Theris A. Touhy
Social, psychological, spiritual, and cognitive aspects of aging
THE LIVED EXPERIENCE
If I Had My Life to Live Over
I’d dare to make more mistakes next time, I’d relax, I would limber up. I would be sillier than I’ve been this trip. I would take fewer things seriously. I would take more chances. I would climb more mountains and swim more rivers. I would eat more ice cream and less beans. I would perhaps have more actual troubles, but I’d have fewer imaginary ones.
You see, I’m one of those people who live sensibly and sanely hour after hour, day after day. Oh, I’ve had my moments, and if I had to do it over again, I’d have more of them. In fact, I’d try to have nothing else. Just moments, one after another, instead of living so many years ahead of each day. I’ve been one of those persons who never goes anywhere without a thermostat, a hot water bottle, a raincoat, and a parachute. If I had it to do again, I would travel lighter than I have.
If I had my life to live over, I would start barefoot earlier in the spring and stay that way later in the fall. I would go to more dances. I would ride more merry-go-rounds. I would pick more daisies.
Nadine Stair (1992)
Learning objectives
Upon completion of this chapter, the reader will be able to:
• Explain the major psychological and sociological theories of aging.
• Discuss the influence of culture and cohort on psychological and social adaptation.
• Discuss the importance of spirituality to healthy aging.
• Explain cognitive changes with age and strategies to enhance cognitive health.
Glossary
Cognition The mental process characterized by knowing, thinking, learning, and judging.
Cross-sectional A study design in which data are collected at one point in time on several variables such as gender, income, education, and health status.
Geragogy The application of the principles of adult learning theory to teaching for older adults.
elsevier.com/Ebersole/gerontological
Social, psychological, spiritual, and cognitive aspects of aging
There are normal biological, psychological, social, and cognitive changes in the process of aging. The biological changes are discussed in Chapter 5. This chapter is meant to provide the reader with information on the psychological, social, cognitive, and spiritual aspects of aging. Factors influencing learning in late life, appropriate teaching and learning strategies, and health literacy are also discussed.
Each individual has unique life experiences and because of this must be seen holistically, through the lens of his or her time, place, culture, gender, and personal history. The close relationship among biological, social, and psychological development that exists through childhood and adolescence varies more in adulthood because of the greater variations in life experiences and demands as one matures.
Life span development approach
Human development goes on throughout life and is a lifelong process of adaptation. Life span development refers to an individual’s progress through time and an expected pattern of change: biological, sociological, and psychological. A summary of the key principles of the life span developmental approach, provided by Papalia and colleagues (2002), is based on the work of Paul Baltes and colleagues (Baltes, 1987; Baltes et al., 1998). Principles include the following:
Types of aging
People age in a number of ways. Aging can be viewed in terms of chronological age, biological age, psychological age, and social age. These ages may or may not be the same. Chronological age is measured by the number of years lived. Biological age is predicted by the person’s physical condition and how well vital organ systems are functioning. Psychological age is expressed through a person’s ability and control of memory, learning capacity, skills, emotions, and judgment. Maturity and capacity will direct the manner in which one is able to adapt psychologically over time to the requirements of the physical and social environment. Social age may be quite different from chronological age and is measured by age-graded behaviors that conform to an expected status and role within a particular culture or society. A person may be chronologically 80 years of age but biologically 60 years of age because he or she has remained fit with a healthy lifestyle. Or, a person with a chronic illness may be biologically 80 years of age but psychologically is much younger because he or she has remained active and involved in life.
There are several psychological and sociological theories of aging. In contrast to biological theories of aging, the psychological and sociological theories are not always based on empirical evidence because of methodological and measurement-related problems. The majority of these theories were developed from a Eurocentric perspective and may be less useful to describe aging within other cultures, especially those that are collective rather than individualistic (see Chapter 4). The importance of opportunity, ethnicity, gender, and social status is largely ignored. In addition, the theories have little to do with personal meaning and motivation; however, they may be useful as a guide in helping us understand the world around us and move toward healthy aging. As current generations of elders move through this period of life development, many of the ideas we have about this period of life are being, and will continue to be, redefined.
Sociological theories of aging
Sociological theories of aging attempt to explain and predict the changes in roles and relationships in middle and late life, with an emphasis on adjustment. Many of the basic theories were developed in the 1960s and 1970s and must be viewed within the context of the historical period from which they emerged. Some of the theories continue to generate interest and thought, such as modernization and social exchange theories, and others, such as disengagement theory, are no longer considered relevant.
Disengagement theory
The disengagement theory states that “aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social system he belongs to” (Cummimg & Henry, 1961, p. 2). This means that withdrawal from one’s society and community is natural and acceptable for the older adult and his or her society. The measures of disengagement are based on age, work, and decreased interest or investment in societal concerns. The theory is seen as universal and applicable to older people in all cultures, although there are expected variations in timing and style.
Activity theory
The activity theory is based on the belief that remaining as active as possible in the pursuits of middle age is the ideal in later life. Because of improved general health and wealth, this is more possible than it was 40 years ago when Maddox (1963) proposed this theory. The activity theory may make sense when individuals live in a stable society, have access to positive influences and significant others, and have opportunities to participate meaningfully in the broader society if they continue to desire to do so. Attempts at clarifying activity theory as a general concept of satisfactory aging have not been supported.
Continuity theory
The continuity theory, proposed by Havighurst and co-workers (1968), explains that life satisfaction with engagement or disengagement depends on personality traits. Three ideas about personality (Neugarten et al., 1968) are important to understanding continuity theory:
Age-stratification theory
Age-stratification theory is a newer approach to understanding the role, the reactions, and the adaptations of older adults. Like continuity theory, it specifically challenges activity theory and disengagement theory. Age-stratification theory goes beyond the individual to the age structure of society (Marshall, 1996). The structuring of different ages can take a number of different forms, including the conceptualization of “young,” “middle-aged,” and “old.” With the increasing life expectancy and compressed morbidity, age categories are changing. Readers have probably heard that “60 is the new 40.” In the future, 60 to 80 years of age may be considered “young-old,” 80 to 100 years of age “middle-old,” and 100 years of age and over, “oldest-old.”
Historical context is a key component of age-stratification theory. Elders can be understood as members of cohorts along with others who have shared similar historical periods in their lives, with age-graded systems of expectations and rewards. They have been exposed to similar events and conditions and common global, environmental, and political circumstances (e.g., World Wars, Great Depression, Viet Nam, civil rights movement) (Riley et al., 1972). Hooks (2000) reminds us that race must be considered when understanding cohort effects.
This theory may be particularly useful to examine aging within a global context. The definitions of age strata usually encompass social and cultural expressions of aging as well as who is placed in a given stratum and when. The cohort effect can be used as a powerful tool for understanding the potential life experiences of people from not only different cultures, but also different parts of the world.
Social exchange theory
Challenging both activity theory and disengagement theory, social exchange theory is based on the consideration of the cost-benefit model of social participation (Dowd, 1980). It explains that withdrawal or social isolation is the result of an imbalance in the exchanges between older persons and younger members of society and that the balance is what determines one’s personal satisfaction and social support at any point in time.
Older adults are often viewed as unequal partners in the exchange and may need to depend on metaphorical reserves of contributions to the pool of reciprocity. This may be seen in the expectation of elderly African Americans for care as “pay-back” for their providing care to others earlier in their lives (Jett, 2006). Other elders care for younger grandchildren so that their adult children can work. For this they may receive total support (i.e., room, board, income). Although this exchange may appear uneven, it can also be viewed from the more holistic perspective of a lifetime of exchanges and contributions. Hooyman and Kiyak (2011) noted that “although older individuals may have fewer economic and material resources, they often have nonmaterial resources such as respect, approval, love, wisdom, and time for civic engagement and giving back to society” (p. 323). Intergenerational programs are an example of the value of social exchange between generations.
Modernization theory
Modernization theory attempts to explain the social changes that have resulted in the devaluing of both the contributions of elders and the elders themselves. Historically (before about 1900 in the United States), materials and political resources were controlled by the older members of society (Achenbaum, 1978). The resources included not only their time, as shown in the examples just described, but also their knowledge, traditional skills, and experience. According to this theory, the status, and therefore the value, of elders is lost when their labors are no longer considered useful. Kinship networks are dispersed, the information they hold is no longer useful to the society in which they live, and the culture in which they live no longer reveres them. It is proposed that these changes are the result of advancing technology, urbanization, and mass education.
Treatment of the elderly in modern Japan was long considered evidence of the inaccuracy of the theory. Historically, Japanese elders were given the highest status and held the greatest power. This did not seem to change with the industrialized advances after World War II. However, today Japan not only is a highly modern country from an industrial point but also is showing signs of “modernization” in social relations with elders. Other researchers have also found support of the modernization theory in other societies such as India and Taiwan (Dandekar, 1996; Silverman et al., 2000).
Symbolic interaction theories
Symbolic interaction theories focus on the interaction between the older adult and their social world. The interactions between older adults and their environment significantly affect their experience of the aging process and of themselves. “People reflect on their lives and design ways of understanding their position in the social system. When confronted with change, whether in the process of relocating to a long-term care facility or learning to use a computer, elders are expected to try to master the new situation while extracting from the larger environment what they need to retain a positive self-concept” (Hooyman & Kiyak, 2011, p. 320). With this perspective, one has to examine how the individual’s resources and activities, as well as the environmental demands and supports, can be altered to enhance satisfaction and self-concept.
Implications for gerontological nursing and healthy aging
The sociological theories of aging provide the gerontological nurse with useful information and a background for enhancing healthy aging and adaptation (Box 6-1). Although these theories have neither been proved nor disproved, many of the ideas they discuss have withstood the test of time. The theories have been adapted and applied to contemporary approaches to aging in many ways, from the concept of senior centers (activity theory) to nursing assessments of social support (social exchange theory). And, unfortunately, the disengagement theory is still applied any time one incorrectly assumes depression and isolation to be a “normal” part of aging. Further research is needed to explore how culture, ethnicity, and gender influence aging and adaptation. This is particularly important in light of the expected growth of a very diverse aging population.
Psychological theories of aging
Psychological theories presuppose that aging is one of many developmental processes experienced between birth and death. Life, then, is a dynamic process. Although these are widely accepted because of their face validity, like the sociological theories, they are not well suited to testing or measurement and do not address the influence of culture, gender, and ethnicity.
Jung’s theories of personality
Psychologist Carl Jung (1971), a contemporary of Freud, proposed a theory of the development of a personality throughout life, from childhood to old age. He was one of the first psychologists to define the last half of life as having a purpose of its own, quite apart from species survival. The last half of life is often a time of inner discovery, quite different from the biological and social issues that demand a great deal of outward attention during the first half of life. The last half of life, ideally, is less intensely demanding and allows more time for inner growth, self-awareness, and reflective activity.
According to this theory, a personality is either extroverted and oriented toward the external world or introverted and oriented toward the subjective inner world of the individual. Jung suggested that aging results in the movement from extraversion to introversion. Beginning perhaps at midlife, individuals begin to question their own dreams, values, and priorities. The potentially resulting crisis or emotional upheaval is a step in the process of personality development. With chronological age and personality development, Jung proposed that the person is able to move from a focus on outward achievement to one of acceptance of the self and to the awareness that both the accomplishments and challenges of a lifetime can be found within oneself. The development of the psyche and the inner person is accomplished by a search for personal meaning and the spiritual self. This personality of late life can easily be compared to Erikson’s ego integrity, Maslow’s self-actualization (see Chapter 1), and Tornstam’s gerotranscendence, described in the following sections.
Developmental theories
Psychologist Eric Erikson is well known for articulating the developmental stages and tasks of life, from early childhood to later “elderhood.” Most students have studied Erikson’s eight-stage or task model. Erikson (1963) theorized a predetermined order of development and specific tasks that were associated with specific periods in one’s life course. He proposed that one needed to successfully accomplish one task before complete mastery of the next was possible and originally articulated these in “either/or” language. He proposed that all persons would return again and again to a task that had been poorly resolved in the past.
Erikson’s task of middle age is generativity. If successful in this task, one establishes oneself and contributes in meaningful ways for the future and future generations. Failure to accomplish this task results in stagnation. Erikson saw the last stage of life as a vantage point from which one could look back with ego integrity or despair on one’s life. Ego integrity implies a sense of completeness and cohesion of the self. In achieving this final task, individuals can look back over their lives, at the joys and the sorrows, the mistakes and the successes, and feel satisfied with the way they lived.
In later years, as octogenarians, Erikson and his wife, Joan, reconsidered his earlier work from the perspective of their own aging. They modified their “either/or” stance of the developmental tasks to the recognition of the balance of each of the tasks. Thus ego integrity is tinged with some regrets, wisdom is balanced with frivolity, and letting go is balanced with hanging on (Erikson et al., 1986).
Robert Peck (1968) expanded on the original work of Erikson with the identification of specific tasks of old age that must be addressed to establish ego integrity. Peck’s tasks represent the process or movement toward Erikson’s final stage. Peck’s tasks are as follows:
To achieve ego integrity, according to Peck’s theoretical model, one must develop the ability to redefine the self, to let go of occupational identity, to rise above bodily discomforts, and to establish meanings that go beyond the scope of self-centeredness. Although these are admirable and idealistic goals, they place a considerable burden on the older person. Not everyone may have the courage or the energy to laugh in the face of adversity or surmount all of the assaults of old age. The wisdom of old age involves a crisis of understanding in which the ordinary structures are shaken and the meaning of life is reexamined. It may or may not include the wisdom of questioning assumptions in the search for meaning in the last stage of life.
Robert Havighurst (1971) is another developmental theorist who has proposed specific tasks to be accomplished in middle age and later maturity. Havighurst’s developmental tasks are presented in Box 6-2.
Theory of gerotranscendence
Lars Tornstam (1994, 1996, 2005), a Swedish sociologist, proposed the theory of gerotranscendence. According to Tornstam, human aging brings about a general potential for what he terms gerotranscendence, a shift in perspective from the material world to the cosmic and, concurrent with that, an increasing life satisfaction. Gerotranscendence is thought to be a gradual and ongoing shift that is generated by the normal processes of living, sometimes hastened by serious personal disruptions. An understanding of transcendence and the unique characteristics of this transformation in older people is important to the continued growth and development of older people. It is associated with wisdom and spiritual growth, similar to Erikson’s concept of integrity and Maslow’s self-actualization. Characteristics of gerotranscendence are presented in Box 6-3.
BOX 6-3
Characteristics of Gerotranscendence
• A high degree of life satisfaction
• Midlife patterns and ideals are no longer prime motivators
• Complex and active coping patterns
• A greater need for solitary philosophizing, meditation, and solitude
• Social activities are not essential to well-being
• Satisfaction with self-selected social activities
• Less concern with body image and material possessions
• Affinity with past and future generations
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
