Julie Blaskewicz Boron, K. Warner Schaie, Sherry L. Willis
The Aging Personality and Self
Diversity and Health Issues
Personality may be defined as the pattern of thoughts, feelings, and behaviors that shape an individual’s interface with the world, distinguish one person from another, and manifest across time and situation.1–3 Personality is impacted by biologic, cognitive, and environmental determinants, including the impact of culture and cohort. Theoretical approaches to personality are as varied as the breadth of the construct they attempt to describe and explain yet each approach, to varying degrees, emphasizes stability and change within individuals across time and situation.
The impact of personality across the adult life span touches every domain—personal, professional, spiritual, and physical. Certainly, personality characteristics have direct and indirect influences on health status, health behaviors, and behavioral interactions with health care professionals. Although no single chapter can adequately condense such rich empirical and theoretical research, we will attempt to provide a concise overview of stage models, trait theory, and social-cognitive approaches to personality. As such, we will focus on aspects of personality development among cognitively intact older adults, not personality changes that may ensue as the result of dementia.
Each section of this chapter contains four subsections. For each of the three major approaches—stage, trait, social-cognitive—we first provide an overview of classic along with the most current research on stability and maturational and environmental changes in the adult personality. Our focus will be on findings from longitudinal data. Second, we include cross-cultural comparisons of adult personality, where available. This focus provides a unique contribution to reviews of adult personality and aging.4,5 Third, we examine the health correlates of adult personality, focusing on morbidity and mortality, well-being, life satisfaction, positive and negative affect, anxiety, and depression. Finally, we discuss measurement issues and provide examples of current assessment instruments.
Personality Stages and Ego Development
Freudian Theory
The psychoanalytic approach to adult personality development has its roots in the theories of Sigmund Freud. His theories encompassed four domains—level of consciousness, personality structure, defense mechanisms, and stages of psychosexual development.6,7 Freudian theory postulates that adult personality is made up of three aspects: (1) the id, operating on the pleasure principle generally within the unconscious; (2) the ego, operating on the reality principle within the conscious realm; and (3) the superego, operating on the morality principle at all levels of consciousness. The interplay of these personality structures generates anxiety that must be reduced through various defense mechanisms. These mechanisms act to obscure the true, anxiety-laden reasons for one’s behavior.
Although seminal in the expansion of our understanding of the human psyche, Freud’s specific theories receive little attention in the scientific study of personality today.6 His theories are not easily amenable to scientific inquiry in that they frequently lead to nonspecific hypotheses, wherein failure to find expected effects may simply be a result of unknown defense mechanisms. Additionally, having postulated that personality development associated with his stages of psychosexual development essentially ends in adolescence, Freud’s theories have limited applicability to the fields of gerontology and geriatric medicine.
Post-Freudian Theorists
In contrast, some post-Freudian theorists have conceptualized personality development as a continuing process focused on current interpersonal and/or family of origin issues as the source of individual distress and coping patterns. Carl Jung proposed that as individuals age, they achieve a balance between the expression of their masculine characteristics (animus) and feminine characteristics (anima).8,9 Findings regarding increased balance of gender roles with age have emerged in different cultures, lending some support to Jung’s hypothesis.2
Erik Erikson’s stages of psychosocial development are perhaps the best known of the stage theories of adult personality. The sequence of Erikson’s eight stages of development is based on the epigenetic principle, which means that personality moves through these stages in an ordered fashion at an appropriate rate.3,10 Two of the eight stages describe personality change during the adult years. Although the identity crisis is placed in adolescence, deciding “who you are” is a continual process that is reflected throughout adulthood, even in old age.11 In the midlife stage of generativity versus stagnation, individuals seek ways to give their talents and experiences to the next generation, moving beyond the self-concerns of identity and interpersonal concerns of intimacy.5 Successful resolution of this stage results in the development of a sense of trust and care for the next generation and assurance that society will continue. Unsuccessful resolution of this stage results in self-absorption.
Ego integrity versus despair is Erikson’s final stage of ego development, beginning around the age of 65 years and continuing until death. In this stage, individuals become increasingly internally focused and more aware of the nearness of death. Successful resolution of this stage results in being able to look back on one’s life and find meaning, developing a sense of wisdom before death. Alternatively, meaninglessness and despair can ensue if this process of life review results in focus on primarily negative outcomes.
Difficulties arising from attempts to investigate Erikson’s theory empirically include the assertion that stages must be encountered in order and there is lack of specification regarding how developmental crises are resolved, so that an individual may move from one stage to the next. However, the environmental influences of culture and cohort on adult personality have been minimized. One 22-year investigation found significant age changes supportive of Erikson’s theory.12 Middle-aged adults expressed emotions and cognitions consistent with successful completion of more psychosocial developmental crises than younger adults. In addition, Ackerman and colleagues found a stronger association between generativity in midlife compared with that in young adulthood.13 Some theorists have postulated that the ego integrity versus despair period initiates a process of life review.14
Life Review
The concept of life review is the exception to this lack of empirical investigation regarding stage theories of adult personality.14,15 Life review can be thought of as a systematic cognitive-emotional process occurring late in life in which an individual thinks back across his or her life experiences and integrates disparate events into general themes. The portion of life review focusing on recall of primarily positive life experiences is reminiscence. Reminiscence has been linked to successful aging16 by contributing to sustained identity formation and self-continuity, a sense of mastery, meaning, and coherence in life, and acceptance and reconciliation of one’s life.17 Although this approach to adult personality development can be conceptualized as a cognitive process in which identity emerges from the story of one’s life, we have chosen to include it with stage models because it is most frequently described as occurring near the completion of one’s life. Nevertheless, it should be acknowledged that individuals likely undergo a process of life review periodically throughout the adult years, including young adulthood18 and midlife.19,20
Stage Theory
Stage Theories and Diversity
Few studies investigating stage theories of personality have focused on diverse cultural or racial and ethnic groups. Most of the stage models, such as Freud’s original theories, were based on highly select samples. Only a few investigations of life review have succeeded in recruiting participants reflecting the general population of interest.21–23 Cross-cultural evidence has indicated that life review programs have improved self-esteem and life satisfaction in Taiwanese older adults,24 depressive symptoms in community-dwelling Chinese older adults,25 and depression and anxiety symptoms in Dutch older adults.26 Data reflecting the broader diversity of the population are needed for examining the universality of life review and generalizability of the basic assumptions.
Stage Theories and Health
There has been limited investigation of the relation between stage approaches to adult personality and health. One study on generativity found that those perceiving more generativity in their lives had fewer activity of daily living impairments and decreased risk of mortality 10 years later.27 However, most research has focused on life review processes. Several intervention studies have supported the contention that life review, in comparison with nonspecific but supportive interventions, has a positive impact on health, life satisfaction, well-being, and depression.
A meta-analysis on reminiscence and well-being in older adulthood has demonstrated that although reminiscence was moderately (effect size, 0.54) associated with life-satisfaction and well-being in older adulthood, engaging in life review had a stronger effect.17 This suggests that consideration of all major life events, positive and negative, as is typical for life review, has a greater impact on well-being in older adulthood. Furthermore, another meta-analysis by Bohlmeijer and associates have investigated the effects of life review on late-life depression.28 Results suggested that life review and reminiscence may be an effective treatment for depressive symptoms in older adults. Additional research has supported the utility of life review interventions to decrease depressive symptoms and improve life satisfaction in older adults.29–33 Recent research has considered the effects of psychological resources and found that mastery and meaning in life mediated the relationship between negative reminiscence and psychologically distressing symptoms consistent with depression and anxiety.34 Finally, participants in life review programs have demonstrated wider psychological benefits, including increased autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance in comparison to control groups.35
Measurement Issues
The primary methodologic problem plaguing empirical research involving stage theory approaches to adult personality development has been the lack of specification of change mechanisms and limitations in psychometrically reliable and valid measures. Personality stability is assumed with these stage theories. This is not necessarily problematic; however, measuring how people progress through the proposed stages, including the order of progression, and whether non-normative life events can lead to changes in personality, is not captured through current measures, nor is the consideration of age changes versus cohort differences.36 The most current stage approach to adult personality in our organizational scheme involves the concept of life review near the end of life. Bohlmeijer and coworkers have noted the lack of standardized protocols to life review as a therapeutic technique in the delivery of interventions.17
A common methodologic limitation in much of this research is the problem of making causal inferences of age-related personality change from cross-sectional studies. In these studies, age-related differences could be observed because of the impact of aging or due to cohort differences. Without cohort sequential data, it is impossible to tease apart these influences. Thus, although stage theories of adult personality have intuitive appeal, their contribution is limited by vague delineation of constructs and methodology.
Personality Traits
In contrast to stage approaches to adult personality development, empirical research regarding trait approaches has experienced a significant boom in recent years. The Big Five Factor Model of Personality provides a broad framework for organizing the hundreds of traits, or individual differences, that characterize people.37 These five core dimensions have been demonstrated at most life stages through extensive factor analyses of personality descriptors.38,39 A description of the most commonly identified five factors can be found in Box 31-1.
Early studies suggested that maturational changes in personality occur in young adulthood until approximately the age of 30 years, with relative intraindividual stability in traits thereafter.40–44 However, stability of personality across adulthood lacks consensus. The debate as to whether personality remains stable or changes in adulthood may be based on different criteria for determining change. Roberts and Mroczek have described various forms of change, including mean-level change, rank-order consistency, structural consistency, and individual differences in change.45 Usually, research supporting stability refers to rank-order consistency, whereas research emphasizing change focuses on individual differences in change. Consistent with cross-sectional results,41 longitudinal assessments and meta-analyses46 have shown small age-related declines in neuroticism, extraversion, and openness to experience, with age-related increases in agreeableness and conscientiousness in adults up to the age of 70 years (declines in neuroticism persisted until age 80). However, this research is often cited as supporting stability of personality in adulthood. Although mean-level changes are shown, individuals maintain their rank-order on the personality domains.47 Findings from other research teams have contributed support for stability.48–52
Studies of variability in individual rates of change have provided support for the notion that personality may change, even in adulthood.53–57 Together these studies suggest that some individuals change more or less than other individuals in terms of personality traits. Thus, studies have attempted to investigate factors that may contribute to these varying rates of individual change. In a 12-year longitudinal study of middle-aged to older men, Mroczek and Spiro found cohort, incidence of marriage or remarriage, spousal death, and memory complaints to be associated with differential rates of change in personality.55 Individual differences in life circumstances or other environmental sources were also found to be associated with differential rates of change in personality, affecting overall well-being.58 Social support, unmet needs, health, and psychosocial needs are examples of various life circumstances found to be significant predictors of differential rates of change in older women.59 Thus, specific life experiences may have an impact on personality. Consideration of the various definitions of change and the factors accounting for change is important when reviewing research on personality stability or change.
Trait Theories and Diversity
Cross-cultural studies have most frequently compared non-Hispanic whites in the United States with individuals living in other countries.60–62 These studies seek to estimate the effects of environment on different age cohorts by comparing adults in cultures with different recent histories. Using the NEO Personality Inventory-R, McCrae and colleagues studied parallels in adult personality traits across cultures in five countries—Germany, Italy, Portugal, Croatia, and South Korea.61 Once again, different patterns of age changes would result if environmental factors play a major role in adult personality development. In contrast, intrinsic maturational perspectives would suggest that even widely different cultures should show similar age trends. Results have shown that across cultures, midlife adults scored higher on measures of agreeableness and conscientiousness and lower on neuroticism, extraversion, and openness than 18- to 21-year-olds. Congruence was strongest for openness and weakest for neuroticism, for which only two cultures (Germany and South Korea) replicated the American pattern.
Using the California Psychological Inventory (CPI), factor structures similar to the Big Five were compared among adults in the United States and the People’s Republic of China; comparisons revealed very similar patterns of age correlations.60,62 In a study by Yang and associates,62 the Chinese sample was an average of 25 years younger than the U.S. sample, and age effects were smaller in the U.S. sample. Likewise, Labouvie-Vief and associates found high congruence on all four personality factors derived from the CPI—extraversion, control-norm orientation, flexibility, and femininity-masculinity.60 Older cohorts across cultures had lower scores on extraversion and flexibility and higher scores on control-norm orientation. Once again, age differences were more pronounced among Chinese than U.S. adults. Smaller cultural differences were found among the youngest age groups than among the oldest groups.
In general, the results of these cross-cultural studies are consistent with the hypothesis that there are universally intrinsic maturational changes in personality.60–62 Yang and coworkers reported, however, that across the span from 18 to 65 years, age never accounted for more than 20% of the variance in CPI scale scores.62 Gender did not influence the pattern of results in these cross-cultural studies. The authors differed in their interpretation of the influence of environmental factors. In the Yang and McCrae studies,61,62 the authors maintained that the results offered little support for historical cohort effects being major determinants of cross-sectional age differences in adult personality traits. Although noting the high degree of similarity in personality traits across cultures, Labouvie-Vief and colleagues also noted that cultural climate and cultural change do affect the relationship between age and personality.60
Trait Theories and Health
There is extensive literature on the association of adult personality and health. Neuroticism is one of the traits most frequently studied in relation to health. Neuroticism has been associated with greater reactivity to stress,63 whereas high levels of personal control or mastery serve as a protective factor in regard to the impact of stress on health.64,65 In a recent review of the literature, Hill and Roberts documented several physiologic markers of aging associated with personality traits. In particular, lower interleukin-6 levels, affecting inflammation and C-reactive protein, also influential for acute injuries, have been associated with higher conscientiousness and lower neuroticism.66 Siegman and associates found the dominance factor derived from the Minnesota Multiphasic Personality Inventory (2-MMPI) to be an independent risk factor for incidence of fatal coronary heart disease and nonfatal myocardial infarction among older men, with an average age of 61 years.67 Niaura and coworkers found that among older men, greater hostility may be associated with a pattern of obesity, central adiposity, and insulin resistance, which can exert effects on blood pressure and serum lipid levels.68 A study of Japanese older adults found extraversion, conscientiousness, and openness to be negatively associated with 5-year mortality rates.69 Overall, several studies have documented an association between personality and mortality, indicating that higher levels of neuroticism and lower levels of conscientiousness serve as risk factors of mortality.70–73
Measurement Issues
There are multiple instruments of personality traits that measure the Big Five.74–76 Regardless of the specific measurement instrument used, however, these measures demonstrate remarkable consistency in the derivation of five dimensions of personality via factor analysis.37 However, multiple methodologic issues remain. One major complication of stability estimates in adult personality research involves the type of stability that is under consideration. The impact of cohort and time of measurement on trait consistency within the longitudinal studies conducted to date has not been fully considered.51 Studies of gender role differences have shown that age is not as good a predictor as the life experiences of different cohorts on personality traits of men and women across time.77–79 Thus, it may be that earlier born cohorts developed more consistent personality traits earlier in life as the result of numerous social, historical, and life span–related influences.
More extensive consideration of the relative impact of biologic and environmental variables on stability and change in adult personality is essential. Although the influence of genetic factors has been investigated in the development of personality among monozygotic and dizygotic twins over a 10-year period, no such investigations have addressed the contribution of genetics to the maintenance of personality across the adult age range. Regarding the impact of environmental influences, with time and age individuals may encounter fewer novel experiences.52 Thus, the stability of personality factors may be causally related to the decreasing novelty of the environment in which individuals live rather than genetic factors. Finally, prior research on traits has been primarily descriptive and would profit from a theory-driven approach.
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