Journal of Gerontological Nursing

Aging - A Progressive Phenomenon

Neville Strumpf

Abstract

In spite of the plethora of literature on the subject of the aging process, it is important to recognize that appropriate conceptual frameworks from which current gerontological theories can be evaluated and new theories elaborated are lacking. Studies of aging, like other phenomena of life, have been no exception to heiter skelter research methods, namely, the gathering and interpretation of data without adequate conceptual models and theoretical frameworks. The thrust of gerontological research has been the accumulation of facts and the location of causes, rather than development of the broad conceptualizations and theories requisite for satisfactory explanation and reasonable prediction. For the most part, the little that exists in the way of a theory of aging is rooted in an entropie model of the life process postulating that man regresses to a state of homogeneity and undifferentiation. Reliance on this entropie, or décrémentai model, which is closed, deterministic, ana unidimensional has considerably influenced the interpretation of data about aspects of aging.

It is the purpose of this paper to demonstrate how the use of a negen tropic model of man, rather than an entropie one, can serve as a useful means of describing, interpreting, and predicting the progressive phenomena of aging. Unitary man, as articulated by Martha Rogers1 'in Theoretical Basis of Nursing, will serve as a reference point for seriously questioning the data used in support of a décrémentai view of aging. The contrast between the latter and those studies delineating the complexity and the diversity of man will be noted.

It is necessary at the outset to distinguish between aging and the aged. Aging is a lifelong process, a maturing and ripening; it is not pathological or dysfunctional. Aged is generally used to mean having "grown old" or "having attained a specified age"; it is also a term designating that which is "typical of old age."* Aged, a relative term, is often associated with undesirability and decrepitude. The focus of this paper is not the aged per se, but aging, a process of tremendous variability which cannot alone be defined by chronological norms or physical appearances.

Theoretical Background

Biological research has been directed by an unshakable belief in the inexorability of an advancing deterioration from which escape is impossible. Cell theory, now considered archaic in some scientific circles, has been used to explain aging as the direct outcome of irreversible cell mutation curtailing functioning and eventually leading to senescence. From this unfavorable and grim perspective aging appears to be the result solely of what Kastenbaum3 aptly calls a "molecular manifesto."

Generally, experimental psychologists, following the lead of the biologists, have been mesmerized by the décrémentai model and have viewed aging as a process of decline. Changes in learning, ability, memory, intelligence, concept attainment, problem solving, and creativity have been attributed to decreased functioning of the central nervous system.

In the psychosocial realm, approbation has been granted to theories advancing the notion of aging as at least "normal," but an underlying supposition of decline is pervasive. Notable among such theories is that of disengagement. Although widely accepted at the time of its inception in 1961, disengagement is now being seriously questioned. Nevertheless, its essential thesis that "aging is an inevitable mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social systems he belongs to"4 has serious implications because the basic assumption of such a developmental scheme is that all individuals must advance through a precisely ordered sequence of events and accomplish certain tasks, including curtailment of involvement. The latter, unfortunately, has practically come to be regarded as the sine qua non of…

In spite of the plethora of literature on the subject of the aging process, it is important to recognize that appropriate conceptual frameworks from which current gerontological theories can be evaluated and new theories elaborated are lacking. Studies of aging, like other phenomena of life, have been no exception to heiter skelter research methods, namely, the gathering and interpretation of data without adequate conceptual models and theoretical frameworks. The thrust of gerontological research has been the accumulation of facts and the location of causes, rather than development of the broad conceptualizations and theories requisite for satisfactory explanation and reasonable prediction. For the most part, the little that exists in the way of a theory of aging is rooted in an entropie model of the life process postulating that man regresses to a state of homogeneity and undifferentiation. Reliance on this entropie, or décrémentai model, which is closed, deterministic, ana unidimensional has considerably influenced the interpretation of data about aspects of aging.

It is the purpose of this paper to demonstrate how the use of a negen tropic model of man, rather than an entropie one, can serve as a useful means of describing, interpreting, and predicting the progressive phenomena of aging. Unitary man, as articulated by Martha Rogers1 'in Theoretical Basis of Nursing, will serve as a reference point for seriously questioning the data used in support of a décrémentai view of aging. The contrast between the latter and those studies delineating the complexity and the diversity of man will be noted.

It is necessary at the outset to distinguish between aging and the aged. Aging is a lifelong process, a maturing and ripening; it is not pathological or dysfunctional. Aged is generally used to mean having "grown old" or "having attained a specified age"; it is also a term designating that which is "typical of old age."* Aged, a relative term, is often associated with undesirability and decrepitude. The focus of this paper is not the aged per se, but aging, a process of tremendous variability which cannot alone be defined by chronological norms or physical appearances.

Theoretical Background

Biological research has been directed by an unshakable belief in the inexorability of an advancing deterioration from which escape is impossible. Cell theory, now considered archaic in some scientific circles, has been used to explain aging as the direct outcome of irreversible cell mutation curtailing functioning and eventually leading to senescence. From this unfavorable and grim perspective aging appears to be the result solely of what Kastenbaum3 aptly calls a "molecular manifesto."

Generally, experimental psychologists, following the lead of the biologists, have been mesmerized by the décrémentai model and have viewed aging as a process of decline. Changes in learning, ability, memory, intelligence, concept attainment, problem solving, and creativity have been attributed to decreased functioning of the central nervous system.

In the psychosocial realm, approbation has been granted to theories advancing the notion of aging as at least "normal," but an underlying supposition of decline is pervasive. Notable among such theories is that of disengagement. Although widely accepted at the time of its inception in 1961, disengagement is now being seriously questioned. Nevertheless, its essential thesis that "aging is an inevitable mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social systems he belongs to"4 has serious implications because the basic assumption of such a developmental scheme is that all individuals must advance through a precisely ordered sequence of events and accomplish certain tasks, including curtailment of involvement. The latter, unfortunately, has practically come to be regarded as the sine qua non of aging.

A conceptual model is an essential prerequisite to the construction of theories which explain or predict. However, a decremental model of man as an organism regressing with increasing age is inadequate because the ensuing theoretical explanations, as cited in the previous examples from the biological and psychological literature, are particulate and completely overlook the processes of change and interaction.

Unitary Man

Because it incorporates the processes of change and interaction, Roger's1 model of unitary man is a more suitable paradigm for a theory of aging. The model rests upon five basic assumptions:

1. Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts.

2. Man and environment are continuously exchanging matter and energy with one another.

3. The life process evolves irreversibly and unidirectionally along the space-time continuum.

4. Pattern and organization identify man and reflect his innovative wholeness.

5. Man is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.

From these assumptions Rogers derives a number of principles, one of which she calls helicy. "Helicy is a function of continuous innovative change growing out of the mutual interaction of man and environment along a spiralling longitudinal axis bound in spacetime.1 Aging is seen as a manifestation of helicy and is viewed as a negentropic process in man from conception through death. This negentropic model of man, quite unlike an entropie and teleological one, represents a multidimensional open system characterized by the simultaneous interaction of man and environment. From the model, a theory of aging with positive connotations emerges. The nature of aging is one of increasing complexity, innovation, and diversity; the direction of aging is one of progression rather than regression. This may sound more akin to wishful thinking than to sound theorizing; however, except for a few bits of speculation, the ensuing paragraphs favor a progressive view of the aging process.

Aging as Illness

Tenacious adherence to the decremental model, reinforcing a negative perception of aging, distinguishes much of the gerontological literature. The enormity of the problem becomes clearer when one reflects for a moment upon the widespread acceptance of an a priori determination, based on some research findings, that aging is synonymous with intellectual and physical decline, decreasing social effectiveness, and the extinction of intellectual and sensual stimulation and pleasure. The unfortunate result is "ageism," what Butler describes as a "process of systematic stereotyping of and discrimination against people because they are old."5

The high premium which Americans place upon youthfulness has moved the aging from a position of respect to one of "cultural disenfranchisement."6 Mandatory retirement and special communities for the aging are but two examples of a deliberately planned obsolescence based on the belief that the old want to, and should, withdraw from the general society. The aging relinquish the things they value most and the expectation of uselessness, consequently, becomes a self-fulfilling prophecy for many.

Aging does not go hand-in-hand with illness. Nevertheless, the idea was the support of many. In a world of the sick, the aging become and are treated as patients, and respond in ways considered appropriate to illness. Their responses may take any number of forms, including anxiety, confusion, anger, or delusions, all of which are considered normal under some circumstances and all of which are usually considered abnormal, or senile, whenever they occur in the aging, It is shocking that in the United States one of every six persons over 65 is labelled by a health professional as senile.7 However, Palmore reports that less than ten percent of the aged are disoriented or demented.8

It is unfortunate that many allegedly undesirable responses of the aging are explained away in terms of physiological cause-and-effect. The success of such thinking is aptly demonstrated by the frequency with which behavioral alterations are attributed to irrevers- j ible vascular changes. While the dynamic interactions and continuous repatterning of man and environment tend to be ignored in favor of more rigid views, it is more than reasonable to suggest that any behavior might better be interpreted on the basis of the interactions occurring between an individual and his particular environment than on the basis of the old "molecular manifesto."

Research

Large gaps remain in knowledge of the aging process partly because little research has been done using healthy subjects. The prevailing decremental view of the aging process has been upheld by a half century of gerontological research documenting the decline of biological, cognitive and psychomotor functioning in aging persons largely confined to instutitions.5 The results may be as much a reflection of illness, personality variables, and sociocultural effects as of increasing age.

Gubrium's9 statement that the disengagement theory suffers severe explanatory problems methodologically corroborates Botwinick's1 suggestion, based on recent studies, that cultural patterning must be considered in an explanation of disengagement. It appears that the majority of old people are not as isolated as disengagement theorists suggest. Harris11 notes that most old people say that loneliness is not a problem; furthermore, at least half are able to spend a great deal of time socializing with friends. Participation in churches and voluntary organizations indicate that a large portion of the old are clearly not socially isolated.

Swenson12 comments on the amount of erroneous information disseminated by faculty psychological research of man's intellectual capacities. In regard to the latter, Bayley and Oden13 note that increment and decrement in intelligence varies with the instrument used, an important regard, sometimes ignored, in the evaluation of research measuring intellectual ability in the aging. That little justification exists for the notion of intellectual deterioration is increasingly evident; in fact, many recent studies indicate that the majority of the aged have no serious memory defects.8 Kogan's14 work on categorizing and conceptualizing styles failed to confirm other published studies maintaining that aging is marked by conceptual deficits or a regressed mode of cognitive functioning. Outcomes of his study suggest that older adults, reasonably matched with younger adults on level of formal education, demonstrate greater imagination with certain types of classification exercises and also show a willingness to try alternative modes of thinking. A different study showed that certain abilities, such as vocabulary and capacity to understand different words, may actually improve with age.13

Bayley and Oden13 and Shaie15 point out that in the area of cognitive functioning, decline with age has been shown primarily in those instances where speed of performance is an issue. However, even in instances of reduced speed of reaction, there has been no demonstrable decline in accuracy of performance. In any event, to evaluate cognition of the basis of speed of completion is as specious as the evaluation of sexual equality on the basis of strength. It might be more fruitful to look at the relationship between the amount of experience, a concomitant of increasing age, and the speed with which one arrives at conclusions, not to mention the value of the conclusions reached.

Denial of the aging person's potential for change aids in solidifying the stereotype of declining intellectual performance. It is commonly believed, even by the aged themselves, that the majority of old people are "set in their ways," but Palmore8 states that most older people do change and adapt to the many major events that occur to them.

Creativity

Because of the array of literature asserting that one invariably regresses with increasing age, those of advanced years who are unusually creative have aroused considerable curiosity and have been subjected to great scrutiny. Witness the artistic genius, Arthur Ruben- t Stein, who at the age of ninety, was a star attraction of I the symposium probing the majesty of man and the mysteries of creativity at the Stanford University Medical Center. Rubenstein16 tells how "they wanted to poke my brain and examine me - they seemed amazed that I was still alive. Look, he can walk and talk."

The number of masterpieces (those of Titian, Cervantes, Tolstoy, and Verdi come immediately to mind) produced by persons well beyond the age of 60, does not, of course, prove a relationship between age and creativity; however, it serves as a cogent reminder of the range of individual patterns not a function of age alone. Studies by Blum and Jarvik17 and DeCarlo18 show that a relationship exists between continuous intellectual activity and productivity in later life; and Gardiner,19 involved in a creative writing workshop with a group of aging persons, found them "to be at the very least minor poets and at most future novelists."

The expectation, says Mead, that one's best work is done prior to age 35 is detrimental, because many are retired at the height of creativity.20 It is no surprise that old age is viewed as horrible in societies denigrating experience and seniority. Contrast these with a few remote regions of the world where longevity is common, and aging persons are highly valued: the valley of the Vilcabamba in Educador, Abkhazia in the Georgian Soviet Socialist Republic, and Hunza in Kashmir. All are places virtually untouched by the techniques of modern medicine and the mores of technological society. The centenarians, recognized for their wisdom, have interestingly arrived at their ripe old age in spite of heavy smoking, lusty drinking, and hearty eating, habits generally considered to be unhealthy by Western society.21 For those committed to the prevention of illness and the maintenance of health, it is a point worth pondering.

Conclusion

Rogers's five assumptions of unitary man have been used as a framework for proposing a theory of aging. The explicative virtue of such a paradigm is its attention to interactions between man and environment and to the irreversible and unidirectional nature of the life process.

A theory of aging based upon a negentropic model of man has many implications for nursing practice, nursing education, and nursing research. A procrustean attitude disregarding individual differences has dominated nursing practice, and the aging continue to be categorized as homogenized, desexualized Golden Agers and Senior Citizens. The finding of Gillis22 that education is no guarantee of a favorable attitude toward the aging seems to indicate that the impact of nursing educators on geriatric practice has not always been positive. Such a sta te of affairs serves to heighten the urgency for nurse researchers to develop, test, and refine theories of aging which will aid in the understanding of interaction between man and environment.

The preceding remarks are not to be construed as a denigration of much of the gerontological research, but the suggestion has been made that the data can be more appropriately interpreted using a negentropic, rather than an entropie, model of man. Studies of the wide range of human variability and man's potential for continuous creative development serve to weaken, on theoretical and empirical grounds, the decremental model of aging. Finally, greater acceptance of a theory of aging as a progressive phenomenon could aid in dispelling the image of aging as illness and could nourish a philosophical climate worthy of the dignity of man.

Acknowledgment

I would like to add my appreciation to Dr. Robert Finley tor his assistante in editing the manuscript.

"Culturally, the concept of dependency is sanctioned for children; however, for the elderly who are viewed as dependent, unlike the child for whom it is "becoming?" this is a sign of aging or the process of deterioration."

"Culturally, the concept of dependency is sanctioned for children; however, for the elderly who are viewed as dependent, unlike the child for whom it is "becoming?" this is a sign of aging or the process of deterioration."

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