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Chapter: Medical Surgical Nursing: Health Care of the Older Adult

Psychosocial Aspects of Aging

Normal Age-Related Changes and Health Promotion Activities


Successful psychological aging is reflected in the older person’s abil-ity to adapt to physical, social, and emotional losses and to achieve contentment, serenity, and life satisfactions. Because changes in life patterns are inevitable over a lifetime, the older person needs resiliency and coping skills when confronting stresses and change.

Apositive self-image enhances risk taking and participation in new, untested roles.


Although attitudes toward old people differ in ethnic subcul-tures, a subtle theme of ageism—prejudice or discrimination against older people—predominates in our society. It is often based on stereotypes, simplified and often untrue beliefs that re-inforce society’s negative image of the aged person. Elderly peo-ple make up an extremely heterogeneous group, yet negative stereotypes are attributed to all of them.


Fear of aging and the inability of many to confront their own aging process may trigger ageist beliefs. Retirement and perceived nonproductivity are also responsible for negative feelings, since the younger working person may see the older person as not con-tributing to society and draining economic resources. This nega-tive image is so common in American society that the elderly themselves often believe it. Only through an understanding of the aging process and respect for each person as an individual can the myths of aging be dispelled. If the elderly are treated with dignity and encouraged to maintain autonomy, the quality of their lives will improve.

Stress and Coping in the Older Adult

Coping patterns and the ability to adapt to stress are developed over the course of a lifetime and remain consistent later in life. Experiencing success in younger adulthood helps a person de-velop a positive self-image that remains solid through even the ad-versities of old age. A person’s abilities to adapt to changes, make decisions, and respond predictably are also determined by past ex-periences. A flexible, well-functioning person will probably con-tinue as such. Losses may accumulate within a short period of time, however, and become overwhelming. The older person will often have fewer choices and diminished resources to deal with stressful events. Common stressors of old age include normal aging changes that impair physical function, activities, and ap-pearance; disabilities from chronic illness; social and environ-mental losses related to loss of income and decreased ability to perform previous roles and activities; and the deaths of significant others. Many older adults rely strongly on their spiritual beliefs for comfort during stressful times.


Lack of social engagement (interaction with people within their environment) may be a modifiable risk factor for death in older persons residing in nursing homes. A 5-year study of more than 900 residents of nursing homes, whose average age was 87 years, revealed that those who did not receive social interaction were 2.3 times more likely to die during the follow-up period (Kiely et al., 2000).


Developmental Theories of Aging


Erikson (1963) theorized that a person’s life consists of eight stages, each stage representing a crucial turning point in the lifespan stretching from birth to death with its own developmentalconflict to be resolved. According to Erikson, the major devel-opmental task of old age is to either achieve ego integrity or suffer despair. Achieving ego integrity requires accepting one’s lifestyle, believing that one’s choices were the best that could be made at a particular time, and being in control of one’s life. De-spair results when an older person feels dissatisfied and dis-appointed with his or her life, and would live differently if given another chance.


Havighurst (1972) also suggested a list of developmental tasks that occur during a lifetime. The tasks of the older person include adjusting to retirement after a lifetime of employment with a pos-sible reduction of income, decreases in physical strength and health, the death of a spouse, establishing affiliation with one’s age group, adapting to new social roles in a flexible way, and es-tablishing satisfactory physical living arrangements.

Combining the concepts of both Erikson and Havighurst suggests the following developmental tasks for the older adult: (1) maintenance of self-worth, (2) conflict resolution, (3) adjust-ment to the loss of dominant roles, (4) adjustment to the deaths of significant others, (5) environmental adaptation, and (6) main-tenance of optimal levels of wellness.


Sociologic Theories of Aging


Sociologic theories of aging attempt to predict and explain the social interactions and roles that contribute to the older adult’s suc-cessful adjustment to old age. The activity theory proposes that life satisfaction in normal aging requires maintaining the active lifestyle of middle age (Havighurst, 1972). The continuity theory proposes that successful adjustment to old age requires continu-ing life patterns across a lifetime (Atchley, 1989; Neugarten, 1961). Continuity and a connection to the past are maintained through a continuation of well-established habits, values, and interests that are integral to the person’s present lifestyle.


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