Health promotion efforts will play a powerful role as we work to enhance function and reduce morbidity by intervening on modifiable risk factors such as physical activity (PA), inactivity, social engagement, and nutrition. This chapter examines the state of the art of theoretical foundations for health behavior change that are used to design and implement health promotion programs for older adults. The principles of social cognitive theory (SCT) have been used frequently in health behavior interventions. The chapter uses the ecological model as a guide to describe the level(s) targeted by each theory. It presents the most prominent multilevel approach, the social-ecological model. Recently, there has been a push toward broader ways of thinking about behavior change using structural approaches that target all levels of the social-ecological model. The chapter presents theories targeted at each level and argues for the use of multilevel interventions whenever possible.
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This chapter begins with analysis of life-span development and life-course perspectives as applied to research on older adults and their families. It examines theories that are useful for guiding such research, thus yielding broader and deeper understanding of the ways older adults and their relatives negotiate family roles, responsibilities, and interactions in the context of both traditional and pluralistic family configurations. The chapter also examines the promise and problems associated with two key theoretical approaches that have been particularly effective in guiding family gerontology research in recent years, intergenerational solidarity and conflict, and intergenerational ambivalence. These approaches are strong in their own right and have the further advantage of linking well with life-span development and life-course perspectives. The chapter focuses on their theoretical tenets and principles, empirical applications, and strengths and limitations, with a critical assessment throughout. It considers theoretical and empirical directions for future research in family gerontology.
- Go to chapter: Theories That Guide Consumer-Directed/Person-Centered Initiatives in Policy and Practice
This chapter explores a paradigm shift in policy and practice related to the delivery of services and supports to older adults or adults of any age with disabilities-the growth of person-centered (PC) and participant-directed (PD) practice initiatives. It discusses new theoretical approaches, particularly the Consumer-Directed Theory of Empowerment (CDTE), which are salient to explaining the growth and impact of PC and PD initiatives as an evolving practice model that represents a paradigm shift from past approaches to working with older adults and persons with disabilities. Research is needed on recent practice and policy changes that have implications for the continued development and examination of theories that support PC and PD care. With both the aging and the increasing diversity of the US population combined with federal policy initiatives related to LTSS, the demand for PC and PD initiatives will continue to grow.
- Go to chapter: Theories of Help-Seeking Behavior: Understanding Community Service Use by Older Adults
This chapter focuses on the prominent psychosocial theories and models used to predict service utilization. It begins with a discussion of Andersen’s Behavioral Model of Health Services, the most commonly used framework for predicting formal service use among older adults. The need-use gap has been documented in use of mental health services, home and community-based services (HCBS) among non-Whites, among caregivers of older adults, and in the use of adult day care, respite care, personal care, meals, and transportation services. The chapter focuses on help-seeking behavior models that were not necessarily developed for or frequently used with older populations, but have the potential for enhancing the study of service use in late life. Developing new theories and further elaborating and testing existing models are essential for unraveling the use-need paradox and helping reduce the barriers to programs and services that, when accessed, can contribute to increased well-being of older adults.
Scholars studying social connectedness draw on the sociological theory of social capital. In recent years, social scientists have proposed theoretical and conceptual models to explore the role of social connectedness in the specific context of aging. Recent data on the social networks of older adults paint a rich picture of the individual, or egocentric, social networks of the elderly community-dwelling population. This chapter discusses the theory of social capital, and explores the main effects and stress-buffering models of social connectedness and health. Although social capital theory has effectively guided empirical research, new ideas and concepts in aging research are generating interest among scholars, and are taking the field in innovative directions. A series of studies based on the Veterans Affairs Normative Aging Study (NAS), an ongoing study of aging established in 1963, documents a relationship between air pollution and various health conditions such as increased blood pressure and inflammation.
This chapter combines the increasing number of studies that pertain to the stereotype embodiment theory (SET) and reflects upon to represent the current state of this theoretical perspective and how it can help explain age stereotypes’ contributions to health and aging. It describes the history, cultural context, and nature of age stereotypes and age self-stereotypes in a largely ageist society. The chapter presents SET, which provides a framework for explaining how age stereotypes are acquired to subsequently influence health outcomes. It discusses replication studies conducted in different countries, as well as meta-analyses, to demonstrate the validity of this theory as well as to illustrate the meaning and impact of its components. The chapter illustrates how SET may be applied to shape future healthy aging research, policy, and practice. Empirical evidence supports the importance of age stereotype self-relevance among older adults.
This chapter includes a discussion of the practice-oriented framework for service use delineated by Yeatts, Crow, and Folts and the caregiver identity theory articulated by Montgomery and Kosloski. Throughout history, family members, most often women, have been the primary providers of care for individuals, young and old, who are in need of assistance. What has occurred in the past century is significant growth in the number of family members who are providing care and expansion of the responsibilities that these family caregivers now assume. The steady expansion of family caregiving has been mirrored by the steady expansion of research focused on caregivers and interventions to support them. The behavioral model of services utilization has been used to study the use of a wide range of health services by older adults and caregivers.
This chapter discusses prominent theoretical models that link age-related changes in emotional processes with changes in cognition. It also discusses the dynamic integration theory (DIT), which outline how older adults may optimize emotional experience to compensate for reduced affective complexity resulting from declines in fluid cognitive processing. The chapter evaluates the current evidence for and the potential contributions of these theories. It introduces neuroscientific perspectives and reviews how these perspectives interpret age-associated changes in the brain in terms of cognitive-emotional processing. Aging Brain model (ABM) and DIT, therefore, provide more neurologically based explanations for age-related changes in emotional processing, whereas socioemotional selectivity theory (SST) postulates motivation as the cause of such changes. Another theory that might be relevant to the aging literature is the arousal competition biased theory, which posits that the affective state of the perceiver may also play a role in the salience of information.
Speech-language pathologists are professionals who specialize in understanding the science behind the process of human communication. As a member of the interdisciplinary team in a medical setting, speech-language pathologists diagnose and treat disorders of speech sound production, resonance, voice, fluency, language, cognition, feeding, and swallowing. At times, the therapists encourage development of untapped potential and skill. In working with those with chronic disabilities, the speech-language pathologist may focus on the appreciation and development of the patients’ preserved abilities. Older adults exhibit retrieval difficulties in spelling, suggestive of challenges with word phonology and orthography. In the acute hospital arena, the speech-language pathologist serves to identify cognitive communication or swallowing deficits, educates patients and families regarding areas of concern, and suggests appropriate discharge treatment options aimed to enhance self-sufficiency. The goal of intervention is not geared to “cure” a disability, but rather, to foster an optimal level of independence and function.
The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.