Journal of Gerontological Nursing

Healthy People 2010 

A Key to Successful Aging: Learning-Style Patterns of Older Adults

Elizabeth A Van Wynen, EdD, RN, CNA, BC

Abstract

Health care providers need to understand older adults' style of learning to more effectively teach this population how to live longer, healthier lives.

Abstract

Health care providers need to understand older adults' style of learning to more effectively teach this population how to live longer, healthier lives.

Education is key for helping older adults maintain good health and independent functioning. It also can teach them how to live a longer, healthier life. Most older adults continue to live in the community, are mentally alen, and have a positive perception of their health. Only approximately 5% of older adults currently live in nursing homes (Beare & Graveley, 1995; Rowe & Khan, 1998).

According to Goldberg and Chavin (1997):

Health protection and health promotion are emerging as appropriate frameworks for care of the elderly. Professionals caring for older adults are recognizing that prevention for a 65-year-old, who can be expected to live another 20 years, is a necessary component of Healthcare (p. 345).

Historically, health care providers have not used education techniques with older adults to promote their health and wellness. As a result, there has been little, if any, research conducted on the effects of teaching older adults various health promotion and wellness topics. Instead, the emphasis has been on a health care model of illness. If that pattern is to be altered, it is important to teach older adults new ways of caring for their health effectively, perhaps through their learning-style preferences. Prior to this investigation, older adults had not been examined to determine whether or not their learning styles might be channeled toward assisting them, or whether those styles changed with the passage of time and life experiences. Therefore, the purpose of this investigation was to examine the previous and current learning styles of a sample of older adults.

REVIEW OF THE LITERATURE

Aging has undergone change from a negative to a more positive image because of an increasing awareness of the aging process and because more adults are living longer, healthier lives. Awareness was due, in part, to the noted writings and research of Alford and Futrell (1992); Clark et al. (1997); Ebersole and Hess (1998); Larson (1997); and Wetle (1997). Rowe and Khan (1998) reponed that to age successfully, it is crucial to incorporate the following three important strategies:

* Low risk of disease and disease-related disabilities.

* High mental and physical functioning.

* Active engagement with life.

John (1988) defined the term geragogy to elaborate on Malcolm Knowles' Theory of Adult Learning to be more responsive to older adults. Geragogy provided educators with a theory for older adult learning; John (1988) provided strategies to help the older adults learn (see the Sidebar on page 8).

Health promotion and welhiess has been documented as an important factor in increasing the life expectancy of older adults. Rubenstein and Nahas (1998) challenged health care providers to increase older adults' awareness of the importance of incorporating preventive health care strategies into their daily lives. Moneyham and Scott (1997) described how change is difficult, but not impossible, for older adults. Various researchers supported the importance of linking aging and health promotion and wellness education to provide longlasting benefits.

Nurses are those members of the health care team who are on the forefront of providing appropriate health education to older adults. It is their challenge to support older adults with proper teaching methods to provide them with the knowledge of how to comply with preventive health activities (Rubenstein & Nahas, 1998). According to Rubenstein and Nahas (1998):

Effective health care education must begin with an assessment of the individual's perceived health status, health care knowledge, perceived benefits and barriers of health-promoting behavior, and personal life goals (p. 15).

Of the three goals outlined in Healthy People 2000 (U.S. Department of Health and Human Services, 1991), achieving access to preventive services for all Americans is an enormous challenge for nurses. One of the most important professional roles that a nurse has is that of patient advocate. In this role, the nurse stresses health promotion and disease prevention strategies that will improve the health and well being of all (Alford & Futrell, 1992; Drugay, 1997). The nursing profession has been charged with developing a comprehensive model of health and wellness care in the 21st century for all people. Nurses must accept their leadership role in promoting health and wellness among all people, especially older persons. According to Koroknay (1997):

As the profession that focuses on the promotion of health, nurses are the appropriate discipline (sic) to lead the way in providing care that promotes positive functional outcomes (p. 3).

The literature on aging brains indicated no reason for older adults not to remain mentally vigorous, Greenfield (1996), Herzog and Rodgers (1989), and Restak (1979, 1988, 1995, 1997) acknowledged that the older adult brain decreases in size and amount of neurons, but still functions effectively.

For example, the research applicable to aging, memory, and retention reported significant results with groups that received mnemonic training to enhance their memory functions (Verhaegen, Marcoen, & Goossens, 1993). Although there is a reduction in the explicit memory of older adults, working memory is similar among both young and old individuals (Rowe and Khan, 1998). Internal memory strategies were successful when older adults needed to remember to take medications (Gould, McDonald-Miszczak, & King, 1997). Therefore, activities of daily living were remembered when external memory strategies were used, such as mnemonics or note taking.

Limited research has only begun to identify the learning-style preferences of older adults. Kuznar, Falciglia, Wood and Frankel (1991) were the sole researchers to identify the learning-style preferences of older adult women ages 65 and older (Table 1). Other available data concerning the learning-style preferences of older adults have been limited to correlational and descriptive studies.

Certain elements of the Dunn and Dunn Learning- Style Model have changed over rime (Dunn, 1995; Dunn & Griggs, 1995). Rowe and Khan (1998) identified clues to explain some of the gender differences that described how young versus old individuals focus on tasks. Langer (1997) explained her mindfulness approach elderly individuals could use to assist them to live longer. The research applicable to learning-style theory, as it affected achievement and attitudes, reported significant gains in both factors when individuals were taught through their learning-style preferences.

There has been a paucity of research concerning older adults' learning styles. Thus, there was a need to examine closely how a population of older adults learned in the past and how they currently learn.

THEORETICAL FRAMEWORK

Learning-Styles Model

The Dunn and Dunn LearningStyle Model focuses on identifying individuals' preferences for instructional environments, methods, and resources and is based on the theoretical postulates as seen in Table 2. That model was first published in 1972 when the Dunns "identified 12 variables that significantly differentiated among students" (Dunn & Dunn, 1972). As a result of more than 30 years of research conducted by the Dunns, their colleagues, and graduate students at St. John's University, their model expanded to include 21 elements classified into five strands, as illustrated in Figure 1.

Educational research has shifted its paradigm from understanding the content of teaching and learning to recognizing the importance of how students learn. Miller and Dunn (1997) emphasized the importance of individualizing the learning process for medical students based on their learning-style preferences. Van Wynen (1997) elaborated on the fact that individuals have diverse methods of processing information, ranging on a continuum from highly analytic to highly global. A comparison of the Learning-Styles Model to Information-Processing Styles is illustrated in Table 3. These two contrasting processing styles were related to other learning-style preferences, including sound, light, design, intake, and mobility.

The Dunn, Griggs, Olson, Beasley, & Gorman (1995) metaanalysis was validated by practitioners at the elementary, secondary, and college levels, as well as with corporate employees. When college students and other adults were taught with interventions congruent with their cognitive processing styles, significant increases in academic achievement were documented (Clark-Thayer, 1987; Dunn, Bruno, Sklar, Zenhausern, & Beaudry, 1990; Dunn, Ingham ߣ Deckinger, 1995; Hanna, 1989; Ingham, 1991; Ingham, Dunn, Deckinger & Geisert, 1 995; Lenehan, Dunn, Ingham, Murray & Signer, 1994; Miller, 1997; Napolitano, 1986; Nelson et al., 1993; Sullivan, 1996/1997; Williams, 1994/1995).

METHODS

Setting

This investigation was conducted in one independent, suburban, senior citizen residential community located 30 miles northwest of New York City, New York. Approval to conduct this study was obtained from the Director of Thorpe Village and the Institutional Review Board of St John's University, Jamaica, New York.

Sample

This convenience sample was comprised of 61 residents who volunteered to participate. There were 47 women and 14 men ranging from age 64 to 88. These residents did not demonstrate any cognitive dysfunction as measured by the Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer, 1975).*

Data Collection Procedures

The residents completed several instruments to identify their previous and current learning-style preferences. These included the following instruments:

* Productivity Environmental Preference Survey (PEPS) (Dunn, Dunn & Price, 1991, 1996).

* Previous Learning Experiences Questionnaire (Van Wynen, 1999).

Demographic data were assessed with a researcher-developed questionnaire, as illustrated in Figure 2.

Hypotheses

The following two directional hypotheses were tested to answer research questions concerning the learning-styles of older adults and the relationships between selected learningstyle elements and age and gender.

* Hypothesis 2. Older adults will have scores on learning-style elements, as measured by the PEPS, that are significantly different from those of participants in the original normed group.

* Hypothesis 2. There will be statistically significant relationships among age, gender, and PEPS learning-style preferences within a sample of older adults.

CONCLUSIONS FROM HYPOTHESIZED FINDINGS

Hypothesis 1 Results

This first hypothesis failed to be rejected. There were significant differences between the mean scores of the older adult participants compared to the mean scores of the normed group on 14 of the PEPS 21 elements. Based on t test results, older adults scored significantly higher (strong preferences for) than the normed group on the following PEPS elements: sound, design, structure, peers, authority, auditory, late morning, and mobility. Interpretations of these data indicated that older adults preferred to learn in the late morning, with an authority figure (teacher) present, and with the opportunity in which to work with their peers. These older adults also preferred to sit in a formal learning environment, which included tables and chairs with room in which to move freely. They preferred to listen to a structured presentation by their teacher. It was acceptable for them to have some soft sound in the background.

Table

TABLE 1LEARNING-STYLE PREFERENCES OF OLDER AND YOUNGER ADULT FEMALES

TABLE 1

LEARNING-STYLE PREFERENCES OF OLDER AND YOUNGER ADULT FEMALES

These older adults scored significantly lower (strong opposite preferences) than the normed group on the following PEPS elements: temperature, motivation, responsibility, varied ways of learning, visual, and tactile. Interpretation of these data indicated that the perceptual preferences of these older adults were less visual and tactile than for the normed group. They preferred routines and patterns in contrast with a learning experience that provided variety when compared to the normed group. The temperature needs in the learning environment for these older adults differed from those of the normed group because the older adults preferred a slightly cooler room. Their responses to the elements of motivation and responsibility were lower than for the normed group, indicating that older adults were generally less motivated and conforming about learning new and challenging information than the normed group.

Table

TABLE 2THEORETICAL POSTULATES OF THE DUNN AND DUNN LEARNING-STYLE MODEL

TABLE 2

THEORETICAL POSTULATES OF THE DUNN AND DUNN LEARNING-STYLE MODEL

Hypothesis 1 Discussion

Theoretically, this cohort of older adults may be reflecting a traditional learning style because they preferred a learning environment with the following characteristics:

* Structured.

* A formal design.

* Authority figure present.

* Not inclusive of many learning alternatives.

* Not essentially tactile.

The environmental elements of sound, temperature, and design mattered to these older adults. This cohort preferred having sound present during learning, a formal seating design, and a cool environment in which to learn. These three findings were supported by the ex-post facto research conducted by Price (1987) with 1,475 individuals randomly selected from the national database of participants who had completed the PEPS.

The number of older adults with a strong preference for structure included 22 of 47 (46.80%) women and 8 of 14 (57.14%) men. The number of older adult women and men who were not academically motivated or conforming included 4 of 47 (8.70%) and 10 of 47 (21.74%); and 3 of 14 (21.43%) and 6 of 14 (42.86%), respectively. The PEPS elements of structure, responsibility (conformity), authority figures present, learning in varied ways, late morning, and mobility were confirmed by Kuznar and others' (1991) findings. Structure, responsibility, learning with peers, auditory perceptual preference, late morning, and mobility were confirmed by Price's (1987) findings. Low academic motivation was not supported in the literature and learning with peers and visual and tactile perceptual preferences for this group did not support the findings of Kuznar et al. (1991). The elements of authority figures present, learning in varied ways, and visual and tactile perceptual preferences did not support Price's (1987) findings.

These older adults demonstrated uniqueness in contrast with the normed groups in several ways, but the gap in generations may have accounted for this result. It is possible that the results were due, in part, to differences in their developmental processes or in the ways in which all people change as they age. Perhaps, because the original PEPS was standardized with a younger population, a norming with an older population might be useful.

Hypothesis 2 Results

Age. When investigating age categories and the PEPS learning-style preferences, the only element that produced significance was temperature (t - 2. 195, p = .032). This confirmed Kuznar and others' (1991) finding. The sub-cohort group of older adults age 75 to 85+ was bothered more by changes in temperature than the adults age 64 to 74. This is in contrast with Dunn and Griggs* (1995) finding among adolescents. However, the nursing literature stated that tolerance for temperature is a physiological preference that affects adults as they age (Ebersole & Hess, 1998).

This result did not yield strong evidence to suggest that various age categories exhibited differences in their learning-style preferences, with the single exception of temperature that revealed an increase in the need for warmth as people grew older. The number of older adults aged 55 to 74 years who had a strong preference for temperature included only three women. Four women and one man in the same age category had a strong opposite preference for temperature, indicating they learned best in a cool environment.

Figure 1. The Dunn and Dunn Learning-Style Model. Reprinted with permission from Dunn & Dunn (1973).

Figure 1. The Dunn and Dunn Learning-Style Model. Reprinted with permission from Dunn & Dunn (1973).

Gender. Older adult men scored significantly lower (strong opposite preference) on the PEPS elements of design and time of day. Neither supported Price's finding (1987) that older adult women were significantly higher than the normed group (strong preference) on the PEPS elements of learning with peers, tactile, kinesthetic, evening, and mobility. The learning-style preferences of learning with peers, kinesthetic, evening, and mobility all were supported by Price (1987). The learning-style preferences of peers and kinesthetic did not support Kuznar et al/s data (1991). The perceptual preference of tactile (ranked third) in the modality category, following auditory, kinesthetic, and mobility, were supported by Kuznar and others (1991). These results failed to reject the hypothesis that there were definitive gender differences in learning styles even within this small sample.

Discussion of age and gender differences. These gender differences may be the result of several of the following factors:

* A very disparate gender cohort size (N = 61), men (n - 14), women (n - 47).

* Strongly socialized men and women.

* More, rather than less, unique adults.

* A multitude of life's experiences that influenced participants* reactions.

* Many styles of aging evolving.

* Many different pathways for the aging process.

Previous data evidenced that, within every category, individual differences existed.

CONCLUSIONS FROM NONHYPOTHESIZED FINDINGS

Learning-Style Perceptual Preferences

The learning-style element of perception provided additional information that may be useful for educators to know when their classes contain older adults. For that learning-style preference, the following results were obtained.

Data on the physiological elements revealed some interesting information regarding the different perceptual preferences of younger and older individuals. Perceptual preferences (i.e., auditory, kinesthetic, tactual, visual) were analyzed to detect how certain learning-style preferences changed with the passage of time. Older adults, via a questionnaire, were asked to recall which perceptual preference most closely resembled their previous learning style when they were in grammar or high school. Their current perceptual preferences were identified as auditory (62.30%), kinesthetic (13.20%), tactual (9.80%), and visual (14.70%). A comparison of the study's sample of older adults* previous, versus their current, perceptual preferences is depicted in Figure 3. It is interesting to note how the ranking of perceptual preferences changed over time for this sample of older adults who once were visually pref erenced now prefer an auditory perceptual preference. Price (1987) analyzed a national database of 1,475 older adults who had been administered the PEPS and reported the combined sample of older adults preferred an auditory perceptual preference.

Forty-seven older women in this investigation identified auditory, visual, and kinesthetic as their top three perceptual preferences. Visual, auditory, and tactile were the top three perceptual preferences identified for older women in previous research (Kuznar, Falciglia, Wood, & Frankel, (1991). Price's (1987) findings contradicted what Kuznar and others identified for women. Older adult women preferred kinesthetic and auditory perceptual preferences according to Price (1987).

Older adult men did not prefer auditory and kinesthetic perceptual preferences (Price, 1987). Price further delineated the responses of the total sample of men (n - 419; N = 1,475) from the national database composed of 35 men, age 55 and older. These older men preferred not to learn through their auditory sense. Ingham (1991) identified the perceptual preferences of a predominately male population of corporate employees to have been the following: non-preferenced (45%), auditory (28%), and tactual/kinesthetic (27%).

Table

TABLE 3MAJOR LEARNING-STYLE PREFERENCES OF GLOBAL AND ANALYTIC LEARNERS

TABLE 3

MAJOR LEARNING-STYLE PREFERENCES OF GLOBAL AND ANALYTIC LEARNERS

SIGNIFICANCE OF HNOINGS

Most older adults, given the opportunity, are eager to absorb new information. They deserve encouragement to pursue any form of education, whether for recreational purposes or for survival. They can learn anything they put their mind to. It is important to use the valuable information that this investigation uncovered about older adults.

The significance of this investigation is that, as health care providers, we now have insight into the learning-style patterns of a population of older adults. These older adults did not prefer to be given a booklet and told that everything they need to know is included in this material. This investigation also identified an auditory, rather than a visual, perceptual preference as the methodology for teaching many older adults.

Patient education materials, such as booklets, are in abundance in doctors* offices, clinics, hospitals, and outpatient waiting rooms across the nation. These are not what many older adults prefer. This passive learning approach does not appear to satisfy their changing physiological needs. They want to listen. They prefer a personal and humanized presentation that allows for interaction. Printed booklets are cost-effective in their approach to disseminate important health information, but lead to increasing numbers of patient non-compliance with medical instructions, possibly as a result of the ineffectiveness of this medium as a teaching strategy for this age group. A learning strategy responsive to the patterns of older adult learners would help increase their self-esteem and the type of socialization they seek and need. The question is where to spend valuable health care dollars, in prevention education and health promotion, or in in-hospital admissions for expensive treatments and procedures requiring skilled custodial care.

Figure 2. Demographic Data Questionnaire (Van Wynen, 1999). Reprinted with permission.

Figure 2. Demographic Data Questionnaire (Van Wynen, 1999). Reprinted with permission.

RECOMMENDATIONS AND NURSING IMPLICATIONS

Recommendations were generated as a result of this investigation and seem worthy of consideration for others interested in educating older adults. These recommendations follow:

* Patient educators must become knowledgeable about the Dunn and Dunn Learning-Style Model and the learning-style preferences of older adults, because they can then develop lessons that respond to the various learning-style preferences of their patients. It is important for the patient to be able to retain the vital medical information they learn. Educators need to understand their patients' styles of learning to present meaningful lessons.

* Patient educators must integrate various learning-style instructional methodologies into their repertoire when teaching, because in any group of learners, a diversity of instructional methodologies is needed to obtain congruence with varied learning-style preferences.

* Workshops or seminars should be scheduled during late morning or evening hours for women; time of day is not as important for men.

* Learning environments should include background sound, bright light, and a formal design of table and chairs for women and an informal design of softer chairs or couches for the men. Regulation of the room's temperature can be difficult because the majority of older adults prefer a cooler temperature as compared to the older adults age 75 and older who prefer a warmer environment. Jackets, sweaters, and light blankets should be available.

* Learning environments should allow participants the ability to move around and stretch (to prevent their joints from stiffening).

* Learning environments should allow food and drinks for consumption.

CONCLUSION

This study has expanded the Dunn and Dunn Learning-Style Model's continuum of age levels and older adults' respective learning preferences. Currently, with 30 years of research, nine decades of life have been examined to determine predominant learning-style preferences for each group. Information of this nature is important to students of all ages, corporate employees, and older adults. In addition, this awareness is vital to their parents, teachers, employers, and health care professionals. This research is important because of the applicability of findings to a population that still has a lot of learning to do. Health care professionals are equipped with specific recommendations concerning how they best can support older adults* adeptness to health promotion - a key to successful aging!

Figure 3. Comparison of older adults' previous and current perceptual learning-style preferences.

Figure 3. Comparison of older adults' previous and current perceptual learning-style preferences.

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TABLE 1

LEARNING-STYLE PREFERENCES OF OLDER AND YOUNGER ADULT FEMALES

TABLE 2

THEORETICAL POSTULATES OF THE DUNN AND DUNN LEARNING-STYLE MODEL

TABLE 3

MAJOR LEARNING-STYLE PREFERENCES OF GLOBAL AND ANALYTIC LEARNERS

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