Theories of Aging

Learning Objectives
At the end of this chapter
the reader will be able to:

1. Identify the major theories of aging.

2. Analyze the rationale for using multiple theories of aging to describe the
complex phenomenon of aging Define aging from a biologic, sociologic, and
physiologic framework.
3. Develop nursing interventions based on the psychosocial issues and biologic
changes associated with older adulthood.
4. Discuss several nursing implications for each of the major biologic, sociologic,
and physiologic theories of Aging.

Theories of Aging

Theories of Aging have been debated since the time of ancient Greeks. We have
sought to embrace a theory that can explain the entire phenomenon. However, many
scholars have concluded that quest is in vain and that no one definition or theory exists
that explains all aspects of aging. Rather scientists have found that several theories
maybe combined to explain various aspects of the complex phenomena we call aging.
 Theories function to help make sense of the particular phenomenon, they provide
a sense of order and give a perspective from which to view the facts. Theories provide a
springboard for discussion and research.

Human aging is influenced by a composite of biologic, sociologic, physiologic,

functional and spiritual factors. Aging may be viewed as a continuum of events that
occur from conception to death. Biologic, sociologic, and physiologic theories of aging
attempt to explain and explore the various dimensions of aging.

Theories of aging attempts to explain that phenomenon of aging as it occur over

the lifespan, which is thought to be a maximum of approximately 120 years.

Dickoff and Wiedenbach (1968) assert that for theories to be useful in a practice
discipline ,they must be specific enough to guide nursing care of select populations in a
given setting. The complex needs of older adults include declining health and
functioning that may require moving to more supportive environments. Psychological
challenges facing older adults include dealing with social and economic losses, finding a
mean-ingful life after retirement, and contemplating death. Cultural, spiritual, regional,
socioeco-nomic, educational, and environmental factors as well as health status impact
older adults’ per-ceptions and choices about their health care needs. Theories that can
effectively guide nurs-ing practice with older adults must be comprehensive yet consider
individual differences. According to Haight and colleagues, “a good gerontological
theory integrates knowledge, tells how and why phenomena are related, leads to
prediction, and provides process and under standing. In addition, a good theory must
be holistic and take into account all that impacts on a person throughout a lifetime of
aging” (Haight,Barba, Tesh, & Courts, 2002, p. 14).

Since the early 1950s, sociologists, psychologists, and biologists have proposed
theories of aging. Although there is increased emphasis in the nursing literature on
issues regarding the growing elderly population, little work has been done to develop
discipline-specific aging theories.

BIOLOGIC THEORIES OF AGING

 Are concerned with answering basic questions regarding the physiologic
processes that occur in all living organisms as they chronologically age. These age-
related changes occurs independent of any external or pathologic influence. The
primary question being addressed related to the factors that trigger the actual aging
process.

The biological theories explain information regarding the physiologic

processes that change with aging. In other words, how is aging manifested on the
molecular level in the cell, tissues, and body systems; how does the body-mind
interaction affect aging; what biochemical processes impact aging; and how do one’s
chromosomes impact the overall aging process? Does each system age at the same
rate? Does each cell in a system age at the same rate? How does one’s chronological
age influence an individual who is experiencing a pathophysiological disease process
—how does the actual disease influence the organism as well as the treatment,
which might include drugs, immunomodulation, surgery, or radiation?
The foci of biologic theories includes explanations of the following

1. Deleterious effects leading to decreasing function of the organism.

2. Gradually occurring age-related changes that are progressive overtime.
3. Intrinsic changes that can affect all members of a species because of chronologic
age.

The decreasing function of an organism may lead to a complete failure of either an

organ or an entire system. In addition, according to these theories, all organs in any
one organism do not age at the same rate, and any single organ does not
necessarily age at the same rate in different individuals of the same species.

Some aging theorists divide the biologic theories into two categories:
1. A stochastic or statistical perspective, which identifies episodic events that
happen throughout one’s life that cause random cell damage and accumulate over
time, thus causing aging

2. The Nonstochastic theories that view aging as a series of predetermined events

happening to all organisms in a timed framework.

Stochastic Theories
Free Radical Theory

Oxidative free radical theory postulates that aging is due to oxidative

metabolism and the effects of free
radicals, which are the end products of
oxidative metabolism. Free radicals are
produced when the body uses oxygen,
such as with exercise. This theory
emphasizes the significance of how cells
use oxygen (Hayflick, 1985). Also known
as super oxides, free radicals are
thought to react with proteins, lipids,
deoxyribonucleic acid(DNA), and
ribonucleic acid (RNA), causing cellular
damage. This damage accumulates
overtime and is thought to accelerate
aging. Free radicals are chemical species
that arise from atoms as single unpaired
electrons. Because a free radical
molecule is unpaired it is able to enter
reactions with other molecules,
especially along membranes and with
nucleic acids.

Free radicals cause:

 • Extensive cellular damage to DNA, which can cause malignancy and
accelerated aging, due to oxidative modification of proteins that impact cell
metabolism

• Lipid oxidation that damages phospholipids in cell membranes, thus

affecting membrane permeability

• DNA strand breaks and base modifications that cause gene modulation.

This cellular membrane damage causes other chemicals to be blocked from their
regularly friendly receptor sites, thus mitigating other processes that may be crucial to
cell metabolism. Mitochondrial deterioration due to oxidants causes a significant loss of
cell energy and greatly decreases metabolism. Ames (2004) and Harman (1994)
suggest some strategies to assist in delaying the mitochondrial decay, such as

 Decrease calories in order to lower weight.

 Maintain a diet high in nutrients.
 Use antioxidants.
 Minimize accumulation of metals in the body that can trigger free radical
reactions.
Orgel/Error Theory
This theory suggests that, over time, cells accumulate errors in their DNA and
RNA protein synthesis that cause the cells to die. Environmental agents and
randomly induced event scan cause error, with ultimate cellular changes. It is well
known that large amounts of x-ray radiation cause chromosomal abnormalities.
Thus, this theory proposes that aging would notoccur if destructive factors such as
radiation did not exist and cause “errors” such as mutations and regulatory
disorders. Hayflick (1996) does not support this theory, and explains that all aged
cells do not have er-rant proteins, nor are all cells found with errant proteins old.

Error theories - Error theories believe that aging is not something which is
programmed to occur, but rather aging is due to a series of "accidents."

Wear and Tear theory

 The wear and tear theory of aging, one of several theories, asserts that the
effects of aging are caused by progressive damage to cells and body systems
over time. Essentially, our bodies "wear out" due to use. Once they wear out,
they can no longer function correctly.
  The wear and tear theory is deeply ingrained in our thinking, and it is the theory
you will often hear expressed in conversation and our culture. It was first
proposed scientifically by German biologist Dr. August Weismann in 1882. We
simply expect that the body, as a mechanical system, is going to break down with
use over the years. The wear and tear theory of aging may also be referred to as
simple deterioration theory or fundamental limitation theory.
 In considering the different theories of aging, the wear and tear theory may at
first appear to be the most reasonable. It fits with our experience and carries
familiar patterns. Yet there are other theories which, instead of viewing aging as
a random wear and tear process, view aging as a more intentional process, a
planned event. That aging may be more than just an accumulation of damage -
as occurs in cars - is a relatively new field of study.

Cross-Linking Theory: 

The cross-linking theory is the idea that chemical changes like this happen in
your body and can lead to aging. Over time, proteins, DNA and other structural
molecules in the body develop inappropriate attachments, called cross-links, to one
another. When these cross-links accumulate, it can cause tissues to become stiffer
and function poorly, contributing to aging.

What Is Cross-Linking?

When you heat onions or toast bread, the sugar molecules in the foods bond to protein
molecules. This bonding, which in cooking is called caramelization, is a result of the
sugar molecules attaching to protein molecules. When this happens, a series of
reactions occur, called glycation, that result in protein molecules bonding with each
other.

This cross-linking theory is the idea that chemical changes like this happen in your body
and can lead to aging. The process is slow and complicated, but over time, more and
more proteins, DNA and other structural molecules in the body develop inappropriate
attachments, called cross-links, to one another. These cross-linked molecules don't
function properly, and when enough cross-linked molecules accumulate in a specific
tissue—such as cartilage, lungs, arteries, and tendons—it can cause problems.

Results of Cross-Linking

When cross-linking occurs, tissues become stiffer, and when tissues stiffen they don't
function as efficiently. Many of the symptoms of aging have to do with the stiffening of
tissues. Cataracts, for example, are a stiffening of your eyes' lenses. Cross-linking of
skin protein collagen has been found to be partially responsible for wrinkles and other
age-related skin changes, and researchers believe that cross-linking of protein the walls
of the arteries account for atherosclerosis, or the hardening of arteries that increases
your risk for heart attack and stroke, among other conditions.
In addition, cross-linking of brain proteins occurs naturally with age, supporting the
cross-linking theory of aging.

Slow It Down

While you can't stop cross-linking, you can slow it down. Researchers believe that if the
concentration of sugar in the blood is high, then more cross-linking occurs. Foods with a
high glycemic index, such as sugary sodas and juices, release sugar into the body
quickly. These foods have been associated with cardiovascular disease, possibly
because of protein cross-linking. Everyone could benefit from keeping their blood sugar
from spiking. And it could keep you looking and feeling young!

Nonstochastic Theories
Programmed theories

Programmed theories believe that aging is a normal process, just as puberty is a normal
developmental process. Programmed theories of aging assert that aging is an essential
and innate part of the biology of humans and that aging is programmed into our body
systems. Otherwise, we would live forever. The three main systems that are connected
with aging are the endocrine (hormonal) system, the immune system, and our genes.
These systems change over time, and these changes cause the symptoms and signs of
aging.

Aging Is About Evolution

Technically, there is really no reason that the human body should "wear out," as long as
it can repair and renew itself. Therefore, something other than time must be at play to
cause the inevitable effects of aging. The programmed theory of aging asserts that
aging and death are necessary parts of evolution, not of biology. If a species did not
have the genetic capacity for aging and death, then it would not be forced to replicate to
survive. Individuals in the species would just keep on living until a climate or other
change wiped them all out. The key point here is that if biological individuals live
forever, evolution would not exist.

Aging Is Programmed

Since aging is about evolution and not biology, it must be inherent in the organism and
not simply a result of environmental factors or disease. That means that aging and
death, according to this theory, are not a result of wear and tear or exposure, but are a
programmed, natural and necessary part of genetics. In short, we are genetically
programmed to age and die.
Evidence Supporting the Theory

The evidence supporting this theory is that there is not a great deal of variation in
lifespan within species. Elephants die at around 70 years old, spider monkeys die at
around 25 years old, and humans die around the age of 80, on average. Some changes
can be made based on nutrition, medical care, and other demographic factors, but
overall lifespan within species is fairly constant. The programmed theory asserts that if
aging were due to wear and tear, there would be more variation in lifespan within each
species.

That said, aging and dying are inevitable, but there are things you can do to improve
your chances of living a long and healthy life.

Neuroendocrine Theory

This theory describes a change in hormone secretion, such as with the

releasing hormones of the hypothalamus and the stimulating hormones of the
pituitary gland, which manage the thyroid, parathyroid, and adrenal glands, and how
they influence the aging process. The following major hormones are involved with
aging:

• Estrogen decreases thinning of bones, and when women age less estrogen is
produced by the ovaries. As women grow older and experience menopause, adipose
tissue becomes the major source of estrogen.

• Growth hormone is part of the process that increases bone and muscle
strength. Growth hormone stimulates the release of insulin-like growth factor
produced by the liver.

 Melatonin is produced by the pineal gland and is thought to be responsible

for coordinating seasonal adaptations in the body.

Do Hormones Cause Aging?

There is some evidence to support the hormone theory of aging. In one older
study, researchers removed the pituitary gland of mice, which controls much of the
endocrine system. The researchers then substituted the absence of the pituitary gland
with supplementation of all of the hormones identified in mice. It turns out that those
without a pituitary gland lived longer than a control group of normal mice who did have
a gland. This led researchers to conclude that the pituitary gland must also excrete
another, unknown, a hormone that negatively impacts aging.
 Research on a variety of organisms has shown that mutations that reduce
insulin-like growth factor 1 (IGF-1) result in longer lives. But reducing IGF-1 has
inconsistent effects on age-related diseases in humans, reducing the risks for some but
increasing them for others. Growth hormone stimulates the production of IGF-1, which
is a strike against supplementing with human growth hormone to stop aging.

An intriguing review of studies, published in Frontiers in Endocrinology in 2019,

noted that subjects on a caloric restricted diet had a similar endocrine profile to studied
centenarians, with both having a favorable GH/IGF-1/insulin profile. This is only one
area where lifestyle modification has been shown to improve hormonal function; another
example of lifestyle changes improving hormone function is the observation that weight
loss and exercise improve insulin sensitivity.

Immunologic/Autoimmune Theory

This theory was proposed 40 years ago and says that the normal aging process
of humans and animals is related to faulty immunological function (Effros, 2004).
There is a decreased immune function in the elderly. The thymus gland shrinks in size
and ability to function. Thymus hormone levels are decreased at the age of 30and are
undetectable by the age of 60 (Williams,1995). Involution of the thymus gland
generally occurs at about 50 years. The elderly are more susceptible to infections as
well as cancers. There is a loss of T-cell differentiation so that the body incorrectly
perceives old, irregular cells as foreign bodies and attacks them. Aging is due to faulty
immunological function, which is linked to general well-being

Psychosocial Theories
The earliest theories on aging came from the psychosocial disciplines (Ta.
Psychosocial theories attempt to explain aging in terms of behaviour, personality, and
attitude change. Development is viewed as a lifelong process characterized by
transitions.

Psychological theories are concerned with personality or ego development and

the accompanying challenges associated with various life stages. How mental
processes, emotions, attitudes, motivation, and personality influence adaptation to
physical and social demands are central issues.

Sociological theorists consider how changing roles, relationships, and status

within a culture or society impact the older adult’s ability to adapt. Societal norms can
affect how individuals envision their role and function within that society, and thus
impact role choices as well as how roles are enacted. There has been a large
redefinition of the role of women in the United States since the 1960s. Such cohort or
generational variables are a key component of sociological theories of aging.
 SOCIOLOGICAL THEORIES

Activity Theory

Sociological theorists have attempted to explain older adult behavior in

relationship to society with such concepts as disengagement, activity, and continuity.
One of the earliest theories addressing the aging process was begun by Havighurst and
Albrecht in 1953 when they discussed the concept of activity engagement and positive
adaptation to aging. From studying a sample of adults, they concluded that society
expects retired older adults to remain active contributors. Activity theory was conceived
as an actual theory in 1963 and purports that remaining occupied and involved is a
necessary ingredient to satisfying late-life (Havighurst, Neugarten, & Tobin, 1963).

Disengagement Theory
In stark contrast to activity theorists, sociologists Cumming and Henry (1961)
asserted that aging is characterized by gradual disengagement from society and relationships.
- e authors contended that this separation is desired by society and older adults, and that it
serves to maintain social equilibrium. Cumming and Henry proposed that by disengaging,
older adults are freed from social responsibilities and gain time for internal reflection, while
the transition of responsibility from old to young maintains a continuously functioning
society unaffected by lost members. - e outcome of disengagement is a new equilibrium that
is ideally satisfying to both the individual and society. Challengers of Disengagement -
theory argue that the emphasis on social withdrawal is inconsistent with what appears to be a
key element of life satisfaction: being engaged in meaningful relationships and activities.
(Baltes, 1987; Lemon et al., 1972; Neumann, 2000; Schroots, 1996). Others contend that the
decision to withdraw varies across individuals and that disengagement theory fails to account
for differences in sociocultural settings and environmental opportunities (Achenbaum &
Bengtson, 1994; Marshall, 1996). Rapkin and Fischer (1992) reported that demographic
disadvantages and age-related transitions were related to a greater desire for disengagement,
support, and stability. Elders who were married and healthy were more likely to report a
desire for an energetic lifestyle
 Subculture Theory
Unlike activity theorists, Rose (1965) theorized that older adults form a
unique subculture within society to defend against society’s negative attitude
toward aging and the accompanying loss of status. As in disengagement theory, Rose
contended that older adults prefer to interact among themselves. He suggested that
social status is determined more by health and mobility than occupation, education,
or income; therefore older adults have a social disadvantage regarding status and
associated respect because of the functional decline that accompanies aging.

Continuity Theory
In the late 1960s, Havighurst and colleagues recognized that neither activity,
subculture nor disengagement theories fully explained successful aging (Havighurst,
Neugarten, & Tobin, 1968). Borrowing from psychology, they created Continuity -
theory, which hypothesizes that personality, influences the roles we choose and how
we enact them. - is in turn influences satisfaction with living. Continuity -theory
suggests that personality is well developed by the time we reach old age and tends
to remain consistent throughout our lives.

Age stratification
Society is stratified by age groups that are the basis for acquiring
resources, roles, status, and deference from others. Age cohorts are
influenced by their historical context and share similar experiences, beliefs,
attitudes, and expectations of life course transitions.

Person-Environment
Function is affected by ego strength, mobility, health, cognition, sensory
Fit perception, and the environment. Competency changes one’s ability to
adapt to environmental demands.

Gerotranscendence
The elderly transform from a materialistic/rational perspective toward
oneness with the universe. Successful transformation includes an outward
focus, accepting impending death, substantive relationships, intergenerational
connectedness, and unity with the universe.
 Psychological Theories
Explain aging in terms of mental processes, emotions, attitudes,
motivation, and personality development that is characterized by life stage
transitions.

Human needs

Five basic needs motivate human behavior in a lifelong process toward

need fulfillment.

Individualism

Personality consists of an ego and personal and collective

unconsciousness that views life from a personal or external perspective. Older
adults search for life meaning and adapt to functional and social losses.

Stages of personality development

Personality develops in eight sequential stages with corresponding life

tasks. The eighth phase, integrity versus despair, is characterized by evaluating
life accomplishments; struggles include letting go, accepting care, detachment,
and physical and mental decline.

Life-course/lifespan development

Life stages are predictable and structured by roles, relationships,

values, and goals. Persons adapt to changing roles and relationships. Age
group norms and characteristics are an important part of the life course.
Selective optimization with compensation

Individuals cope with aging losses through activity/role selection,

optimization, and compensation. Critical life points are morbidity, mortality,
and quality of life. Selective optimization with compensation facilitates
successful aging.

Conclusion
 Both nursing theories contribute to our understanding of aging from
the perspectives of thriving and functionality; however, neither encompasses
all of the holistic elements (cultural, spiritual, geographic, psychosocio
economic, educational, environmental, and physical) of concern to nursing.
Until nursing has a comprehensive theoretical framework to guide its practice
that is tested with diverse patients in varied settings, there remains much that
can be useful from the theories of other disciplines. From the stochastic and
programmed biological theories of aging, nurses can better manage nutrition,
incontinence, sleep rhythms, immunological response, catecholamine surges,
hormonal and electrolyte balance, and drug efficacy for older adults with
chronic illnesses. Using psychosocial aging theories, nurses can assist both the
older adult and his or her family in recognizing that the life they have lived has
been one of integrity and meaning and facilitate peaceful death with dignity.
Ego integrity contributes to older adults’ wellbeing and reduces the negative
psychological consequences that are often linked to chronic illness and older
age. Finally, being cognizant of older adults’ socioeconomic resources will
assist the nurse and older adult in planning cost effective best practices to
improve symptom management and treatment outcomes.

Using knowledge gained from aging theories, nurses can assist people
to:

• Use their genetic makeup to prevent co-morbidities

• Facilitate best practices for managing chronic illnesses

• Maximize individuals’ strengths relative to maintaining independence

• Facilitate creative ways to overcome individuals’ challenges

• Assist in cultivating and maintaining older adults’ cognitive status and

mental health.

In conclusion, aging continues to be explained from multiple theoretical

perspectives. Collectively, these theories reveal that aging is a complex
phenomenon still much in need of research. How one ages is a result of
biopsychosocial factors. Nurses can use this knowledge as they plan and
implement ways of promoting health care to all age groups. As in other
disciplines, the state of the science on aging is rapidly growing within the
nursing profession. Nursing is developing a rich body of knowledge regarding
the care of older adults. Programs and materials developed by the Hartford
Institute for Geriatric Nursing, the End of Life Nursing Care Consortium, the
American Association of Colleges of Nursing, and the Mather Institute provide
a strong foundation for developing and disseminating our current knowledge.
Nursing research must continue to span all facets of gerontology so that new
information will be generated for improved patient outcomes.