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Chapter 2

Theories Related to Care of the Older Adult

No one definition or theory exists that explains all aspects of aging.

Several theories may be combined to explain various aspects of the complex phenomena we call aging.

Biologic, sociologic, and psychologic theories of aging attempt to explain and explore the various dimensions of aging.

No single gerontologic nursing theory has been accepted by this specialty.

Introduction

Help make sense of a particular phenomenon

Provide a sense of order

Give a perspective from which to view the facts

Provide a springboard for discussion and research

Purpose of Theories

Influenced by a composite of biologic, psychologic, social, functional, and spiritual factors

A continuum of events that occur from conception to death

Varies from individual to individual

Human Aging

Concerned with answering basic questions regarding physiologic processes that occur in all living organisms as they age chronologically

Include explanations of the following: (1) deleterious effects leading to decreasing function of the organism, (2) gradually occurring age-related changes that progress over time, and (3) intrinsic changes that may affect all members of a species because of chronologic age

Biologic Theories of Aging

Free radicals are byproducts of fundamental metabolic activities within the body.

Neutralized by enzymatic activity or natural antioxidants, but if they are not neutralized, they may cause cell damage.

Administration of antioxidants postpones the appearance of diseases such as cardiovascular disease and cancer and can influence the decline of the immune system and on degenerative neurologic diseases.

Mitochondrial Free Radical Theory

With age, some proteins become increasingly cross-linked impeding metabolic processes by obstructing the passage of nutrients and wastes between the intracellular and extracellular compartments.

Theory proposes that as a person ages and the immune system becomes less efficient, the body’s defense mechanism cannot remove the cross-linking agent before it becomes securely established.

Cross-linkage has been proposed as a primary cause of arteriosclerosis, decrease in the efficiency of the immune system, and the loss of elasticity often seen in older adult skin.

Cross-linkage theory

A cumulative effect of improper functioning of cells and eventual loss of cells in organs and tissues are therefore responsible for the aging phenomenon.

Life expectancy seen as preprogrammed, within a species-specific range

This biologic clock for humans was estimated at 110–120 years.

Sometimes called the “Biologic Clock Theory,” “Cellular Aging Theory,” or “Genetic Theory.”

Hayflick Limit Theory

As a person ages, the immune system functions less effectively immunosenescence.

Changes include a decrease in humoral immune response: Decreased resistance to a tumor cell challenge and the development of cancer, decreased ability to initiate the immune process and mobilize the body’s defenses against aggressively attacking pathogens, and heightened production of autoantigens, leading to an increase in autoimmune-related diseases.

Immunological Theory

Aging and disease do not necessarily go hand in hand.

There may be a limited replication capacity for certain cells that causes overexpression of damaged genes and oxidative damage to cells.

Free radicals may cause damage to cells over time.

To reduce free radical damage, advise patients to ingest a varied, nutritious diet and suggest supplementation with antioxidants such as vitamins C and E.

Implications for Nursing (1 of 2)

Encourage physical activity like walking to facilitate peripheral circulation and promotes the development of collateral circulation, help with weight control, the replacement of fat with muscle tissue, prevent muscle atrophy, and increase the sense of well-being.

Encouraging preventive measures such as annual influenza vaccination or a one-time inoculation with the pneumococcal vaccine

Recognize that stress, both physical and psychologic, has an impact on the aging process

Implications for Nursing (2 of 2)

Which of the those theories do you believe provides the best explanation for aging? Why?

Quick Quiz!

Answers will vary.

Answer to Quick Quiz

Focus on changing roles and relationships

Early research was carried out largely on institutionalized and ill older persons, which skewed the information collected.

Contemporary research is being conducted in a variety of more naturalistic environments, reflecting more accurately the diversity of the aging population.

Sociologic Theories of Aging

Theory sees activity as necessary to maintain a person’s life satisfaction and positive self-concept.

Even with illness or advancing age, the older person can remain “active” and achieve a sense of life satisfaction.

Activity Theory

The theory proposes that as people age, they try to maintain or continue previous habits, preferences, commitments, values, beliefs, and the factors that have contributed to their personalities.

Continuity Theory

Theory views the aging person as an individual element of society and also as a member, with peers, interacting in a social process.

Attempts to explain the interdependence between older adults and society and how they constantly influence each other in a variety of ways

Age Stratification Theory

Each individual has personal competencies (ego strength, motor skills, individual biologic health, and cognitive and sensory–perceptual capacities) that assist the person in dealing with the environment

Competencies may change with aging, thus affecting the older person’s ability to interrelate with the environment.

Person-Environment Fit Theory

Remember that all older adults cannot be grouped collectively as just one segment of the population.

Four distinct cohort groups and the individuals within each of these cohort groups have their own history:

Young-old: 65–74 years old

Middle-old: 75–84 years old

Old-old: more than 85 years old

Elite-old: more than 100 years old

Implications for Nursing (1 of 2)

Older adults respond to current experiences based on their past life encounters, beliefs, and expectations.

It is within the nurse’s scope of practice to identify maladaptive responses and intervene to protect the integrity of the person.

Helping older adults adjust to limitations while accentuating positive attributes may enable them to remain independent with a high quality of life during later years.

Implications for Nursing (2 of 2)

The basic assumption of the psychologic theories of aging is that development does not end when a person reaches adulthood but remains a dynamic process throughout the life span.

As people age, various adaptive changes help them cope with or accept some of the biologic changes.

The adaptive mechanisms include memory, learning capacity, feelings, intellectual functioning, and motivations to perform or not perform activities.

Psychologic Theories of Aging

Human motivation is viewed as a hierarchy of needs that are critical to the growth and development of all people.

When people achieve fulfillment of their elemental needs, they strive to meet the needs on the next level, continuing until the highest order of needs is reached.

Maslow’s Hierarchy of Human Needs

According to this theory, a person’s personality is visualized as oriented either toward extroversion or toward subjective, inner experiences introversion.

A balance between these two forces is essential for mental health.

The onset of middle age the person begins to question values, beliefs, and possible dreams left unrealized—“ midlife crisis.”

Successful aging is when a person looks inward accepts past accomplishments and limitations.

Jung’s Theory of Individualism

Major focus in this theory is on an individual’s ego structure, or sense of self, especially in response to the ways in which society shapes its development

In each of the eight stages, a “crisis” occurs that affects the development of the person’s ego and the way a person masters any particular stage influences future success or lack of success in mastering the next stage of development.

In 1968, Peck expanded Erikson’s original theory regarding the eighth stage of older adulthood.

Erikson’s Eight Stages of Life

This theory’s central focus is that individuals develop certain strategies to manage the losses of function that occur over time.

This general process of adaptation consists of three interacting elements: selection, optimization, and compensation.

The lifelong process of selective optimization with compensation allows people to age successfully.

Selective Optimization With Compensation

Older adults should be encouraged to engage in a “life review” process by using techniques such as reminiscence, oral histories, and storytelling.

Understand that in each stage of life, specific developmental tasks need to be achieved.

Keep in mind that intellectual functioning remains intact in most older adults.

Remember all individuals enjoy feeling needed and respected and being considered contributing members of society.

Implications for Nursing

Successful aging is “an individual’s perception of a favorable outcome in adapting to the cumulative physiologic and functional alterations associated with the passage of time, while experiencing spiritual connectedness, and a sense of meaning and purpose in life.”

Guides the gerontologic nurse in the provision of mental, physical, and spiritual nursing interventions aimed at promoting positive coping and successful aging.

Theory of Successful Aging

Identifies health as a dynamic state directed at improving the person’s overall sense of well-being

Health is multidimensional in nature and influenced by the person’s environment.

Health Promotion Model

Comfort is “the immediate experience of being strengthened through having the needs for relief, ease, and transcendence met in four contexts of experience (physical, psychospiritual, social, and environmental).”

The theory recognizes the importance of patient involvement in identifying their needs.

Comfort is the holistic outcome of nursing interventions.

Comfort Theory

Important for the nurse to acknowledge the spiritual dimension of a person and support spiritual expression and growth

Spirituality no longer merely denotes religious affiliation; it synthesizes a person’s contemplative experience.

Illness, a life crisis, or even the recognition that one’s days on earth are limited may cause a person to contemplate spirituality.

Moral Spiritual Development