Gerontological Nursing and

Healthy Aging, 6th Edition

 Chapter 5

Clinical Judgment to Promote

Psychosocial, Spiritual, and Cognitive
Health
 Lesson 5.1 Clinical Judgment to Promote
Psychosocial, Spiritual, and Cognitive Health
Objectives
 Explain the major psychosocial theories of aging.
 Discuss the importance of spirituality to healthy
aging.
 Explain cognitive changes with age and strategies to
enhance cognitive health.
 Discuss factors influencing learning in late life and
appropriate teaching and learning strategies.
 Utilize clinical judgment to identify nursing actions to
enhance cognitive health, learning, and promote
spiritual well-being.
 Psychosocial Aging Theories
 Early theories were attempts to explain and
predict the changes in middle and late life with
an emphasis on adjustment.
 Adjustment was seen as an indication of
success.
 Based primarily on “face validity”
 First Generation Theories
 Role
 Activity
 Role Theory
 One of the earliest explanations of how one
adjusts to aging
 Self-identity is believed to be defined by one's
role in society.
 The ability of an individual to adapt to changing
roles is a predictor of adjustment to aging.
 Activity Theory
 The ideal of life is to remain as active as
possible.
 Activity is possible when living in a stable
society.
 The older person has
 Access to positive influences and significant others
 Opportunities to participate in the broader society if he
or she chooses to
 Second-Generation Theories
 Disengagement
 Continuity
 Age stratification
 Social exchange
 Modernization
 Developmental
 Gerotranscendence
 Disengagement Theory
 In the natural course of aging the person does,
and should, slowly withdraw from society to
allow the transfer of power to the younger
generations.
 This is necessary for the maintenance of social
equilibrium.
 Provided the basis of age discrimination
 An elder’s withdrawal is no longer an indicator of
successful aging.
 Continuity Theory
 People develop and maintain a consistent
pattern of behavior over a lifetime.
 Aging reflects a continuation of the patterns of
roles, responsibilities, and activities.
 Successful aging is associated with one’s ability
to maintain and continue previous behaviors and
roles or to find suitable replacements.
 Age-Stratification Theory
 Believes in age categories of older adults as
young, middle aged, and old
 Historical content is the key to the age-
stratification theory.
 Social and cultural expressions of age are
examined.
 Social Exchange Theory
 As one ages, one has fewer and fewer economic
resources to contribute to the society, resulting
in loss of social status, self-esteem, and political
power.
 Only those who are able to maintain control of
their financial resources have the potential to
remain fully participating members of society
and anticipate successful aging.
 Modernization Theory
 Value in older adults is lost when their skills are
no longer considered useful.
 Is due to technology, urbanization, and mass
education.
 Modernization has had a notable effect on
cultures such as those in China and Japan.
 Developmental Theories
 Erikson’s hierarchy presents predetermined
order of developmental stages and tasks.
 Erikson’s last stage of life is to look back and
reflect (ego integrity or despair).
 Successfully completing this phase means
looking back with few regrets and a general
feeling of satisfaction.
 Gerotranscendence
 Aging is an ever-evolving process that alters
one’s view of reality, sense of spirituality, and
meaning beyond the self.
 The person withdraws from society to give time
for self-reflection and contemplation.
 Wisdom is achieved through personal
transformation, and transcendence is a marker
of successful aging.
 Question 1
A 75-year-old patient has remained unmarried and
childless. She shares with you that she feels her life has
little meaning and no one cares if she lives or dies. She
wishes she had made different choices so that she was
now not alone. The issue the patient needs to resolve is

A. premature disengagement.
B. ego integrity versus despair.
C. inability to provide continuity.
D. overinvolvement in gerotranscendence.
 Answer to Question 1
ANS: B

During ego integrity versus despair, people reflect

back on the lives they have lived and come away
with either a sense of fulfillment from a life well
lived or a sense of regret and despair over a life
misspent.
 Third-Generation Theories
 The life story
 Reminiscing
 Any recall of the past
 Provides a pleasurable experience, increases
socialization, provides cognitive stimulation, improves
communication, facilitates personal growth, and can
decrease depression scores
 Life review
 A formal therapy technique than reminiscence
 Takes a person through his or her life in a structured
and chronological order
 Question 2
A nurse caring for an 80-year-old patient would like
to use reminiscence as therapy. Which question
best encourages reminiscence?

A. What is your favorite food?

B. How many children do you have?
C. Does your religion provide you comfort?
D. What are some of your favorite childhood
memories?
 Answer to Question 2
ANS: D

Asking the patient to recall past events in an open-

ended manner best encourages the older adult to
relive life experiences.
 Spirituality and Aging
 Spirituality is a broader concept than religion.
 It encompasses a person’s values or beliefs;
search for meaning; and relationships with a
higher power, with nature, and with other people.
 As people age and move closer to death,
spirituality may become more important.
 Spiritual belief and practices play a central role
in helping older adults cope with life challenges
and are a strength in the lives of older adults.
 Nurturing the Spirit of the Nurse
 Nurses must consider
 What gives their own life meaning and value
 What assists them in offering spiritual support to
patients
 Taking care of nurses’ own spiritual needs help
them to better meet the patient’s spiritual needs.
 Adult Cognition
 Cognition is the process of acquiring, storing,
sharing, and using information.
 Its components include language, thought
process, memory, execution of function,
judgment, attention, and perception.
 Cognition can remain stable or decline with
aging.
 Fluid and Crystalized Intelligence
 Fluid intelligence consists of skills that are
biologically determined and independent of
experience or learning.
 Crystallized intelligence is the knowledge and
abilities acquired through education and life.
 Older people perform more poorly on
performance scales (fluid intelligence), but
scores on verbal scales (crystallized
intelligence) remain stable.
 Memory
 The ability to retain and store information and thus
retrieve the information when needed
 Immediate memory
 Short-term memory
 Long-term memory
 Familiarity, previous learning, and life experiences
can compensate for memory loss.
 Age-associated memory impairment (AAMI) is
memory loss that is considered normal in light of
person’s age and educational level.
 Learning in Later Life
 Must be relevant information
 New learning must relate to what the older
person already knows.
 Literacy level and cultural variations play a role.
 Many older adults have computers and make up
the fastest growing age group who owns them.