114 Module 2F: Psychosocial Changes
The psychological and social
• People age in a number of ways and it can be viewed
in chronological, biological, psychological, and social
age. These ages may or may not be the same.
Chronological Age – measured by the number of years
lived
Biological Age – predicted by the person’s physical
condition and how well vital organ systems are
functioning.
Psychological Age – expressed through a person’s ability
and control of:
• Memory
• Learning capacity
• Skills
• Emotions
• Judgement
Maturity in capacity will direct the manner in which one
is able to adapt psychologically over time to the
requirements of the physical and social environment.
Models and Theories
Psychological Theories of Aging
• Carl Jung’s Theories of Personality
o Suggested that aging results in the movement
from extraversion to introversion, beginning
perhaps at midlife where individuals begin to
question their own dreams, values, and
priorities.
o Personality is the extrovert and oriented
toward the external world
o Introverted are oriented toward the subjective
inner world of the individual
Sociological Theories of Aging
• Measured by age graded behaviors that perform to
an unexpected status and role in the particular
culture or society.
theories are not always based on empirical
evidence because of the methodological and
measurement related problems
• The majority of these theories were developed
from a Eurocentric perspective and may be less
useful to describe aging with other cultures
especially those that are collective rather than
individualistic.
• The importance of opportunity, ethnicity, gender
and social status are largely ignored.
• In addition, the theories have little to do with
personal meaning and motivation. However, they
may be useful as guide in helping us understand the
world around us and move toward healthy aging.
As current generation of elders move to this period
of life development, many of the ideas we have of
this period of life are being and will continue to be
redefined.
Personality and Aging
Personality – refers to individual differences in
characteristic patterns of thinking, feeling, and behaving.
- What makes an individual unique from the other
Focused on 2 broad areas:
1. Understanding individual differences in
particular personality characteristics, such as
sociability or irritability.
2. Understanding how the various parts of a person
come together as a whole.
“Much of what we know about optimal aging has focused
on the lifelong importance of health-related behavior –
exercise, drinking, and eating in moderation… being
engaged in life and having a strong social network.” She
said. “But personality is arguably the driving force behind
all of these.” - Oregon State University Psychologist
Karen Hooker, PhD
• Late life is often when a person’s personality is most
evolved.
Healthy Personality
Jahoda (1958) observed Schultz (1977) assessed
that “positive mental components of healthy
health includes one or personality and stated
more of the following six the following
(6) aspects of individuals: characteristics to be
 • The degree of agreed upon by most Components of cognitive function
personal integration theorists:
achieved by the • Capability to • Language
individual. consciously and • Thought
• The degree of rationally direct • Memory
autonomy achieved one’s behavior. • Executive function
by the person. • Being in-charge of • Judgment
• The adequacy of the one’s own destiny • Attention
person’s perception • Knowing who and • Perception
of reality. what one is and
• The degree of being accepting of **The determination of intellectual capacity and
environmental strengths and performance has been the focus of the major portion of
mastery achieved weaknesses. gerontological research.
by the person. • Being firmly
• The attitudes anchored in the • Cognitive functions may remain stable or decline
shown by a person present. with increasing age.
toward his or her • Pursuit of challenge • The cognitive functions that remain stable include:
own self. through new goals attention span, language skills, communication
• The style and and new skills, comprehension and discourse, and visual
degree of a person’s experiences. perception.
self-actualization. • Recent neuroimaging research has suggested that
changes in the brain once seen only as a
• Self-actualization – the complete realization of compensation for declining skills are now thought
one’s potential and the full development of one’s to indicate the development of new capacities.
abilities and appreciation of life These changes include using both hemispheres
o Self-actualized people have an acceptance of more equally than younger adults. Greater density
who they are despite their faults and of synapses and more use of the frontal lobe which
limitations and experience the drive to be are thought to be important in abstract reasoning,
creative in all aspects of their lives. problem solving, and concept formation.
• Healthy personality is manifested by individuals • The renewed emphasis of the cognitive capabilities
who have been able to gratify their basic needs, provide a view of aging that reflects the history of
their acceptable behavior, such as their own many cultures and provides a much hopeful view of
personality, is no longer a problem to oneself. They aging and human development.
can take themselves more or less for granted and
devote energies and thoughts to socially
meaningful interests and problems beyond security
or lovability or status.
• Therefore, to have a good and positive mental
health, we are required to have a healthy
personality.

Cognition and Aging

Cognition – both a biological and psychological factor
that must be considered in caring for the older adult.
Cognition and Memory
- It is the process of acquiring, storing, and in
1. Fluid intelligence – “native intelligence”
sharing and using information.
- Skills that are biologically determined,
independent of experience or learning
- Associated with flexibility thinking, inductive
reasoning, abstract thinking and integration
 - Assists people to identify and draw conclusions o maintain social relations with people of same
about complex relationships age
o establishing good physical living
2. Crystallized intelligence arrangements
- Knowledge and abilities that the person acquires • Such tasks arise in response to the changes in the
through education and life. biological condition of the body related to age,
- Include verbal meaning, word association, social cultural traditions, and individual aspirations.
judgment, number skills

Classic Aging Pattern (Hooyman & Kiyak, 2011)
• Older people perform more poorly on performance
scales (fluid intelligence), but scores on verbal
scaled (crystallized intelligence) remain stable.
• May be due to age-related changes in sensory and
perceptual abilities, as well as psychomotor skills.
Age-associated Memory Impairment (AAMI)
• One of the first few human development as a
lifelong process composed of many aspects of
human activity manifested as development tasks.
• These developmental tasks may be regarded as the
challenges of people from a certain age.
2. Erik Erikson’s Theory
o Highlights Integrity vs Despair

• Has been used to describe memory loss that is

considered normal in light of a person’s age and
educational level.
• May include a general slowness in processing,
storing, and recalling new information, and
difficulty remembering names and words.
• Natural process associated directly with growing
age. Almost 40% of people aged 65 up experience
gradual memory loss which has no direct link to any
of the medical conditions
• First, is a desire to achieve a sense of integrity – that
Developmental Tasks
is to achieve a sense of meaning and a sense of a
2 Common theories associated: well-lived life
• The other is a tendency to fall into despair and
• Two classical general developmental theories
hopelessness. It is possible to overcome the fear
authored by Havighurst and Erikson examine the
associated with death by adopting a commitment
specific nature of each stage of human
to integrity accompanied by acceptance. This
development.
commitment fosters the feeling that one’s life
• They posit a trajectory of development spans
makes sense and is derived from a broader
infancy to old age and emphasizes the key
perspective of synthesis of lived experience that is
elements of functioning in each particular life
experiencing the balance of life
period. Experience in deteriorating health and
infirmity compared to others and their own past On the other hand, this theory of crisis and psychosocial
selves, the individual is preset to strong opposing development throughout the lifetime, Erikson highlights
forces. the need for a space for the continuum of integrity and
despair during the period of late adulthood.
1. Robert Havighurst’s Theory
• Faced by people 60 years and above
o Adapting to a decline in physical strength
o adapting to retirement and reduced income
o coming to terms with the death of a spouse
 Promoting Mental Health in the Older Adults
Mental Health – Global Incidence (WHO, Dec 2017)
• Over 20% of adults aged 60 and over suffer from a
mental or neurological disorder.
• 6.6% of all disability (disability adjusted life years –
DALYs) among people over 60 years is attributed
to mental and neurological disorders.
• Most common mental neurological disorders in
this age group are:
o Dementia and depression (approximately 5%
and 7% of the world’s older population)
o Anxiety disorders (affects 3.8%)
o Substance use problems (affect almost 1%)
• Substance abuse problems among older adults are
often overlooked or misdiagnosed.
• Psychological aging influences the way we view with
the biological changes in a capacity to adjust to
different life events
• It is affected by education, income, employment
history, and social and support networks.
• Social aging comprises the external changes
imposed in individuals based on their chronological
age (Ex. Being forced to retire at age 65)
• An important aspect of healthy aging is the
promotion of good mental health and well being in
later life.
• It is assumed that quality of life decreases with age,
but this is not necessarily true. Study shows that for
many people, particularly women, life satisfaction
increases as they grow older.
Mental health – the positive ability to enjoy life and cope
with its difficulties. It is a resource that enables us to
grow and learn and experience life as enjoyable and
fulfilling.
George Valliant describes 7 concepts of positive mental
health:
• Effective functioning
• Strengths of character
• Maturity
• Positive emotional balance
• Socio-emotional intelligence
• Life satisfaction (true happiness)
• Resilience
• It is widely acknowledged that the mental
health and well-being of older people has been
neglected in across the spectrum of promotion,
prevention, and treatment services.
• Within mental health policy, older people are
often neglected and mental health initiatives
have tended to target adults of working age,
many adults up to age 65, as well as children
and young people.
• This has resulted in an even progress in mental
health developments for people of different
ages.
• This inequality is starting to get recognized that
more work is needed to ensure that mental
health programs address older people’s needs
and interests.
With Good Mental Health, we can:
• Develop emotionally, creatively, intellectually, and
spiritually
• Initiate, develop and sustain mutually satisfying
personal relationships
• Face problems, resolve them and learn from them
• Be confident and assertive
• Be aware of others and empathize with them
• Use and enjoy solitude
• Enjoy life and have fun
• Laugh, both at ourselves and at the world
Why Pay Attention to Mental Health?
• Good mental health and well-being in layer life
benefit each of us personally
• Good mental health and well-being in later life
benefit society by maximizing the contributions
that older people can make.
• Good mental health and well-being in later life
benefit society by minimizing costs of care related
to poor mental health.
Mental Health Promotion
- Any activity or action that strengthens or
protects mental health and well-being
Works at 3 levels:
1. Strengthening individuals. By increasing
emotional resilience through interventions
designed to promote self-esteem, life and coping
 skills such as communicating, negotiating, and
relationship skills.
2. Strengthening communities. By increasing social
inclusion and participation, improving
neighborhood environments, developing a range
of interventions which supports mental health
for all people of all ages, including anti-bullying
strategies at school, programs to improve health
in the workplace or community safety measures,
or self-help networks
3. Reducing structural barriers to mental health.
By tackling societal structures through initiatives
to reduce discrimination and inequalities to
promote access to education, meaningful
employment, housing services, and support for
those who are vulnerable.
ENHANCEMENT LECTURE NOTES
• Mental health disorders occur in nearly 20% of the
older population, with the most frequent diagnoses
being anxiety and depression (Touhy & Jett, 2010).
• Symptoms are often underreported by and under-
diagnosed in older individuals.
• Only 3% of older persons report being actively
treated by a mental health professional, and it is
estimated that 63% of those individuals who are
diagnosed with a mental illness do not receive
appropriate care.
• As a maladaptive response to the challenges of
aging, older adults may present with symptoms of
anxiety and/or depression (Fiske, Loebach-
Weatherell & Gatz, 2009).
• Often older adults will minimize their concerns
about possible symptoms of anxiety and
depression because of learned sociocultural
patterns of beliefs about mental illness.
Risk Factors of Developing Anxiety
1. Family history of anxiety disorders
2. Female gender
3. Perimenopause (due to hormonal changes)
4. Increased frailty
5. Acute or chronic illness
6. Chronic pain
7. Loss of family members, friends, independence, or
home (including being moved to another residence
such as a nursing home)
8. Lack of social supports
9. Recent traumatic event
10. Poor self-rated health
11. Concurrent diagnosis of depression, dementia,
bipolar disorder, or schizoaffective disorder
12. Certain medications
Types of Anxiety
1. Generalized anxiety disorder (GAD)
- Constant worries and fears distract an individual
from day-to-day activities or the person is
troubled by a persistent feeling that something
bad is going to happen
- Chronic fear with anxious symptoms nearly all of
the time, through the individual may not even
know why
- Often presents with physical symptoms like
insomnia, stomach upset, restlessness, and
fatigue.
2. Agoraphobia
- Anxiety about being in places where escape
might be difficult or available should a panic
attack develop
- Can be with or without panic disorder
3. Panic Disorder
- Repeated, unexpected episodes of severe
anxiety, as well as fear of experiencing another
episode
- May be incapacitating, where the individual may
be frozen and unable to move, may have feelings
of shortness of breath or smothering as well as
feelings of choking
- Panic disorder may also be accompanied by
agoraphobia, which is a fear of being in places
where escape or help would be difficult in the
event of a panic episode
4. Obsessive-compulsive disorder
- Unwanted thoughts or behaviors that seem
impossible to stop or control
- Recurring worry or obsessed by a thought such
as forgetting to turn off the oven or that a fall
may occur
5. Phobia
- An unrealistic or exaggerated fear of a specific
object, activity, or situation that in reality
presents minimal to no danger.
- Common phobias include fear of animals, fear of
places such as hospitals, or fear of events such as
testing situations
- In the case of a severe phobia, an individual
might go to extreme lengths to avoid the thing
feared.
6. Posttraumatic stress disorder (PTSD)
- PTSD is a condition that can develop following a
medical event (such as a fall or cardiac arrest),
traumatic or terrifying event (such as a sexual or
physical assault), the unexpected death of a
loved one, or a natural disaster, as well as
present in individuals who have served in war
situations.
- Older individuals who exhibit symptoms of PTSD
often have lasting and frightening thoughts and
memories of the event and tend to be
emotionally numb.
7. Social phobia
- Persistent and irrational fear of situations that
may involve scrutiny or judgement by others,
especially in social settings such as parties and
other social events.
8. Substance-induced anxiety disorder
- Prominent anxious symptoms that are
determined to be the direct physiological
consequences of a drug of abuse, a medication,
or toxin exposure.
Nursing Care for the Patient Experiencing
Anxiety
1. Decrease environmental stimuli
2. Stay with the patient
3. Make no demands and do not ask the patient to
make major decisions
4. Support current coping mechanisms (crying,
talking, etc.)
5. Do not confront or argue with the patient
6. Speak slowly in a soft, calm voice.
7. Avoid reciprocal anxiety (emotions can be
contagious, and sensing anxiety in the nurse can
worsen the patient’s anxiety).
8. Reassure the patient you will help develop a
solution to managing the problem
9. Reorient the patient to reality (unless this causes
more anxiety).
10. Respect the patient’s personal space.
Depression
- A significant number of older individuals
experience depression, which can impact
individual health and overall quality of life as well
as decrease an individual’s lifespan.
Types of Depression
1. Major Depression
- A depressive episode where an individual
experiences pervasive feelings of anxiety and
sadness that coincide with anhedonia, or loss of
pleasure and interest in daily activities.
2. Minor Depression
- A subset of major depression and is defined as an
episode of depressive thoughts that is less
severe than major depression, but has a similar
2-week time frame for presentation.
3. Dysthymia
- Is a chronic form of depression that is often
diagnosed in older adults with prolonged illness
or those who experience long-term challenges in
their daily living.
- Older adults who present with dysthymia
experience mild to moderate depressive
symptoms that are present throughout most
days over a 2-year period.
Different Presentations of Depression
Symptoms of depression can also manifest in varying
patterns of thought and behavior.
• Catatonic depression – individual is very
withdrawn, thinking, speech, and general activity
may slow down, as well as the cessation of all
voluntary activities, may not take care of
him/herself, household, or pets; and may also
mimic others’ speech (echolalia) or movements
(echopraxia).
• Melancholic depression – individual does not
receive pleasure from usual activities; may appear
sluggish, sad, and withdrawn; may speak little, stop
eating, and lose weight; often shows no emotions,
or may feel excessively or inappropriately guilty.
• Psychotic depression – individual has false beliefs
(delusions) about having committed unpardonable
sins or crimes, having incurable or shameful
disorders, or being watched or persecuted, may
have hallucinations, usually of voices accusing
 them of various misdeeds or condemning them to
death; and some individuals may imagine that they
see cons or deceased relatives.

Schizophrenia
- Is a severe mental disorder characterized by two
or more of the following symptoms: delusions,
hallucinations, disorganized thinking,
disorganized or catatonic behavior (called
positive symptoms) and affective flattening,
poverty of speech, or apathy (called negative
symptoms) that cause significant social or
occupational dysfunction, and are not
accompanied by prominent mood symptoms or
substance abuse or can be attributed to medical
causes (American Psychiatric Association, 2000).