we will be able to find each other better and better in order to develop this broad view of health and to be able to answer the question: What is a better life and how do we contribute to it? The mutually beneficial interaction between students of Nursing, Social Work, Theology and Philosophy of Life and Applied Gerontology is therefore very valuable.

What does the future of this research look like?
We have completed the exploratory study PROZINS and we are now one year on with the follow-up study ZINSITIEF, an action study in which we collect and exchange more in-depth information. We do this in four locations: Dalfsen, Meppel, Zwolle and Nijmegen. There, we will take stock of the needs and bottlenecks, test new working methods and types of collaboration, exchange information and evaluate our findings. There are also some concrete initiatives, such as in the Neighbourhood Rooms in Zwolle, where we are working on a new type of intermediary social work offer in collaboration with spiritual care. There, people can enter into conversations on certain themes related to existential questions, exploring the 'question behind the question'. Such an initiative is an example of our joint search for products that we can design and deploy to improve how social workers deal with existential questions among the elderly.

Franka Bakker is Associate Professor of the professorship Living a Better Life with Dementia and conducts research on health and well-being among the elderly (with dementia). Among other things, she developed the Living a Better Life framework, in which a holistic view of ageing forms the starting point for care provision.