UNDERSTANDING THE NEEDS OF OLDER PEOPLE:
A QUALITATIVE APPROACH
Lauretta G. Larson
B.A., University of Denver, 1990
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirements for the degree of
Master of Social Science
This thesis for the Master of Social Science
Lauretta G. Larson
has been approved
Larson, Lauretta G. (M.S.S.)
Understanding the Needs of Older People: A Qualitative Approach
Thesis directed by Associate Professor Candan Duran-Aydintug
Our understanding of the needs of older people is often attained through descriptions
of seniors physical and mental health, levels of income, residential and marital
status, and other basic demographic characteristics. We frequently make assumptions
about what seniors need based on what they currently have versus what they lack.
These assumptions are often formulated by viewing seniors circumstances through
societys lenses and standards. This study focuses on gaining a better understanding
of what types of need exist in the lives of people 65 years of age and older by asking
them what is lacking in their lives and what they feel could improve the quality of
their lives. Utilizing a convenience sample, fifteen people age 65 and older provide
in-depth responses about the concepts of need and desire, and discuss what is lacking
in their lives and what their greatest concerns are. The study uses participants own
words to describe the current needs and desires of seniors and the perception of
potential future needs. In comparing responses from heterosexual and non-
heterosexual participants, the study then explores the potential unique needs of these
This abstract accurately represents the content of the candidates thesis. I recommend
I dedicate this thesis to Sharon Jae for her support and willingness to patiently tend to
my needs while I was immersed in this project, and with whom I hope to have the
pleasure of growing old.
I am grateful to my family who has always been supportive of my interests and
endeavors. Thank you Mom, Dad, Doe and Mike for providing me with a strong
foundation and healthy system of social support, and for giving me the space I needed
to stay focused on my studies. I extend a special thanks to my father, Carl Larson,
who provided me with valuable advice on both the methodology and content of this
I am much appreciative of my patient and helpful committee members: Candan
Duran-Aydintug, Marci Eads, and Karl Flaming. It has been a pleasure working with
Most of all, I wish to thank the 15 people who agreed to participate in the study by
sharing their thoughts, ideas, hopes and fears so that we may all better understand
how to build be more responsive to the needs of our societys seniors. Thank you
Alamo, Carshow, Claire, Frank, Jerry, Juan, Karl, Kate, Kenny Ray, Marge, Pug,
Sallie, Shorty, Theresa, and Voss for your willingness to be heard.
2. REVIEW OF THE LITERATURE......................................5
The Senior Population......................................5
The Aging Homosexual.......................................8
Reporting of Findings.....................................31
Current Needs and Desires: Categories.....................33
Current Needs and Desires: Discussion.....................44
Differences between heterosexuals and non-heterosexuals...47
Concept of Need versus Desire.............................51
Differences between heterosexuals and non-heterosexuals.57
5. DISCUSSION AND CONCLUSTIONS................................63
Discussion of Findings..................................64
Needs as a Means to an End...........................64
Needs and Desires are Relative.......................67
A. INTERVIEW GUIDE............................................76
B. SUPPLEMENTAL QUESTIONNAIRE.................................79
C. RESOURCE SHEET.............................................80
2.1 Eriksons Life Stages...........................................14
3.1 Selected Participant Demographics...............................26
3.2 Number of Questions and Responses by Sub-group.................29
4.1 Frequency of Responses to Core Questions.......................44
4.2 Frequency of Response to Core Questions, by Sexual Orientation.47
4.3 Frequency of Responses Regarding Greatest Concerns.............58
As people approach their later years they often ponder what lies ahead. Some
people have visions of extra time to be filled with doing all those things I never had
time for. Others see growing older as an opportunity to continue working in an area
of interest without the constraints of having to rely on a paycheck. Still others view
the upcoming years with anxiety and concern; concerns that are well-founded, as the
elderly face a multitude of challenges. As we grow old we tend to have an increased
dependency on others, more frequent and serious health concerns, and limited fixed
incomes. Furthermore, an increasingly competitive job market, forced retirement
policies, and the often slow-paced lifestyle of the elderly in the midst of an
increasingly face-paced society, many times leaves the elderly with the stigmatized
status of being out-of-touch and unable to be productive contributing members of
The issues surrounding aging are being experienced by an increasing number
of people. In a thorough examination of U.S. Census data, Roberts (2004) found that
in the year 2000, 12.4 million people living in the United States were between 74 and
85 years old. This sub-group of seniors represented 35 percent of all seniors, and
those who were older than 85 years represented 12 percent of the total senior
population at 4.2 million people. He states, While the nations total population
tripled in the twentieth century, the number of people 65 and over multiplied 10
times, (Roberts, 2004, p. 55).
Statistics about senior citizens have become more readily available as our
population ages. However, who is included in each statistic seems to vary greatly
with the definition of senior. The legal definition of senior citizen seems to have
its roots in the Social Security Act of 1935. This piece of federal legislation was
established in part .. .to provide for the general welfare by establishing a system of
Federal old-age benefits, and by enabling the several States to make more adequate
provision for aged persons..., (Social Security Act of 1935, p. 4). These aged
persons were also guaranteed a federal payment based on previous employment
status and earnings:
Every qualified individual (as defined in section 210) shall be
entitled to receive, with respect to the period beginning on the
date he attains the age of sixty-five, or on January 1, 1942,
whichever is the later, and ending on the date of his death, an
old-age benefit (payable as nearly as practicable in equal
monthly installments), (Social Security Act of 1935, p. 8).
Essentially, in January, 1942, Americans aged 65 and older were legally considered
to be of old-age. Apparently this particular definition has held up through many
years because we refer to those 65 years of age and older as the senior citizens of
our society. However, the increase in age expectancy since 1935 has altered our
understanding of what it means to grow older and has expanded our repertoire of
definitions for this particular population. Sometimes we speak of the elderly versus
the very elderly, or the frail elderly. We see senior discounts offered at age 65, age
62, and age 60. The literature reflects the multiple categories of the senior
population(s) and addresses the various issues faced by the oldest members of our
society, but lacks in two important areas of discovery related to aging: defining
need and the aging homosexual.
Most descriptions of the elderly population in relation to need are based on
predetermined categories of deficit created with the general elderly population in
mind. For example, often times, in order to determine need for older Americans,
we ask questions about income, disability status, residential status, and marital status.
The assumption is that if a woman is a 70-year old widow, with an annual income of
$10,000, she experiences a higher level of need than a 70 year-old, married woman
with an annual income of $30,000. Although there may be limitations faced by any
member of society who earns less money, has physical disabilities, and lacks social
support, the degree to which these limitations affect those who experience them may
be relative to many different factors. When we define need in terms of such
categories, are we describing their needs, or simply focusing on what we feel their
needs must be? In order to answer that question, we must ask the seniors themselves
what they actually need.
The literature does reflect the knowledge that particular social characteristics
are more likely to put people at risk for ill-health, poverty, and a host of other factors
that can affect quality of life (Wilson and Hardy, 2002, Ferraro and Farmer, 1996).
Disparities in income, health-related issues, and psychosocial characteristics may be
found between different races and genders, as well as other demographics. When, for
example, an African American woman reaches retirement age, the inequalities she
has experienced up to that point may have a compounding effect on the challenges
she will face as she grows old. One demographic believed by some to have a similar
compounding effect on the status of elderly is sexual orientation. Due to the lack of
equality for homosexuals, and the stigmatization that is experienced by lesbians and
gay men, the aging homosexual may be faced with either different challenges, or
additional challenges, than their heterosexual counterparts.
The current study focuses on gaining a better understanding of what types of
need exist in the lives of people 65 years of age and older by asking them what is
lacking in their lives and what they feel could improve the quality of their lives. It
uses participants own words to describe the current needs and desires of seniors and
the perception of potential future needs. In comparing responses from heterosexual
and non-heterosexual participants, the study then explores the potential unique needs
of gay and lesbian elders.
The Senior Population
As the baby-boomer generation continues to age, issues regarding senior
citizens in the United States are becoming more crucial. The Administration on
Aging (2006) reports that by the year 2030, people age 65 and older will represent
20% of the United States population, while in the year 2000, they represented 12.4%.
The estimated increase in the number of elderly people suggests that we need to be
particularly attentive to the special needs of this population. Some of their needs may
be reflected in the demographics of the elderly. Using data from several different
sources, the Administration on Aging reports that in the year 2003 about 10.2% of the
elderly were living below poverty level, and an additional 6.7% were considered
near-poor, with women and ethnic minorities having higher poverty rates than men
and whites. Roughly 30% of the non-institutionalized elderly were living alone, with
the majority of those being women. Most of those who did not live alone were living
with their spouse and/or other family members.
Health concerns were found to be very prevalent among the elderly. In 1997,
over half the elderly population (54.5%) reported having some sort of disability, with
37.7% reporting a severe disability, (Administration on Aging, 2006). The disability
classification is correlated with age, income, and educational attainment. Thus, those
who are older and have low incomes and low educational attainments are much more
likely to report having a severe disability. Furthermore, regardless of other
characteristics, many elderly have multiple health conditions, and most have at least
one chronic health condition. In a study conducted by Artz, Hadsall, &
Schondelmeyer (2002) it was shown that elderly who had less healthcare coverage
were more likely to allow medical needs to go unmet than those whose healthcare
coverage was more comprehensive. Although the study focused on the willingness of
participants to fill prescriptions obtained from the doctor, the fact that many elderly
go without needed medication due to economic concerns suggests that the already
poor physical health experienced by the elderly may be compounded by variables
other than age.
As can be seen from statistics such as these, the elderly are faced with many
challenges. At a time when greater economic and physical dependency on others
becomes increasingly likely, many elderly people are faced with a greater chance of
losing their spouse, and without strong family connections, are faced with the
possibility of having to live alone. Siegel, Raveis, & Karus, (1998) studied the
perceived advantages and disadvantages of age among older HIV-affected adults.
Although participants identified several advantages of being an older member of
society, among the disadvantages identified were social isolation and the perception
that old people are viewed by other members of society as less worthy of resources
and attention. The social isolation and stigmatization experienced by the elderly may
increase their need for affirming social contact. The elderly have been shown to have
a high need for socio-emotional help, while relying on primary health care to fulfill
particular psychosocial needs (Azzarto, 1993; Berkman, Chauncey, Holmes, Daniels,
Bonander, Sampson, & Robinson, 1999). These studies demonstrate the need for
social work services among the elderly population, as well as the importance of the
role physicians play in the lives of the elderly. Although the elderly do have medical
needs, their reliance on physicians to fulfill psychosocial needs may point to the lack
of comfortable, safe resources available for fulfilling the need to feel psychologically
competent and socially valid. The lack of economic resources, coupled with the high
need for medical attention, poses a dilemma particularly difficult for the elderly.
Part of the challenge in growing old in America is due to our cultures
emphasis on youth (Dychtwald, 1988; Lewis and Cachelin, 2001). Older people do
not just face physiological difficulties resulting from an aging body, but also social
difficulties due to ageism (Katz, 2005). In some societies elders are honored and
revered (Chappell, 2005). However, in American society competition for jobs and
government funded programming, as well as generational differences in values and
beliefs often create tension between the young and the old. Seniors in American
society are considered vulnerable, because they are often taken advantage of,
discriminated against, and neglected. This puts older people in jeopardy of, or at risk
for a decrease in quality of life. Although being an aging American may place an
individual in jeopardy, other social characteristics may put an elder at further risk,
placing them in double jeopardy.
Women and ethnic minorities seem to be particularly vulnerable to the
challenges that come with growing old. Many older people rely heavily on Social
Security, and AARP points out that Social Security is the sole source of income for
24 percent of people 65 and over and the principal source for two-thirds, (AARP,
2005). Wilson and Hardy (2002) studied racial disparities in income security for
older women. They concluded that African American women are much more likely
than their white counterparts to experience economic hardship in later life, and that
other social characteristics contribute to the likelihood of an impoverished existence.
They state, The most secure women combined employment with marriage: not
surprisingly, healthy, college-educated, employed, married white women fared best
(Wilson and Hardy, 2002, p. 12).
The idea that double jeopardy exists for ethnic minorities is often used to refer
to health disparities between them and their non-minority counterparts. Although
there is general agreement among social scientists that such disparities exist, some
researchers suggest that the health disparities existing between minorities and non-
minorities level out as people get older. In other words, different ethnic groups
experience the same level of health problems in much later years of life. Using
longitudinal data collected from a national survey of adults, the hypothesis that age
becomes a leveler of health inequalities was tested by Ferraro and Farmer (1996).
Confirming the double jeopardy concept, they found that, the weight of the evidence
shows persistent health inequality over the life course, (p. 1).
Although it is clear that certain social characteristics pose more risk during the
elderly phase of life, the list of possible risk-associated characteristics has not been
exhausted. One such characteristic of increasing interest is sexual orientation. With
the aging population of the United States, and the increasing political visibility of
lesbians and gay men, the aging homosexual is slowly becoming recognized as a
valid topic of study in the field of social science research.
The Aging Homosexual
Research on the aging homosexual has sparked the interest of a handful of
social scientists. However, one critical issue faced by those interested in this
population is the lack of ability to identify members of the elderly who are also
homosexual. Due to the fact that the majority of national studies do not ask questions
regarding sexual orientation, there are conflicting estimates of the proportion of
American adults who are homosexual. This, combined with the likelihood that when
studies do ask about sexual orientation, some homosexuals fear identifying
themselves as such, creates special difficulties in assessing the demographic
characteristics of this population.
Despite challenges in creating gay and lesbian samples for study, some
research has been conducted to help shed light on the needs of this population. In a
ground-breaking report, Cahill, South, and Spade (2000) take a critical look at issues
facing gay, lesbian, bisexual and transgendered elders in light of public policy issues.
They state that institutionalized heterosexism reflected in unequal access to spouse-
related benefits offered through Social Security, Medicare, employment pensions and
401K plans, as well as tax laws, put the homosexual partner at a disadvantage. For
example, when the spouse of a heterosexual couple dies, his/her spouse is eligible for
Social Security survivor benefits. However, this benefit is only available to the legal
spouse of the deceased. Since homosexuals are not allowed to legally marry, they are
automatically shut out of this, and many other similar benefits.1
Another important contribution to the field is a report by Badgett (1998)
dispelling the myth that gay, lesbian and bisexual Americans fair better economically
than their heterosexual counterparts. Using several different national samples, the
author shows that, The average lesbian or gay man earns no more than the average
heterosexual woman or man, and in some cases, gay people earn less on average (p.
12). This finding, combined with the economic disadvantages described by Cahill et
al. (2000), furthers the argument that homosexuals, especially as they grow old, may
be at a greater disadvantage than heterosexuals.
Other research lends support to the idea that gay men and lesbian elders face
issues unique to members of a hidden population. In a needs assessment conducted
on older gays and lesbians in the Chicago area, Beeler, Rawls, Herdt, and Cohler
(1999) found that aging homosexuals represent diverse demographics and lifestyles
and have a wide range of needs and concerns. Although there was some concern
1 According to the Human Rights Campaign, California and the District of Columbia allow same-sex
couples to officially acknowledge their relationships by registering as domestic partnerships. Civil
unions between people of the same sex are recognized by Connecticut and Vermont. However, most
benefits are still not applicable to homosexual couples since those benefits, and rights, are federally
among participants about physical health, independence, and financial security, the
authors found that The most frequently cited need was for increased social
interaction and for additional opportunities to meet other gay people (p. 42).
The concern about being socially connected is not unique to the homosexual elderly;
however, the ability to maintain this sense of connectedness may pose a particular
challenge to members of a stigmatized group. The fear associated with coming out
to ones peers may exacerbate the feeling of being alone and isolated. Dorfman,
Walters, Burke, Hardin, Karanik, Raphael, and Silverstein (1995) in a study
conducted on the elderly in urban Central and Southern California, found that
although there was no difference in the levels of depression and social support
experienced by homosexual and heterosexual participants, homosexuals were much
more likely to receive their social support from friends, while heterosexuals relied
more on family members for fulfilling social needs. Therefore, those homosexuals
who do not have a strong network of friends may experience a greater sense of social
isolation than those who are connected to peers. Furthermore, the lack of connection
to family members may pose additional challenges, since as people grow old they are
more likely to receive help from family members, especially when they are faced with
physical disability and dependency. Therefore, the lack of family connections by
homosexual elders may put them more at risk for dependency on social institutions.
Reliance on social institutions may pose additional risks for the aging
homosexual. The Boulder County Department of Health, Aging Services Division, in
Boulder, Colorado, created a video tape highlighting issues faced by older gays and
lesbians. The tape is part of a training curriculum used for training healthcare
professionals. Several gay and lesbian elders expressed concern about having either
themselves or their partner transitioned to a residential care facility should they ever
become too physically dependent to remain at home. One of the older lesbians
interviewed contemplated the possibility of having to transition her partner to such a
facility. Theres still a lot of conservative people, and some of them must be
working there, and Im wondering, Will she get treated differently? Will she get
neglected, or whatever, because they know that she is lesbian and not
heterosexual?, (Boulder County Health Department, 2004).
There are many possible approaches to determining a persons needs. Most of
the literature on elders focuses on specific concepts (e.g. social support, depression,
or income). Studies often define a concept then make assumptions about the needs of
elders based on the degree to which that concept exists within the sample and/or
population. If an elderly person is given a prescription from a doctor, the assumption
is that s/he has a need for medication. Likewise, if a study reveals that older people
tend to visit the doctor when nothing is wrong, more often than non-elderly people,
it sometimes leads to the conclusion that older people have a higher level of unmet,
social needs than their younger counterparts. Although there is obviously a certain
amount of validity to these types of assumptions, the term need appears to be
broadly used to describe what it is that people lack that by wider social standards,
they likely do not want to lack. In other words, we tend to superimpose our idea of
what someone needs based on what we would need if we were in their situation. In
our studies, we often embrace a socially-constructed concept of the word need.
However, the field of psychology relies on a more general concept of need and offers
insight into the possible innateness of need as a human condition.
In Motivation and Personality, Maslow (1954) lays the foundation for creating
a theory of motivation. Using the words need, desire, and goal
interchangeably, he states that motivation stems from an unfulfilled state of being,
and describes sixteen propositions about motivation that must be incorporated into
any sound motivation theory (p. 63).
One of Maslows propositions is that most desires exist as motivation for the
fulfillment of other desires. He states, If we examine carefully the average desires
that we have in daily life, we find that they have at least one important characteristic,
i.e., that they are usually means to an end rather than ends in themselves (Maslow,
1954, p. 65). He uses the desire for money as an example to suggest that the majority
of desires exist due to an unfulfilled fundamental or basic need. Someone may desire
money in order to buy an automobile, but the desire for an automobile may reflect the
desire for status. Status, in turn, satisfies the need for self-esteem, one of the basic
needs shared by all human beings. Even if the motivation for an automobile is
actually a means to satisfy the desire to save time running errands, (so that one may
have more time to spend with family and friends), it is still a means to another end.
Thus, the same motivation (to get money) may reflect different underlying needs.
Maslow also states that a sound theory of motivation has to recognize that As
one desire is satisfied, another pops up to take its place...It is a characteristic of the
human being throughout his life that he is practically always desiring something
(Maslow, 1954, p. 69). However, people only desire what they believe they
themselves can actually achieve. Peoples desires are based on their own realm of
Using these propositions as a framework, Maslow describes what has become
a classic theory of human motivation expressed through a hierarchy of basic needs.
As lower-level needs are satisfied, higher-level needs arise, with physiological needs
being at the lowest level.
Physiological Needs (basically water, nutrition, oxygen, and blood
Safety Needs (appearance of threat or danger)
Belonging and Love Needs (belonging to a group and/or affectionate
Esteem Needs (self-respect, self-esteem, and the esteem of others)
Need for Self-actualization (Even if all these needs are satisfied, we may still
often (if not always) expect that a new discontent and restlessness will soon
develop, unless the individual is doing what he is fitted for. A musician must
make music, an artist must paint, a poet must write, if he is to be ultimately at
peace with himself. What a man can be, he must be (Maslow, 1954, p. 91)).
This category includes the fulfillment of larger, moral values.
Maslow speaks of relative satisfaction. A lower-level need does not need to be
completely satisfied prior to a higher-level need emerging. The emergence of a new,
higher-level need comes gradually as lower-level needs are gradually satisfied.
In a later work Maslow (1972) describes the existence of metaneeds, needs
that are a level above self-actualization. Massey (1981) summarizes this new
category: ...self-actualization does not constitute a restful mecca, but generates new
desires called metaneeds...Metamotivated people incorporate the interest of
others... (Massey, 1981, p. 339). Thus, people experiencing needs/desires in this
category aim toward the fulfillment of needs external to themselves, and often get
involved in larger effort causes. Others have also offered recommended changes to
Maslows original theory. Rowan (1998) suggests eliminating the idea that any level,
no matter what it is called, be coined as the highest. He states, To call something
the ultimate or the highest is to say that here is nothing furtherthat this is the end of
the line of psychospiritual development, (p. 4).
Trigg (2004) also critiques Maslows organization of levels. He suggests that
Maslow does not place enough emphasis on social connections, but rather implies
that once people reach the level of self-actualization, they are primarily focused on
fulfilling needs that relate solely to oneself:
Referring back to the five stages in the hierarchy of needs, it can be
seen that social needs, which include love, esteem, prestige and status,
are relegated to stages three and four. They hardly feature on the radar
in the top of the hierarchy, they do not provide the ultimate goal for
the individual seeking personal fulfillment (Trigg, 2004, p. 3).
However, Maslow does state:
A firm foundation for a value system is automatically furnished to the
self-actualizer by his philosophic acceptance of the nature of his self,
of human nature, of much of social life, and of nature and physical
reality. These acceptance values account for a high percentage of the
total of his individual value judgments from day to day. What he
approves of, disapproves of, is loyal to, opposes or proposes, what
pleases him or displeases him can often be understood as surface
derivations of this source trait of acceptance, (Maslow, 1954, p. 230).
Regardless of age, Maslows theory of human motivation speaks directly to
the existence of needs based on the lack of fulfillment one experiences. Another
potential paradigm for predicting the types of need a person may have is by placing
the individual in the context of his/her stage of life. Erikson (1980) describes the
stages of psychosocial development in an attempt to answer the following question:
How does a healthy personality grow or, as it were, accrue from the successive
stages of increasing capacity to master lifes outer and inner dangerswith some
vital enthusiasm to spare? (Erikson, 1980, p. 53). Thus, he describes the
developmental stages one goes through when forming a healthy personality.
He suggests eight stages of development each with its own crisis to be
confronted, and potential strength to be achieved.
Table 2.1: Eriksons Life Stages
Phase Crisis Psychosocial Strength Emerging from Phase
I: Infancy Basic Trust vs. Basic Mistrust Hope
II: Early Childhood Autonomy vs. Shame, Doubt Will
III: Play Age Initiative vs. Guilt Purpose
IV: School Age Industry vs. Inferiority Competence
V: Adolescence Identity vs. Identity Confusion Fidelity
VI: Young Adulthood Intimacy vs. Isolation Love
VII: Adulthood Generativity vs. Stagnation Care
vm: Old Age Integrity vs. Despair, Disgust Wisdom
Source: Adapted from Erikson (1982, Pg. 56-57).
Erikson (1980) states that each stage contains both a criterion of relative
psychosocial health and the corresponding criterion of relative psychosocial ill-
health: in normal development, (p. 128). Since the criteria are relative, Erikson
explains that we never alleviate the second criterion. Instead, in order to become
healthy, we must allow the first criterion to persistently outweigh the second.
The sequence of stages thus represents a successive development of the component
parts of the psychosocial personality (p. 128).
Although he does not directly state that individuals have needs or desires
based on their life stage, implicit in his discussion is the individuals need to develop
the first criterion to a greater degree than the second criterion in order to emerge with
the corresponding psychosocial strength, and thus continue on to the next stage with
some vital enthusiasm to spare. Since we never completely do away with the
criterion reflecting ill-health, we do face it again throughout other stages. However,
as long as the healthy criterion is more strongly developed, and we leave a particular
phase with the corresponding psychosocial strength, we will be able to rely on that
strength when we are faced with the unhealthy criterion in later stages. Thus,
although Erikson represents psychosocial development in a successive manner, our
development, and thus our needs may be revisited and repeated.
In the last stage, that of old age, an individual is confronted with the crisis, or
choice between integrity and despair/disgust. Erikson states:
It is the acceptance of ones own and only life cycle and of the people
who have become significant to it as something that had to be and that,
by necessity, permitted of no substitutions... and acceptance of the fact
that ones life is ones own responsibility. It is a sense of comradeship
with men and women of distant times and of different pursuits, who
have created orders and objects and sayings conveying human dignity
and love. Although aware of the relativity of all the various life styles
which have given meaning to human striving, the possessor of
integrity is ready to defend the dignity of his own life style against all
physical and economic threats...
.. .But I can add, clinically, that the lack or loss of this accrued
ego integration is signified by despair and an often unconscious fear of
death.. .Despair expresses the feeling that the time is short, too short
for the attempt to start another life and to try out alternate roads to
integrity (Erikson, 1980, p. 104).
Thus in old age one is confronted with either embracing the choices s/he has made
and accepting the physical limitations that inevitably increase as one ages, or
becoming despondent over lost opportunities and a failing body.
In his in-depth, narrative study of eleven elderly people, Koch (2000) critiques
Eriksons theory due to its linear presentation. He states, It is not lifes ladder-like
stages, but the protocols of grieving and loss that define the emotional status of both
these seniors and of other people learning to live with limits (Koch, 2000, p. 166).
Indeed the acceptance of limitations is faced at every stage of life, and the likelihood
of satisfying any particular needs or desires is based at least partially on an
individuals circumstances. As Koch points out, those who have physical disabilities
or chronic illnesses at any age confront many of the same issues as those who are
physically old (Koch, 2000). Also, since according to Erikson, we tend to carry forth
some of our ill-health criterion from one stage to the next, there must exist within any
cohort a wide variety of unattained psychosocial strengths, and therefore, needs.
Regardless of whether a sociological, psychological, biological, or other
paradigm is used to view the later stages of life, it is generally accepted that older
people do indeed have needs. Given the unique experience of homosexuals, they may
be faced with even more difficulties as they enter the elderly phase of life. Issues of
institutionalized heterosexism, lack of family connections, fear of discrimination, and
even illness, such as AIDS, that has had a particularly strong influence on the
homosexual community, may all contribute to special needs of older homosexuals.
The lack of knowledge about how older people define and describe their
needs, combined with the lack of comparative research on homosexual and
heterosexual elderly poses limitations on our understanding of the needs of the
general elderly population. Therefore, in order to help further our understanding of
the needs of older Americans, the study contained three research questions:
1) What needs do people 65 years old and older identify for themselves?
2) Are the needs of older people adequately and accurately addressed in
the current literature?
> Is the full spectrum of needs represented in literature aimed at
the academic community, practitioners, and professional
associations serving older Americans?
3) Do heterosexuals and non-heterosexuals identify different needs?
The primary purpose of the study was to understand what is missing in the
lives of older people, and how they articulate their needs/desires. The research design
was both exploratory and descriptive. It sought to explore the general concept of
need among all participants, but contained a research question aimed at describing
differences between sub-samples. The study utilized both convenience and
purposeful sampling and sought to address the research questions with qualitative
In-depth interviews were conducted with 15 people during which participants
were asked various questions aimed at gaining an understanding about what was
lacking in their lives. Qualitative methods such as in-depth interviews are
particularly useful for Understanding the meaning, for participants in the study, of
the events, situations, and actions they are involved with and of the accounts that they
give of their lives and experiences, (Maxwell, 1996 p. 17).
By allowing participants to define for themselves what they feel their needs
and desires are, it is more likely that the complete essence of their experience will be
captured. Thus, by collecting qualitative data, participants are not restricted to pre-
determined categories of need, and therefore, can discuss the entire realm of need
as it applies to them. For example, we might assume that if someone is living below
poverty level, access to financial resources will enhance his/her quality of life.
However, the degree to which it will do so may be relative to other conditions such as
social support, physical health, personal interests, etc. If two people who are living
below poverty level are asked what their needs are, one may mention the need for
financial security while the other may focus on the need for social interaction.
Furthermore, someone who expresses the need for financial security may do so by
using several different types of words (e.g. more money, fewer bills, less worry about
money, etc.). Different people express themselves differently. It is likely that by
allowing participants to discuss this issue thoroughly the majority of ideas underlying
the reality of need for the elderly will be obtained after speaking with a minimal
number of people. The use of in-depth interviews allows for a thorough exploration
of this topic.2 Since the purpose of this approach was to gain a deeper understanding
of the reality of need for elderly, and not to generalize to a larger population, the
study utilized a small sample drawn through two different approaches: convenience
sampling and purposeful sampling.
The studys target population was people age 65 and older. However, in
addition to gaining an understanding of the needs/desires of the general senior
population, the study also aimed to explore potential differences between
heterosexual and non-heterosexual participants. Therefore, the recruitment process
was implemented with the goal of obtaining an equal number of heterosexuals and
2 Although similar information may be obtained through focus groups, the possible complications with
requiring participants to attend a focus group at a particular location (e.g. transportation issues, safety
issues, and general mobility concerns) renders this data collection strategy less feasible and/or
convenient for participants.
Given the sensitivity around sexual orientation, particularly among older
people, these two sub-samples were recruited using two different strategies. This was
done to avoid having to ask potential participants their sexual orientation prior to
inclusion in the study. During the search for heterosexual participants, it was possible
to find non-heterosexuals, as after the interview, participants completed a brief
questionnaire containing a question on sexual orientation. This question provided a
means for keeping track of the balance between heterosexuals and non-heterosexuals
in the sample, without having to screen participants based on sexual orientation. In
contrast, non-heterosexuals were recruited by contacting groups specifically designed
to bring non-heterosexuals together. Although participants were obtained primarily
through convenience, they were specifically sought out due to either their age or their
sexual orientation. In describing purposeful sampling, Maxwell (1996) states: This
is a strategy in which particular settings, persons, or events are selected deliberately
in order to provide important information that cant be gotten as well from other
choices, (p. 70). Participants in the study were deliberately selected based on two
demographic characteristics: age and sexual orientation.
Although the intent of the study was not to make generalizations about older
people, it was originally hoped that the sample would contain enough heterogeneity
so that the full spectrum of needs was captured. Therefore, the recruitment plan
included drawing participants from several different sources. The primary source of
heterosexual participants was my own personal contact list. I interviewed friends,
and also received referrals from family members. However, all of these participants
possessed many of the same demographic characteristics. They were all white,
physically independent, and able to meet at least most of their financial needs. In
order to diversify on some of these characteristics, I visited agencies serving seniors.
I was prepared for the fact that many of these establishments would not allow me to
approach their clients, but assumed that I would be able to gain entrance through
some of them.
I was able to speak to some agencies and organizations catering to seniors.
However, I found that the majority of senior centers, groups, and clubs have a 50-60
year-old minimum requirement for membership. One of the organizations I visited,
Senior Support Services, offers a variety of services to Denver residents while placing
an emphasis on basic services such as emergency food and shelter. The facility
contains multiple rooms with a pool table, computers, and tables at which to
congregate and visit. When I walked through the door, I was relieved to see so many
people hanging out, talking, etc. There were probably between 50 and 80 people
there, many of whom appeared to be old enough for my study. However, when I
spoke with the staff member, he said that they rarely see anyone 65 years or older.
The majority of their clients are between 55 and 64 years old. He could not think of
one person in the room who would qualify for an interview.
I also visited a senior housing facility and a long-term care facility. Although
the majority of residents/clients in these programs were at least 65 years of age, I
was told that I would likely not be given approval to approach people for the purpose
of the study. They also indicated that even if I were allowed to approach potential
participants, I would not likely be able to interview them, as these facilities catered to
either people with a high level of dementia or other disability that would render
responses too difficult to interpret.
The process of recruiting non-heterosexuals was easier in some ways.
Although I did not have any non-heterosexual seniors on my personal contact list, I
found many social/political groups designed to bring older homosexuals together. All
non-heterosexuals were obtained through referrals from three different sources: The
Old Lesbians Organizing for Change (OLOC) group, Rainbow Elders, or the Prime
My search for non-heterosexual participants began with a phone call to a
friend of mine who is actively involved in the gay and lesbian community. He
referred me to a woman who is also very actively involved in the community and who
suggested I introduce myself at an OLOC meeting to see if people were interested in
participating in the study. After the group was finished with lunch, I spent a few
minutes explaining who I was and the general purpose of the study. I then passed out
my card and asked people to give me a call if they were interested. Some of the
participants heard about the study through this meeting.
One of the women who attended the OLOC meeting was also affiliated with
the Rainbow Elders, a group organized by the Boulder County Health Department,
Aging Services. She asked if I would like to give a similar call for participants at a
Rainbow Elders meeting. Again, I attended the meeting, introduced myself and my
study, and handed out my card to those interested. This also resulted in some
I had also sent an email to the Gay and Gray in the West Planning Committee
explaining my intent, and asked if committee members had any ideas about where I
could recruit gay/lesbian participants. A few weeks later, I began receiving phone
calls from men who said they read my announcement in the March issue of the Prime
Timers newsletter, a newsletter catering to senior gay men. I had not yet spoken with
anyone from this group, and therefore, was not sure how an announcement about my
study ended up in their newsletter. After speaking with one of the men who
responded (one with whom I scheduled an interview), I learned that the email I sent to
the Gay and Gray Planning Committee was sent by a member to the Prime Timers
editor with a request that it be included in the next edition.
The response from the non-heterosexuals was much greater than anticipated,
and a few inquiries were turned down. Two men responding to the Prime Timers
announcement were too young, and another who heard about the study from another
participant was old enough, but inquired after I had already reached the point of
saturation with the non-heterosexuals. Had his demographic characteristics differed
enough from other participants, I would have included him in the study.
The majority of participants chose to do the interview in their homes. One
participant who requested the interview be conducted in his home was the first
respondent to the Prime Timers announcement. Since at that time I did not know how
the announcement ended up in the newsletter, nor was I certain of its contents, I asked
him if he would be willing to come to my office for the interview. He agreed and
stated that he understood my concern.
Two participants requested that the interview take place in my home, and one
interview was conducted over the telephone. The telephone interview was conducted
with a woman who was living in another state. She heard about the study while
inquiring into senior services in the Boulder area in preparation for moving to
Each interview began with an explanation of informed consent and a request
of the participant to sign an informed consent form. As part of the attainment of
informed consent, the participants were told that their names would not be associated
with any comments; all comments would be held confidential. Some participants
chose a nickname to be used in conjunction with any of their quotations. With the
assurance of confidentiality, I requested that the interviews be tape-recorded to which
all participants agreed.
The interview contained questions aimed at exploring the existence of need in
participants lives, but also included questions geared toward gaining an
understanding of participants current lifestyles and living conditions. The first four
interviews began with questions about need and desire, and ended with the more
descriptive questions. This sequence was used as it was originally assumed that the
descriptive questions (e.g. How would you describe your physical health?) would be
perceived as too personal for people to answer without first speaking about more
general issues (e.g. Do you remember the last time you said to yourself If only I had
blank?). However, after the fourth interview, it became apparent that the ordering
of questions needed to be changed. A copy of the interview guide used for the
remaining interviews can be found as Appendix A.
Typically, the interviews lasted just over an hour. The shortest interview was
45 minutes, and the longest one ran close to two hours. The variation in interview
length was primarily due to responses to the more general questions about needs and
desires. Some interviewees had very little to say regarding this issue, whereas others
provided multiple, lengthy responses. This variation is discussed later in the
description of Data Analysis.
At the end of each interview, participants were asked to complete a
supplemental questionnaire designed to gather basic, demographic information. A
copy of the questionnaire may be found as Appendix B.
Prior to the interview, participants were told that they would receive a $15 gift
card to King Soopers in appreciation for their time and willingness to speak with me.
The gift card was given to each participant after s/he completed the questionnaire. It
is interesting to note that one participant stated that the only reason he responded to
the announcement in Prime Timers was because of this incentive. He said that
although he did not really need the extra financial help, the fact that it was offered
showed him that his time and input were perceived as important.
In addition to the gift card, some participants also received a list of resources
for seniors. This resource sheet was originally created with the intent of giving it to
all participants. However, due to the low level of basic needs expressed by most
participants, combined with the types of resources listed on the resource sheet, giving
the list to all participants seemed inappropriate. A copy of the resources sheet is
included as Appendix C.
The sample consisted of 15 people age 65 years or older and all but one were
Colorado residents. The following table lists each participant by their nickname and
offers selected demographic characteristics.
Table 3.1: Selected Participant Demographics
Name Age Sex/ Gend* Sexual Orient. Place of residence Partner status Lives with Fin. Sec.**
Kate 73 F Heterosexual Denver Divorced Alone 10
Jerry 70 M Heterosexual Westminster Domestic Partner Partner 5
Marge 66 F Heterosexual Denver Divorced Grand- daughter 9
Voss 67 M Heterosexual Denver Married Spouse 9
Shorty 72 F Heterosexual Denver Married Spouse 7
Alamo 74 M Heterosexual Denver Married Spouse 7
Claire 74 F Homosexual Arvada Longtime Partner Alone 5
Frank 67 M Homosexual Denver Domestic Partner Alone 6
Sallie 69 F Homosexual Denver Single Alone 5
Juan 76 M Homosexual Boulder Single Alone 9
Kenny Ray 70 M Homosexual Ft. Collins Domestic Partner Partner 9
Karl 78 M Bisexual Boulder Single Companion 5
Theresa 71 F Bisexual Out of state Single Alone 5
Pug 69 F Homosexual Boulder Single Alone 6
Carshow 66 M Homosexual Boulder Single Alone 9
*The supplemental questionnaire contained the question What is your sex/gender identity?
**The supplemental questionnaire administered after the interview asked participants to rate their level
of financial security on a scale ranging from one to ten with the following values:
1 = No financial security/I have no financial resources
5 = Medium financial security/I can meet most financial needs
10 = High financial security/I can meet all financial needs
The supplemental questionnaire also asked, Which ethnic/racial group do you
belong to? All participants except one selected White. The participant who was
interviewed over the phone stated that she was Jewish.
As can be seen from the sample characteristics, the sample did contain some
variation in age, partner status, and financial security. However, all participants
indicated they were able to meet at least most of their financial needs, were physically
independent, and all but one were White. Therefore, the sample was homogeneous
with regard to several demographic characteristics. The inability to find potential
participants whose demographic characteristics varied from those interviewed
contributed to the conclusion that the sample was large enough to end data collection
efforts. However, equally important was the fact that during the last few interviews,
participants did not offer ideas or concepts not already mentioned by those previously
interviewed. Therefore, data collection ended once a point of saturation had been
The original plan for data analysis included a comparison between
heterosexual and homosexual participants. Since two of the participants identified
themselves as bi-sexual, the plan was altered to analyze differences between
heterosexuals and non-heterosexuals.
The primary purpose of the study was to explore the types of need that exist in
the lives of people 65 years of age and older. In an attempt to solicit participants
perceptions of personal need, I asked four different questions:
1) Do you remember the last time you said to yourself, If
only I had blank?
2) Do you remember the last time you said to yourself,
Something is missing from my life?
3) If you could have access to anything in order to
improve the quality of your life, what would it be?
4) What would you describe as the ideal situation for
These four questions, which are hereafter referred to as the core questions, received a
total of 44 responses with variation in the number of responses given by participants.
The variation was due in part to the number of questions each participant was asked.
Some participants were much more talkative to begin with, and provided lengthy
and/or multiple responses to the first two questions. For example, if a participant
offered a response to the first question, s/he was asked if they could think of another
time when s/he said If only I had blank. At times, this shortened the amount of
time available to ask questions three and four. Likewise, some participants were very
brief in their responses to the first two questions, sometimes stating that they could
not think of any possible response. This increased the likelihood that they would be
asked questions three and four.
During data analysis, the number of questions asked each participant, as well
as the number of responses given, was noted. A question was counted as being asked
even when it was a repeat of the same question after a response was given. For
example, if a respondent was asked if there was a time when she said, If only I had
blank, and she stated that just last week she thought, If only I had a relationship,
this was logged as one question with one response. If I asked her to think of another
time when she said to herself, If only I had blank, and she stated that she could not
think of anything, it was noted that she was asked another question with no response.
The number of questions asked each sub-group (heterosexuals and non-
heterosexuals) was disproportionate to the number of people in each sub-group.
Although there were 33% fewer heterosexuals than non-heterosexuals (6
heterosexuals and 9 non-heterosexuals), the number of responses given to the core
questions reflects only 12% fewer responses given by the heterosexuals than the non-
Table 3.2: Number of Questions and Responses by Sub-group
Sub-group Number of Questions Asked Number of Responses
Heterosexuals 24 18
Non-heterosexuals 27 26
The heterosexuals were more likely to be asked each core question at least once, and
were not as likely to be asked any one question more than once. This is because they
were less likely to provide a response to the first two questions, giving more time to
ask them questions three and four. The non-heterosexuals were more frequently
asked questions one and two multiple times, because they were more likely to offer a
response to the question the first time it was asked. This increased the likelihood that
they would not be asked questions three and four.
Each response to the core questions was followed with the question: Would
you consider this more of a need or desire? Of the 44 responses, a total of 10
(22.7%) were considered needs, 25 (56.8%) desires, 4 (9.1%) both a need and a
desire, and 5 (11.4%) were considered neither a need or desire, or the follow-up
question was not asked.
Although the overall purpose of the study was to explore the needs of older
people, the concept of need really describes what is lacking in ones life. The
majority of responses were described by participants more as desires than needs. On
the other hand, there were several times throughout many of the interviews when
participants often used the words need, desire, and want interchangeably. Even
Maslows (1954) use of the words need, desire, and goal were used
synonymously throughout his description of the human hierarchy of needs.
Consequently, the responses to these questions were grouped together for analyses,
regardless of whether they were identified as needs or desires.
In qualitative research, Creswell states, The researcher collects open-ended,
emerging data with the primary intent of developing themes from the data, (p. 18).
After reading through each transcript, all responses given to any of the four core
questions were copied into a separate document and labeled with the participants
nickname. This document was then reviewed and general categories created without
reference to individual responses. Each response was then read and placed in a
category. During this process, some of the category names were changed to more
accurately reflect the variation in responses they held.
Once the categories were established, the participants responses were
combined to describe a homogeneous group. Subsequently, differences in the type
and frequency of responses between heterosexuals and non-heterosexuals were teased
In addition to the core questions aimed at exploring current needs, I asked
participants what their greatest concerns were. This question was asked in hopes of
gaining insight into the potential future needs of participants. The same process of
analysis was followed for responses to this question. These responses were pulled
from the transcripts and reviewed. Then categories were created and all responses
were placed in general categories describing the themes that emerged. After
analyzing the group as a whole, differences between heterosexuals and non-
heterosexuals were examined.
Participants were also asked the following question: Can you think of the
last time you felt your needs had changed? It was hoped that this question would
provide insight into times when needs changed as a result of growing older.
However, the majority of responses to this question referenced periods of time in the
distant past, and did not relate to the attainment of senior as a status. There were
references made to retirement and issues related to the decision to retire. Therefore,
these specific responses were reviewed and discussed. The limited number of
responses did not allow for a comparison between the two sub-groups.
Reporting of Findings
The emerging themes from each of the areas of inquiry were summarized and
participant quotations were used to highlight the content of categories established.
These categories are presented and discussed in Chapter 4: Findings. Wherever
possible, the actual words of participants were used to both describe categories and
discuss the differences between sub-groups, and quotes taken from the interviews
were referenced by the participants nicknames. This was done for several reasons.
First of all, by identifying the participant offering a specific response, the response
and its related category are personalized rather than de-personalized. Not only does
this allow the reader to connect more with the participants, it also may increase the
likelihood that quotes will be remembered. Linking nicknames with quotes may
allow the reader to see patterns in comments made by one person allowing the reader
to better judge any interpretation I may have offered.3 Although the identification of
certain participants was only done through the use of nicknames, it was sometimes
necessary to omit the nickname in order to protect a participants identity. This was
done in a few instances when the responses were so unique that the potential for
identifying the participant within the sometimes small community in which s/he
lives posed too great of a risk.
3 It is important to remember that some participants chose their own nickname. Consequently,
sometimes nicknames might lead to incorrect assumptions about the participant. For example, one
participant chose the nickname Juan. Juan is a non-Hispanic, White male, although some may
automatically assume he belongs to a different ethnic/racial group based on his name. For a reminder
of participants demographic characteristics, see page 26.
The primary purpose of the study was two-fold. First, it aimed to better
understand what needs people age 65 years and older identify for themselves, and
secondly to ascertain whether heterosexual and non-heterosexual seniors identify
different needs. This chapter seeks to shed some light on these issues through the
analysis of participant interviews.
The first section, Current Needs and Desires, reports on the themes emerging
from the four core questions aimed at assessing need:
1) Do you remember the last time you said to yourself, If only I had blank?
2) Do you remember the last time you said to yourself, Something is missing
from my life?
3) If you could have access to anything in order to improve the quality of your
life, what would it be?
4) What would you describe as the ideal situation for yourself?
If a response was given to one of these questions, it was followed up with the
question, Would you consider that more of a need or desire? The discussion in the
first section of the chapter includes responses to this follow-up question. Differences
in responses between heterosexuals and non-heterosexuals are then discussed.
The remaining sections of the chapter report on findings from the following
How do you distinguish between a need and a desire?
What are your greatest concerns?
Can you think of the last time when your needs changed dramatically?
Current Needs and Desires: Categories
The four core questions solicited multiple responses. These responses were coded
into four general categories: Relationships, Money, Health, and Self-expression/Self-
The most frequent concept mentioned when asking the four core questions
relates to the general category of relationships. People expressed the need and desire
to have more contact with other people in varying degrees and types. The ideas
expressed in this general category have been further sub-divided into three more
specific types of relationships: Intimate Companionships, Friendships/Family, and
Intimate Companionship. The majority of responses about relationships refer
to intimate companionship. People discussed the desire for a partner, long-term
relationship, or someone with which to spend special, quality time. Juan stated:
If only I had a relationship with another guy, a long-term relationship
with another guy.. .Id like to have someone I can share things with,
beautiful sunrises, you know, to be able to talk to someone about
something like that. Or, with an idea, a concept. I have tickets that
Ive had for a long time, to both Opera Colorado and the Denver
Center for the Performing Arts, type thing. And its double. I mean,
Ive had two [tickets]...., (Juan).
Marge expressed a similar desire. She stated, And its really not that Im looking for
a mate, but sometimes it would just be nice to have someone to talk to. Although I
have my friends, and I have people that I go to the movies with, and I have family
here, you know, that I do things with. Once in a while its just a loneliness.
However, she then goes on to describe how she really thought she was better off
without this non-mate after listening to her friends in bible study discuss all the
problems they have with their partners or spouses. Therefore, even though she
indicates that what is lacking is simply someone to talk to, implicit in her
description is a loneliness for a deeper, or committed connection, one that is created
through more of a partnership than a friendship.
The interplay between the need for a long-term relationship, or partnership,
and the need to simply feel more connected to someone, regardless of sexual
involvement, was best described by Carshow:
If only I had blank? It would be in the area of human need,
companion, best friend. Cause you can have people in your life, but I
think the concept of best friend, especially being transplanted here
from where you came from, youve just got to meet a lot of people and
kiss a lot of frogs before you find those best friends.
Even though he discusses his need in terms of having a best friend, a few sentences
later he states, ...You see people, and everybody else seems to be coupled up, and
me being a single, I really felt, Geez. Id like to be like everybody else and have that
companionship. Therefore although he desires a best friend, he also seems to be
hoping that he and his best friend will be a couple.
Participants also referred to past relationships when expressing a desire for
intimate companionship. When asked to describe the ideal situation for herself, Kate
stated that the continued companionship she once shared with her husband would
have been part of that ideal:
So if the ideal situation with three children, grown and out of the
house, living their own lives, a husband and we did the things we
enjoyed doing together, that would be the ideal, but now looking at it,
it would be an unrealistic ideal, but thats what I would have liked. To
grow old together, take our walks, (Kate).
Kate stated that while she was married, she was able to convince herself she had the
companionship she needed, when in reality, she did not. She and her husband did not
have the ideal marriage, and after he divorced her, she actually grieved the idea of
living happily after, more than she grieved the actual loss of it. She stated It was
more the romantic, and they lived happily ever after, because that was what was
going to happen to me. I was going to live happily ever after with my husband, until
Im an old lady. No youre not. She then explained that once she realized it was
realistically unattainable, she no longer desired it.
The responses related to intimate companionship reflect one of Maslows
motivation propositions, the Possibility of Attainment. He states, On the whole we
yearn consciously for that which might conceivably be actually attained, (Maslow,
1954, p. 77). Marge seems to question whether or not she can really be satisfied with
an intimate companion given the failure of her friends to achieve full satisfaction in
their maniages/partnerships. Carshow sees all the other couples, and therefore, sees
the possibility for himself. Kate desired such a relationship with her husband until
she realized that it was not possible to seek such companionship with him.
Many respondents mentioning intimacy stated that the lack of an intimate
partnership represented more of a need than a desire:
.. .Its almost a need, I think. Well, for example, I think physical
closeness is very important. And you know, I have some of that, hugs
or things, or holding hands with friends, but like somebody to cuddle
up with, and stuff like that. I think that thats really a need, in my
mind, so thats something thats lacking, not totally non-existent, but
definitely more would be very good, healthy even. I think of it even a
source of healthiness and a sense of well-being and stuff like that,
Theresa referred to her lack of physical intimacy when she discussed her need for a
deeper connection with someone. The physical nature of the need for intimate
companionship was also explicit in Carshows comment: I think human interaction
is as much of a need as food and water and air. I mean we know it is. The babies, the
studies are you can give them food, you can give them water, you can give them air.
If they dont have physical touch, they die. He essentially believes that human
interaction is necessary to continue living. The need for physical touch was also
discussed by another participant who referred to sexual intimacy between himself and
.. .sometimes I think, both of us have admitted it to each other, that we
sometimes dont discuss the idea that we might have sexual intimacy a
little more often when Im there, or when hes here.. .But, it doesnt
mean that we dont have our sexual intimacy, but sometimes we
perhaps address that a little more often, be a little more open about it,
and say, Look, what are waiting for? But its not a negative thing,
its just we both admit to each other that we should talk about it a little
Intimate companionship seems to be desired for multiple reasons. Participants
expressed a need for the feeling of connection to someone, a sort of guaranteed
person to talk to and spend time with, and another human being with which to share
physical and sexual experiences. Although participants did not specifically discuss
the need or desire for a spouse, the nature of their comments about intimate
companionship reflect many of the same qualities as a marriage or partnership. In
their review of several studies on the implications of marital status, Mares and
Fitzpatrick (2004) state, Put simply, marriage appears to provide a lifestyle and a set
of resources that protect older adults from declines in activity and health, p. 232.
Health status and functional ability have been found to be higher in those who are
married. This suggests a relationship between intimate connectedness and physical
needs. Although the majority of research focuses on marital status, Ross (1995)
found that the crucial factor for psychological well-being was not so much marital
status, as domestic partnerships reflecting happy relationships. Thus, such
connectedness may have profound effects on both a persons physical and mental
Friendships/Family. The majority of comments about friendships and family
were expressed as desires. Participants discussed the desire to have a wider social
network and/or more people with which to spend casual time. Jerry, whose son had
recently died, stated that he missed having his son, .to go to the bar, shoot a game
of pool, drink a beer together, you know, sort of like pals. Alamo stated that
although it was not a need, it would be awfully nice to have his children and
grandchildren living closer to allow for more frequent visits. Pug described the first
two years of being in a new city after retiring. She stated that she is an introvert, and
that forming fast friendships takes time. She stated that at first she did not notice
the loneliness as much since she was getting used to retirement.
I didnt work for the first two years, because I was just here, and
letting go of all the stress of working and whatever that does to your
body. I relaxed. Im kind of, a little bit intense at times. And so, I
realized, it took two years to relax, (Pug).
However, after relaxing into her new life, she found she missed social interaction:
But I want to be able to do things with people, not just by myself. Go
up to Cheyenne for breakfast or lunch. Its only an hour and a quarter.
Ive done that once by myself. But I dont find doing things by myself
that wonderful anymore, (Pug).
When asked if this was more of a need or a desire, she stated:
Its not so much a need. I think it just would be good for me to do.
Its not even a big desire. Its just, I think it would be healthy for me
to do that, to get around a little more. Ive seen a lot of Colorado, but
Im curious. And I think it would be healthy, (Pug).
Carshow expanded the idea to include pets. When asked if anything was missing
from his life, he sated, A horse. And maybe it fits under recreation. Maybe it fits
under a pet, or having something to care for.. .And I know animals or pets are good
for old people.
The importance of being socially and interpersonally connected to others has
been discussed by many researchers. In a review of the literature on connectedness,
Townsend and McWhirter (2005) state:
Human beings have a powerful need for connectedness (Jordan, 1997;
Lee & Robbins, 2000), or, as Baumeister and Leary (1995) have
stated, a fundamental human motivation, (p. 497) for regular,
positive interactions within an ongoing relational connection. When
individuals do not meet this need to be connected to each other and to
maintain lasting social connections, there can be a negative impact on
their health, adjustment, and well-being (Moen, 1998; Rude &
Burham, 1995), (p. 1).
Although Carshow expressed a desire for a pet, both he and Pug acknowledged that
having more of a connection to others would be healthy.
Such connection in and of itself is important, but participants also described
how having a closer connection to family and friends was also a means to another
end. Kate stated, I wish I had a friend who could help me in a situation because I
cant do it by myself and therefore, I will either do a second-rate job, or I wont do
it. She sees the value in having particular types of connections in order to fulfill
other desires. Pug also discussed an additional benefit of social connectedness.
When discussing plans for moving closer to one of her children or grandchildren she
stated, Ill be 70 in June, and I think that its time to think about being close to
somebody...Thats social security of another sort.
Community. People also described their desire for a sense of community.
Carshow stated, ...feeling that I belong to, I dont know, a bigger group, a
community, a neighborhood. I know I belong to my family, my three sisters and I.
Although he feels connected to his family, he also desires a connection to a larger
group. When asked what type of community he desired he stated, Something that I
feel where Im needed, where my presence was important.
Frank also discussed community, but in a more indirect manner. When
responding to the question, How would you describe the ideal situation for
yourself, Frank stated that he would rather be living in Tokyo. Although part of his
motivation is to obviously spend more time with his partner, he states, Because apart
from the partnership, when I came back to live in America, I hadnt lived here in so
long. He then described feeling more Japanese than American, referring to food,
music, and language stating that he thinks in Japanese.
The idea that one need manifests itself as a means for achieving another need
was also apparent in Theresas description of her need for community:
I have a very strong desire for more community, which Im hoping I will find
in Boulder, a very strong desire for more community.. .for me, community is
almost like a primary relationship in a way.. .But my needs and my ability to
fulfill them also seem so tied in with money. Like, if I didnt have to put this
energy into work, I would have more time for creativity, I would have more
time to be part of communal groups, and stuff. So, theyre very intertwined
there, do you see what I mean? But the actual need and desire itself is for
community, but the money somehow is a vehicle, or an obstacle. It seems to
be, what it takes to support myself, (Theresa).
Theresa states that money is somehow a vehicle, a vehicle she needs in order to
fulfill her need for community.
The second category emerging from the four core questions about need and
desire relates to financial security or money. The majority of comments about money
referred to a desire rather than a need, as people discussed the desire for more money
in order to make an already financially comfortable situation more comfortable.
People described the desire to have more money to buy a home or a newer car, make
home improvements, take more vacations, or have the ability to share more with their
children. An example of the typical response in this category comes from Kenny
The totally obvious one, of course, is money. We live comfortably
enough, but of course, if we had more money we would do certain
things that we dont do. We would do more traveling. I would have a
Mercedes Benz [laughs], or maybe something more expensive. Maybe
a Lexus. I think that would apply to many areas of our life, though. If
we had more money, we could do certain things. At the same time I
would have to say that were not suffering. Were comfortable,
Although most participants referred to the desire for more money as a way to
attain more of what they already have, some participants implied that the lack of
money may impede their ability to fulfill future needs. Claire stated that she wished
she had been a little more far-sighted about handling her funds. She said that even
though she is not wringing my hands in hysteria, she said she really need[s] to
make some adjustments. Implicit in her comment is the notion that if adjustments
are not made, she may run short of funds in the future. Sallie, who is still working,
stated, ...But, I do want to have an income of at least $1000 more. I could live okay
with my Social Security. I only get $700 a month, but my demands arent high, so
maybe $2000 a month. That would be fine for me for the rest of my life... Her
comment reflects the need for an actual increase in current income.
The idea that money provides the means to satisfy other desires and/or needs
was either expressed or implied by several participants. Theresa discussed her desire
for money as a way to fulfill her need to have time for creativity. Frank described his
desire for a healthier retirement portfolio which would allow him to spend more time
in Tokyo with his partner. He states:
My portfolio, I thought was pretty good, but it just rakes it in. But, Im
not a person who dwells on money. Its just that when you retire, its
not quite the same as when youre in the workforce. The money just
goes quickly, even though you thought, I think everything will be
okay. And it is, it just flies a little faster than you wanted it to,
Sallie also referred to retirement when discussing her desire for more money.
...So, thats the sad part. People say to me, Well, arent you old enough to
retire? Even my doctor said that. I said, Are you kidding? Can you live on
$700 a month? I mean, they presume. And even the young whipper-
snappers presume. Because the young kids who are 28 or 29 they say, Well,
didnt you do any 401-Ks? I said, In our day, those things werent
invented. People dont understand that in the 50s, nobody talked about
retirement, unless you worked with the railroad or the post office, (Sallie).
Money, or financial security represents the ability to spend more time engaging in
creative activities, freedom to see loved ones, and the ability to retire. Karl did not
express the desire for more money, but one of his responses implied that he may have
a desire in this area if he had less money:
I dont think I ever said that [if only I had blank], because Ive known
what the possibilities are in my life. And I figure Im lucky to have
found the path that I wanted to go on. Ive always had enough money,
just enough, to do what I want, or what I need to do, (Karl).
There were only four references to health when participants responded to the
four core questions, and all were expressed as desires. Marge spoke of wanting to be
rid of the concern about her health as a way of improving the quality of her life:
Well, what I think about that, its probably something I cant have,
because I have arthritis really bad. Ive had both my knees replaced.
Ive had one hip replaced, and so I do have pain a lot in my joints.
Different times are worse than others. Sometimes its not there at all.
But I fret in my mind a lot about it. I fret that my legs will go, or
something. And I dont know if I could bear that, if I couldnt walk
and take myself places, (Marge).
Reference to quality of life was also made by Kenny Ray. Twice he discussed his
desire to have more energy in order to spend more active time with his partner:
Well, I think probably if I had verbalized that thinking, I would have said, If
only I had more energy I would be a better companion, more fun to be
around. ...So often I have to say, Oh, I dont have the energy. Im too
tired. So, if only I had more energy, I would be more fun for him to be
around....Ive had a problem with low energy level all my life. And Ive
never found the answer.. .Obviously, fifty years ago I had my youth to keep
me going, and even though I still had the problem then, it didnt affect my life
nearly as much as it has in more recent years. So, its been gradually
changing, getting worse, however you want to put it, (Kenny Ray).
The only other reference to health during the four core questions was also in
response to the question specifically about quality of life. When asked about having
access to anything in order to improve the quality of his life, Voss responded: A
house with a bedroom on the main floor, so that as I get older I dont have to worry
about going up and down steps.. .Right now its a desire, based on the fact that we
might need it some day. Vosss anticipation of future needs creates current desire.
There were a number of comments that described needs and desires related to
participants sense of self. People expressed a desire to engage in creative activity,
help others, or possess different characteristics and abilities. Jerry is a professional
musician whose band recently broke up when a member moved out of state. Since
that time, he has struggled with the desire to continue playing his music
professionally. He expressed this desire both in terms of wanting to work in a great
band, as well as simply having professional gigs:
If only I had a gig... You, know, cause I havent played for, well, New
Years Eve was my last gig, and its already 17 days since then. And before
that its been, I dont know how long its been before that. Maybe a month or
Then later he stated, Well, a band, I think, working in a great band. I would love
that! That seems to be my desire. Although he expresses this desire in terms of
work, during the course of the interview, Jerry never referred to the desire or need
for more money. Therefore, his desire for this work seems to be for the fulfillment of
something more internal or self-expressive. The idea of expressing oneself creatively
was also offered by Theresa. She stated that this was a need because its stayed with
me for so many years:
Well, the thing that comes to mind is the right kind of time and energy
to do more creativity, because I love creative work, and somehow,
besides the time I spend working, and the very important time with
friends, and time relaxing, and reading, and stuff like that, I havent
been making very much space.. .for writing, and painting. So I feel
that thats a lack because it is something that can be a source of great
meaning and satisfaction to me, and I think I am very creative. So I
feel that thats something thats missing, (Theresa).
Although Shorty did not express any desires or needs throughout the interview, her
response to the question about If only I had blank, provides some insight into what
she feels is necessary for her to live a fulfilled life. For Shorty, the essentials are not
about material things, but rather include passions such as weaving:
I think of passions, okay? So, weaving is a big passion in my life. But
I cant remember if I only had. You know, I am at the place in my
life where its giving up, rather than accumulating. I see things and I
think, Oh, its just more stuff. And I would assume most people my
age are like that. Its a whittling down, just to the essentials, (Shorty).
Marge discussed the need to volunteer at a school, or a hospital, or something. She
stated that she wanted to feel like I was doing something for mankind.
...You know, at this point how I feel about it, I think its a need, because I feel
I need to share my time, my excess time with others. I really feel Id feel
better about myself if I did that. So, in a way, Id kind of say thats really
kind of a need for me to feel good about myself.. .1 think I would feel better if
I did offer a section of time, and offer it to others, (Marge).
Marge essentially stated that she needs to help fulfill the needs of others in order to
feel good about herself. Although Marges comment reflects a desire for social
connectedness in some sense, its focus is on how she can express herself in a way that
will fulfill her sense of self worth.
Other comments relating to self-image or self-perception were expressed as
desires to have different characteristics, attributes and/or talents. Kate discussed
wanting the ability to be more self-reliant in a general, comprehensive way. She gave
examples of wanting to be able to fix electrical problems without having to call an
electrician, and having the ability to call forth facts during conversations. The desire
for more knowledge was also expressed by Sallie. When she was describing her
desire for more money, she discussed the competition she faces at work:
And the competition with the computer people is tough for me.
Because, at one time in real estate, most people in real estate were
quote-unquote mature, 40s, 50s, 60s, mostly 50's and 60s and on,
and now theyre coming right out of, I dont if you have to be 21 to be
a realtor, but I think so...And they come in there and theyre slick.
And theyre slick with computers. I mean, we all wear jeans and stuff.
Im not talking about their clothes, but they dont know a dam thing
about people skills. And I have people skills. So, they come to me for
my people skills, but they are still way ahead of me on that computer.
I asked this one guy, How do you do this?, (Sallie).
Sallies desire to know more about computers would help make her more competitive
at work, and therefore, might strengthen her ability to earn more money. Pug
discussed the fact that she wished she had gotten my self degreed due to the
perception that people in her social group prefer to be around others who hold higher
educational degrees. Therefore, having such a degree might bring more social status.
Current Needs and Desires: Discussion
Study participants offered a total of 44 responses to the four core questions
relating to needs and desires. Below is a frequency distribution of the responses.
Table 4.1: Frequency oi Responses to Core Questions
Number of Responses Percentage
Relationships 21 47.7%
Self 10 22.7%
Finances 9 20.5%
Health 4 9.1%
Nearly half (47.7%) of the responses to the core questions were related to
relationships. Participants have a need to feel connected to others through family ties,
friendships, intimate companions and community. This expressed need does not
simply reflect an acknowledgement that relationships are important. Due to the fact
that these were responses to questions such as What is missing from your life, and
What would improve the quality of your life, the high number of comments about
relationships suggests that a necessary feeling of connectedness to others is lacking in
the lives of many participants. Thus, it may be assumed that participants have fairly
weak social support networks. However, prior to asking the questions about need and
desire, I asked participants introductory questions related to their social support
network, memberships in clubs, social groups, and churches.4 Although participants
varied in the degree to which they belonged to formal groups, all participants
discussed having meaningful relationships with family and/or friends, and the
majority did belong to either formal or informal social groups. This leads to the
conclusion that the prevalence of the need for relationships does not reflect a lack of
relationships in the lives of participants, but rather the need for an expansion on what
Participants mentioned the need for relationships even after being asked about
their social support networks and current relationships to which they belong. This
suggests that they felt free to discuss anything in response to the four core questions,
even ideas that had been previously discussed. The same logic then should apply to
the area of health. Prior to asking people about their needs and desires, I asked them
to describe their physical and mental health.5 Many participants described health
4 During the first four interviews, I began with the four core questions and asked other questions later.
Then I reorganized the interview format and began with more introductory questions prior to asking
the core questions on needs and desires. For further explanation, please refer to the Methodology
chapter, pages 23-24.
issues varying from taking medications and experiencing sleeping problems or
occasional depression to having had heart attacks, cancers, major surgeries, and
injurious falls. On the other hand, references to health only came up four times (9%
of total responses), and all were expressed as desires. In fact health was mentioned
fewer times than any other concept. Therefore, the existence of health conditions for
this sample, did not accurately predict the existence of health-related needs.
Although many participants did describe ailments/conditions of various sorts
and degrees, most stated that they were in good to excellent health. This seeming
contradiction appears to be related to identity. When asked to describe her physical
health, Sallie stated, Perfect for my age. Then she went on to describe how she had
had breast cancer, uterine cancer, skin cancer, had her thyroid removed, and had high
blood pressure. She ended by stating that her health was better than most. When
asked about his mental health Voss stated, I think it's okay. You have your senior
moments. Responses such as these indicate that the idea of being healthy is relative
to age. When we are 70 years old, we do not expect to be as healthy as we were
when we were 40. Shorty did not couch her response in the context of age, but her
comment reflects the same notion that health is relative: My physical health is
compromised, but I take advantage and work to overcome that. So I dont know what
physical health means, because I never see myself as sick, but I know that I have
illness. In Eriksons (1980) theory of developmental stages, in the last stage, that of
old age, an individual must accept the limitations that come with ones own life
cycle in order to emerge with wisdom. Applying Eriksons theory leads to the
conclusion that the acceptance of physical and mental ailments experienced by the
participants reflects healthy personalities.
Given the lack of congruency between particular demographics (social
support network and health) and the reference to need/desire in those areas, it appears
as though certain demographic characteristics do not always provide an accurate
predictor of need. Likewise, when reference to need is made, it is not always obvious
what exactly the need is. Participants referred to the need for money, but many times
it was expressed as a means for fulfilling other needs such as the need to be creative,
the need to spend time with others, and the need to retire. When participants
expressed the need for relationships, they sometimes described it as a means for
fulfilling the need to be secure in their futures, to have people on whom they could
depend to take care of them in times of illness.
When participants discussed their need for community, they described it as a
need for connectedness, identity, and social support. The particular need for
community emerged only for the non-heterosexuals.
Current Needs and Desires: Differences between Heterosexuals and Non-
One of the primary research questions for the study was: Do heterosexuals
and non-heterosexuals identify different needs? In order to address this question,
each response was also coded as either being given by a heterosexual or a non-
heterosexual. A frequency of responses by sexual orientation is given below.
Table 4.2: Frequency of Res ponses to Core Questions, by Sexual Orientation
Heterosexuals (n=6) Non-heterosexuals (n=9) Total
Relationships Intimate 4 8 12
Relationships Family/Friends 3 3 6
Relationships Community 0 3 3
Self 6 4 9
Finances 3 6 9
Health 2 2 4
Total Responses 18 26 44
In order to determine whether there was a statistically significant difference between
heterosexuals and non-heterosexuals in the frequency of responses for each category,
the original analysis plan included a Chi Square on the frequency distribution of
responses. However, due to the low number of responses, some of the expected
frequency cells contained a value lower than five. This was true even when all
responses relating to relationships were collapsed into one Relationships category.
Therefore, statistical significance was unable to be determined. In spite of this, some
visual differences are worth noting.
The frequency distribution of responses shows that the overall category of
relationships represented 39% of the heterosexuals responses compared to 54% of
the responses given by the non-heterosexuals. The most glaring difference between
these two groups in terms of relationships is that the heterosexuals did not mention
the need for community, while a total of 11% of the responses given by non-
heterosexuals referred to such need. There are several possible reasons for this
One possible explanation is that non-heterosexuals are less likely to have
strong family connections. In the study done by Dorfman, et al. (1995), they found
that homosexuals were much more likely to receive their social support from friends,
while heterosexuals relied more on family members for fulfilling social needs. One
of the participants (Theresa) who mentioned community as a need stated that she had
no family, and even though she described her need for community as a need to
reconnect with her Jewish identity, she thought of community as a primary
relationship. For Theresa, sexual orientation may be less of a predictor of a need for
community than is the lack of family, familial-type group, or other primary
The other two participants who mentioned community as a need (Frank and
Carshow) both made reference to having strong family connections. However,
Carshows primary need, expressed strongly from the beginning of the interview, was
for an intimate companion. When I asked him if community was more of a need or a
desire, he stated that it was a want, and then stated, I think I need one-on-one. I
dont know if I need one of a group.
Frank did not directly discuss community. Instead, he made reference to the
desire to be living in a different community, abroad, where he felt more at home with
the culture. Perhaps Franks desire for community represents a need to be with
people with whom he has established social and interpersonal connections. His desire
for community may be more due to familiarity with an environment than the lack of
If the logic that supply responds to demand holds true, the desire for
community appears to be fairly strong among seniors in our society as reflected in the
senior housing industry. There is an abundance of senior housing and intentional
communities designed for seniors who wish to move from independent, to assisted
living to dependent/nursing care with relative logistical ease. These communities
often offer social gatherings, outings, and community meals in hopes of satisfying
residents need for social interaction and connectedness. However, a new type of
community is emerging in our society. Basler (1995) describes a non-profit agency
called Beacon Hill Village in Massachusetts that is an all -encompassing concierge
service created by residents who want to grow old in the home they have lived in for
years, p. 14. Members can call the agency and request the delivery of groceries,
transportation to get to appointments, even 24-hour in-home nursing care. The cost is
$550 a year per person, $750 a year per couple and $100 a year for lower-income
residents, who also get a $250 credit toward services, p. 15. This agency has
sparked the interest of many residents, researchers, and seniors from around the
country. If programs like this become more in demand, it may be possible that the
need for socialization, offered by the more traditional intentional communities for
seniors, is outweighed by a need to remain in ones own home. However, it is likely
that the emergence of this new concept of community reflects the acknowledgement
that the need for community actually fulfills different needs for different individuals
as suggested by the non-heterosexual participants in the current study.
Another difference between heterosexuals and non-heterosexuals related to
relationships is that the non-heterosexuals were more likely to mention the need for
intimate partnerships. Twenty-two percent of the responses from heterosexuals were
related to intimate partnerships, compared to 31% of the responses from non-
heterosexuals. However, the nature of the responses given by these two sub-groups
does not seem to differ. Furthermore, two out of the six (33.3%) heterosexuals were
not partnered, compared to six out of the nine (67.0%) non-heterosexuals. This
particular demographic is likely to have some influence over the frequency of
responses related to intimate relationships.
The other visual difference between heterosexuals and non-heterosexuals is
that the category Self-expression/Self-image represented 33% of the heterosexuals
responses compared to 15% of the responses given by the non-heterosexuals. One
possible explanation for this difference is that because the heterosexuals are more
fulfilled in the area of relationships in general, their esteem and self-actualization
needs are more likely to emerge. Maslows theory of motivation suggests that our
needs usually emerge only when more prepotent needs have been gratified, (1954, p.
104). In his hierarchy of needs, the self-actualization needs begin to emerge when the
esteem needs are satisfied, and the esteem needs begin to emerge when the
physiological, safety and belonging/love needs are satisfied. The non-heterosexuals
had a much greater response rate in the area of relationships, and when speaking of
relationships they were much more likely to refer to the need for relationships as a
way of fulfilling other more important needs. Theresa and Carshow both spoke of the
lack of physical contact in their lives, and both Pug and Juan talked about needing to
be close to others who could help take care of them in their old age. It may be that
the non-heterosexuals have manifest needs for love and belonging, not only due to the
need for relationships in and of themselves, but also stemming from more latent needs
in the areas of physiology (physical contact) and safety (need to be cared for).
The heterosexuals, on the other hand, being more fulfilled in the area of love
and belonging, develop more needs in the area of esteem. Maslow states:
All people in our society (with a few pathological exceptions) have a
need or desire for a stable, firmly based, usually high evaluation of
themselves, for self-respect, or self-esteem, and for the esteem of
others, (1954, p. 90).
The majority of responses in the Self-expression/Self-image category reflect the
desire to possess different characteristics which result in a different sense of self.
Kates desire to have more knowledge during conversations, and Pugs desire to hold
a degree so she would better fit into her social group, are examples of the need for
esteem. Also included in this category are the responses related to the need to be
creative and engage in work that allows the participant to express him/herself.
Maslow states, What a man can be, he must be. This need we may call self-
actualization, (p. 91). Jerrys desire for a gig, or to work in a great band, and
Theresas need for creative work, reflect such a need.
Concept of Need versus Desire
One unexpected finding was the ways in which participants responded to the
word need. In describing the need for an intimate partnership, Sallie stated, I need
that in my life now. I want that to be in my life now. So, the word need sounds
negative, but it doesnt sound negative to me. However, after a few more minutes of
describing her need for a relationship, she stated, But right now thats what I nee...I
want right now. When I said that it sounded as if she were going to say need, but
then stopped herself and said, want, she stated, Yes, I know, because I hate that
negative word. I watch myself all the time...It makes you sound needy.
The idea that having needs means one is needy was also implied by Claire.
She stated that she could not think of a time when her needs had changed, because
Ive never felt needy. I dont mean financially needy, I mean Ive never felt needy in
terms of lack of contact with the outside world, and lack of friends, lack of very
satisfying employment, social experiences, and stuff like that.
In order to avoid asking people about their needs, Sallie proposed a different
way of asking people about what is lacking in their lives: Is there a want in your
life, or how about active choice in your life? Thats a positive. Im choosing to do
this now, where I didnt choose it before. The idea that ones perception of need is
rooted in attitude, or world view, emerged during other interviews as well. People
spoke of their beliefs that they have exactly what theyre supposed to have and things
are just as they should be, due to a higher order of the universe that has placed them
on their lifes path. Some participants stated that they had no needs because they
fully accept their path, and embrace lifes challenges.
Regardless of whether or not people stated they had needs and/or desires, I
asked each participant how s/he distinguishes between the two concepts. People
described need as something that is urgent, almost life-threatening. Examples of
responses are as follows:
> Kate stated, ...a need makes one sleepless. A need makes one hungry or
> Jerry: .. .a need is something you have to have to sustain your life.
> Theresa: Well, you know, when I think of need, I usually feel like it has to
be something pretty central and dire. It has to be like really urgent and really
essential... there has to be a sort of urgency there for me.
A desire, on the other hand, is something that is not necessary to maintain
physical health, to keep yourself alive. Kate implied that a desire is something you
want, but you really cannot have, cannot fulfill. She stated, I wish I could fly
through the air. Thats a desire, but come on, you cant do that. Shorty stated that
desire is much more self-oriented, and that the difference between the two concepts
is one of intensity.
Although most people were able to come up with a distinction between the
two concepts, often times the definition of a desire contained the word need. Jerry
stated that ...a desire is something that you need to fulfill your inner-structure, inner-
core. Alamo offered a similar explanation: I think a need would be something that
gnaws at me that is not satisfied. A need would be, needing more energy to
accomplish what I want to accomplish... He seems to imply that a need exists if it is
something that prevents you from fulfilling a want.
People do seem to use the two terms synonymously. This may be due to their
discomfort with using the term need to describe their own situation. However,
even in Maslows classic description of basic, human needs, the terms are used
interchangeably. It is more likely that many times the two terms do have the same
meaning, as there is often a fine line between needing something and simply desiring
it. Our needs and desires are relative to our culture, our social groups, and even
ourselves as we were yesterday or as we will be tomorrow. When asked to
distinguish between the two concepts, Voss stated:
That is a tough question, because it changes the older you get. Your
desires become needs as you go along. Right now I feel very healthy.
I feel like Im in good shape, but as I grow older, I realize that Im not
25. I realize I cant do the things I used to do, and so like, Id like to
go skiing, but I cant anymore. So, its a health issue, even though you
are healthy, based on your age, but youre not as healthy as you should
be. And its something you have no control over, because you age,
you become older, (Voss).
What were once needs are no longer needs because they are impossible to satisfy.
Our needs can also dissolve to the point where they are not even desires, and what we
do not concern ourselves with today, may end up reflecting needs in the future.
One of the questions asked toward the end of the interview was, What are
your greatest concerns? In asking the question the assumption was that current
concerns may reflect perception of future needs. The categories emerging from this
question were External Factors, Social/Interpersonal, Heath, and Financial Security.
Although there was some overlap between the content of these categories and those
that emerged during the four core questions, participants also offered some new
concepts and ideas.
This category contains all the responses that refer to global, societal, and/or
environmental concerns. Many people spoke of their concern about the political path
of the United States, the recent presidential election, the future of Medicare and/or the
general state of national affairs. Responses offered by Juan and Alamo mirrored that
of many of the respondents:
I think my greatest concern now is that I think were heading in the
wrong direction as a country. Were trying to act like we know better
than anyone else, and to hell with what they think. We think that force
is the answer to everything, and indeed it is not. I look at my
grandchildren, and I say, God, what are we leaving them?, (Juan).
Maybe this is a strange answer, but the political situation that we're in.
I want a president that I can feel proud of. I want my kids to live in
the kind of environment I had when we had somebody like Franklin
Deleanor Roosevelt as president. The drift that I see in this country
toward the wealthy become even wealthier and the decline in the size
of the middle class, and a growing number of poor. Those are my
concerns really. Thats what I wake up feeling upset about, (Alamo).
People also expressed concern for the world, socially and politically.
Participants described their concerns related to equality, prejudice, war, and
corruption. Concern for the environment was also expressed by many participants.
Karls comment summarized this concern when he stated, If you cant see that
plastic is a forever, then you cant see, well be buried in it. If you dont recycle, and
you dont understand air pollution and water pollution, and all this stuff.
The second category reveals participants concern about social and
interpersonal relationships. People stated that they are concerned about having
people in their lives that care about them, and being happy in their relationships.
Frank stated, But I think I would honestly say that that is the big concern, is love.
The concern about social support was also expressed by Theresa, who again brought
up her need for community: Well, personal concerns, because I dont have family
anymore, I have a concern to be in a more close-knit community..
Theresas lack of family seemed to spark her concern about not being in a
close-knit community, almost as if a community substitutes for family. The idea
that family can provide needed support as one grows older was also expressed by
Pug. Earlier in the interview she said that she was waiting for her children and
grandchildren to settle down before deciding where to move. She wanted to be closer
to her family. When asked about concerns, she stated:
.. .1 dont want to live with my children, and.. .Thats one of the things
weve been talking about, the grandchild from [out of state], theyre in
their mid-twenties, and they have three little kids, and they think,
Well, we should all find a big place together, and well fix up a
separate place for you. And Im thinking, Im not ready for that
yet. And then my other daughter says much the same thing. And I
told them both, Im not ready for that. You know, Id want to be
independent, and have my own friends, and people over if I want, and
whatever. So, were just waiting to see how that works, (Pug).
In this passage Pug seems to be struggling with the idea that even though she wants to
be close to her family, she also wants to remain independent. She can see that some
day she may need to depend more on her family, but its almost as if her current
concern is that she will lose her independence before she is ready because of pressure
from her familial relationships.
While some participants discussed the health of the country or the earth,
others expressed concern about their own health. The implied inter-play between
relationships and health referred to in the previous category takes on a much more
direct tone here with Carshows comment: Living alone, having an accident,
choking on a pill or food, and nobody knows. His concern about future health is
directly related to the fact that he lives alone. Kenny Ray, who lives with his partner,
also has concerns about health. He stated:
Or, if, God forbid, one of us, or both of us should end up in a nursing
home, how would they handle that? I suppose if one of us needed a
nursing home and the other didnt, there wouldnt be too much
question of our being together, but its a concern, (Kenny Ray).
After the interview he and his partner told me about their search for possible
residential communities, but had concerns about those that were not openly gay
friendly. They worried about whether or not they would be accepted by the other
Marge discussed her concerns about her legs and her future ability to walk.
Although Marge specified a particular type of health concern, the majority of
responses in this category refer to a more vague sense of not knowing what would
happen to their health. Kenny Ray stated, ...number one, will my health hold out.
Since I see other people, my own age and younger, dropping by the way side, or
experiencing problems...So, naturally Im thinking, Whats in the cards for me?
The concern about not knowing what course health will take lead some
participants to discuss the idea of suicide. Sallie was describing her concern about
being able to determine her own path up until the end of her life. She stated that
someone had asked her how she knew she was not going to be hooked up to these
tubes. Sallie replied: Because I know I have a real big, strong, mind and that I can
make it happen.. .Ill either have a stroke or a heart-attack or something. However,
she acknowledged the possibility that her mind would not win out. .Maybe if I get
impatient Ill do it another way. So my concern is that I want to make sure Im settin
that little thing straight because I want it to be a sure thing versus a maybe
thing... And I want to make sure I know what that next journey will be.
Sallies conviction that she will be able to will her own end-of-life journey
waivers, but is replaced by the idea that she will do it another way, if necessary, to
maintain control over her own quality of life. Pug echoed Sallies concern about
living an undesirable life:
To stay healthy. To not live too long as to be incapacitated...If I
develop this, Im checking out... I left the only church that would get
all excited about suicide or something [laughs]. And I dont have any
problem with that. You just cant put it on anybody else. They
wouldnt be able to assist, or be involved in it, and I know that. But I
wouldnt stick around with something like that..., (Pug).
The fourth category emphasizes participants concerns about their financial
security. Theresa stated, .especially becoming older and needing to sustain myself
and not having a huge amount of money or anything and needing to continue to
work. Although most of the comments in this category simply state a general
concern about the future, Vosss response implies that although he feels financially
stable now, his concern is about whether or not he will be able to financially support
his current lifestyle, ...to be able to do the things financially that you enjoy doing,
Greatest Concerns: Differences Between Heterosexuals and Non-heterosexuals
Originally, the study planned to use Chi Square to determine if there was a
statistically significant difference between heterosexuals and non-heterosexuals in the
frequency of responses for each category. However, the low overall number of
responses did not allow for this statistic to be calculated. Therefore, in order to
determine if differences between the two sub-groups exist, the frequency distribution
of responses must first simply be visually reviewed.
Table 4.3: Frequent y of Responses Regarding Greatest Concerns
# of Responses (% of responses for sub-group)
Category* Heterosexuals Non-heterosexuals Total
External 9 (60%) 5 (28%) 14
Social/Interpersonal 3 (20%) 6 (33%) 9
Health 2 (13%) 4 (22%) 6
Financial Security 1 (7%) 3 (17%) 4
Total 15 18 33
There were two other responses originally coded as other, then omitted during analysis.
The frequency of responses demonstrates that:
> The heterosexuals have fewer concerns than the non-heterosexuals in every
category except External.
> Social/Interpersonal issues were mentioned by non-heterosexuals more often
than any other issues.
The observation that heterosexuals expressed fewer concerns than non-heterosexuals
on every issue except external factors echoes the findings from the four core
questions. Again, it may be that as lower-level needs are satisfied, higher-level
needs emerge. Since the heterosexual sub-group has fewer concerns about issues
relating to their own safety, security, and sense of belonging, they are free to focus
more on external factors. Additionaly, the most interesting difference between these
two sub-groups is in the nature of their responses related Health. The non-
heterosexuals were much more concerned about not knowing what will happen to
them with regard to their health. It was the non-heterosexuals who described fears of
being incapacitated, or being able to make sure the quality of the next journey is
known. It was also a non-heterosexual who discussed being concerned about nursing
home care and whether or not he or his partner would be given the same quality of
care as their heterosexual counterparts.
Current concerns of both the heterosexuals and non-heterosexuals do seem to
reflect perception of future needs. Participants are worried that they may need
healthcare in the future, healthcare that they either might not be able to afford, or that
lacks in quality. They are concerned that they will not be able to meet their financial
needs both in a general sense, and in a way that will allow them to live the lives to
which theyve become accustomed. They also fear that in the future, they may not
have the types of relationships they need to feel like they belong and are cared for.
They also have concerns about factors that are not as likely to affect their own
quality of life. They are concerned about the world, its political, social and cultural
tone, as well as its physical destruction. These types of concerns may impy that many
participants feel fairly satisfied with their own lives and their own fates. Perhaps they
are at a point in their lives when they have few basic needs. Needs that at one time
may have existed have since been fulfilled, as needs and desires change course
throughout our lives.
Most of the interviews ended with the following question: Can you think of
the last time your needs changed dramatically? The question was asked as a way of
assessing whether or not needs changed dramatically as a result of getting older or
moving into the senior status. References were made to relationships ending and/or
beginning, times when financial stability was not as strong, and periods of self-
reflection. Furthermore, some participants did discuss retirement as a time in their
lives when their needs changed in a noticeable way.
The majority of participants (12, or 80%) stated they were retired.6 For many
of them, retirement was described as a time of dramatic change, change that both
creates and fulfills need. People discussed needing to retire due to medical problems
and/or stress. In fact, the only time health was mentioned when participants
discussed changing needs was in reference to retirement, the need to retire due to
Frank described his need to retire due to stress, but retirement also meant
having to move away from his partner. They were living out of the country, and since
Medicare does not cover medical expenses incurred in other countries, Frank had to
move back to the United States in order to maintain medical health insurance
coverage. Struggling with this issue, he and his partner discussed their options:
.. .But thats when my partner and I started talking about were going
to have to face reality. Ive got to retire. I cant handle this
anymore...He and I had talked, should I retire at 62, one time. And
then I said, No, Im going until 65. Well, at 63, in 2000, thats when
the trouble all started, the stress built up. So then we talked and we
decided two homes, two years later, and we have to prepare ourselves
for this, (Frank).
Medical concerns were also at the root of Kenny Rays decision to retire. He stated,
I was sixty-four at the time, and I turned 65 ten months later and my practice had
really dried up, and I said, Theres a message here. Sixty-five, two heart attacks, no
practice to speak of, dont be stupid. It was then that Kenny Ray decided to retire.
For some, retirement also creates the need for routine, and adjustments to
social support network. Marge spoke of having too much time on her hands,
watching too much tv, needing a routine, and not having enough to do for several
months after retirement.
6 Although most participants were retired, the majority of them (11, or 73%) stated they were engaged
in some type of paid or volunteer employment.
.. .So I needed routine in my life, and it was really big. Because, you
know once I realized that and started building my days around getting
a routine going, I felt so much better. I mean I wasnt at such loose
ends, wandering to-and-fro, wondering, What should I do with
myself? So that was one of the best things I did for myself. Now, Im
not real strict about it. What Im strict at is trying to maintain the
same hours, because I feel better, (Marge).
In contrast to Marges need for structure after retirement, Alamo stated that he was
ready for retirement so that he could spend more time doing what he wanted, instead
of having to respond to the demands of a job.
And then, reaching a point in retirement where I could step away from it. Ive
removed myself pretty forcefully away from that. I didnt want to go back to
the office after I didnt have to, even though there was one sitting there...So
that was a great switch in me, the need not to be involved, (Alamo).
The idea that retirement both creates and fulfills needs is best described by Voss. He
first discussed the fact that retirement means a change in income, which can create
very different circumstances than what someone is used to:
.. .a good example is when you do retire, and all of the sudden you do
have medication, or your health is changing, and that kind of thing.
Then, you really do have needs...You become less spend-thrifty. You
dont spend as much money. You dont go out to eat. You know, that
kind of thing, and so your environment starts to change, and its based
on age is what happens to you, (Voss).
Even though continuing to work would provide more income and alleviate some
concerns about money, a change in desires and/or needs occurs so that the desire not
to work outweighs financial concerns:
See, if you would have asked me these questions 10 years ago, I
would have told you that Im never going to retire, so Im not going to
worry about money. And then all of the sudden you get to the age
where lifestyle starts changing, you dont feel the same about what
youre doing. I dont want to go to the office anymore, to speak
of...So, your thinking changes. Im not that anxious to go to work
anymore, even though I do, (Voss).
Although participants did discuss what is missing from their lives, what is
currently lacking in their lives, they also expressed dissatisfaction in using the term
need to describe these issues. Many participants discussed desires instead of needs,
and some used the two words interchangeably. Regardless of the way in which it was
expressed, participants identified many different needs and desires, some that
currently exist in their lives, and some that may potentially exist in their futures.
Responses from the sample suggest that people age 65 and older have a need to feel
connected to others through intimate companionships, family and friends. They have
a need to feel secure in their financial standings, health status, and sense of self. They
also have concerns about their futures as well as the futures of their loved ones, the
earth, and others who will continue on after them.
There are some differences between the responses offered by heterosexuals
and non-heterosexuals. Non-heterosexuals were much more likely to discuss the need
for relationships, and were also the only participants mentioning the need for
community. The heterosexuals expressed concern for external factors much more
frequently than the non-heterosexuals. The potential reasons for these differences, as
well as the content of responses from the sample as a whole, are discussed further in
the next chapter.
DISCUSSION AND CONCLUSIONS
One of the research questions for this study was: Are the needs of older
people adequately and accurately addressed in the current literature? Studies have
been conducted on multiple aspects of growing old in our society. The elderly have
been shown to experience social isolation and stigmatization (Siegel, et al, 1998),
psychosomatic illness (Berkman, et al, 1999), and have relied on family physicians
for fulfilling socioemotional needs (Azzarto, 1993). People age 65 and older often
times have limited incomes and rely heavily on Social Security (AARP, 2005).
Those who are also ethnic minorities often experience lower incomes than non-
minorities (Wilson and Hardy, 2002), and greater health disparities (Ferraro and
With the refinement of sampling techniques, methods of data collection, and
statistical methods, our body of knowledge about seniors has grown to include
generalizable descriptions of many of our seniors demographic characteristics.
According to US Census data, many seniors live alone, have physical disabilities, and
live below poverty level (Administration on Aging, 2006). The combination of
medical conditions and lack of generous healthcare coverage has been shown to
increase the likelihood of the elderly not seeking medical attention (Artz, et al, 2002).
Although there are multiple studies describing Americas seniors, they do not
usually address the needs of seniors from the perspective of the participants. Some
studies take a leap of faith from description to conclusion about needs. The elderly
who visit their doctors, do not have any visible medical problem, but ask for
reassurance, are assumed to have high socioemotional needs and a lack of means for
fulfilling those needs. The demographic descriptions of the elderly (e.g. poverty
rates, residential status, and physical ability) are often used to make recommendations
about funding for services targeting seniors. Maddox (2000) offers a summary of
how the needs of the elderly are usually determined:
Older populations are typically characterized in terms of
functional status in addition to health status. The usual
designations of functioning are Activities of Daily Living
(ADLs) and Instrumental Activities of Daily Living (IADLs).
The former reference self-care activities such as bathing,
toileting, and eating; the latter, activities such as ambulation,
cooking and money management. These designations have
stood up well in both research and practice for use in
characterizing types and levels of need in populations and as
triggers for authorizing services for individuals, p. 325.
Therefore, our understanding about the needs of the elderly is often limited to our
assessment of their ability to care for themselves.
Based on the literature, it would appear that the elderly have needs in the areas
of health, social interaction, and financial security. The participants in this study
echoed these themes, but offered insight into how the needs of seniors are articulated,
as well as how those needs might be assessed and interpreted.
Discussion of Findings
Needs as a Means to an End
The importance of being connected to others was a strong theme throughout
the interviews. Whether people were discussing their current needs or their greatest
concerns, it was apparent that participants have a strong need for relationships with
people with which they can spend quality time, care about and be cared by, and with
whom they can grow old. Although people can desire relationships simply for the
sake of companionship, implicit in many of the participants responses was the idea
that to have a particular type of relationship would fulfill a more basic need.
Participants mentioned companionship as a means for fulfilling the need for physical
and sexual intimacy. They also discussed being close to others to ensure that they
would be cared for if they ever became physically unable to care for themselves.
Although the need for relationships was expressed by both heterosexuals and
non-heterosexuals, it was done so more frequently by non-heterosexuals. The
heterosexuals, on the other hand, were much more focused on needs related to self-
expression/self-image, and concerns about external factors such as politics, the
environment, and the global state of affairs.
The difference in what needs and concerns arose for heterosexuals versus non-
heterosexuals may be due to several factors. First of all, non-heterosexuals were
twice as likely to be single, or not partnered. This obviously increases the chance of
non-heterosexuals desiring intimate relationships. However, given the reference to
relationships as a means for fulfilling other needs, it may be suggested that non-
heterosexuals have greater needs in other areas. Maslows hierarchy of needs offers a
framework with which to interpret the differences in responses given by
heterosexuals and non-heterosexuals.
According to Maslows (1954) theory of human motivation, human beings are
motivated by the existence of basic needs that can be categorized along a hierarchy.
Once a lower-level need is largely fulfilled, a higher-level need is likely to
emerge. The most basic needs are physiological in nature, and represent our need for
things like water, nutrition, oxygen and blood temperature. This category of needs
also includes sexual satisfaction and physical touch. During the interviews, although
both heterosexuals and non-heterosexuals offered responses related to intimate
relationships, it was only the non-heterosexuals who discussed relationships as a
means for fulfilling the need for physical and sexual contact. Therefore, the
percentage of responses by non-heterosexuals in the Relationships category may
reflect some of the needs these participants have in the area of physiology.
Once physiological needs are largely fulfilled, we develop safety needs, or the
need to be free of the appearance of threat or danger, and then we can develop the
need to feel like we belong and are loved. The non-heterosexuals were the only
participants who referred to needing community, or a sense of belonging to a
group. This may reflect a lack of acceptance of non-heterosexuals, compared to
heterosexuals, within our society. Beeler, et al. (1999), found that among older gays
and lesbians, The most frequently cited need was for increased social interaction and
for additional opportunities to meet other gay people, (p. 42). Although participants
in the current study did not discuss community in terms of bonding with other non-
heterosexuals, they did describe their need for community in terms of belonging to,
and being accepted by a larger group of people. When discussing his greatest
concerns, one non-heterosexual stated that he was concerned about whether or not
nursing facilities would be accepting of he and his partners lifestyle should they ever
have to rely on one for future care. Given the fact that non-heterosexuals are not
legally protected in the same way as heterosexuals (Cahill, et al, 2000), the threat of
being discriminated against, and even harmed as a physically dependent individual, is
understandable. Consequently, the higher percentage of responses by non-
heterosexuals in the Relationships category may reflect a greater need to feel safe,
and to feel like they belong in a society that suggests they are not as valued as their
The fulfillment of safety, love and belonging needs leads to the development
of the need for self-respect, self-esteem, and the esteem of others. When discussing
current needs, the heterosexuals were twice as likely to offer responses in the Self
category which describes the need to engage in creative, self-expressive activities,
allowing participants to gain a greater sense of self-worth and self-esteem.
The final basic need is that of self-actualization which includes the fulfillment
of larger, moral values. This last set of needs may reflect the category External
Factors which emerged from participants responses about their greatest concerns.
Heterosexuals were more likely to mention external factors when discussing their
According to Maslow (1954), in order to develop needs outside of oneself, the
need for love, belonging, self-esteem and the esteem of others needs to be somewhat
fulfilled. This is not to say that non-heterosexuals are not concerned about others, or
do not have needs that go beyond themselves, but in order to more readily identify
those needs, other basic needs have to first be satisfied. The fact that heterosexuals
offered more responses related to self-esteem and self-actualization may simply
reflect the fact that they do not have the additional worry about whether or not they
will be accepted by others, or ill-treated due to their sexual orientation. They may be
more fulfilled in the area of safety, love, and belonging in a more general, societal
sense, allowing them more psychic energy to develop higher-level needs.
Needs and Desires are Relative
The development of needs and desires is influenced by the fulfillment of
other, lower-level needs. This is primarily due to the fact that in order to desire, for
example, love, one must not be bothered with having to find enough food and water
to sustain ones life. In other words, the more basic the need, the more likely it must
be fulfilled before a different need arises. Related to this is the notion that the
development of needs and desires is relative to the possible attainment of such needs
and desires. One is less likely to achieve love if s/he is starving and in fear of his/her
life. Therefore, s/he is less likely to desire love than someone else who is safe and
well-fed. Likewise, one is less likely to desire a million dollar home on the beach if
s/he is living in poverty in the middle of a large, urban area than s/he would be if s/he
lived near the beach and made a six-figure income. Maslow states, On the whole we
yearn consciously for that which might conceivably be actually attained, (1954, p.
The fact that needs are relative may help shed light on one of the seeming
contradictions bore out by the interviews. Prior to asking people about their
needs/desires, participants were asked to describe their physical and mental health.
They offered many details in their descriptions, as they described various ailments,
illnesses, conditions, and most stated they were taking some form of prescription
medication. In contrast, when later asked about current needs and desires, very few
participants discussed health issues. During data analysis, the lack of needs related to
health was originally thought to have been potentially due to the fact that people had
already described their health conditions, and therefore, may have thought that there
was no need to repeat these issues when describing current needs. However, prior to
asking about current needs, participants were also asked several questions about their
social support network, who they spend most of their time with, whether they
attended church and/or belonged to other informal or formal groups, and whether
there were any particular individuals on whom they depended, or who depended on
them. Although participants also gave great details about their network of
relationships, and most offered descriptions indicating they were well connected to
others, had family and/or friends to whom they felt close, the issue of relationships
emerged frequently when discussing current needs and desires. For that reason, if
questions prior to the four core questions influenced participants responses to the
core questions, it should have done so equally for health as well as relationships. It is
then safe to assume that the prior questions did not have any effect on, or at least had
an equal effect on, participants propensity to discuss current health needs and current
relationship needs. Why then did relationship issues emerge as such a strong need for
a group of people who appear to be well connected to others when health issues were
so infrequently mentioned by the same group who described having multiple health-
related issues? It may be due to the idea that the development of health needs, and
relationship needs are relative to the possible fulfillment of those needs.
After describing various ailments, diseases, physical and mental disorders,
many participants stated that their health was better than most, or perfect for my
age. Comments such as these reflect the idea that ones health is relative to age.
People do not have a need to be free of health problems because as our bodies age,
the ability to be free of such problems is not likely attainable. On the other hand,
such age-restrictions do not apply to the attainment of relationships. People of all
ages are in partnerships, begin new relationships, connect to others, have family and
friends, and belong to communities.
The need for fulfillment in particular areas of ones life seems to develop as a
result of two factors: importance and possibility. It is difficult to argue against the
idea that if one is hungry or thirsty, s/he will likely develop a need for food or water,
even if the likelihood of that need being fulfilled is very slim. Our bodies require
food and water in order to survive. Therefore, some needs are likely to develop
mainly based on their importance. However, some needs may also develop even
when the fulfillment of those needs knowingly leads to the end of ones life. Two
participants stated that they would likely end their own lives if they were unable to
maintain the quality of life they desired. In this case, it was suggested that the need
for health (quality of life) is sometimes more important than the need for life itself,
but only because the possibility of controlling the situation (through suicide) exists.
Importance and possibility may also help explain participants use of the term
need versus desire. Participants described needs as those that make one
sleepless...makes one hungry or hurting, or are things you have to have to sustain
your life. Perhaps desires become needs when more basic needs have been satisfied.
In other words, needs do not arise until they are realistic, not only from an attainment
perspective, but also from a physiological perspective. Ones body simply will not
allow him/her to need a relationship for companionships sake if s/he is hungry and/or
physically ill. Instead, ones body will need food and rest, and once it has received
some food and rest, the individual may begin to develop a desire for a relationship.
When someone is physiologically fulfilled enough, his/her desire for a relationship
may become a need, as his/her body aches for physical or sexual contact. Some
participants stated that they had no needs, and some stated they had no needs because
they did not like the term needy. This may be due in part because people think of
needs as those that fulfill physiological needs, and physiological needs are usually
more narrowly defined as life-sustaining.
The Definition of Senior. Related to the idea that needs are relative is the
way in which we determine who holds the particular status of elderly, or senior.
This study had a minimum age of sixty-five as a requirement for participation. This
age requirement was established due to the fact that those currently sixty-five or older
are eligible for Social Security and Medicare benefits, automatically giving them the
legal status of senior. Social status more often than not both determines and follows
legal status. For example, the labels child or company owner hold particular
meaning in our society because we have given them legal meanings due to our
socially-constructed ideas about what type of status the bearer should have. We have
decided as a society, that people who are sixty-five years of age or older should have
a particular status. They should be able to retire from work while receiving a
minimum amount of money on which to live, as well as receive low-cost medical
benefits. However, along with these benefits often comes the expectation that their
lives are nearing an end. They should be able to retire because they dont have much
more time to enjoy themselves before they become unable to function on their own.
This end-of-life path seniors are on leads to further suggestions that they are
slower, not as quick-minded, and as a result, not as able to contribute to the
functioning of society as their younger counterparts. This study focused on this
particular population due to both its legal status, and the often-times stigmatizing
social status it carries.
However, the use of the term senior does not seem to imply a particular age
group throughout society as a whole. Part of the challenge in recruiting participants
for this study was that most of the groups that offer basic services to seniors have a
50-60 year-old minimum requirement for membership, and those organizations seem
to attract many more people under the age of 65 than those 65 and older. Is it that
those in more need are really those who have not yet reached age 65 and therefore,
are not receiving federal benefits? This may be the case for those who have more
basic needs, but it is not just the organizations serving high need seniors that include
people younger than 65 in their target population. The minimum age requirement for
joining AARP (formerly the American Association for Retired People) is 50. Since
age 65 was established as the more common age at which one becomes a senior, the
average life expectancy has increased. It is more interesting then, that AARP has
deemed 50 as the age at which people gain entry into the world of aging. Could it
be that AARP changed its focus simply to expand membership and thus political
clout? What about senior centers? Even though people are not eligible for federal
senior benefits until they are 65 years old, senior centers allow people 15 years
younger to utilize services offered. Of course, those services are only offered after
the membership dues have been paid. In summary, it seems that the term senior is
used by organizations as a marketing tool for gaining membership and the related
economic and political power it holds.
The use of the term senior as a self-serving label does not appear to be
limited to organizations and institutions. I was speaking with a woman who was 66
years old. Upon hearing that I was interviewing older people, she said, Oh, I just
love older people. We then had a conversation about older people and how easy
they are to speak with; how comfortable they are to be around. During a different
conversation with the same woman, she was talking about the different places at
which she receives a senior discount (e.g. movies and grocery store). She did not
consider herself an older person, but was more than willing to accept discounts
offered to seniors.
The Need to Be Heard. Although I have had difficulty accessing people 65
years and older who are less financially secure, my ability to easily access the gay
and gray population is worth noting. The sample consisted of 6 heterosexuals and 9
non-heterosexuals. This is at least in part due to the fact that gay, lesbian, and
bisexual individuals want their voices to be heard. When recruiting within this sub-
population, people were so excited that I wanted to interview them partly because
they were queer, that they often times misunderstood that my primary focus was on
their age, not their sexual orientation. Many of the gay/lesbian participants seemed to
want to talk about their coming out process and their perceptions as gays/lesbians
much more than they did their needs as older people. The response from this
community was so great that I had to begin turning people away because they
possessed too many of the same demographic characteristics as those I had already
interviewed. They were white, financially secure, living independently, etc.
In all probability, the positive response from the non-heterosexual community
was likely due to the studys interest in ensuring the inclusion of their perspectives.
This may have increased the potential threat to validity. Although non-heterosexual
participants rarely couched their needs and desires within the frame of their sexual
orientation, their knowledge of the fact that I was interested in them due to their
sexual orientation may have influenced what they discussed and the manner in which
they discussed it.
People age 65 years and older have needs that span the realm of possibilities.
They have the need for physical and economic security, and the need to feel
connected to others through various types of relationships. They are concerned about
their future, the future of others, and the future of the world. They also provide great
insights into how their needs should be assessed and interpreted.
In order to accurately measure the needs of older people, we must first clearly
define the population of interest. Is the goal of the study to learn more about those
who call themselves elderly or senior? Is it to determine who among all possible age
groups has the greatest level of basic needs? Does the study aim to assess those who
qualify for government benefits due to their age?
Regardless of age, it is likely that participants will have strong feelings about
the use of the term need. People have difficulty using the term need to describe
what is lacking in their lives, and therefore, when asking people about their needs, it
may be more accurate to ask about their wants or desires. Most needs
assessments are simply societys way of determining who should get what based on
what society feels is an appropriate or good quality of life, regardless of what people
state they need, want or desire. If we really want to know what people feel they need,
we should ask them what about their lives they wish was different.
The current study utilized a convenience sample comprised of very little
heterogeneity in terms of basic demographic variables. The lack of heterogeneity
allowed for greater validity in comparisons between the heterosexual and non-
heterosexual participants. However, future studies should increase variability in age,
ethnicity, financial security and disability. In order to ensure that all seniors needs
are represented, we need to hear from a more representative sample of seniors.
Further research would also benefit by including both quantitative and
qualitative methods. By increasing the sample size in future studies, researchers will
likely obtain enough responses to determine if there is a statistical difference between
the responses given by different sub-samples. By utilizing both quantitative and
qualitative data, we can further develop our understanding of what is lacking in the
lives of the elderly, how the fulfillment of some needs can both directly and indirectly
satisfy other needs, and consequently, how best as a society to help enrich the lives of
APPENDIX A: INTERVIEW GUIDE
Id like to begin by learning a little bit about you and your life.
1) You found out about my study through...
a) How long have you been with that group, organization, etc.?
2) You say youre retired?
a) How long have you been retired?
b) What type of work did you do, etc.?
c) What type of work do you do, etc.?
3) You live [general area, etc.]
a) How long have you lived here/there?
b) Do you own, rent, or neither?
c) Do others live with you?
4) Services receiving community involvement
a) Do you belong to any community centers or senior centers?
i) What types of things do you do there?
b) Do you belong to any support groups or clubs?
i) What types of things do you do there?
c) Do you belong to a church?
i) How often do you attend?
5) Health status
a) How would you describe your physical health?
i) Do you have any medical conditions, illnesses, etc.?
b) How would you describe your mental health?
Probe: Would you say you are generally happy, struggle with
a) What type of insurance do you have?
Part A, Part B
7) Now Id like to find out about your social support network.
a) Who do you spend time with?
b) Are there particular individuals you depend on?
i) For help?
ii) For company?
c) Are there particular individuals you depend on you?
i) For help?
ii) For company?
Questions Regarding Need/Desire
Now I would like to ask you some very general questions about your needs and
desires. I am interested in exploring your concept of the word need as well as what
types of needs you currently have. People use the word need differently. Some
people use it to describe something they desire, but do not have. Other people use it
to describe something that prohibits them from living a healthy life. I believe all the
different ways in which people use the term to describe their own circumstances is
valid. In order to better understand how you perceive your needs, I will be asking
you many different types of questions.
8) Do you remember the last time you said to yourself If only I had blank?
a) Would you tell me about the situation you were in?
b) How often does that occur? (This specific situation, not just wishing in
c) Would you call this a need? If so, how does it differ from a desire/wish?
d) How do you differentiate between needs and desires?
9) Can you think of another example of when you said this to yourself?
10) Do you remember the last time you said to yourself something is missing
from my life?
a) Would you tell me about the situation you were in?
b) How often does that occur?
c) Would you call this a need?
11) If you could have access to anything in order to improve the quality of your
life, what would it be?
12) What would you describe as the ideal situation for yourself?
13) What are your greatest concerns?
Probe: What do you worry about the most?
14) All of us have experienced a period of time when our needs have changed
considerably. Can you think of the last time you felt your needs had changed?
a) When was that?
b) In what way(s) had your needs changed?
c) Probe: If you were either younger or older, would your
needs/concems be different?
15) Please describe your typical day.
Probe: How do you normally spend your time during a typical 24-
APPENDIX B: SUPPLEMENTAL QUESTIONNAIRE
The information from this next set of questions will allow me to describe the group of people
I interviewed using specific categories.
How old are you?.
. years old.
Which ethnic/racial group do you belong to? Please check all that apply.
_____American Indian or Alaska Native _____Hispanic/Latino
_____African American/Black _____White
3) What is your sex/gender identity?
4) What is your sexual orientation?
5) What is the highest level of school you have completed?
_____Grammar school ____Some college
_____Jr. High/Middle school ____College graduate
_____Some high school ____Graduate degree (Masters, Ph.D.)
_____High school graduate Professional degree (e.g., MD, JD)
6) What is your current employment status? (Please check all that apply)
____Employed for pay or profit average # of hours per week:_
____Retired at what age did you retire?________
____Work as unpaid volunteer average # of hours per week:___
7) What is your current, marital/partner status?
_____Single _____Married, but separated
_____Now married _____Domestic partnership
_____Widowed _____Widowed from domestic partnership
8) Using the following scale, please indicate your level of financial security by circling
the appropriate number:
security/I can meet
most financial needs
security/I can meet
APPENDIX C: RESOURCE SHEET
The following list provides contact information for some resources offered to seniors
in the Denver Metropolitan area. These resources are offered to seniors at either a
low cost or for free.
Senior Support Services
846 E. 18* Avenue
Denver, CO 80218-1025
> Provides day shelter for
indigent and homeless
seniors, emergency food
baskets, storage, and a
variety of other services.
Open 7-7 M-F and 11-4 on
5840 E. Evans Ave.
Denver, CO 80222
> Provides a variety of
assistance with legal
issues, home repairs,
financial planning, and
in-home care. This
provides information and
referrals on a variety of
Low Income Home Energy
Assistance Program (LEAP)
> Provides assistance with
paying utility bills.
Meals on Wheels
Coordinated by Volunteers of America
> Provides cooked meals delivered to
people who are unable to leave their
Colorado Area Agency on Aging
Denver Regional Council of Governments
> Provides a variety of services
including nutrition and health
services, educational programs, legal
services, and long-term care
Senior Answers and Services
> Provides information on utility
assistance and property tax/rent
rebates, and referrals for dental
services for low income seniors.
Appendix C: Resource Sheet, continued
Benefits CheckUp of Colorado
> Website where you
answer a series of
questions that will help
you determine for which
types of services you are
Elder Care Locator
> National directory
offering referrals to a
variety of services.
Pfizer for living Share Card
> Program for low-income,
Medicare recipients who
have no prescription drug
Denver Commission on Aging
> Provides referrals to a
variety of services for
Denver County residents
Catholic Charities Adult Services
> Offers four different programs for
seniors and their families: Case
Management Program, The Mulroy
Senior Center, Hispanic Outreach
Program, and the Senior Partner
> A non-profit organization that
purchases massive quantities of
common grocery items (e.g. fruits,
vegetables, and meats) through a
national affiliate. Items are then
bagged and sold to members at about
50% of retail cost.
The Gay, Lesbian, Bisexual and
Transgender Community Center of Colorado
Denver, CO 80206
> Offers social support groups geared
specifically toward seniors, as well
as non age-specific groups, programs
> Seniors clinic providing outpatient
mental health services they accept
Appendix C: Resource Sheet, continued
Medicare 1-800-633-4227 > Medicare covers mental health services. Patient usually pays 50% of the approved cost, but may also be required to pay a co-pay. Boulder County Aging Services Division 3482 N. Broadway Boulder, CO 80304 (303)441-3570 www.co.boulder.co.us/cs/ae/ > Offers a full range of programs and referrals for Boulder County residents.
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