Erikson described the psychological challenge of the last stage of life as Ego Integrity vs. Despair. By this he meant that adults at this stage are facing the end of their life. Many decisions have been made, life has been largely lived, and it has brought both disappointments and rewards. When people can see their life as a whole and accept both its disappointments and gratifications as part of a complete narrative, then they can achieve ego integrity. When older adults cannot accept their disappointments and thwarted dreams, they fall into despair. Life will soon be over and there are no more chances.

Erikson’s wife, Joan, later wrote about an additional stage for the very old, which she termed gerotranscendance. In this stage, in the ninth or tenth decade of life, people begin to look beyond their own individual lifespan. Very close to their own death, they start to transcend their identity as a single, isolated person and begin to see themselves as part of a larger whole that will live on after their own death. Accordingly, research has shown that older adults are more involved in religious activities than are younger people. Several other theorists, such as Heinz Kohut, Daniel Levinson, and Bernice Neugarten, also write about the need in late life to come to terms with both the positive and negative aspects of one’s life as lived as well as the losses of aging, the diminished role of the self, and the impending end of life.