NCM 114 - 5F

Aging: Aspects and Theories

Four Aspects of Aging

• Chronological Age

  • Definition: Number of years a person has lived.

  • Characteristics:

  • Most objective form of age.

  • Does not necessarily reflect health, cognition, or social function.

  • Example: A 75-year-old may function younger or older physically or mentally.

• Biological Age

  • Definition: Predicted by physical conditions and functioning of vital organ systems.

  • Influences:

  • Lifestyle choices, genetics, diseases, and environmental factors.

  • Example: An active 80-year-old marathon runner may have a lower biological age than a sedentary 65-year-old.

• Psychological Age

  • Definition: Expressed through memory, learning ability, emotional control, and judgment.

  • Importance:

  • Indicates emotional and mental capabilities regardless of chronological age.

  • Affects older adults' coping mechanisms and social engagement.

  • Maintaining mental activity is essential to preserve a younger psychological age.

• Social Age

  • Definition: Measured by culturally defined roles and expectations based on age.

  • Characteristics:

  • Roles such as grandparent, retiree, or community elder.

  • Influences self-esteem, identity, and social engagement.

  • Loss of social roles can lead to isolation and confusion in late adulthood.

Psychological Theories of Aging

• Carl Jung's Personal Psychological Theory

  • Personality: Individual's unique patterns of thinking, feeling, and behaving.

  • Concept of Aging: Jung suggested this: Movement from extroversion to introversion.

  • Dimensions of Personality Change:

  • Extraversion vs. Introversion:

    • Introversion: Energy directed inward towards thoughts and feelings.

    • Extraversion: Energy directed outward towards people and activities.

  • Sensing vs. Intuition: how you understand the world

    • Sensing: Focus on facts and details.

    • Intuition: Focus on big ideas and possibilities.

  • Thinking vs. Feeling: how you make decisions

    • Thinking: Based on logic and rules.

    • Feeling: Based on values and emotions.

  • This shift starts at Midlife Shift: Begins questioning dreams, values, and priorities, accumulating into individual styles such as introversion + sensing + thinking.

Sociological Theories of Aging

• Disengagement Theory

  • Definition: Older individuals naturally withdraw from social roles and relationships.

  • Societal Expectations: As people age, society often expects them to step back from societal activities and connections.

  • Basically stepping back from societal rules

• Activity Theory

  • Definition: Older adults are happier and healthier when they remain active socially, mentally, and physically.

  • Examples of Engagement: Volunteering, joining clubs, and maintaining social interactions.

• Continuity Theory

  • Definition: Older adults seek to maintain the same lifestyle, habits and relationships as they had earlier in life.

  • Examples: Continuing hobbies, routines, and relationships.

• Age Stratification Theory

  • Definition: Society is divided into age groups (youth, middle age, old age) with distinct roles, expectations, and privileges.

  • Dynamics: Movement from one age group and its associated roles to another.

• Modernization Theory

  • Definition: Aging status changes as society modernizes.

  • Observations: In traditional societies, elders were respected; in modern industrialized societies, their status may decline due to a focus on youth and technology.

Nursing Implications of Aging Theories

• Disengagement Theory: Respect the desire for solitude; support fewer but meaningful activities to prevent social isolation.

• Activity Theory: Encourage hobbies, community involvement, and physical activity, foster social participation

• Continuity Theory: Support familiar routines, encourage independence, and incorporate life history into care.

• Modernization Theory: Advocate for the dignity and rights of elders; educate families about elder contributions, empower elders in decisions

• Age Stratification Theory: Address ageism in healthcare; ensure access to services and promote intergenerational health programs.

Jahoda’s Six Aspects of Positive Mental Health

he observed that positive mental health includes one or more of the following aspects

• Self Attitudes: Good self-image, self-acceptance, and confidence.

• Growth and Development: Ability to grow, learn, and realize potential.

• Integration: Balancing stress and emotions effectively.

• Autonomy: Making independent decisions and not just follow others

• Perception of Reality: Seeing things as they are not with too many distortion or denial.

• Environmental Mastery: Managing everyday life and adapting to changes effectively.

Cognition and the Aging Brain

• Cognition Defined: The process of acquiring, storing, sharing, and using information.

• Cognitive Function Stability: Functions that may remain stable include:

  • Attention span 

  • Language and communication skills

  • Comprehension and discourse

  • Visual perception

• Myths and Facts About Aging Brain:

  • Myth: People lose brain cells every day.

  • Fact: Most brain areas do not lose cells daily; rather, lost nerve connections are part of brain plasticity.

  • Myth: Aging means you can't change your brain.

  • Fact: The brain retains plasticity and can adapt in response to experiences.

  • Myth: Memory decline is inevitable.

  • Fact: Many older adults maintain good memory without problems; lifestyle factors influence this.

  • Myth: You can’t teach an old dog new tricks.

  • Fact: Older adults can and should be provided opportunities for continued learning.

Fluid vs. Crystallized Intelligence

• Fluid Intelligence: also called as quick thinking

  • Definition: Ability to think quickly, solve new problems, and adapt to new situations; declines with age.

  • Example: Solving a puzzle or using a brand new device.

• Crystallized Intelligence:

  • Definition: Knowledge and skills gained from experience and education; generally stable or improves with age.

  • Examples: Vocabulary, general knowledge, and practical skills like cooking or driving.

Developmental Tasks of Late Adulthood

• Erik Erikson’s Integrity vs. Despair:

  • Integrity: Sense of fulfillment from a meaningful life despite imperfections.

  • Despair: Regret and fear of death due to unresolved issues from younger years. Tendency to fall into hopelessness

• Robert Havighurst’s Tasks for Ages 60+:

  • Adapting to decline in physical strength

  • Adapting to retirement and reduced income.

  • Coming to terms with the death of a spouse.

  • Maintaining social relationships and establishing good physical arrangments.

Mental Health Incidences and Influencers in Older Adults

• Global Incidence: Over 20% of adults aged 60 or older suffer from a mental or neurological disorder.

  • Common Issues: Dementia (5%) and depression (7%)

  • Overlooked Issues: Substance abuse problems affecting nearly 1%.

• Influencing Factors: Education, income, employment history, and social support networks.

Common Mental Health Problems

• Depression in Older Adults: Higher rates of suicide among older adults than younger individuals; symptoms include vegetative signs.

  • Vegetative Signs: Symptoms are often physical, like sleep disturbances, appetite changes, and fatigue, somatic complaints (unexplained physical aches and pain that have no clear medical cause)

• Bipolar Disorder: May appear in early life but continue into old age, or rarely onset in later years.

• Manic episodes may be milder in older adults, but risk of psychosis or medical complications increase.

• Mood: 

• they spend more time in the depressed state and less time in the manic state.

• the “highs” (Mania) is usually less happy/euphoric and more about irritability, being cranky, or acting confused

  • Medication Monitoring: Lithium is the gold standard; safe levels must be monitored closely (lithium toxicity is higher in elderly) toxic level: 0.8-1.2 mEq/L, greater than 1.5 early signs of toxicity, especially in older patients.

  • Monitor mood changes, nutrition, sleep, and safety risks

  • Coordinate with mental health professionals for mood stabilization.

• Anxiety Disorders: Includes generalized anxiety disorder (GAD), panic disorder, phobias, and post-traumatic stress disorder (PTSD).

• Often occurs with depression and chronic illness.

• Symptoms: Restlessness, muscle tension, insomnia, excessive worry, and irritability 

• Constant overall worrying about normal, everyday things (money, work, family) that is hard to control.

• Duration: The worry must be present on most days for at least six months for a diagnosis.

• Panic Disorder: involves current, unexpected panic attacks followed by persistent worry about having more attacks.

• Key features: sudden episodes of intense fear or terror that reach a peak within minutes. They often feel like they come “out of the blue”.

• Post-traumatic Stress Disorder (PTSD): a mental health condition that some people develop after experiencing or witnessing a terrifying, life-threatening, or extremely distressing event.

Common Mental Problems in Older Adults

• Stress in Aging: Comes from Health changes, loss of independence, caregiving responsibilities, or bereavement.

• Defense Mechanisms:

  • Common ones: Denial, projection, regression, rationalization.

  • Can be adaptive or maladaptive depending on intensity and duration.

Personality Disorders

• Definition: Less common in older adults but can persist from earlier in life; types includes: paranoid, schizoid, obsessive-compulsive, avoidant, and borderline disorders.

  • Can interfere with Relationships, treatment adherence, quality of life.

  • pattern of behavior (fixed, maladaptive, inflexible)

  • here we have clusters/group

• Cluster A (PA S ST): odd and eccentric

• Cluster B (HIS TO BO NA): dramatic erratic and functional

• Cluster C (DO PA): fearful and anxious

Schizophrenia and Suicide in Older Adults

SCHIZOPHRENIA

• A thought disorder characterized by altered perceptions of reality, alterations in thought process and declines in ADLs and occupational and social functioning

• Onset occurs between the late teens and mid 30’s. However in rare cases, schizophrenia has an onset after age 45 (APA, 2013)

SUICIDE

• One of the leading causes of suicide among older adults is depression

• The act of suicide is rarely preceded by only one cause or one reason; common risk factors include the following:

  • Recent death of a loved one

  • Physical illness, uncontrollable pain, or fear of a prolonged illness

  • Perceived poor health

  • Social isolation and loneliness

  • Major changes in social roles (retirement)

• Passive suicide and subintentioned suicide – it is a passive attempt to hasten one’s death

Promoting Mental Health (Jahoda & Vaillant)

• Vaillant’s 7 Concepts of Positive Mental Health

  • Above Normal Functioning

  • Presence of Strengths

  • Maturity

  • Positive Emotions

  • Socio-Emotional Intelligence

  • Subjective Well-Being

  • Resilience

MENTAL HEALTH PROMOTION

• Is any activity or action that strengthens or protects mental health and well-being

• Works at 3 levels:

  • Strengthening individuals

  • Strengthening communities

  • Reducing structural barriers to mental health

AGEISM

• Ageism = stereotyping, prejudice, and discrimination against people based on their age (commonly older adults).

• Can be explicit (direct discrimination) or implicit (unconscious bias).

Ageism (The ABCs)

• Attitudes (Prejudice)

• Beliefs (Stereotypes)

• Conduct (Discrimination)

Elder Mistreatment

• Often referred to as elder abuse, is a serious and growing problem that involves harm or a serious risk of harm to an older adult.

• Includes any act, or lack of action that causes harm or distress to an older person.

Types of Elder Mistreatment

1. Physical Abuse → Infliction of pain/injury (hitting, pushing, overmedicating, restraints).

2. Emotional/Psychological Abuse → Verbal threats, humiliation, intimidation, isolation.

3. Financial Exploitation → Misuse of money, property, or assets.

4. Neglect → Failure to provide food, shelter, medical care, or protection.