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Aging MattersAddressing issues related to geropsychiatry and the
well-being of older adultsJeanne M. Sorrell, PhD, RN, FAAN, Section
Editor
Aging is inevitable; becom-ing wiser with age is not.
Researchers, theorists, and clinicians have noted that older adults
approach their lives in one of two ways: Either they draw on their
strengths and live life to the fullest, or they magnify their
weaknesses and re-strict their lives to succumb to lifes
in-evitable end (Rowe & Kahn, 1998). A movement toward wisdom
involves a daily struggle to choose activities that facilitate
health promotion, lifelong learning, and adaptation.
The work of the MacArthur Foun-dation Research Network on
Success-ful Aging provided a basis for chang-
ing the manner in which aging is viewed (Rowe & Kahn, 1998).
Prior to this time, aging was viewed as ei-ther pathological or
nonpathological; that is, older adults with disease and those
without disease. This concept suggested that conditions largely due
to genetic predisposition (e.g., elevat-ed blood pressure, memory
loss) rep-resented nonpathological aging and were considered
normal. In 1998, Rowe and Kahn further suggested that the risk for
disease be denoted so that interventions to decrease health risks
could be addressed in an effort to move from normal aging to
suc-cessful aging.
SucceSSful AgingTheoretical frameworks can be
helpful in understanding successful aging. The conscious aging
theory es-pouses late life as a period of deeper meaning and
personal growth (Ronch & Goldfield, 2003). This theory is built
on individuation and adaptation. In-dividuation can lead to
development of a personal spirituality in later life to serve as a
buffer against the experi-ence of losses (Bianchi, 2005).
Adapta-tion is the reserve capacity that allows one to cope with
losses. This capacity is strengthened by the contribution of ones
sense of patriotism, connection to family, cultural solidarity, and
celebra-
Successful Agingchoosing Wisdom Over Despair
Joanne c. giblin, BSn, Rn-Bc
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ABStRActThis article defines wisdom and despair as choices for
cognitively intact older adults. Some individuals are able to
in-tegrate the conditions of old age while others respond in ways
that inhibit ef-fective integration. The conscious ag-ing theory,
as well as Eriksons develop-mental theory regarding achievement of
integrity/wisdom, provides a theo-retical basis for exploration of
this top-ic. Constructs of personality, including self-concept,
self-acceptance, destiny control, interiority, rigidity, and
flexibil-ity, are described. Finally, guidelines for nurses working
with older adults who are facing this developmental stage of life
are provided.
Journal of Psychosocial nursing Vol. 49, no. 3, 2011 23
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Aging Matters
tion of ones ethnic identity (Ronch & Goldfield, 2003).
Successful aging is a multidimen-sional process, with its
components tiered by hierarchical relevance (Rowe & Kahn,
1998). The first premise is the avoidance of disease or disability.
This incorporates active involvement in lowering the risk of
disease. This risk is not an inherent part of aging, but rather the
cumulative effect of lifestyle and diet choices. Lifestyle risks
include increases in systolic blood pressure, ab-dominal fat, blood
sugar, and decreases in lung, kidney, and immune function (Rowe
& Kahn, 1998, p. 41).
The second premise is maximizing high physical and cognitive
function-ing, with these two factors partnering to optimize overall
functioning. Physi-
cal function is maintained with moder-ate exercise and a network
of support from family and friends. Cognitive function can be
sustained with men-tal exercises and active engagement through
conversation. The MacArthur Foundation Research Network on
Suc-cessful Aging conducted a longitudinal study to identify
predictors of high cog-nitive function in older adults (Rowe &
Kahn, 1998). The four identified predictors were education, peak
pulmo-nary flow rate, strenuous activity, and self-efficacy.
Education was the stron-gest indicator. This is thought to be due
to the effect of early education on brain circuitry, as well as the
possibility that education may prompt intellectual in-terests
throughout the life span, which in turn maintains cognitive
function. Pulmonary peak flow rate is a predictor
of cardiac risk and thus is closely related to overall function.
Strenuous activity affects cognitive function due to the ef-fect of
exercise on the central nervous system. Self-efficacy allows one to
de-velop and carry out a plan of action, al-lowing for a sense of
competency.
The third premise of successful ag-ing, engagement with life, is
two-fold. The first is maintaining social relation-ships to provide
a sense of belonging. Maintaining relationships promotes the
identification and expression of feelings, whereas isolation is a
predictor of mor-bidity and mortality (Rowe & Kahn, 1998). The
second part of engaging with life is becoming involved in
productive activities such as helping others.
It should be noted that the con-structs of successful aging are
part of a
fluid process, changing from minute to minute and day to day.
One can move from wellness to illness and back but always strive
toward becoming well, us-ing the capacity to change and learn. As a
result, the final chapter of life can hold new beginnings.
PeRSOnAlity cOnStRuctSAccording to Aiken (1989), per-
sonality is the unique organization of traits and behavioral
patterns that typify a person (p. 11). This forma-tion is based on
the interplay between genetics and environment in response to new
experiences and challenges. As long as one remains engaged late in
life, personality continues to develop (Atchley, 1999).
Several personality characteristics shape the older adult
experience (Aiken,
1989). Self-concept, or the integration of ones strengths and
weakness as iden-tified by both self and significant others, can
contribute to ones mental health. Self-acceptance helps develop a
sense of competence when faced with challeng-es. Destiny control is
a construct that subscribes to the notion that one has options to
choose from, allowing one to have control of decisions that impact
outcomes. Interiority is the tendency to find solutions by turning
inward (e.g., spirituality). Rigidity is a tendency to re-sist
change, while flexibility is the ability to adapt to change.
chOOSing WiSDOm Wisdom is an age-old concept exem-
plified in the military feats of Athena, the Greek goddess of
wisdom; the kind acts of Sophia, the Judeo-Christian goddess of
wisdom; and the reign of King Solomon, often characterized as the
wisest man of all. During the 20th century, wisdom con-cepts were
addressed as a part of larger de-velopmental theories, but it was
not until the 1980s that wisdom became distin-guished as an entity
of its own (Brugman, 2006). Even so, no one clear definition of
wisdom has evolved.
The beginning of a systematic ap-proach toward wisdom concepts
was prompted by Eriksons (1959) theory of psychosocial development.
Erikson theo-rized that personality develops in stages that are
influenced by the social environ-ment. His theory postulates that
sense of self or ego identity is formed based on the impact of
social experiences. The sense of self changes as one negotiates the
con-flicts proposed at each stage. The conflict assigned to old age
is that of integrity versus despair. During this stage, as older
adults look back at the life they have lived, there is a battle
between feelings of regret and bitterness and that of accep-tance
of decisions made and the life lived. The outcome of successful
mastery of this stage is wisdom.
Wisdom is described by Clayton and Birren as a blending of
cognitive, reflec-tive, and affective components (cited in Ardelt,
1997). The cognitive realm rep-
It should be noted that the constructs of successful aging are
part of a fluid process, changing from minute to minute and day to
day.
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Aging Matters
resents both descriptive knowledgefact finding and
interpretative knowledgethe meaning behind the facts. The ability
to reflect on ones own behavior and that of others casts aside
self-centeredness. This process then allows feelings of em-pathy
and caring to be developed and nurtured. The real-life vignette
below de-scribes how the quest for wisdom is a path that is
frequently tested.
A Purple heartTed and Anna (pseudonyms) have
been happily married for 63 years. They grew up in the Bronx and
mar-ried prior to Teds enlistment in the Navy. During World War II,
Teds boat was hit by a kamikaze plane, in which Ted sustained
life-altering but not life-threatening injuries. Ted was cited to
be awarded a Purple Heart. After re-turning home, Ted was eager to
put the war behind him and return to normal life. He had forgotten
about the Purple Heart that he was owed. He secured a job with the
postal ser-vice and immersed himself in family life, coaching
baseball for his four sons and later for his grandson. He also
re-mained active in his church commu-nity and the Knights of
Columbus.
When Ted was in his 70s, one of his sons was diagnosed with a
rare bowel disease and required long hospitaliza-tions over the
course of 2 years. Ted and Anna visited daily and babysat for his
sons children when they could. They relied heavily on their strong
faith and close friendships to help them meet the demands of this
challenging time.
Later, Ted himself was diagnosed with bowel cancer but remained
moti-vated and hopeful with his treatment. It was after his second
surgery that Ted decided to give up driving, as he had a few
near-miss incidents. The adjustment was seamless as Ted and Anna
enlisted a nearby cousin and church friends to transport them to
church. In addition, they moved to a senior development that
provided shuttle service to the gro-cery store and physician
appointments. Ted felt relieved with this new change.
Ted had not talked much with his children about his war
experiences, but at this point in his life he felt compelled to
share. The children contacted their congressman, who arranged for
Ted to
finally receive his long overdue medal on Veterans Day. This
prompted Ted to put together a scrapbook of his war memo-ries, news
articles, and photos. In this way, Ted was able to process the
trauma of his experience, much of which he had repressed, in a way
that created a sense of pride for the acts of bravery he had never
allowed himself to feel.
chOOSing DeSPAiRDespair is the unchallenged accep-
tance of negativity. Negative life events are viewed without a
search for greater meaning. Losses are carried as heavy bur-dens
from which one does not recover. Where wisdom calls for recovery
from loss, despair is immobilized by the fear and anxiety triggered
by loss. The follow-ing fictional vignette describes how the
outcomes of choosing despair are differ-ent from choosing
wisdom.
the Older SisterNatalie (pseudonym) was the oldest
of five girls. As the oldest, she enjoyed all of the privileges
of being the first child in her family. Her parents doted on her
achievements. She took dance lessons and went to private schools
and college, even though it was some-thing her parents could not
afford to extend to her siblings. Natalie, how-ever, never
developed a close relation-ship with her sisters, often expressing
envy of them.
During her adult years, when the family came together for
holidays, the sisters enjoyed talking about the good old days of
their childhood. Natalie privately challenged their stories.
She
believed her parents treated her more harshly than her siblings
and that they never supported her dancing talents. She contended
that she would be a profes-sional dancer if only her parents would
have been more supportive of her.
Natalies family had a long history of cardiac disease. Natalie
experienced warning signs herself but was never ad-herent to her
treatment. She took her medications inconsistently and gained
weight. When Natalies mother had a stroke, all of the sisters
agreed to help out. Natalie, however, could not stop blaming her
parents for her lack of ca-reer success and left most of the
care-giving to her sisters.
This negativity spilled over into her other relationships. In
fact, Natalie could not work productively with her coworkers and
was encouraged to work from home, which further isolated her. As a
result, she entered older adulthood with poor health and
nonadherence with both preventive and prescribed health measures.
She made a life that belied social supports and continued her life
with a pessimistic outlook.
clinicAl imPlicAtiOnSNurses are in a unique position to
foster the concepts of successful aging by guiding older adults
through self-evalua-tion. Older adults interface with nurses in a
multitude of settings, so nurses of all specialties should be armed
not only with
When older adults remain actively involved in their world, they
hold the power to chart the course of this last chapter of
life.
Journal of Psychosocial nursing Vol. 49, no. 3, 2011 25
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Aging Matters
the capacity to listen and reframe nega-tive thoughts, but with
educational infor-mation about successful aging.
Successful aging theories encour-age older adults to engage in
active and meaningful lives, minimizing health risks and
maintaining productive activi-ties. Conscious aging challenges
older adults to adapt to whatever the future may hold by drawing on
ones personal strengths and support. The process is af-fected by
personality characteristics that foster change as long as the older
adult allows this to occur. When older adults remain actively
involved in their world, they hold the power to chart the course of
this last chapter of life. The choice of accepting illness
prevention or adapta-tion, physical and mental activity, and social
and productive activity is the choice of wisdom.
cOncluSiOnHelping older adults focus on the
three pillars of successful agingavoid-ance of disease or
disability, maxi-
mizing high physical and cognitive functioning, and engagement
with lifemay provide the motivation needed to improve their quality
of life. Older adults should know that they need not succumb to
familial disease, but rather that lifestyle and diet can improve
health risks; physical and cognitive exercises can strengthen ones
body and mind even at a late age; adopting a positive outlook and
maintaining social contacts can pro-mote health; and productive
activity, such as volunteering, enhances ones sense of competence
and allows one to choose how to make a difference for the
community. No matter how small or great the effort, it leaves a
legacy of choosing wisdom over despair that is modeled for the next
generation.
RefeRenceSAiken, L.R. (1989). Later life (3rd ed.).
Hillsdale,
NJ: Erlbaum.Ardelt, M. (1997).Wisdom and life satisfaction
in
old age. Journals of Gerontology. Series B, Psycho-logical
Sciences and Social Sciences, 52, P15-P27.
Atchley, R.C. (1999). Continuity and adaptation in aging:
Creating positive experiences. Baltimore: Johns Hopkins University
Press.
Bianchi, E. (2005). Living with elder wisdom. Jour-nal of
Gerontological Social Work, 45, 319-329.
Brugman, G.M. (2006). Wisdom and aging. In J.E. Birren &
K.W. Schaie (Eds.), Handbook of the psychology of aging (6th ed.,
pp. 445-469). Burl-ington, MA: Elsevier.
Erikson, E.H. (1959). Identity and the life cycle. New York:
International Universities Press.
Ronch, J.L., & Goldfield, J.A. (2003). Mental well-ness in
aging: Strengths-based approaches. Balti-more: Health Professions
Press.
Rowe, J.W., & Kahn, R.L. (1998). Successful aging. New York:
Dell.
Ms. Giblin is Geriatric Psychiatric Nurse Clini-cian,
NewYork-Presbyterian Hospital, Westches-ter Division, White Plains,
New York.
The author discloses that she has no significant financial
interests in any product or class of products discussed directly or
indirectly in this activity, including research support.
Address correspondence to Joanne C. Giblin, BSN, RN-BC,
Geriatric Psychiatric Nurse Clinician, NewYork-Presbyterian
Hospital, Westchester Division, 21 Bloomington Road, White Plains,
NY 10605; e-mail: [email protected].
Posted: February 16, 2011doi:10.3928/02793695-20110208-01
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Reproduced with permission of the copyright owner. Further
reproduction prohibited withoutpermission.
