Chapter 2: Theories of Aging

The nurse is doing patient teaching for a 50-year-old woman. Based on the application of the programmed theory of aging, which brochure is the nurse most likely to offer the patient? 1. "Perimenopause and Menopause: Most Frequently Asked Questions" 2. "Do the Benefits Outweigh the Risks of Antioxidant Supplements?" 3. "Exercise, Food, Sleep, and Fun: Healthy Lifestyle Tips for Older Adults" 4. "Healthy Nutrition Is More Than Just Counting Calories and Losing Weight"

1. "Perimenopause and Menopause: Most Frequently Asked Questions" The programmed theory suggests that a person experiences predictable changes according to a biologic clock, such as menopause and graying of the hair. The free radical theory proposes that excess free radicals in the body cause physiologic aging. The use of antioxidants is thought to reduce the number of free radicals. The wear-and-tear theory suggests that good health maintenance practices may slow the rate of wear on the body parts. A fairly new theory of aging correlates aging to calorie intake, but the theory is based on animal studies.

The nurse is designing a group activity for a group of older women who have mild loss of self-esteem and a reluctance to socialize. None have serious cognitive or physical impairments. Based on the activity theory, which activity will the nurse suggest? 1. A weekly knitting group to make hats for premature infants 2. A daily game of unfolding and refolding a stack of towels 3. A weekly activity to sort buttons into different color groups 4. A daily group discussion about local politics

1. A weekly knitting group to make hats for premature infants Knitting hats for infants is purposeful; this raises self-esteem, and sitting in a group while knitting allows time for socialization. The knitting can stimulate conversation as the women help and compliment each other. Sorting buttons and folding towels are more appropriate for persons with significant cognitive impairment. These busywork activities will not stimulate intellect or increase self-esteem. A daily group discussion about local politics may be very suitable for some, but for participants who show reluctance to socialize, or for those whose selfesteem is further threatened by disagreement, the nurse is more likely to start with other themes or topics for discussion.

Two nursing students are exhausted after studying about the biologic theories of aging. They decide to have some fun and perform an action that is based on the rate of living theory. Which action do they perform? 1. Go for a leisurely walk in the sunshine 2. Hold their breath for as long as they can 3. Share an apple and an orange 4. Give each other a facial and then use anti-aging cream

2. Hold their breath for as long as they can The rate of living theory proposes that individuals have a finite number of breaths or heartbeats that are used up over time. The students are just having fun with this theory, by saving the number of breaths.

A friend tells you she thinks her father is experiencing a "midlife crisis", because he purchased a new red sports car, started wearing trendy clothing, and is considering a career change. Whose theory explains this behavior? 1. Newman's 2. Jung's 3. Havighurst's 4. Erickson's

2. Jung's Jung's theory proposes that development continues throughout life by a process of searching, questioning, and setting goals that are consistent with the individual's personality. Thus, life becomes an ongoing search for the "true self." As individuals age, they go through a reevaluation stage at midlife, at which point they realize there are many things they have not done. At this stage, they begin to question whether the decisions and choices they have made were the right choices for them. This is the so-called midlife crisis, which can lead to radical career or lifestyle changes or to the acceptance of the self as is.

A friend asks the nurse what could be done to improve the chance of a long life. Using current biologic theories of aging, the nurse recommended that her friend discuss this first with her physician, but advises that the approach more likely to cause harm than good is which one. 1. Intake of antioxidants, such as vitamins A. B6, B12, C, and E. 2. Replacing of hormones, such as HGH, DHEA, and estrogen. 3. Calorie -restricted diet. 4. Intake of herbal and nutritional supplements.

2. Replacing of hormones, such as HGH, DHEA, and estrogen. Hormone therapy includes hormones such as dehydroepiandrosterone (DHEA), estrogen, testosterone, melatonin, and human growth hormone (HGH). Hormone therapy may actually cause more harm than benefits in improving the chance of a long life according to current theories of aging.

The same friend asks how long humans can live; What is the nurse's best reply? 1. 100 years 2. 105 years 3. 110 years 4. 120 years

3. 110 years The activity theory proposes that activity is necessary for successful aging. Active participation in physical and mental activities, such as participation in a current events game, helps maintain functioning well into old age. Purposeful activities and interactions that promote self-esteem improve overall satisfaction with life, even at an older age. "Busywork" activities and casual interaction with others were not shown to improve the self-esteem in older adults.

According to the disengagement theory, what is the nurse most likely to observe while assessing an older adult? 1. Dryness of the skin with wrinkles and loss of elasticity 2. Decreased muscle mass and increased body fat 3. Decreased interest and involvement in social interactions 4. Adjustment to retirement and loss of income

3. Decreased interest and involvement in social interactions The disengagement theory is a highly controversial psychosocial theory that proposes that older adults desire to withdraw and society also withdraws for the mutual benefit of both. Changes in skin or body composition are addressed by biologic theories. Havighurst's theory suggests that adjustment to retirement and loss of income are tasks of aging.

According to Jung's theory, which statement by an older adult indicates successful aging? 1. "I have a strong belief that there is life after death. So I am not afraid of dying" 2. "I never experienced travel around the world, but I traveled in my imagination" 3. "I lost my wife several years ago; I still miss her, but I focus on the good memories" 4. "Well, when I look back at my life, I am happy to say that I did it my way"

4. "Well, when I look back at my life, I am happy to say that I did it my way" Successful aging, according to Jung, includes acceptance and valuing of the self without regard to the view of others.

According to Erikson, what is the primary developmental task of the older adult population?

4. Integrity vs. despair Erikson's theory identifies eight stages of developmental tasks that an individual must confront throughout the life span. The last of these stages is the domain of late adulthood (integrity versus despair), but failure to achieve success in tasks earlier in life can cause problems later in life. Late adulthood is the time when people normally review their lives and determine whether they have been negative or positive overall. The most positive outcomes in this life review are wisdom, understanding, and acceptance; the most negative outcomes are doubt, gloom, and despair. The statement "I have done the best I could, and I'm pretty content about how I've lived my life. I really wouldn't change very many things I've done" indicates that this person has successfully achieved the developmental task of integrity.

The nurse working in the long term care facility plans care based on Havighurst's theory of aging. Which task(s) should the nurse facilitate his patients to achieve? (Select all that apply.) A. Adjusting to the loss of a spouse B. Preserving and increasing strength C. Adjusting to a decrease in income D. Stabilizing one's self in one's social roles E. Looking back on one's life with pride and contentment

A. Adjusting to the loss of a spouse C. Adjusting to a decrease in income Havighurst's theory of aging proposes tasks for older adults including adjusting to the loss of a spouse and a decrease in income, adapting to new social roles flexibly, and establishing relationships with other individuals of one's own age. Achieving the task of looking back on one's life with pride and contentment is a part of Erikson's theory.

The 45-year-old patient reports to the nurse he feels he is going through a "mid-life crisis." The nurse recognizes this phenomenon refers to the theory developed by which psychologist? A. Jung B. Erikson C. Newman D. Havighurst

A. Jung Carl Jung's theory of development proposes that an individual progresses through life searching and setting goals for him or herself in an ongoing search for one's "true self." The "mid-life crisis" is the time in which the individual reevaluates his or her life and progresses toward his or her true self. The theories of Erikson, Newman, and Havighurst do not include a mid-life crisis.

The patient requests information on ways to prevent the damage associated with free radicals. Information on which antioxidants would be most appropriate for the nurse to include? (Select all that apply.) A. Zinc B. Copper C. Selenium D. Vitamin A E. Vitamin C F. Vitamin B12

A. Zinc C. Selenium D. Vitamin A E. Vitamin C Antioxidants such as zinc, selenium, and vitamins A, C, and E may help decrease the damage caused by free radicals.

Identify one of the biologic theories of aging that you would like to know more about and describe why that theory appeals to you.

Answers to this question will vary widely, but the selection of theory may be based on a desire to create interventions for yourself and your patients. For example, the free radical theory would include the use of antioxidants and the avoidance of contaminants such as radiation or pollution. Various programmed theories allow for some predictability in changes of aging, so coping and adaptation skills would be encouraged. Other theories, such as wear-and-tear theory, suggest that good health maintenance practices will reduce the rate of wear and tear.

Based on your observations of an older adult whom you know or have cared for during a clinical experience, give an example of how that older adult is achieving (of failing) the developmental task of integrity versus despair.

Answers will vary by your experience; however, when you conduct a life review with an older adult, note whether he or she has pride and satisfaction with past accomplishments or whether events are remembered with regret and unhappiness.

___________________ therapy is a proposed method of neutralizing free radicals, which may contribute to aging and disease processes

Antioxidant

The patient in the clinic tells the nurse she has heard about the dangers of free radicals and requests more information. The nurse bases his response on an understanding that free radicals have been associated with which age related change(s)? (Select all that apply.) A. Hypothyroidism B. Atherosclerosis C. Rheumatoid arthritis D. Type 2 diabetes mellitus E. Peripheral vascular disease F. Chronic obstructive pulmonary disease (COPD)

B. Atherosclerosis D. Type 2 diabetes mellitus E. Peripheral vascular disease Free radicals have been associated with atherosclerosis, diabetes, circulatory diseases such as peripheral vascular disease, and arthritis. Rheumatoid arthritis is an autoimmune disease. Hypothyroidism and COPD are not associated with free radicals.

The nurse working with aging individuals knows the use of antioxidants to slow the aging process corresponds to which theory? A. Crosslink theory B. Free radical theory C. Somatic mutation theory D. Connective tissue theory

B. Free radical theory Antioxidants are thought by some to reduce or prevent the damage to DNA caused by free radicals, which are the cause of aging in the free radical theory. The crosslink theory and connective tissue theories are the same. The somatic mutation theory discusses DNA mutations caused by exposure to radiation and chemicals.

The nurse in the long term care facility who cares for primarily older adults knows these adults are in which stage of Erikson's developmental tasks? A. Trust versus mistrust B. Integrity versus despair C. Industry versus inferiority D. Generativity versus stagnation

B. Integrity versus despair The developmental stage for the older adult is integrity versus despair, where the individual looks back on his or her life with pride that he or she had a positive impact or despair that his or her impact was negative. Trust versus mistrust, integrity versus despair, and industry versus inferiority are stages for younger individuals.

The patient in the clinic tells the nurse she can "feel her biologic clock ticking." The nurse knows the patient views aging based on which theory? A. Gene theory B. Programmed theory C. Rate of living theory D. Somatic mutation theory

B. Programmed theory The programmed theory proposes that, at conception, a "biologic clock" begins ticking that determines the number of cell divisions that occur before death. The rate of living theory postulates each person has a finite number of heart beats. The gene theory discusses aging from the perspective of one or more harmful genes that are activated over time and bring about age-related changes. The somatic mutation proposes that aging is caused by environmental damage to DNA.

___________________ theories of aging attempt to explain the physical changes of aging

Biologic

The aging patient requests information on the causes for the age-related changes he sees in his body. In order to educate the patient using the neuroendocrine theory of aging, the nurse should discuss which structure in the brain? A. Cerebellum B. Hippocampus C. Hypothalamus D. Anterior pituitary gland

C. Hypothalamus The neuroendocrine theory of aging proposes that age-related changes are caused by chemical interactions in the hypothalamus of the brain. The cerebellum, hippocampus, and anterior pituitary gland are not the focus of the neuroendocrine theory of aging.

The nurse in the long term care facility frequently observes older adults being separated from their friends and family and excluded from society. This phenomenon is described in which psychosocial theory of aging? A. Activity theory B. Life-course theory C. Developmental theory D. Disengagement theory

D. Disengagement theory The disengagement theory describes the phenomenon in which older adults are separated from their friends and become disengaged from society because they are perceived to no longer be a benefit to society. The activity theory states successful aging requires continued activity. The life-course theories include theories by Erikson, Havighurst, Newman, and Jung. The developmental theory uses Erikson's eight stages of developmental tasks to describe aging.

The student nurse studying aging knows which theory was originally used to describe failures in electronic equipment? A. Error theory B. Wear-and-tear theory C. Run-out-of-program theory D. Reliability theory of aging and longevity

D. Reliability theory of aging and longevity The reliability theory of aging and longevity is a mathematical equation originally used to explain the failure of electronic equipment. The error, wear-and-tear, and run-out-of-program theories were not originally used with electronic equipment.

_____________________ ____________________ are unstable molecules produced by the body during the normal processes of respiration and metabolism or following exposure to radiation and pollution

Free radicals

Identify the main points of Havighurst's theory of aging.

Havighurst's theory details the process of aging and defines specific tasks for late life, including (1) adjusting to decreased physical strength and health, (2) adjusting to retirement and decreased income, (3) adjusting to the loss of a spouse, (4) establishing a relationship with one's age group, (5) adapting to social roles in a flexible way, and (6) establishing satisfactory living arrangements.

The premise of the ___________________ theory is that there is an increase in autoimmune diseases and allergies with aging, because of changes in the immune system.

Immunologic

Discuss two or three reasons that may contribute to the older adult's personal decision to try nutritional supplements.

Many patients, young and old, will try over-the-counter products because of barriers to adequate health care, such as cost, difficulty scheduling or getting to medical appointments, or lack of knowledge about side effects or drug interactions. Also, these products are often marketed as "natural" remedies that can enhance nutritional status

Identify the main points of Newman's theory of aging.

Newman's theory identifies the tasks of aging as (1) coping with the physical changes of aging; (2) redirecting energy to new activities and roles, including retirement, grandparenting, and widowhood; (3) accepting one's own life; and (4) developing a point of view about death.

The disengagement theory and the activity theory are the two examples of _____________________ theory.

Psychosocial

A 53-year-old woman (5′2″ and 120 pounds) tells you that she has decided to follow a calorie-restricted diet to improve longevity. What could you tell her?

The studies about calorie reduction to increase longevity were conducted with rats, mice, fish, and worms. There is no proof that the findings apply to humans. Some studies have shown that severely underweight persons have a higher risk for some diseases and even death. This woman is not overweight and should be advised to consult a health care provider or nutritionist to ensure that adequate nutrition is maintained.

There is no single unified rationale for why we age or why different people live for different lengths of time, but _______________ help to explain and give some logical order to our observations.

Theories

In your own words, explain why theories of aging are important to nursing practice.

Theories are created and used to explain and organize observations of what happens in the world around us and how we live in and respond to those surroundings. Nurses use many kinds of biopsychosocial theories to understand patients, to improve care, and to conduct research.

Discuss some of the limitations of hormone therapy.

There is little evidence to support claims made by persons who advocate for hormonal therapy, and hormone treatments may actually cause more harm than benefits. The therapy usually requires a prescription or supervised medical administration, which may not be covered by health insurance.

Describe the advantages and disadvantages of antioxidant therapy.

Vitamins and minerals, including vitamins A, B6, B12, C, and E; beta carotene; folic acid; and selenium can be obtained over the counter. This could be an advantage and disadvantage, because the supplements are readily available at a reasonable cost, but there is a potential for problems because high doses of some antioxidants may cause more harm than benefits. There is no proof that antioxidants are effective; however, consuming fruits and vegetables to obtain these nutrients would generally be considered safe.