Theories of Aging

issues addressed by theory

what do we want to explain?

• the aged: the population of those who can be categorized as elderly in terms of their length of life or expected life span, often with an emphasis on disability or barriers to independent living

• aging as a developmental process

• age as a dimension of structure and behavior within species

biological theories of aging

focus on body systems and body functions

• stochastic theories

• developmental-genetic theories

• evolutional theories

stochastic theories

• explains aging as resulting from the accumulation of “insults” from the environment, which eventually reach a level incompatible with life

• defect in protein synthesis mechanism, leads to errors in proteins

developmental-genetic theories

propose that the process of aging is continuous with and probably operating through the same mechanisms as development and, hence, is genetically controlled

evolutionary theories

evolutional theories attempt to explain the origin of again as well as the divergence of species’ life spans

neuropsychological theories of aging

theories of typical age-related change

• based on the principle that neural structures and related abilities laid down last should be the most vulnerable to processes of aging

theories of neurodegenerative change

• age-linked neuropathological changes of the brain that produce observable degenerative deficits in cognitive functioning

psychological theories of aging

• life-span development

  • theory that the 2nd half of life is characterized by

    • significant individual differentiation

    • multi-directionality

    • intra-individual plasticity

• selective optimization with compensation

  • model of psychological and behavioral adaptation, identifying 3 fundamental mechanisms…for managing adaptive development in later life

    • selection

    • optimization

    • compensation

• socioemotional selectivity

  • describes the individual choices in interaction, based on

    • self-interest

    • needs for emotional closeness that lead to selective interactions

• cognition and aging

  • thinking about…

    • distal determinance- the factors that affect cognition reside outside the individual

      • e.g., in a social and cultural environment

    • proximal determinance- specific individual differences that are the cause of cognitive changes

• personality and aging

  • theories that focus on the extent and the nature of personality stability and change over time

life-span development theory

• conceptualizes ontogenetic development as biologically and socially constituted and as manifesting both developmental universals (homogeneity) and interindividual variability (e.g., differences in genetics and in social class)

• identify 3 principles regulating the dynamics between biology and culture across the ontogenic life span:

  • 1. evolutional selction benefits decrease with age

  • 2. the need for culture increases with age

  • 3. the efficacy of culture decreases

selective optimization with compensation (SOC)

a model of psychological and behavioral adaptation where the central focus is on managing the dynamics between gains and losses as one ages

• selection refers to the increasing restriction of an individual’s life to fewer domains of functioning because of age-related loss in the range of adaptive potential

  • e.g., the number of hobbies an older adult takes part in may slowly decrease over time as they age

  • e.g., the extent/difficulty to which a hobby is done is decreased over time as an older adult ages (e.g., walking 1 mile a day instead of 3 miles)

• optimization reflects the idea that people engage in behaviors that augment or enrich their general reserves and maximize their chosen life courses

• compensation results from restriction of the range of adaptive potential and becomes operative when specific behavioral capacities are lost or are reduced

socioemotional selectivity theory

• combines insights from developmental psychology- i.e., the Selective Optimization with Compensation Model

• through mechanisms of socioemotional selectivity, individuals reduce interactions with some people as they age and increase emotional closeness with significant others

  • less quantity of people in their lives, but stronger quality in relationships

• chosen interactions reflect the levels of reward these exchanges of emotional support achieve

cognition and aging

personality and aging

• the primary phenomenon to be explained by a theory of cognition is the age-related decline in fluid cognitive performance (e.g., relevant and functional in-the-moment cognition, involving problem-solving)

• personality theories focus on the extent and nature of personality stability and change over the life span

  • developmental explanations

  • trait explanations

client-centered approaches with older adults

systems theory of motor control

• motor movement can only be understood as an interaction of internal and external forces acting on the body

• can’t look at things in isolation; must look at physical, social, cultural, virtual, etc. environments

model of human occupation

• occupational participation, or engagement in work, leisure, or activities of daily living comprises 3 interrelated components

  • volition

  • habituation

    • process by which an occupation is organized into patterns and routines

    • how we get clients to generalize and incorporate therapeutic strategies into their daily lives

  • performance capacity

• OTs should enable clients to choose and engage in therapy activities that they

  • find interesting

  • think they are capable of achieving (personal causation)

  • believe is a value to themselves or to others

theory guides practice

• theory is developed to explain phenomena, but also to guide intervention

• assessment and intervention are typically based in beliefs about the nature of humans and strategies for change

• MOHO is an example of a theory that can explain the experience of growing older in the context of human performance

OT role in aging

• promotion of physical activity and physical capacity

  • exercises given, however, must have relevance to occupation (e.g., strengthening arm exercises —> to help with stand-pivot transfers from wheelchair to bed)

• enabling participation in social roles, habits, and routines

• application of strategies to help maintain physical and cognitive function

• AOTA has identified Productive Aging as a key practice area in the 21st century

health promotion is

the process of enabling people to increase control over, and to improve, their health

essence of OT

belief that active engagement in occupation promotes, facilitates, supports, and maintains health and participation

health management is

an important occupation for clients within the domain of OT

potential outcomes of OT services

• OT intervention approaches

• prevention

• health and wellness

• QoL

• participation

• well-being

• occupational justice

AOTA official document: occupational therapy programs:

promotion of health and well-being

• prevention or reduction in incidence of illness or disease, accidents, and injuries (e.g., environmental modifications)

• promotion of positive mental health through competence enhancement strategies (e.g., environmental supports)

• mitigation of mental illness through risk reduction strategies (e.g., healthy habits)

• reduction of health disparities among racial and ethnic minority groups and underserved populations

• enhancement of mental health, resilience, and improvement in health with chronic conditions or disabilities and their caregivers

• promotion of health living practices, social participation, occupational justice, and healthy communities (e.g., inclusive community programming)

basic principles of rehab for older adults

• client-centered

• include caregivers and family members

• use a team approach

• address primary impairments, activity, and participation limitations

• prevent secondary impairments, activity, and participation limitations

• address health promotion and wellness

• optimize functional independence

• consider inter-client variability

• consider how personal and environmental factors may influence outcomes

• goals: meaningful, individualized, collaborative, clearly communicated, realistic, and measurable

goals of the World Health Organization International Classification of Function (ICF)

• provides a scientific basis for understanding and studying health and health-related states, issues, outcomes, and determinants

• establish a common, international language for describing health and health-related states in order to improve communication among different users, such as health-care professionals, researchers, health policy makers and managers, and the public

• allow for comparison of data across countries, health-care disciplines, and health services and sectors

• provide a systematic coding scheme for health information systems

ICF domains

• body function

  • the physiological functions of body systems, and psychological functions

• body structure

  • anatomical parts of the body, such as organs, limbs, and their components

• abnormalities of function, as well as abnormalities of structure, are referred to as impairments

• activity and participation

  • activity is the execution of a task or action by an individual and represents the individual perspective of functioning

  • participation refers to the involvement of an individual in a life situation and represents the societal perspective of functioning

  • difficulties at an activity level are referred to as activity limitations, and problems an individual may experience in his or her involvement in life situations are denoted as participation restrictions
    

how to prioritize what to work on first with a client

Healthy People 2030: objectives for older adults

• aims to promote collaborative efforts- of individuals, institutions, and organizations- to improve and sustain health for all Americans and address community health needs

• nearly half (11/23) of leading health indicators relate to either lifestyle behavioral factors or social determinants of health

• it’s a call to action and a population health blueprint for the next 10 years