THEORIES OF AGING

I. Biologic Theories (Stochastic & Non-stochastic)

II. Sociologic Theories
III. Psychological Theories
IV. Nursing Theories

I. Biologic Theories

Biologic theories are concerned with answering basic questions regarding the physiologic
processes that occur in all living organisms as they chronologically age. These age-related changes occur
independent of any external or pathologic influence. Biologic theories view aging as occurring at molecular,
cellular and even systemic levels. In addition, these theories are not meant to be exclusionary; theories
may be combined to explain phenomena (Hayflick as cited in Meiner and Yeager, 2019).

Biologic theories are divided into two categories: Stochastic theories view episodic events that
happen throughout one’s life that cause random cell damage and accumulate over time, thus causing aging
while nonstochastic theories see aging as resulting from complex, predetermined process happening to all
organisms in a timed framework.

A. Stochastic Theories
1. MITOCHONDRIAL FREE RADICAL THEORY – Free radicals are byproducts of fundamental
metabolic activities within the body. Free radical production may increase because of
environmental pollutants such as ozone, pesticides, and radiation. Normally, they are neutralized
by enzymatic activity or natural antioxidants. However, if they are not neutralized, they may attach
themselves to other molecules. These highly reactive free radicals react with the molecules in cell
membranes, in particular cell membranes of unsaturated lipids such mitochondria, lysosomes and
nuclear membranes. This action monopolizes the receptor sites on the membrane thereby
inhibiting the interaction with other substances that normally use this site; this chemical reaction is
called lipid peroxidation. Therefore, the mitochondria, for example can no longer function as
efficiently, and their cell membranes may become damaged, which results in increased
permeability. If excessive fluid is either lost or gained, the internal homeostasis is disrupted and cell
death may result.

Other deleterious results are related to free radical molecules in the body. Although these
molecules
do not contain DNA themselves, they may cause mutations in the DNA-RNA transcription, thereby
producing mutations of the original protein. In nervous and muscle tissue, to which free radicals
have
a high affinity, a substance called lipofuscin has been found and is thought to be indicative of
chronologic age. Strong support for this theory has continued over the past 35+ years (Jang & Van
Remmen as cited Meiner and Yeager, 2019).
 Lipofuscin, a lipid and protein-enriched pigmented material, has been found to accumulate in older
adult’s tissues and is commonly referred to as “age spots.” As the lipofuscin’s presence increases,
healthy tissue is slowly deprived of oxygen and its nutrient supply. Further degeneration of
surrounding tissues eventually leads to actual death of the tissue. The body does not have
naturally
occurring antioxidants or protective mechanisms. Vitamins C and E are two of these substances
that can inhibit the functioning of the free radicals or possibly decrease their production in the body.

Ames (2004) and Harman (1994) suggested some strategies to assist in terminating propagation of
free radicals and in delaying the mitochondrial decay, such as: decreasing calories in order to
lower weight, maintaining a diet high in nutrients, including antioxidants, avoiding inflammation and
minimizing accumulation of metals in the body that can trigger free radical reactions.

2. CROSS-LINKAGE THEORY – The cross-linkage theory of aging hypothesizes that with age, some
proteins become increasingly cross-linked or enmeshed and may impede metabolic processes by
obstructing the passage of nutrients and wastes between intracellular and extracellular
compartments. According to this theory, normally, separated molecular structures are bound
together through chemical reactions.

This primarily involves collagen, which is relatively inert long-chain macromolecule produced by
fibroblasts. As new fibers are created, they become enmeshed with old fibers and form an actual
chemical cross-link. The result of this cross-linkage process is an increase in the density of the
collagen molecule but a decrease in its capacity to both transport nutrients to the cells and remove
waste products from the cells. Eventually, this results in a decrease in the structure’s function. An
example of this would be the changes associated with aging skin which loses much of its
suppleness and elasticity. This aging process is like the process of tanning leather, which
purposefully creates cross-links (Hayflick as cited in Meiner and Yeager, 2019).

Cross-linkage agents have been found in unsaturated fats; in polyvalent metal ions such as
aluminum, zinc and magnesium; and in association with excessive radiation exposure. May of the
medications ingested by the older persons (eg. antacids and coagulants) contain aluminum, as
does baking powder, a common cooking ingredient. Some research supports a combination of
exercise and dietary restrictions in helping to inhibit the cross-linkage process as well as use of
Vitamin C prophylactically as an antioxidant agent (Bjorkstein, as cited in Meiner and Yeager,
2019).

One researcher, Cerani, has shown that blood glucose reacts with bodily protein s to form cross-
links. He has found that the crystallin of the lens of the eye, membranes of the kidney and blood
vessels are especially susceptible to cross-linking under the conditions of increased glucose.
CErani suggests increased levels of blood glucose caused increased amounts cross-linking which
accelerate lens, kidney and blood vessel diseases (Schneider as cited in Meiner and Yeager,
 2019). This research was more recently updated by Eyetsemitan as cited by Meiner and Yeager
(2019), who identified the stiffening of blood vessels with an increase in thickness caused by the
cross-linking of glucose and protein. The products of this effect are identified as AGEs, or
advanced glycation end-products.

Cross-linkage theory proposes that as a person ages and the immune system becomes less
efficient, the body’s defense mechanism cannot remove the cross-linking agent before it becomes
securely established. Cross linkage has been proposed as a primary cause of arteriosclerosis,
decrease in the efficiency of the immune system, and loss of the elasticity often seen in older adult
skin.

3. EVOLUTIONARY THEORIES – Evolutionary theories of aging are related to genetics and

hypothesize that the differences in the aging process and longevity of various species occur due to
interplay between the process of mutation and natural selection. Attributing aging to the process of
natural selection links these theories to those that support evolution.

The Mutation Accumulation Theory suggests that aging occurs due to a declining force of natural
selection with age. In other words, genetic mutations that affect the children will eventually be
eliminated because the victims will not have lived long enough to reproduce and pass this to future
generation. Genetic mutations that appear in late life, however will accumulate because the older
individuals they affect will have already passed these mutations to their offspring.

The Antagonistic Pleiotropy Theory suggests that accumulated mutant genes that have negative
effects in late life may have had beneficial effects in early life. This is assumed to occur either
because the effects of the mutant genes occur in opposite ways in late life as compared with their
effects in early life or because a particular gene can have multiple effects – some positive and
some negative.

The Disposable Soma Theory differs from other evolutionary theories by proposing that aging
related to the use of body’s energy rather than to genetics. It claims that the body must use energy
for metabolism, reproduction, maintenance of functions, and repair, and with a finite supply energy
from food to perform these functions, some compromise occurs. Through evolution, organisms
have learned to give priority to of energy expenditure to reproductive functions over those functions
that could maintain the body indefinitely; thus, decline and death ultimately occur.

4. BIOGERONTOLOGY – Biogerontology is the study of the connection between aging and disease
process. Bacteria, fungi, viruses and other organisms are thought to be responsible for certain
physiologic changes during the aging process. In some cases, these pathogens may be present in
the body for decades before they begin to affect body systems. Human beings have enjoyed longer
 life expectancies with the control or elimination of certain pathogens through immunization and the
use of antimicrobial drugs.

5. WEAR AND TEAR THEORY – Over time, cumulative changes occurring in cells age and damage
cellular metabolism. An example is the cell’s inability to repair damaged DNA, as in the aging cell.
It is known that cells in heart muscle, neurons, striated muscle, and brain cannot replace
themselves after they are destroyed by wear and tear. Researchers cite gender-specific effects of
aging on adrenocorticotropic activity that are consistent with the wear and tear hypothesis of the
ramifications of lifelong exposure to stress (Van Cauter et al. 1996). There is some speculation that
excessive wear and tear caused by exercising may accelerate aging by increasing free radical
production, which supports the idea that no one theory of aging incorporates all the causes of
aging, but rather that a combination of factors is possible.

Studies of people with osteoarthritis suggest that cartilage cells age over time, and this
degeneration is not due solely to strenuous exercise but also to general wear and tear. The studies
point out that aged cells have lost the ability to counteract mechanical, inflammatory, and other
injuries due to their senescence (Aigner et al., 2004).

B. Nonstochastic Theories
1. GENETIC THEORY

The Programmed Theory of Aging proposes that humans are born with genetic program or
biological clock that predetermines the life span. Various studies support this idea of a pre-
determined genetic program for life span (Hayflick, 1965). For example, studies have shown a
positive relationship between parental age and filial life span. Additionally, studies of in vitro cell
proliferation have demonstrated that various species have a finite number of cell divisions.
Fibroblasts from embryonic tissue experience a greater number of cell divisions than those derived
from adult tissue, and among various species, the longer the life span, the greater the number of
cell divisions. These studies support the theory that senescence – the process of becoming old,
under genetic control and occurs at the cellular level.

As people age, more of their cells start to decide to commit suicide or stop dividing. The Hayflick
phenomenon, or human fibroblast replicative senescence model, suggests that cell divide until they
are can no longer divide, whereupon the cell’s infrastructure recognizes this inability to further
divide and triggers the apoptosis sequence or death of the cell. Therefore, it is thought that cells
have a finite doubling potential and become unable to replicate after they have done so a number
of times. Human cells age each time they replicate because of the shortening of the telomere.
Telomeres are the most distal appendages of the chromosome’s arms. This theory of programmed
cell death is often alluded to when the aging process is discussed. The enzyme telomerase, also
called a “cellular fountain of youth,” allows human cells grown in the laboratory to continue to
 replicate long past the time they normally stop dividing. Normal human cells do not have
telomerase.

It is hypothesized that some cancer, reproductive and virus cells are not restricted, having
seemingly infinite doubling potential, and are thus immortal cell lines. This is because they have
telomerase, which adds back DNA to the ends of the chromosomes. One reason for the Hayflick
phenomenon may be that chromosome telomeres become reduced in length with every cell
division and eventually become too short to allow further division. When telomeres are too short,
the gene notes this and causes the cell to die or apoptosize. Shay and Wright (2001) suggest that
telomerase-induced manipulations of telomere length are important to study to define the
underlying genetic diseases and those genetic pathways that lead to cancer.

Although it is unknown what initial event triggers apoptosis, it is generally acknowledged that
apoptosis is the mechanism of cell death (Thompson, 1995). Henderson (2006) reviewed how
fibroblast senescence is connected to wound healing and discussed the implications of this theory
for chronic wound healing. Increased cell apoptosis rates do cause organ dysfunction, and this is
hypothesized to be the underlying basis of the pathophysiology of multiple organ dysfunction
syndrome (Papathanassoglou et al., 2000).

The Error Theory also proposes a genetic determination for aging. This theory holds that genetic
mutations are responsible for aging by causing organ decline as a result of self-perpetuating
cellular mutations This theory suggests that over time, cells accumulate errors in their DNA and
RNA protein synthesis that cause the cells to die (Orgel, 1970). Environmental agents and
randomly induced events can cause error, with ultimate cellular changes. It is well known that large
amounts of X-ray radiation cause chromosomal abnormalities. Aging would not occur if destructive
factors such as radiation did not exist and cause errors such as mutation and regulatory disorders.

2. IMMUNOLOGIC THEORY – It has been found that as a person ages, the immune system
functions less effectively. The term immunosenescence has been given to this age-related
decrease in function.

Essential component of the immune system are T-lymphocytes, which are responsible for cell-
mediated immunity, and B-lymphocytes, the antibodies responsible for humoral immunity. Both T
and B-lymphocytes may respond to an invasion of an organism, although one may provide more
protection than the other in certain situations. The changes that occur with aging are the most
apparent in T-lymphocytes, also changes also occur in the functioning capabilities of B-
lymphocytes. Accompanying these changes is a decrease in the body’s defense against foreign
pathogens.; this manifests as an increased incidence of infectious diseases and an increase in the
production of autoantibodies, which led to a propensity to develop autoimmune-related diseases.
 The changes in the immune system cannot be explained by an exact cause-and-effect relationship,
but they do seem to increase with advancing age. These changes include a decrease in humoral
immune response, often predisposing older person to: (1) decreased resistance to a tumor cell
challenge and the development of cancer, (2) decrease ability to initiate the immune process and
mobilize the body’s defenses against aggressively attacking pathogens, and (3) heightened
production of autoantigens, often leading to an increase in autoimmune-related diseases.

Immunodeficient conditions such as human immunodeficiency virus (HIV) infection and immune
suppression in organ transplant recipients have demonstrated a relationship between
immunocompetence and cancer development. HIV infection has been associated with several
forms of cancer such as Kaposi sarcoma. Recipients of organ transplant are 80 times more likely to
develop cancer compared with the rest of the population (Black and Hawks, 2005).

In addition to increasing growth of muscle fibers, endurance exercises among older persons had a
significantly increased natural killer cell function that, in turn, caused increased cytokine production
and enhanced T-cell function. There should be a balance of exercising and resting because
overdoing exercise can lead injuries that would then support the wear and tear theory of aging.

3. NEUROENDOCRINE THEORY – This theory describes a change in hormone secretion, such as

with the releasing hormones of the hypothalamus and the stimulating hormones of the pituitary
gland, which manage the thyroid, parathyroid and adrenal glands and how it influences the aging
process. The following major hormones are involved with aging:
a. Estrogen decreases the thinning of the bones and when women age, less estrogen is
produced by the ovaries. As women grow older and experience menopause, adipose
tissue becomes the major source of estrogen.
b. Growth hormone is part of the process that increases bone and muscle strength.
Growth hormone stimulates the release of insulin-like growth factor produced by the
liver.
c. Melatonin is produced by the pineal gland and is though to be responsible for
coordinating seasonal adaptations in the body.
d. OTHERS: With physiological aging (and also with certain psychiatric disorders), there
is increased activation of the hypothalamus-pituitary-adrenal axis which causes
increased plasma cortisol levels which can be linked with several diseases
(Rodenbeck and Hajak, 2001).
e. As one ages, there is loss of neuroendocrine transmitter function that is related to the
cessation of reproductive cells as well as the development of reproductive organ
tumors Grossman and Porth, 2014).
f. Neuroendocrine system impacts aging by decreasing the heart rate variability and
other physiologic processes that would impact the normal regulatory feedback
mechanisms (Zuevos, 2015)
 g. Neuroplasticity may increase as humans age. Thus, neurological changes occurring
secondary to trauma, inflammation or other neurological events may be reversible with
the aging brain given that the brain has the ability to restructure itself (Takahashi et al.,
2015).

4. NUTRITION THEORIES – The quality and quantity of diet and nutrition may minimize or eliminate
some of the ill effects of the aging process or may cause various disease processes.

5. ENVIRONMENTAL THEORIES – Several environmental factors are known to threaten health and
are thought to be associated with the aging process. The ingestion of mercury, lead, arsenic,
radioactive isotopes, certain pesticides and other products; passive and active smoking and other
pollutants; crowded living conditions, high noise levels are factors that are thought to influence the
process of aging.

II. Sociologic Theories

Sociologic theories focus on changing roles and relationships in the lives of older adults.

1. ACTIVITY THEORY – This theory sees activity as necessary to maintain life’s satisfaction and
positive self-concept. By remaining active, the older person stays engaged and gains satisfaction
with aging. This theory is based on three assumptions: (1). It is better to be active than inactive; (2)
It is better to be happy than unhappy and (3) an older individual is the best judge of his or her own
success in achieving the first 2 assumptions. Within the context of this theory, activity may be
viewed broadly as physical or intellectual. (Havigurst, as cited in Meiner and Yeager, 2019).

2. CONTINUITY THEORY – The continuity theory proposes that how a person has been throughout
life is how the person will continue to be through the remainder of life. Old age is not viewed as a
terminal or final part of life separated from the rest of a person’s life. The latter part of life is a
continuation of the earlier part and therefore an integral component of the entire life cycle. As
people age, they try to maintain or continue previous habits, preferences, commitments, values,
beliefs and the factors that have contributed to their personalities (Havigurst as cited in Meiner and
Yeager, 2019).

3. AGE STRATIFICATION THEORY – This theory views the aging person as an individual element of
society and also a member, with peers interacting in a social process. This addresses the
interdependence between older adults and society which is a dynamic process, not stagnant.

4. PERSON-ENVIRONMENT FIT THEORY – This theory as proposed by Lawton (1982), examines

the concept of interrelationship s among the competencies of a group of persons, older adults and
 their environment/society. All people including older persons have certain personal competencies
that help mold and shape them throughout life and deal with the environment in which they live.
These competencies include ego strength, motor skills, individual biologic health and cognitive and
sensory-perceptual capacities. Aging and presence of one or more chronic diseases may impair
some of these personal competencies and limit level of interrelatedness.

The theory further proposes that as a person ages, the environment becomes more threatening
and he/she may feel incompetent dealing with it. In a society constantly making rapid technological
advances, this theory helps explain why an older person might feel inadequate and may retreat
from the society.
5. SUBCULTURE THEORY – This theory views older adult as a group with distinct norms, beliefs,
expectations, habits and issues that separate them from the rest of the society (Rose, 1965 as
cited in Elliopoulus, 2018). Their formation of a subculture is a response to the negative attitudes
and treatment by society. Older persons are accepted by and more comfortable among their own
age group. A component of this theory is the argument for social reform and greater empowerment
of the older populations so that their rights and needs can be respected.

As the population of older adults becomes more diverse, their needs better addressed and their
power recognized, the question can be raised that this theory is less relevant today than it was in
the 1960s when it was first offered.

III. Psychological Theories

The basic assumption of the psychological theories of aging is that development does not end
when a person reaches adulthood but remains a dynamic process throughout the life span.

1. MASLOW’s HIERACHY OF HUMAN NEEDS – According to this theory, everyone has an innate
internal hierarchy of needs that motivate all human behaviors. These human needs have different
orders of priority. When people achieve fulfillment of their elemental needs, they strive to meet the
needs of the next level, continuing until the highest order of needs is reached. These human needs
are often depicted as a pyramid, with the most elemental needs at the base.

The initial human needs each person must meet relate to physiologic needs – the needs of basic
survival. Initially, a starving person worries about obtaining food to survive. Once this need is met,
the next concern is about safety and security. These needs must be met, at least to some extent,
before the person becomes concerned with the needs for love, acceptance and a feeling of
belonging. As each succeeding layer of needs is addressed, the individual is motivated to look to
the needs at the next higher step.

A fully developed, self-actualized person displays high levels of all the following characteristics:
perception of reality; acceptance of self, others and nature; spontaneity; problem-solving ability;
self-direction; detachment and the desire for privacy; freshness of peak experience; identification
with other human beings; satisfying and changing relationships with other people; a democratic
 character structure; creativity and a sense of values. An ideal self-actualized person is probably
only attained by about 1% of the population. Nevertheless, the person developing in a healthy way
is always moving toward more self-fulfilling levels.

2. JUNG’s THEORY OF INDIVIDUALISM – Carl Jung, a Swiss psychologist proposed a theory of

personality development from childhood, youth and young adulthood, middle age and old age. An
individual’s personality is composed of the ego, the personal unconsciousness and the collective
unconsciousness. A person’s personality is visualized as oriented either toward the external world
(extroversion) or toward subjective, inner experiences (introversion). A balance between these two
forces which are present in every individual, is essential for mental health.

Applying this theory to individuals as they progress through life, Jung proposed that it is the onset
of middle age that the person begins to question values, beliefs and possible dreams left
unrealized. The phrase midlife crisis, popularized by this theory, refers to a period of emotional,
and sometimes behavioral, turmoil that heralds the onset of middle age. This person may last for
several years, with the exact time and duration varying from person to person.

During this period, the individual often searches for answers about reaching goals, questioning
whether a part of his or her personality or “true self” has been neglected and whether time is
running out for the completion of these quests. This may be the first time the individual becomes
aware of the effects of aging process and the fact that the first part of the adult life is over. This
realization does not necessarily signal a time of trauma. For many people, it is just another “rite of
passage.”

As the person ages chronologically, the personality often begins to change from outwardly focused,
concerned about establishing oneself in society, to becoming more inward, as the individual begins
to search for answers from within. Successful aging, according to Jung’s theory, is when a person
looks inward and values himself or herself for more than just current physical limitations or losses.
The individual accepts past accomplishments and limitations.

3. EIGHT STAGES OF LIFE – Erikson proposed a theory of psychological development that reflects
cultural and societal influences. The major focus of development of this theory is on an individual’s
ego structure or sense of self, especially in response to the ways in which society shapes its
development.

When considering older adults, one must focus attention on the developmental tasks of both
middle adulthood and older adulthood. The tasks of middle adulthood is resolving the conflict
between generativity and stagnation. During older adulthood, the developmental task needing
resolution balancing the search for ego integrity and wholeness with a sense of despair. In search
for ego integrity, older adults can look back with a sense of satisfaction and acceptance of life and
death while despair is a result of unsuccessful resolution of ego integrity in which individuals view
life as a series of misfortunes, disappointments and failures.

4. SELECTIVE OPTIMIZATION WITH COMPENSATION – Baltes (1987) has formulated a

psychological model of successful aging. The central focus is that individuals develop certain
 strategies to manage the losses of functions. That occur over time. This general process of
adaptation consists of three interacting elements: (1) selection, which refers to an increasing
restriction on one’s life to fewer domains of functioning because of an age-related loss; (2)
optimization, which reflects the view that people engage in behaviors to enrich their lives; and (3)
compensation, which results from restrictions caused by aging, requiring older adults to
compensate for any losses by developing suitable, alternative adaptations.

The concepts of selection, optimization and compensation can be applied in any aspect of older
adulthood to demonstrate successful coping with declining functions, thus allowing successful
aging.
5. GEROTRANSCEDENCE – Gerotranscedence is a recent theory that suggests aging entails a
transition from a rational, materialistic metaperspective to a cosmic and transcendent vision
(Tornstam, 2005). As people age, they are less concerned with their physical bodies, material
possessions, meaningless relationships, and self-interests and instead, desire a life of more
significance and a greater connection with others. There is a desire to shed roles and invest time in
discovering hidden facets of oneself.

IV. Nursing Theories of Aging

1. THEORY OF SUCCESSFUL AGING – One midrange theory related to aging was derived from Sr.
Callista Roy’s Adaptation Model. In this theory, successful aging is defined as “an individual’s
perception of a favorable outcome in adapting to the cumulative physiologic and functional
alterations associated with the passage of time, while experiencing spiritual connectedness, and a
sense of meaning and purpose in life (Flood, 2005, p. 36).” In the development of the Theory of
Successful Aging, Flood (2005) integrated Roy’s Adaptation Model with Lars Tornstams’s
Sociological Theory of Gerotranscedence. The theory identifies three coping mechanisms
(adaptation of functional performance mechanisms, intrapsychic factors and spirituality) that
describe the older adult’s response to their environment. This response provides feedback within
these identified mechanisms, promoting gerotranscedence. In this theory, gerotranscedence is
defined as “a coping process that occurs when there is major shift in the person’s worldview, where
a person examines one’s place within the world and in relation to others……..including decreased
death anxiety, engagement in meaningful activities, changes in relationships , self-acceptance and
wisdom (Fllod, 2005, p. 38).” In turn, the feedback loop centered on the three coping mechanisms,
and gerotranscedence facilitates successful aging. The theory of successful aging guides the
gerontologic nurse in the provision of mental, physical and spiritual nursing interventions aimed at
promoting positive coping and successful aging.

2. FUNCTIONAL CONSEQUENCES THEORY – This theory was developed to provide a guiding

framework for older adults with physical impairment and disability (Miller, 1990). Miller asserted
that aging adults experience environmental and biopsychosocial consequences that impact their
functioning. The nurse’s role is to assess age-related changes and accompanying risk factors, and
 to design interventions that minimize age-associated disability. The goal is to maximize functioning
in ways that improve patient safety and quality of life.

Functional Consequences Theory assumes that quality of life, functional capacity and dependency
are connected and that positive consequences are possible despite age-related limitations. Miller’s
(1990) theory applies to high as well as low functioning older adults. Her theory defines the ficus of
nursing interventions in varied settings (inpatient, outpatient, acute or long-term care); thus her
theory can be used in many contexts. The interventions include other health care providers, older
adults and significant others, so this theory is patient-centeredas well as interprofessional in scope.
Miller’s theory has been used to create an assessment tool for the early detection of hospitalized
elderly patients experiencing acute confusion and to prevent further complications. Additional
testing is needed however to determine the utility of the functional consequences’ theory in other
settings.

3. THEORY OF THRIVING – The theory of thriving (Haight et al., 2002) was developed to explain the
experience of nursing home residents. Failure to thrive first appeared in the aging literature as a
diagnosis for older adults with vague symptoms such as fatigue, cachexia, and generalized
weakness (Campia et al., 1986). Other disciplines later added malnutrition, physical and cognitive
dysfunction, and depression as major attributes (Barun et al., 1988). Newbern & Krowchuk (1994)
suggested that difficulty with social relationships (disconnectedness and inability to find meaning in
life, give of oneself, or attach to others) and physical/cognitive dysfunction (consistent unplanned
weight loss, signs of depression, and cognitive decline) were related to failure to thrive. Haight and
colleagues (2002) proposed that the environment is an important contributor to how people age.
They asserted that people thrive when they are in harmony with their environment and personal
relationships and fail to thrive when there is discord. This theory has helped bring together
elements of earlier aging theorists in ways that make it accessible for nursing practice.

4. HEALTH PROMOTION MODEL – The Health Promotion Model, revised by Nola Pender in 1996,
identifies health as a dynamic state directed at improving the person’s overall sense of well-being.
In this model, health is not viewed as simply the absence of disease. Health is multi-dimensional in
nature and influenced by the person’s environment. The three components comprising health are
(1) the unique characteristics and experiences of the person that affect subsequent actions; (2) the
person’s behavior and cognitive affect, which provide motivation and can be modified through
nursing interventions; and (3) behavioral outcomes which should result in optimum health and
functional ability, and improved quality of life. Gerontologic nurses can effectively use this model to
guide health teaching and improve adherence to health promotion and disease prevention
guidelines.

5. COMFORT THEORY – Comfort theory is a midrange nursing theory developed by Katharine

Kolcaba during the 1990s. In this theory, comfort is defined as “the immediate experience of being
strengthened through having the needs for relief, ease and transcendence met in four contexts of
experience (physical, psychospiritual, social and environmental. Comfort is composed of three
 components; (1) relief occurs when specific comfort needs are met (2) ease is the absence of
discomfort; and (3) transcendence occurs when a patient can rise above the discomfort when it
cannot be completely relieved. The theory recognizes the importance of patient involvement in
identifying their needs. Comfort is the holistic outcome of nursing interventions. Comfort theory has
direct application for gerontologic nurses who practice in medical/surgical environments, as well as
those in hospice and palliative care.

Sources:

Meiner, Sue E. and Yeager, Jennifer J. (2019). Gerontologic Nursing (6 th ed). Singapore: Elsevier

Elliopoulos, Charlotte (2018). Gerontological Nursing (9 th ed).Philadelphia: Wolters Kluwer

AMSR 9-3-21