Our knowledge about healthy aging continues to evolve. To advance the field, new paradigms need to be developed and tested that address the aging experience from the perspective of the person who is aging. The American Geriatrics Society challenged professionals to intensify educational, clinical, advocacy, and research efforts that address healthy aging from a multidimensional perspective (Friedman et al., 2019). More specifically, a key area to further develop is person-centered approaches that address older adults' goals, independence, functioning, resilience, dignity, and life satisfaction. The aim of this special issue is to advance our understanding of a process called Engaging With Aging (EWA).
EWA is an active, conscious process taken on by an older adult or on behalf of the older adult (Primomo & Belza, 2019). This process involves coping with daily living and the aging process, placing an emphasis on active engagement to discover and test adaptations that help individuals maintain independence. The notion of EWA was first put forth in a blog written for older adults and later advanced as a framework that can be used to study the processes of EWA. The EWA framework describes the nuances of how to engage with the impact of age-related changes, approaches to adapting and managing age-related changes, and challenges encountered. Authors of the articles in this EWA special issue represent varied specialties and roles in gerontology. Each article presents a different perspective on the application of EWA.
Carnevali, Primomo, and Belza (2019) describe the EWA framework, a perspective and set of processes older adults may use to manage daily living. Unlike other approaches to aging successfully, EWA was developed from the perspective of a nonagenarian, an insider to the aging process, as well as someone who is a theorist, scholar, and nurse. Carnevali reflects on her own experience with normal age-related changes, the environment in which the age-related changes occur, the impact they have on function and lifestyle, and cognitive processes that can be used to identify ways to adapt and satisfactorily manage daily living tasks. The EWA framework provides a structure to examine the impact of age-related changes as well as older adults' goals, resources, and adaptive capacities to eventually develop person-centered care strategies.
Su et al. (2019) conducted a qualitative analysis of Carnevali's publicly available blog posts on EWA. The blog posts provide a first-person narrative about the raw experience of seeing life through the lens of EWA and include descriptions of what the author does to maintain a balance between her requirements and resources in response to age-related changes (Primomo & Belza, 2019). Emergent themes included the identification of age-related changes (e.g., physical, cognitive, functional, social, societal, psychological), characteristics of the age-related changes process, responses to the age-related changes (e.g., feelings, attitudes), approaches and strategies to addressing the age-related changes (e.g., the use of internal and external resources), and the outcomes of the approaches. The EWA blog posts provide insights into the aging experience from the perspective of the older adult, especially functional changes and how they affect daily life. In addition, the blog posts include strategies used to adapt to changes.
Emami (2019) challenges academic nurse leaders to leverage academic resources to promote EWA research, education, and practice. What are the mechanisms to leverage academic resources to assure a forward-looking curriculum, foster relevant research, disseminate findings, and influence policy change? Academic nurse leaders play important roles in advancing transformational ideas by serving as incubators and resources, hubs and bridges, educational futurists, and public advocates.
Teng et al. (2019) conducted a study in which an innovative peer-to-peer online discussion platform was developed to give older adults an opportunity to share their aging-related experiences. Community-dwelling older adults discussed age-related symptoms, self-help, and self-efficacy in the self-management of chronic conditions. Themes emerged such as symptoms (e.g., pain, weakness/tiredness, sleep difficulties) and management strategies (e.g., health behavior changes, psychosocial support). The researchers observed a change in participants' average self-reported health and chronic disease management self-efficacy scores. This type of moderated online platform could facilitate information exchange among older adults, empowering them to leverage their own knowledge and experiences to promote self-management strategies.
Emerging smart home technologies that introduce passive monitoring features into the residential infrastructure may help facilitate EWA. Choi, Lazar, Demiris, and Thompson (2019) believe that emerging smart home technologies can not only provide convenient functionalities (e.g., automated lights) but also provide a wide variety of health-related services to maintain and support older adults' independence. The built environment along with newly embedded technologies have the potential to promote older adults' ability to better manage their day-to-day living. The authors discuss the opportunities to create smart homes that enhance physical and cognitive capacity for older adults. Importantly, they address the ethical and logistical challenges that will inform the design of future smart home systems.
In summary, EWA is a perspective and set of processes for approaching aging in a reasoned and purposeful manner. Further development and testing are needed to advance the science on how older adults manage the impact of age-related changes to maintain independence, life satisfaction, and well-being. The EWA framework also provides insight into how older adults can flourish in old age and experience eudemonia through the active pursuit of meaning and self-realization. Research questions might include the following. In what ways does EWA address a developmental task ass ociated with aging that includes the ability of older adults to discover new competencies and find personal fulfilment? To better understand the impact areas of normative age-related changes, what are the triggers that alert the individual to the impact of the change? Within the processes of EWA, how can health care providers partner with older adults and their caregivers to enhance the older adult's independence? Are EWA concepts applicable across diverse populations of older adults? How can technology facilitate EWA? And last, how might further research using online discussion platforms or social media with older adults expand our knowledge of EWA and possible interventions that promote adaptive aging? Frameworks such as EWA that delineate older adults' capacity to engage in their own aging processes have the potential to contribute new knowledge about optimizing healthy aging.
Basia Belza, PhD, RN, FAAN
The Aljoya Endowed Professor of Aging
School of Nursing
University of Washington
Janet Primomo, PhD, RN
Associate Professor Emeritus
University of Washington Tacoma
School of Nursing & Healthcare Leadership
- Carnevali, D. L., Primomo, J. & Belza, B. (2019). Engaging with aging: A framework for managing daily living. Journal of Gerontological Nursing, 45(12), 13–20. doi:10.3928/00989134-20191105-02 [CrossRef]
- Choi, Y. K., Lazar, A., Demiris, G. & Thompson, H. J. (2019). Emerging smart home technologies to facilitate engaging with aging. Journal of Gerontological Nursing, 45(12), 41–48. doi:10.3928/00989134-20191105-06 [CrossRef]
- Emami, A. (2019). Academic leadership roles and the promotion of research, education, and practices that reframe aging. Journal of Gerontological Nursing, 45(12), 28–32. doi:10.3928/00989134-20191105-04 [CrossRef]
- Friedman, S. M., Mulhausen, P., Cleveland, M. L., Coll, P. P., Daniel, K. M., Hayward, A. D. & White, H. K. (2019). Healthy aging: American Geriatrics Society white paper executive summary. Journal of the American Geriatrics Society, 67(1), 17–20. doi:10.1111/jgs.15644 [CrossRef]
- Primomo, J & Belza, B. (2019). Engaging with aging through reflection and action. Journal of Gerontological Nursing, 45(4), 1–2. doi:10.3928/00989134-20190305-02 [CrossRef]
- Su, Y., Zhai, S., Kim, B., Miyawaki, C. E., Primomo, J. & Belza, B. (2019). “It may be a bit uncertain but it's never boring”: Thematic analysis of a blog about engaging with aging”. Journal of Gerontological Nursing, 45(12), 21–27. doi:10.3928/00989134-20191105-03 [CrossRef]
- Teng, A. K., Han, S., Lin, S.-Y., Demiris, G., Zaslavsky, O. & Chen, A. T. (2019). Using an innovative discussion platform to give voice to aging-related experiences: A pilot study. Journal of Gerontological Nursing, 45(12), 33–40. doi:10.3928/00989134-20191105-05 [CrossRef]