Aging Theories and Nursing Model for Promoting Wellness older adults

Life span

maximum survival potential for member of a species

Life expectancy

Predictable length of time that one is expected to live from a specific point in time

Compression of morbidity

Morbidity onset is later in life due to living a healthy live and have illness and fragility being compressed into a very short time before death

Active life expectancy

-Ranging from inability to perform ADLs to full independent function

-Concern toward improving functioning

-Prevalence of functional impairment varies significantly by race and ethnic groups

Healthy aging

no illness and preserved function

Active aging

high physical and cognitive function

Productive aging

social participation and engagement

Effective aging

the capacity to manage age related life challenges

Successful aging

full concept of aging well

Theories about aging and older adults

-Answer questions about why and how people age

-Help health care providers identify the risk factors that they can address in clinical practices

-These theories do not focus on nursing care of older adults

-Nursing theory: explains relationships among the core concepts of person, nursing, health, and environment

Biologic Theories: Wear and tear theory

Human ‘machine’ declines over time. Longevity affected by genetics and care provided

-Joints wear down over time; difference between 20 year old knee and a 90 year old knee

Biologic Theories: Free radical theory

-Organisms age because they accumulate oxidative damage. Fix with antioxidants

-Pressure injuries, free radicals break down the tissue from inside out

Biologic Theories: Immunosenescence theory

-Age-related decline in immune system heightens susceptibility, may lead to autoimmune conditions such as RA

-body stops responding to the things it used to

Biologic Theories: Program theory

-lifespan of every species/cell predetermined by a genetic program

-cell lifespan decreases with age

Biologic Theories: Caloric restriction theory

Reducing calorie intake by 30-40% without malnutrition increases lifespan in animals

Conclusions based on Biologic theories

-Currently, biologic aging is viewed as inevitable, irreversible and progressive

-The course of aging differs from person to person

-Different tissues and organs age differently in a person

-Biologic aging increases susceptibility to diseases

-Biologic aging processes differ from pathologic processes

-Suggested variability in aging: ¼ genetics, ¼ early life environment, ½ life circumstances in adult life

Relevance of biologic theories of aging to Nurses

-Primary role: identify and address modifiable factors that lead to diseases, disability, death, as well as health-promoting factors

-Nurses need to understand not only the relationship between aging and disease but also what “causes” healthy aging and longevity

-Nurses serve as teachers and advocates for older adults

-Attitudes of health care professionals:

Perspective of “what do you expect, you’re old” interferes with treatable conditions

Attitude of hopelessness with subscribing to aging as a fatal disease

Sociocultural Theories: Activity theory

-Older people remain socially and psychologically fit if they are actively engaged in life

-Volunteering improves quality of life

Sociocultural Theories: Subculture theory

-Old people interact more among themselves and status is based on health and morbidity

-Culture with older adults is very important; get them around people of similar age

Sociocultural Theories: Age stratification theory

-Address interdependencies between age as an element of the social structure and the aging of people in cohorts as a social process

-Meeting social milestones

Sociocultural Theories: Person-environment fit theory (Ecological)

-Older individuals with functional limitations need to adapt to their environments in order to remain independent

-Environment has to fit their needs, must to be functional for the patient

Relevance of sociocultural theories of aging to nurses

-View older adults in relation to society and environments

-A better understanding of influences, i.e.: culture, family, education, community, ascribed roles, cohort effects, home and living settings, personal and political economics

-Emphasizes the importance of assessing environmental factors that influence the functioning of an older person

Psychological Theories on Aging

Provides a framework for addressing psychosocial issues common among older adults

Life-course theories: Maslow Human Needs Theory

-Address the concepts of motivation and human needs

-Hierarchical order of basic human needs

-Self-actualization gives them purpose

Life-course theories: Erikson’ life-course theory

-8 stages of life

-Trust vs. mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, identity vs. identify diffusion, intimacy vs. self-absorption, generatively vs. stagnation, and ego integrity vs. despair

Psychological theories of successful aging

-The theory of selective optimization with compensation

-Socio-emotional selectivity theory

-Gero-transcendence theory: shifting from materialistic to a transcendent vision

Relevance of Psychological Theories of Aging to Nurses

-Nurses can use psychological theories to address response to losses, continued emotional development; ppl who have outlived all friends and family

-Maslow’s hierarchy of needs framework is useful for conceptualizing the nature of interventions in institutional or home settings; decrease social isolation

-Devoting time and energy to life review and self-understanding can be beneficial for older adults; want them participating in life

-Nurses can facilitate this process by asking sensitive questions and by listening attentively to older adults as they share information about their past; find out what matters to them

-Reminiscence: positive experience

How aging theories relate to nursing

-Biologic aging theories provides important data on: How cells age and what triggers the aging process; Risk factors aggravate age-related changes

-Sociocultural theories: Helps nurses view older adults in relation to society and cultural environment

-Psychological theories: addresses psychological factors pertinent to aging such as coping with loss

-Discipline specific nursing theories focus on the core concepts of person, nursing, health and environment

-Informs nursing care of older adults; Are essential to promote wellness of older adults

Functional Consequences Theory

-A framework to promote wellness, function, and quality of life for older adults

-Age related changes, risk factors, and potential negative functional consequences

-Reflects the evolving understanding of wellness as integral aspect of focused care of older adults

-Goal: address unique relationships among concepts of person, health, nursing, and environment in context of promoting wellness for older adults

-Nurses: what we can change, what we can’t, what we can teach

Basic premises of the functional consequences theory

-Holistic nursing care addresses the body-mind-spirit interconnectedness of each older adult and recognizes that wellness encompasses more than physiologic functioning

-Although age-related changes are inevitable, many risk factors can be prevented or alleviated

-Older adults experience positive or negative functional consequences because of a combination of age-related changes and risk factors

-Interventions can be directed toward alleviating or modifying the negative functional consequences of risk factors

-Nurses can promote wellness in older adults through health promotion interventions and other nursing actions that can address the negative functional consequences

-Nursing interventions result in positive functional consequences, also called wellness outcomes, which enable older people to function at their highest level despite the presence of age-related changes and risk factors

Concepts Underlying Functional Consequences Theory

-Age-related changes and risk factors increase vulnerability to negative functional consequences

-Nurses assess age-related changes, risk factors, and functional consequences

-Goal: to identify factors that can be addressed through nursing interventions

-Wellness outcomes enable functioning at the highest level despite presence of age-related changes and risk factors

Age-related changes

-inevitable, irreversible and progressive and are not caused by extrinsic or pathologic conditions

-On physiologic level: changes are typically degenerative

-On psychological and spiritual levels: potential for growth

Risk factors

-Conditions that are likely to occur in older adults and have significant detrimental effect on their health and functioning

-Sources of risk factors: environments, acute and chronic conditions, psychosocial conditions, or adverse medication effects

-Risk factors can be modified or eliminated to improve functioning and quality of life for older adults

-A major focus of wellness focused nursing is to identify risk factors that can be addressed through health promotion interventions

Functional consequences

-Observable effects of actions, risk factors, and age-related changes that influence the quality of life or day-to-day activities of older adults

-Actions: purposeful interventions initiated by either older adults (i.e., self-care) or nurses (nursing interventions) and other caregivers

-Risk factors can originate in the environment or arise from physiologic and psychosocial influences

-Negative functional consequences: interfere with a person’s level of function or quality of life or increase a person’s dependency

-Positive consequences: facilitate the highest level of performanace and the least amount of dependency

Functional Status

-Part of goal of improving health/wellbeing

-Some types of functional decline can be prevented or decreased through nursing interventions

-Poor functioning often cause of nursing home placement

-Comprehensive functional assessment included Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), cognitive level, sensory ability, pain level, and ability to ambulate safety

Goals Focused on Functional Status

-Focus on existing abilities to facilitate independence, self-determination, and social integration

-Goal of rehabilitation nursing is to assist the patient to attain and maintain optimum health as defined by the patient

-Maximize independence and prevent secondary disability as well as to promote a quality of life acceptable to the patient

Holistic perspective on aging and wellness

-Context of the interplay among the many factors that influence health and aging

-Determinants of living long and well: Inherit good genes, Avoid oxidative damage, Protect from oxidative damage with antioxidants from natural sources, Maintain optimal weight, Engage in physical exercise, Engage in meaningful social interactions, Develop close personal relationships, Maintain a sense of spiritual connectedness, Reject ageist stereotypes