Adjustment to Aging
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Adjustment to aging is a concept based on different theoretical models, ideas, underlying relationships, and research strategies that can help to comprehend the expansion of current and future cohorts in old age (von Humboldt 2016). Adjustment to aging was initially considered as a combination of the person’s adjustments in different areas of experience, namely, religion, recreation, economic security, employment, family, and friends, together with the overall happiness and satisfaction of the person with his or her situation. Based on the idea of balance, the establishment of the concept of adjustment to aging highlighted that it should be examined as a dynamic process (Burgess et al. 1948).
The most pertinent theoretical models related to adjustment to aging only became noticeable after the Second World War. Subsequently, correlates and effects of adjustment to aging (e.g., psychological and environmental variables) were also advanced. Until recently, the use of the construct of adjustment progressively decreased in the literature, due to contradictory empirical outcomes (von Humboldt et al. 2012a). Some authors argued that a complete understanding of mental health in old age must include an appreciation of how older persons deal with the demands associated with aging and that indicated that adjustment to the changes of old age required flexibility to common challenges in old age (von Humboldt 2016). Adjustment to aging is achieved when a balance between the cognitive and motivational systems of the person has been attained (Thomae 1992). Moreover, the concept of successful aging includes a process of continuous adjustment (Lewis 2011). In a more recent perspective, adjustment to aging in older adults is multidimensional and requires elements such as sense of purpose and ambition, body and health, zest and spirituality, aging in place and stability, and social support (von Humboldt 2016). In fact, adjustment to aging is a key consideration for researchers, health professionals, and policy makers and toward further understanding the implications of aging well (von Humboldt 2016).
Key Research Findings
Currently, a larger share of the world’s population is made up of older adults (United Nations 2017). Although aging is responsible for inevitable and challenging losses, a growing literature has shown that a diverse range of older people experience well-being in old age (von Humboldt 2016). In fact, previous research indicated that well-being may increase with age (Siedlecki et al. 2008). In this context, the challenges that older people face and how they relate to them are important for the construction of their adjustment to aging (von Humboldt 2016).
In their initial studies, Burgess and his colleagues (1948) highlighted five criteria for adjustment in old age: (1) participation in activities, (2) satisfaction with activities, (3) happiness, (4) absence of non-adjusting behavior, and (5) degree of fulfillment of desire. Interestingly, the meaning of their personal adjustment to aging was mainly indicated by the attitudes of older people about themselves and their activities (Burgess et al. 1948).
More recently, literature indicated that adjusting to the emotional, social, and cognitive challenges of aging is a dynamic process for older people, where they are able to rely on some of their existing psychological, physical, and social resources, as they experience the decline of others (von Humboldt et al. 2013, 2014a). In a recent study, von Humboldt and her colleagues (2013) proposed a structure of adjustment to aging in a model that included five components of adjustment to aging: “sense of purpose and ambitions,” “zest and spirituality,” “body and health,” “aging in place and stability,” and “social support.”
Concerning “sense of purpose and ambitions,” von Humboldt and her colleagues (2013) pointed out that occupational and productive activities (e.g., artistic work, volunteering) will probably remain during old age, even though labor force participation probably might end at retirement. The dimension “health and body” is pertinent for adjustment to aging: due to illness and the perspective of death, poor body image, and the presence of environmental and genetic risk factors, old age is still perceived as a period of adversities. Physical activity, body image, social support, and psychological variables are factors that may affect health in old age (von Humboldt et al. 2013).
Additionally, “zest and spirituality” is related to maintaining religious, existential, and spiritual values, taking advantage of the best of their age and of the present time, accepting changes in life, deriving a meaning of the events of life, having fun, and feeling relaxed about the future (von Humboldt 2016). Programs and interventions with older adults may benefit them from engaging in leisure and spiritual activities, since these activities benefit older adults to adjustment to aging, by allowing them for connectedness with other people and sense of community, sense of purpose, and a positive influence on health and style of life (Carstensen et al. 2003; von Humboldt 2016; von Humboldt et al. 2014b).
“Aging in place and stability” suggests that older adults may live in the community, with security, independence, and comfort. Research shows the role of environment and the way of life of older adults (von Humboldt et al. 2013). Ultimately, “social support” is the fifth element in the adjustment to aging. Older adults prioritize significant relations in later age, and the relation between social connectedness and quality of life and the health of older people has been acknowledged over a long period of research (Greenfield et al. 2015; von Humboldt et al. 2013). Moreover, the quality of the adjustment to aging is influenced by the design under which the adjustment to aging was attained and by the measurement used for this purpose. Despite some exceptions, to date most of the research including the adjustment to aging construct has been cross-sectional (von Humboldt et al. 2013).
Additionally, the association of culture to adjustment to aging is complex. In fact, the way individuals endeavor culturally to achieve adjustment to aging is influenced by the cultural attribution of the construct’s indicators. In this context, physical and mental health, spirituality, and body image may be culturally assessed and are a culturally significant dimension of adjustment to aging (von Humboldt et al. 2012b, 2014a, b). Moreover, upon researching how culture interacts with the process of adjustment to aging, unmatched opportunities are provided by global socioeconomic, biological, and demographic shifts (Mendoza-Ruvalcaba et al. 2017). Therefore, an empirical and transcultural model for adjustment to aging is valuable when investigating preliminary data consistent with the proposed components of the model (von Humboldt 2016). It suggests guidelines for the design of more competent policies and interventions. In sum, a growing literature indicates the relevance of adjustment to aging for research professionals to understand repercussions of late adulthood and longevity (von Humboldt 2016).
Challenges and Future Directions
In a dynamic way, older people lead many of the global changes related to the adjustment to aging. Since these changes will affect how we conduct future policy, research, and practice, we need to understand how to address these (von Humboldt 2016). Comprehensive interventions with older people can benefit from the inclusion of various indicators of adjustment to aging, including sociodemographic and health variables, spirituality, and lifestyle behaviors, as well as psychosocial factors and social support (von Humboldt 2016).
In a changing sociodemographic structure and considering an active aging perspective, existing adapted interventions and policies consider the need for flexible roles and schedules for older adults and for transferring more physically demanding tasks to younger workers while providing opportunities for continuing education to older workers and introducing wellness programs as a way of investing in preventive health and reducing health-care costs and absenteeism (Bloom and Canning 2012). Existing literature suggested that professional status was a significant correlate of adjustment to aging (β = 0.283; p < 0.001) (von Humboldt et al. 2014a). In addition, the current interventions that stimulate integration, sense of agency, and creativity subsidize well-being in old age and stimulate a better management of everyday issues, which can be seen as a coping mechanism regarding changes in the aging context (Cohen et al. 2006).
For future formulations of adjustment to aging, it would be beneficial to take into account the ability of older adults to integrate into society, either through civic engagement or through an adapted workforce. These formulations should consider the accumulated knowledge and stability, the increased ability to manage conflicts faced by older adults, and their problem-solving abilities while considering the perspectives of other age groups (von Humboldt 2016). In addition, better quantification of type, frequency, and duration of productive activities could further improve our understanding of these activities and their impact on adjustment to aging (von Humboldt et al. 2012a, b).
With regard to the health of older adults, appropriate treatment interventions can also be expanded through a tangible understanding of the role that culture plays in the older adults’ health behaviors and in the search for help behavior (von Humboldt 2016). Perceived health was a strong predictor of adjustment to aging (β = 0.455; p < 0.001) (von Humboldt et al. 2014a). Developing future policy programs and interventions based on health promotion and body issues can increase adjustment to aging, by helping older adults to recognize and interpret health problems such as vitality, cognitive, sensory, and physical declines at an early stage and stimulating the conversation about health, body, and lifestyle concerns during care interventions (von Humboldt et al. 2012a; von Humboldt 2016).
Outcomes for mental health promotion in older adults may be positively influenced by developing informal social networks (e.g., volunteering, continued learning, cultural programs, outdoor activities) (Cohen et al. 2006), in older-helping programs (Butler and Eckart 2007) or in occupational therapy programs (Hay et al. 2002). In relation to this, approximately 25% of older Americans indicated that they had volunteered recently (Bureau of Labor Statistics 2009). In Europe, the percentage of people age 71 or older who volunteer is one-half the rate of those ages 61–70 (Haski-Leventhal 2009).
Programs and interventions with older adults that involve older adults in leisure, spiritual, and lifestyle activities benefit adjustment to aging, by allowing for social support, self-agency, and increased health (von Humboldt et al. 2014b). Indeed, spirituality was the strongest predictor of adjustment to aging (β = 0.816; p < 0.001), and leisure significantly predicted adjustment to aging (β = 0.322; p < 0.001) (von Humboldt et al. 2014a). Further interventions with older adults may also strongly benefit from the integration of dimensions of spirituality, which have been pointed out as pertinent by older adults (e.g., sense of limit and religious beliefs, spiritual practices) (von Humboldt et al. 2014b).
Intervention policies which encompass aging in place and stability contribute to reduce disability and social isolation, to stimulate social engagement, and to improve coping with health problems (von Humboldt 2016). Furthermore, von Humboldt (2016) proposed that the results of comprehensive assessments related to aging in place – in combination with other human, health, environmental, and technological resources (e.g., accessibility, self-perceived safety factors, neighborhood support) – should be integrated into the formulation of future concepts of adjustment to aging.
Sadly, data on the predictive value of psychological characteristics for adjustment to aging in adult life are still limited. Since psychological factors, such as perceived self-determination, well-being, self-acceptance, and self-efficacy, are positively related with adjustment for aging, psychotherapeutic interventions may gain from including these variables and exploring other psychological factors relevant for adjustment to aging (Battini et al. 2006). Moreover, the benefits of adjustment to aging may be promoted by combining interventions and policies involving education; economic security; health; productivity; intentional, healthy, and leisure lifestyles; spirituality; and meaningful social relationships (von Humboldt 2016).
Often, beliefs and cultural values sculpt social experience in old age. Policy makers must consider that this variable is influenced by what is expected of older people, which differs widely among geographic regions. Thus, to properly address social support, it is important to consider characteristics such as frequency, type, quality, and intensity of social relationships (von Humboldt et al. 2012a, b, 2014a). In relation to this, household negatively influenced adjustment to aging (β = −0.208; p = 0.007) and well-being (β = −0.072; p < 0.001) (von Humboldt et al. 2014a). In relation to social support, von Humboldt (2016) proposed the study of less explored elements, such as social exchange, social context, interpersonal similarity, the type, significance and quality of the relationship, sexuality, and intimacy. Moreover, effective interventions with older people and consistent policies will powerfully benefit from reliable culture-adapted data concerning adjustment to aging (von Humboldt et al. 2012a; von Humboldt 2016).
Further studies (e.g., mixed and the longitudinal) are indispensable to assess the stability of the results in a varied sample of cultures. Adjustment to aging in older populations will greatly benefit from future research, aging policies, and interventions that integrate the above challenges into new forms of joint and interchangeable support for older populations and that ultimately ensure a transition to a adjusted, productive, consistent, and equitable aging society (von Humboldt 2016). Due to the existence of pertinent theoretical and methodological questions, the study of adjustment to aging is promising. The aging adjustment construct is valuable, as it focuses on the challenges that older people face and how they relate to them. In order to correctly evaluate the stability of the current dimensions of adjustment to aging in the proposed empirical multicultural model, more research is needed. Finally, future debate considering adjustment to aging may include life-stage-appropriate capabilities, needs, and objectives of people of different age groups to improve social benefits and reduce social stratification (von Humboldt et al. 2014b).
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