Effect of Physical and Mental Health Issues on Positive Aging Literature Review Chapter

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Positive Aging and the Impact of Physical and Mental Health






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April 17, 2013








Positive Aging and the Impact of Physical and Mental Health
Positive aging can be defined as experiencing old age in a positive light. Other terms that have been used to describe this process are aging well and successful aging. These terms are intended to imply both physical and psychological health sufficient to sustain a meaningful and rewarding quality of life (reviewed by Rohr and Lang, 2009). The possibility of experiencing positive aging has increased as life expectancies doubled over the past 100 years, with most of this increase affecting persons over the age of 60. In practical terms, elderly individuals who are able to continue working in their profession or are otherwise active are considered to have aged successfully. This essay will sample the research literature to better understand the physical and mental health issues that can have a positive or negative impact on positive aging through the lens of developmental theory.
Social Context
Social role theory suggests there are cultural norms, and thus expectations, concerning what role the aged should play in society (reviewed by Newman and Newman, 2007). Examples of an expectation is establishing a legal retirement age of 65, becoming an elder in a tribal community, or developing physical and mental infirmities that increase an aged individual's medical and financial dependency on the state.
Rohr and Lang (2009) discussed the evidence supporting their theory that social connectedness can determine how well a person ages, such that aged person in need of social contact will strive to meet expectations, even to the point of self-harm. This is consistent with the findings of Baltes (as discussed by Newman and Newman, 2007, p. 191), who found that dependency expectations by nursing home staff inadvertently encouraged dependency behavior by the residents. After training the staff to reward independent behaviors the residents began to behave independently. This result revealed how the need for social interactions by residents moderated their fear of the isolating effect of behaving independently.
The impact of social expectations and roles are not limited to changes in behavior, but also to physical and mental health. Jackson (2004) revealed that women of European descent living in the United States experienced better mental health if they lived life according to a sequence of work, marriage, and parenting. This finding is consistent with Baltes developmental theory of life span psychology, which proposes that social and cultural expectations define what roles individuals inhabit as they transition through life (Newman and Newman, 2007, p. 189). If retirement is one such role, then Jackson's findings would suggest that retirees could experience better mental health if they retire at the expected age. If the nursing home example given above is used, this suggests that a resident experiences better mental health if they conform to the expectations of the staff, regardless of whether it results in dependent or independent behaviors.
Psychosocial Contexts
The developmental theories of social roles and life span psychology emphasize the influence of environmental factors on human behavior. In doing so, contributions from biology and cognitive processes are largely viewed as passive. In contrast, psychosocial theory brings together environmental, biological, and psychological factors in an effort to explain how a human being progresses from infancy to old age (reviewed by Newman and Newman, 2007). If this theory can be boiled down to its essentials, a person will transition through one social context after another as they go through life and adapt to changing expectations psychologically; however, their ability to adapt will depend to some extent on their biological maturity. Successful adaptation brings about an expanding repertoire of social and cognitive abilities, while failure leads to cognitive rigidity and social isolation.
One aspect of growing old in many western societies is the expectation of retirement and the subsequent enjoyment of leisure activities. While life expectancies continuing to increase, some aged individuals may bristle when expected to limit their activities in order to conform to social norms (reviewed by Newman and Newman, 2007, p. 191). This suggests that the internal lives of individuals matter independent of the social context.
Kleiber and colleagues (2008) argued that resisting the expectation of retirement may be akin to `throwing the baby out with the bathwater.' They suggest that many `involuntary' retirees fail to realize that their lives could be substantially rewarding if they would take a step back and analyze their options.

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For example, working 40-60 hours per week may have conferred a sense of value and contribution for the past 30 to 40 years and its loss is understandably viewed as a negative in a retiree's life; however, long-held dreams of increased family involvement, volunteer activities, or engaging in philanthropic activities are more attainable with an increase in free time. Quality of life can therefore increase substantially if the transition to retirement is based on a deliberate and reflective process. This suggests the internal experience of aged individuals is just as important for positive aging as social context.
When Kunzmann (2008) examined data from the Berlin Aging Study for a possible interaction between affect and functional health, they found that aged individuals with a positive view of aging tended to be more socially involved, had higher intelligence test scores, and were functionally healthier. In contrast, aged individuals with a negative attitude towards getting old tended to be less socially involved. However, the manner by which individuals arrived at a positive or negative affect differed, such that social involvement correlated strongly with positive but not negative affect. Another way of viewing this is that a positive attitude towards getting old is dependent on an outward-based self-evaluation, while a negative attitude is based on internal process self-evaluation. A positive affect is therefore more fragile than a negative affect because social contexts change over time.
The downside of a negative affect is an increased risk of suicide ideation and suicide. When Lapierre and colleagues (2007) examined the efficacy of an intervention program that included cognitive-behavioral counseling and help planning and pursuing a meaningful retirement, they found that suicidal ideation dropped significantly when compared to a control group. At the 6-month follow-up interview, close to 80% of the treated individuals were free of suicidal ideation during the previous week, whereas only 36% of the control group could make the same claim. The core theory behind this 11-week workshop intervention was the belief that setting and pursing goals post-retirement could improve the mental health of retirees, which this study revealed was possible. The treated group also reported more hope, less depression, and a more positive retirement experience.
Heisel and colleagues (2009) took a similar investigative route when they assessed the efficacy of talk therapy for aged adults reporting suicide ideation. The therapy provided was based on the assumption that an inability to satisfy personal needs leads to depression and the resulting depression leads to impaired social functioning and satisfaction of personal needs. Suicidal ideation can therefore be viewed as both severe depression and a form of interpersonal communication. After 16 weeks of weekly 1 hour therapy sessions, the study participants reported significant declines in depressive symptoms and suicidal ideation. The therapists also reported a significant shift from clinical to sub-clinical levels of depression.
In a study that examined the neurophysiological responses to positive, neutral, and negative images, elderly individuals tended to interpret neutral images as slightly more positive than their younger counterparts (van Reekum, Schaefer, Lapate, Norris, and Greishchar, 2011). The reason the authors of this study asked this question was because prior research had shown that aged individuals tended to have a positive bias when interpreting events in their lives. What van Reekum and colleagues added to this body of research is that the positive bias was not due to an increased positive interpretation of positive or negative events, but a positive interpretation of neutral events. Negative events were still viewed as negative. This finding is consistent with psychological adaptation as a person begins to near the end of their lives, which would tend to enhance their ability to retain social connections.
The above studies reveal an important interaction between the social and internal lives of aged individuals and the significant impact that this can have on quality of life. Such an interaction is consistent with psychosocial theory, which holds that social, biological, and cognitive processes interact to determine the developmental trajectory of an individual.
The Biology of Aging
The social and cognitive interactions are important factors influencing the experience of aging, but these interactions occur within certain biological limits. Piaget theorized that individuals move through stages of cognitive maturation during childhood that was based on the physical maturation of a child's brain (Newman and Newman, 2007). As individuals age, they may experience a reverse process as their mental and physical health declines despite attempts to adapt psychologically (reviewed by.....

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