THEORIES OF AGING

Theories of Aging
No single theory has been deemed the cause of aging
rather there are many theories from a number of disciplines that
overlap. If this is the case ,there must be a way to delay aging, thereby
increasing lifespan.

Theories of Aging

Aging is a complex phenomenon that continues to be explained from multiple

theoretical perspectives/point of views.
The theories of aging attempt to provide a framework to understand aging
process and each theory is useful to health professionals
The knowledge gained from the different theories of aging will be helpful in
providing quality care to older adults.

The purpose of these theories of aging is to review the chronological

development of biopsychosocial aging theories, the evidence
supporting these theories, and discuss their application to nursing
practice in helping older adult navigate the changes they experience as
they age.

Types of Theories of Aging

Biologic Theories
Stochastic Theories
Non-stochastic Theories
Psychosocial Theories
Sociological Theories
Psychological Theories
Nursing Theories

Biologic Theories:

• Concerned with answering basic questions regarding the physiological

processes that occur in all living organisms as they chronologically age
• Foci of Biologic Theories
Explanations of:
1) deleterious effects leading to decreasing function of the organism

2) gradually occurring age-related changes that are progressive over

time

3) intrinsic changes that can affect all member of a species because of

chronologic age

ALSO:
all organs in any one organism do not age at the same rate
 any single organ does not necessarily age at the same rate in
difference individuals of the same species

Biologic Theories: Divisions

A. Stochastic: Explain aging as events that occur randomly and

accumulate over time
B. Nonstochastic: Explain biological aging as resulting from a complex
predetermined factors or process.

Stochastic Theories

1. Free Radical and Lipofuscin Theory

• The free radical theory of aging posits that aging is caused by
accumulation of damage inflicted by reactive oxygen species (ROS)
• Describes that membranes, nucleic acid, lipids and proteins are
damaged by free radicals, which causes cellular injury and aging.
• Conditions associated with this theory :
⁃ Atherosclerosis
⁃ Cancer
⁃ implicated in the development of plaques associated with
Alzheimer’s

SOURCES OF ROS:
• External Sources:
⁃ Ionizing radiation- gamma rays, UV rays, xrays, Ultraviolet rays
⁃ Pollutants- fumes, smoking, cigarettes
• Internal/Intrinsic Source:
⁃ ETC- Electro transport Chain-most common (Macrophages)

Defenses to ROS:
Exist in two main group:
Enzymes and Small molecules antioxidants
• Antioxidants delay or inhibit oxidative damage,
• capable to neutralize free radicals by donating electrons,
• prevent cell damage and tissue damage,
• and act as Scavenger

Lipofuscin Theory
⁃ Moreover, there has been considerable interest in the role of
lipofuscin “age” pigments”,
⁃ A lipoprotein by-product of oxidation that can be seen only under
a fluorescent microscope in the aging process.
⁃ Because lipofuscin is associated with the oxidation of
unsaturated LIPIDS, it is believed to have a roles similar to that
of free radicals in the aging process
⁃ As lipofuscin accumulates, it interferes with the diffusion and
transport of essential metabolites and information- bearing
molecules in the cells.
 ⁃ A positive relationship exists between and individual’s age and
the amount of lipofuscin in the body.

2. Cross-Linkage Theory
• Also referred to as the Glycosylation Theory of aging
• Proposed by Johan Bjorksten in 1942.
• According to this theory, an accumulation of cross-linked proteins
damages cells and tissues, slowing down bodily processes resulting in
aging.
• In this theory it is the binding of glucose (simple sugars) to protein, (a
process that occurs under the presence of oxygen) that causes various
problems.
• Once this binding has occurred the protein becomes impaired and is
unable to perform as efficiently.
• Some research supports a combination of exercise and dietary
restrictions in helping to inhibit the cross-linkage process

3.Wear & Tear Theory

• This theory was first introduced by Dr. August Weismann, a German
biologist, in 1882.
• The theory suggests that aging results from a gradual deterioration of
the cells and tissues of the body via wear and tear, oxidative stress,
exposure to radiation, toxins, or other deteriorative processes.
Sources of Cell damage
• Exposure to radiation, toxins, and ultraviolet light can damage our
genes.
• The effects of our body's own functioning can also cause damage.
(HPN)

4. Evolutionary Theories
• These theories of aging are related to genetics and hypothesize
that the differences in the aging process and longevity of various
species occur due to interplay between the processes of mutation
and natural selection (Ricklefs,1998; Gavrilov and Gavrilova,
2002).
• Attributing aging to the process of natural selection links these
theories to those that support evolution.

Theories that relate aging to evolution, namely:

• Mutation Accumulation Theory
⁃ The “Mutation Accumulation Theory” suggests that aging occurs
due to declining forces of natural selection with age. In other
words, genetic mutations that affect children will eventually be
eliminated because the victims will not have lived long enough
to reproduce and pass this to future generations.Genetic
mutations that appear late in life, however, will accumulate
because the older individuals they affect will have already
passed these mutations to their offspring (Alzheimers disease)
 • Antagonistic Pleiotropy Theory
• The “Antagonistic Pleiotropy Theory” suggests the presence of
genes, the functioning of which is beneficial for the organism in
the early stages of life but has negative effects in older ages.
• Example: Testosterone levels in male humans. Higher levels
of this hormone lead to increased fitness in early life, while
causing decreased fitness in later life due to a higher risk for
prostate cancer.

• Disposable Soma Theory

⁃ The “Disposable Soma Theory” proposes that aging is related to
the use of the body’s energy rather than to genetics. It claims
that the body must use energy for metabolisms, reproduction,
maintenance of functions, and repair, and with a finite supply of
energy from food to perform these functions, some compromise
occurs. Through evolution, organisms have learned to give
priority of energy expenditure to reproductive functions that
could maintain the body indefinitely; thus decline and death
ultimately occur.
⁃ Example :
⁃ The disposable soma theory is one of those based on the
idea that the evolutionary value of additional life declines
following the age at which an organism achieves
reproductive capability. This concept in turn suggests that
aging might be the result of a tradeoff between some
quality that produces a benefit in an organism’s youth (in
this case reproduction) that happens to be rigidly linked to
a quality that only causes evolutionary disadvantages in
old age (aging). Rigid linkage means that the evolution
process cannot work out a way to achieve the benefit
without incurring the adverse side-effect (aging).

5. Bio Gerontology Theories

• This theory believes that bacteria, fungi, viruses, and other organisms
are responsible for certain physiologic changes during the aging
process.
• There is no evidence exists to link these pathogens with the body’s
decline, interest in this theory has been stimulated by the fact that
human beings and animals have enjoyed longer life expectancies with
the control or elimination of certain pathogens through immunization
and the use of antimicrobial drugs.
.

Nonstochastic Theories:

1. Apoptosis (Programmed Cell Death Theory)

⁃ Proposes that there is an impairment in the ability of the
cell to continue dividing.
⁃ Apoptosis is the process of programmed cell death that
 continuously occurs throughout life due to biochemical events
(Green, 2011).
⁃ In this process, the cell shrinks and there is nuclear and DNA
fragmentation, although the membrane maintains its integrity.
⁃ According to this theory, this programmed cell death is part of
the normal development process that continues throughout life.

2. Genetic Theory
⁃ Programmed Theory of Aging
⁃ This theory advocates that animals and humans are born
with a genetic program or biological clock that
predetermines the life span (Hayflick, 1965).
⁃ It asserts that aging follows a biological timetable
based on a person's genetics.
⁃ Various studies support this idea of a predetermined
genetic program for life span
(eg. Studies have shown a positive relationship between
parental age and filial life span

⁃ Error Theory
⁃ This theory suggest that, overtime, cells accumulate
errors in their DNA and RNA protein synthesis that
causes cells to die.
⁃ Causes of Errors: Environment factors and randomly
induced events
⁃ X-ray radiation - chromosomal abnormalities

3. Autoimmune Reactions (immunologic Theory)

⁃ Proposes declining functional capacity of the immune system as
the basis for aging.
⁃ It believes that aging is not a passive wearing out of systems but
an active self-destruction mediated by the immune system.
⁃ It is based on observing an age-associated decline in B and T
cell functioning, accompanied by a decrease in resistance and
an increase in autoimmune diseases with aging.
⁃ The primary organs of the immune system, the thymus and the
bone marrow are believed to be affected by the aging process.
The immune response declines after adulthood.
⁃ Some theorists believe that the reduction in immunologic
activities also leads to an increase in autoimmune response with
age. One hypothesis regarding the role of autoimmune reactions
in the aging process is that the cells undergo changes with age ,
and the body misidentifies these aged, irregular cells as foreign
agents and develops antibodies to attack them.
⁃ An alternate explanation for the reaction could be that cells are
normal in old age, but a breakdown of the body’s
immunochemical memory system causes it to misinterpret
normal cells as foreign substances, and cells die.
4. Neuroendocrine and Neurochemical Theories
⁃ Propose that aging occurs because of functional decline in
neurons and associated hormones.
⁃ It believes that neural and endocrine changes may trigger many
cellular and physiologic aspects of aging.
⁃ The main focus of this theory is the functional changes of
hypothalamic- pituitary system. The changes are accompanied
by a decline in functional capacity in other endocrine organs,
such as the adrenal and thyroid glands, ovaries and testes.
⁃ Neuroendocrine and neurochemical theories suggest that aging
is the result of changes in the brain and endocrine glands.
⁃ Some theorists claim that specific anterior pituitary hormones
promote aging. Others believe that an imbalance of chemicals in
the brain impairs healthy cell division throughout the body.

5. Radiation Theories
⁃ The relationship between radiation and age continues to be
explored.
⁃ Repeated exposure to ultraviolet light is known to cause solar
elastosis, (the old ‘’ old age’’ type of skin wrinkling that results
from the replacement of collagen by elastin)
⁃ Ultraviolet light is also a factor in the development of skin
cancer.
⁃ Radiation may induce cellular mutations that promote aging.

6 Nutrition Theories
⁃ The importance of good nutrition throughout life is a theme hard
to escape in our nutrition – conscious society. It is no mystery
that diet impacts heath and aging. Obesity is shown to increase
the risk of many diseases and shorten life ( NIDDK, 2001;
Preston, 2005: Taylor and Ostbyte, 2001.
⁃ The quality of diet is as important as the quantity. Deficiencies of
vitamins and other nutrients and excesses of nutrients such as
cholesterol may cause various disease processes.
⁃ Recently, increased attention has been given to the influence of
nutritional supplements on the aging process; vitamin E , bee
pollen ginseng, gotu kola, peppermint, and kelp are among the
nutrient believed to promote a healthy, long life ( Margolis, 2002;
Smeeding, 2001)
⁃ Although the complete relationship between diet and aging is
not well understood, enough is known to suggest that a good
diet may minimize or eliminate some of the ill effects of the
aging process.

7. Environmental Theories
⁃ Several environmental factors are known to threaten health and
are thought to be associated with aging process.
 ⁃ Examples:
⁃ Ingestion of mercury, lead, arsenic, radioactive isotopes,
certain pesticides, and other substances
⁃ Smoking and breathing tobacco smoke and other air
pollutants
⁃ Crowded living , high noise levels,

Nursing Implication: Application in Nursing Field

⁃ Physical theories of aging indicate that, although biology places
some limitations on life and life expectancy, other factors are subject to
behavior and life choices.
⁃ Nursing can help individuals achieve the longest, healthiest lives
possible by promoting good health maintenance practices and a healthy
environment.

PSYCHOSOCIAL THEORIES

A. SOCIOLOGIC THEORIES OF AGING

• Sociologic theories focus on changing roles, relationships and status
within a culture or society impact the older adult’s ability to adapt.
• Changing FOCUS of Sociological considerations of aging:
60’s focus on losses and adaptation to them
70’s broader global, societal, and structural factors influencing lives of
OA’s
80’s-90’s exploration of interrelationships between OA’s and their
physical, political, environmental & socioeconomic milieu

1. Disengagement Theory
⁃ The basis of this theory arises from the fact that human beings are
mortal and must eventually leave their place and role in society.
Therefore, it is their responsibility to look for suitable
replacement.
⁃ It views aging as process in which society and the individual
gradually withdraw, or disengage, from each other , to the
mutual satisfaction and benefit of both. The benefits to
individuals that they can reflect and be centered on themselves
have been freed from social roles.
⁃ The value of disengagement to society is that some orderly means is
established for the transfer to power from the old to the young,
making it possible for society to continue functioning after its
individual members die.
⁃ The theory does not indicate whether society or the individual
initiates the disengagement process.
⁃ However, it been observed that many older persons desire o remain
engaged and do not want their primary satisfaction to be derived
from reflection on younger years.
⁃ Examples: Senators, Supreme Court Justices, College Processors,
and many senior volunteers are among those who commonly
drive satisfaction and provide a valuable service to society by
 not disengaging

2. Activity Theory (Developmental Task Theory)

⁃ “Activity is viewed by this theory as necessary to maintain a
person’s life satisfaction and a positive self-concept”.
⁃ Theory based on assumptions:
1) it’s better to be active than inactive
2) it is better to be happy than unhappy
3) an older individual is the best judge of his or her own success
in achieving the first two assumptions

3. Continuity Theory
⁃ The continuity theory proposes that older adults maintain the
same activities, behaviors, personalities, and relationships of the
past.
⁃ Old age is not a separate phase of life, but rather a continuation
and thus an integral component

4. Age Stratification Theory

⁃ This theory suggests that society is stratified by age groups
⁃ Persons with a similar age groups generally have similar
experiences, beliefs, attitudes, and life transitions that offer them
a unique shared history.
⁃ Views the aging person as an individual element of society and
also as a member, with peers, interacting in a social process.
⁃ The theory attempts to explain the interdependence between
older adults and society and how they constantly influence each
other in a variety of ways.
⁃ Five Major Concepts
⁃ Each individual progresses through society in groups of
cohorts that are collectively aging socially, biologically,
and psychologically;
⁃ New cohorts are continually being born, and each of
them experiences their own unique sense of history;
⁃ Society itself can be divided into various strata according
to the parameters of age and roles;
⁃ Not only are people and roles within every stratum
continuously changing but so is society at large; and
⁃ The interaction between individual aging people and the
entire society is not stagnant but remains dynamic.

5. Person-Environment Fit Theory

⁃ The P-E Fit theory introduced functional competence in
relationship to the environment
⁃ Individuals have personal competencies that assist in dealing
with the environment:
⁃ ego strength
⁃ level of motor skill
⁃ individual biologic health
 ⁃ cognitive & sensory-perceptual capacities
⁃ As a person ages, there may be changes in competencies &
these changes alter the ability to interrelate with the environment
⁃ Significant implications in a society that is characterized by
constantly changing technology

6. Gerotranscendence
⁃ It suggests that aging undergoes a transition from a rational,
materialistic perspective towards oneness with the universe.
⁃ As people age, they are less concerned with their physical
bodies, materials possessions, meaningless relationships, and self-
interests and instead desire a life of more significance and a greater
connection with others.
⁃ Characteristics of successful transformation includes:
⁃ a more outward or external focus,
⁃ accepting impending death with fear
⁃ an emphasis on substantive relationships
⁃ a sense of connectedness with preceding and future
generations
⁃ and spiritual unity with the universe.

B. PSYCHOLOGIC THEORIES OF AGING

• The basic assumption of the psychologic theories of aging is that
development does not end when a person reaches adulthood but
remains a dynamic process throughout the life span .

1. Maslow’s Hierarchy of Human Needs

⁃ is a theory of motivation which states that five categories of
human needs dictate an individual's behavior.
⁃ These needs are physiological needs, safety needs, love and
belonging needs, esteem needs, and self-actualization needs.
⁃ “…each individual has an innate internal hierarchy of needs that
motivates all human behaviors”.
⁃ the ideal is to achieve self-actualization, having met all the
“lower” level needs successful
⁃ “Maslow’s fully developed, self-actualized person displays high
levels of all of the following characteristics:
⁃ perception of reality
⁃ acceptance of self, others, and nature;
⁃ spontaneity
⁃ problem-solving ability
⁃ self-direction
⁃ detachment and the desire for primacy
⁃ freshness of peak experiences;
⁃ identification with other human beings;
⁃ satisfying and changing relationships with other people;
⁃ a democratic character structure
⁃ creativity
⁃ and a sense of values.
2. Jung’s Theory of Individualism
⁃ This theory is not specific to aging
⁃ Jung proposes a lifespan view of personality development rather
than attainment of basic needs.
⁃ Jung defines personality as being composed of ego (self
identity) with personal and collective unconsciousness
⁃ Personal unconsciousness is the private feelings and
perception surrounding significant persons or life events
⁃ Collective unconsciousness is shared by all persons and
contains latent memories of human origin
⁃ Self-realization is the goal of personality development
⁃ As individual ages, each is capable of transforming into a more
spiritual being
⁃ Successful aging, is when a person looks inward and values him
or herself for more than just current physical limitations or
losses. The individual accepts past accomplishments and
limitations.

3. Stages of Personality Development (Erikson’s Theory)

⁃ Focus: Individual’s ego structure ( sense of self)
⁃ Personality develops in eight stages that have a corresponding
life task. Each represents a crisis to be resolved.
⁃ progression toto a subsequent life stage requires that task at a
prior stages be completed successfully.
⁃ Older Adults experience the following developmental stages:
Middle adulthood :40 to 65 years old
GENERATIVITY
Mature adults are concerned with establishing and guiding the
next generation. Adults look beyond the self and express concern for the
future of the world in general.
STAGNATION
Self-absorbed adults will be preoccupied with their personal
well-being and material gains. Preoccupation with self leads to
stagnation of life.

Older adulthood: 65 years to death

EGO INTEGRITY
Older adults can look back with a sense of satisfaction and
acceptance of life and death.
DESPAIR
Unsuccessful resolution of this crisis may result in a sense of
despair in which individuals view life as a series of misfortunes,
disappointments, and failures.

⁃ To achieve ego integrity , the older adult must have:

a. at least one companion in life
b. stable financial status
c. productive social, civil and religious activities
 4. Peck’s Expansion of Erikson’s Theory
⁃ Erikson’s last stage, ego integrity versus despair, expanded into
three stages:
⁃ The final three of the developmental tasks for old age:
⁃ ego differentiation versus work role preoccupation
⁃ body transcendence versus body preoccupation
⁃ ego transcendence versus ego preoccupation
⁃ Major issues such as
⁃ meaningful life after retirement
⁃ the empty nest syndrome, dealing with the functional
decline of aging, and contemplating one’s mortality are
consistent with Peck”s conceptualization.

5. Robert Butler and Myra Lewis (1982) outlined additional

developmental task of later life:
⁃ Adjusting to one’s infirmities
⁃ Developing a sense of satisfaction with a life has been lived.
⁃ Preparing for death.
⁃ … Mirroring the task s described by Peck

6. Selective Optimization with Compensation

⁃ Baltes’s theory of successful aging asserts that individual learn
to cope with the functional losses of aging through processes
of :

SELECTION: increasing restriction of one’s life to fewer

domains of functioning
OPTIMIZATION: people engage in behaviors to enrich their lives
COMPENSATION: developing suitable, alternative adaptations
⁃ Aging individuals become more selective in activities and roles
as limitations present themselves; at the same time, they chose
activities activities and roles that are more satisfying. Finally ,
individuals adapt by seeking alternative when functional limits
prohibit sustaining former roles or activities

Nursing Implication: Application in Nursing Field

⁃ Psychosocial theories help to explain the variety of behaviors seen in
the aging population.
⁃ Understanding all of these theories can help nurses recognize
problems and provide nursing interventions that will helping
aging individuals successfully meeting the development tasks of
aging.
⁃ Cultural, spiritual, regional, socioeconomic, educational and
environmental factors as well as health status impact older
adult’s perceptions and choices about their health care needs.
⁃ Theories can predict patient outcomes hold the greatest promise
for guiding nursing practice in ways that help each individual
patient age successfully.
Nursing Theories of Aging

1. Functional Consequence Theory

⁃ The functional Consequences Theory for Promoting Wellness in
Older Adults (Miller,2014) integrates theories from aging and
holistic nursing. It advocates that nurses can promote wellness
by addressing individuals holistically, recognizing the
interconnection of body, mind and spirit.
⁃ The consequences of age- related changes and risk factors can
result in either positive or negative functional consequences
(i.e.,, wellness outcomes) for older adults. Through interventions
that promote wellness and alleviate or reduce the impact of
negative factors, nurses can promote positive functional
consequences.

2. Theory of Thriving
⁃ This theory proposes that everything that impacts people
throughout their lives must be linked to create a holistic view of
aging (Haight, Barba, Tesh , and Courts, 2002)
⁃ Failure to thrive results from a discord between the
individual and his/her environment or relationships
⁃ Nurses identify and modify factors that contribute to disharmony
among theses elements
⁃ The Theory is based on the failure to thrive concepts as it
related to other adults in nursing homes (Newbern and
Krowchuk, 1994): the clinical characteristics of older persons
experiencing failure to thrive include disconnectedness, inability
to find meaning in life, problems with social relationships, and
physical and cognitive dysfunction.
⁃ In contrast, thriving is possible when harmony exists between
individuals and their physical and human environment
⁃ the process of thriving is continuous and enables aging
individuals to find meaning in life and adapt to changes.
⁃ this theory reinforces the importance of nurses considering the
many factors that can impact healthy and quality of life for older
adults.

3. Theory of Successful Aging

⁃ Flood (2005) integrated Roy’s Adaptation Model, other aging
literature, and The Theory of Gerotranscendence to develop a
nursing theory to guide the care o older adults
⁃ The Adaptation Model by Sister Callista Roy, saw the individual
as biopsychosocial being that continuously interacts with and
adapts to the changing internal and external environment ( Roy
and Andrews, 2008). Roy viewed health on a continuum and
involves the personal becoming an integrated, whole individual,
Roy assumes that the person has modes of adaptation:
 physiologic needs, self- concept role function , and
interdependence. Furthermore, Roy assumes that there is a
dynamic objective existence with the ultimate goal of achieving
dignity and integrity.
⁃ The Theory of Successful Aging not only considers successful
aging in term of the older adult’s physical, mental, and spiritual
well- being but also includes the individual’s self-appraisal. Food
hypothesizes that people with high levels of personal control and
a positive affect will experience higher levels of wellness in
aging due to their ability to participate in health- promoting
activities. Higher levels of physical health, in turn, contribute to
deeper spirituality. These factors contribute to greater life
satisfaction and the aging individual’s positive perception of his
or her status.
⁃ By aiding older adults in achieving high levels of health and
personal control over their lives, nurses can help aging
individuals to have positive view of their lives, which in turn can
promote their ability to cope and achieve greater life satisfaction
with age.

Six Positive Lifestyle Factors that Promote Good Health (Kirsti A. Dyer
MD, MS, FT Updated: June 11 2018)
1) Getting Regular And Adequate Amounts of Sleep
2) Eating Regular Well- balanced Meals, Including Breakfast
3) Engaging in Regular Physical Activities
4) Maintaining a Healthy Body Weight
5) Not Using Tobacco Products, Including Smoking or
Chewing
6) Using Alcohol in Moderation or Not at All

In addition, it has been proven by studies that the following factors

contribute to a long and healthy life:
1) Play and Laughter
2) Faith
3) Empowerment
4) Stress Management

Overall, the developmental tasks of aging can be summarized as:

⁃ Coping with losses and changes
⁃ Establishing meaningful roles
⁃ Exercising independence and control
⁃ Finding purpose and meaning in life.

Application in Nursing Practices

What are the appropriate nursing actions to assist aging persons
experience a sense of ego integrity and psychological well-being:

1. Learn about patient’s stories; ask about family backgrounds, faith, work
histories, hobbies, achievements and life experiences.
 Encourage patient to discuss these topics, and listen with sincere
interest. Remember: The elderly needs someone to talk to.
2. Build on lifelong interests and offer opportunities for patients to
experience new pleasures and interests, e.g., threading beads to
make bracelets, necklaces, etc., growing plants in small pots; learning
how to paint; group singing; etc.
3. Accept patient’s discussions of their regrets and dissatisfactions. Help
them to put these in perspective of their total lives and
accomplishments.
4. Encourage reminiscence activities between patients and their families.
Help families and staff to understand the therapeutic value of
reminiscence.
5. Respect patient’s faith and assist them in the fulfillment of spiritual
needs (e.g., help them locate a church of their religious affiliation,
request visit from clergy, pray with or for them, and obtain a Bible or
other religious book).
6. Use humor therapeutically. “Laughter contributes to good health.”
7. If patients reside in an institutional setting (e.g., home for the aged),
personalize the environment to the maximum degree possible.
8. Recognize the unique assets and characteristics of each patient.

Implication to Nursing
Using knowledge gained from aging theories nurses can:
✓ Help people use their genetic make up to prevent comorbidities;
✓ Facilitate best practices for managing chronic illness;
✓ Maximize individual’s strengths relative to maintaining independence
✓ Facilitate creative ways to overcome individuals’ challenges
✓ Assist in cultivating and maintaining older adults’ cognitive status and
mental health.