Hope, older adults, and chronic illness: a metasynthesis of qualitative research

AIM:   To report a metasynthesis review of qualitative research studies exploring the hope experience of older persons with chronic illness. BACKGROUND:   Hope is a psychosocial resource used by persons to deal with their chronic illness experience. DATA SOURCES:   A comprehensive search of multiple databases for studies of the hope experience (published 1980-2010) was completed. Inclusion criteria were included qualitative studies of the hope experience of persons (all genders; mean age 60 years and older), with chronic illnesses, and publications in any language and country. REVIEW METHODS:   The metasynthesis followed four procedural steps: (a) comprehensive search, (b) quality appraisal, (c) classification of studies, and (d) synthesis of findings. RESULTS:   Twenty studies were included in the metasynthesis representing research from a variety of different countries and populations with differing medical diagnoses. The characteristics of hope included: (a) dynamic or situational nature, (b) multiple co-existing types, (c) objects that were desirable realistic possibilities, (d) future-focused, and (e) involvement of choice/will. Hope as 'transcending possibilities' represented the integration of two processes of transcendence and positive reappraisal. Reaching inwardly and outwardly and finding meaning and purpose were sub-processes of transcendence, whereas re-evaluating hope in light of illness and finding positive possibilities were sub-processes of positive reappraisal. CONCLUSIONS:   The concept of hope may differ for older adults vs. younger adults in its interaction with suffering. Resources for hope are both internal and external. Finding meaning and positive reappraisal are important strategies to help older adults with chronic illness maintain their hope.