Disease-a-Month 61 (2015) 480–488

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Disease-a-Month

journal homepage: www.elsevier.com/locate/disamonth

Psychological theories of aging

Iris Wernher, MS, Martin S. Lipsky, MD, MS

Introduction

What are psychological theories of aging?

Before elaborating on psychological theories of aging, it is worthwhile to reflect on what this

concept implies. Are psychological theories of aging ideas about psychological changes that
commonly result from aging, much like physiological changes relate to biological theories of
aging, or do we use psychological theories of aging to better understand the ways individuals
cope with age-related losses?
The literature suggests that both explanations are valid; psychological theories of aging can
refer to both psychological changes as a result of aging and adaptive psychological mechanisms
(or lack thereof) to counteract the losses associated with physical decline. For example, the field
of cognitive psychology addresses age-related changes in cognitive performance as well as the
use of strategies to compensate for these changes.1
Adding to the conceptual confusion, distinguishing between psychological and social, or
psychosocial, theories of aging can be conceptually challenging and may be more useful
theoretically than practically. However, just like an individualʼs “psyche” cannot be analyzed in
isolation, one should not make assumptions about individuals without taking into account their
immediate and broader social, cultural, and historical context.
This article will focus on psychological theories of aging using the three traditional domains
of psychology—an individualʼs cognition, emotion, and behavior—in contrast to the article by
Hasworth and Cannon2 in this issue, which emphasizes social relations and interactions. The
overlap among the different contributions in this issue should not be viewed as redundancy but
instead should serve to illustrate the interrelatedness of the many ways aging can be
approached.
This article starts with a description of developmental stage theories and how they relate to a
life course perspective on aging, followed by a brief description of the “classic aging pattern,”
cognitive plasticity, and cognitive reserve. The next section introduces the concept of emotional
self-regulation and explains an age-related phenomenon referred to as “positivity effect,” the
role of cognitive control, and socio-emotional selectivity. The last section describes behavioral
regulation in later life using the model of selective optimization with compensation as an
example for successful adaptation to age-related losses. The term “successful” as used in this

http://dx.doi.org/10.1016/j.disamonth.2015.09.004
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article is defined broadly as being “conducive to a personʼs well-being and life satisfaction,” as
opposed to Rowe and Kahnʼs3(p.433) original definition of successful aging as the “avoidance of
disease and disability, the maintenance of high physical and cognitive function, and sustained
engagement in social and productive activities.” The relevance of the described theoretical
concepts for clinical practice is discussed at the end of each section. The Table summarizes the
theories, phenomena, and concepts and their practical implications.

Table
Psychological theories of aging.

Theory/construct Key assumptions Implications for clinical practice

Stage theories of human Human development and learning are
development lifelong processes and not restricted
(e.g., Erikson’s theory to childhood and adolescence
of psychosocial Aging is not a one-dimensional process
development) of decline; gains are possible even in
older age
Past experiences shape a person’s
current state of well-being (life
course perspective)
Older patients can still learn and adopt
healthy behaviors and attitudes
Practitioners must assess and understand
a patient’s health status in the broader
life context
Guided autobiographic interventions can
be beneficial for patients with
unresolved life conflicts

Classic aging pattern
Fluid intelligence (e.g., abstract
reasoning, problem solving in novel
situations, performance in timed
tasks) naturally decreases with age
Crystallized intelligence (acquired
knowledge and skills) usually
remains relatively stable; gains are
possible
If given more time, older adults can still
perform well in complex tasks; they can
also benefit from memory and learning
strategies
Decreases in information processing
speed are, to some extent, normal signs
of aging; losses in vocabulary or social
judgment, on the other hand, can be a
sign of dementia

Cognitive plasticity and
cognitive reserve
Cognitive plasticity is the ability to adapt
to changes throughout one’s life
Cognitive reserve (active or passive) is
the brain’s backup capacity to
compensate for cognitive losses
Patients can compensate for cognitive
losses by applying alternative
strategies; training can support this
process
Cognitive reserve can delay the
expression of dementia symptoms;
practitioners should pay close attention
to self-reported changes

Positivity effect—
example of a cognitive
control strategy
Older adults tend to prefer positive over
negative information when it comes
to attention and memory
Cognitive control processes can
increase emotional well-being
Practitioners can help identify cognitive
strategies beneficial for emotional self-
regulation
Feeling depressed is not a normal part of
aging and must be clinically addressed

Socio-emotional
selectivity—one
explanation for the
positivity effect
As their time horizon changes, older
adults tend to prefer emotionally
rewarding relationships over
conflictions relationships
When assessing a patient’s social
network, practitioners should not only
pay attention to the number of
existing relationships, but also to their
quality

Selective optimization
with compensation
(SOC)
Older adults can successfully cope with
age-related losses by applying
cognitive and behavioral strategies,
such as selection, optimization, and
compensation
Practitioners can support their patients in
both redefining their personal goals and
using their remaining resources in a
way that is most rewarding to them
482 I. Wernher, M.S. Lipsky / Disease-a-Month 61 (2015) 480–488

Stage theories of human development

Theories of childhood development

Throughout most of the 20th century, many people viewed aging as a one-dimensional
process of decline.4 Based on this belief, it is not surprising that the work of most leading
scholars centered on changes in human development occurring during childhood and
adolescence. One prominent example is Sigmund Freud, who thought of psychological
development as a process occurring in stages and who emphasized the importance of the few
first years of a childʼs life for the formation of personality. Similarly, the Swiss psychologist Jean
Piaget introduced the theory of cognitive development, which posits that children complete
their intellectual development with the formation of abstract reasoning between age 11 years
and 16 years. Expanding on Piagetʼs initial theory of moral development, Lawrence Kohlberg, an
American psychologist, presented a model proposing that the maturity of moral judgment
increases with a child or young individualʼs ability to take into account both the view of persons
and their social perspectives. While research by Kohlberg5 included observations throughout
adulthood, his focus—like that of his contemporaries—remained on younger individuals and the
pedagogical implications of his findings in educational settings.

Eriksonʼs stages of psychosocial development

One of the first and most influential theories of development as a lifelong process is the
theory of psychosocial development by Erik Erikson.6 Eriksonʼs model proposes the existence of
eight stages, each of which includes a developmental challenge, or crisis, that needs resolution
before the person can successfully move onto the next stage. Eriksonʼs eighth stage explicitly
addresses post-retirement age. This stage is characterized by a personʼs life review in the face of
impending death, in which the person “seeks to balance life successes and disappointments and
to reach a compassionate, philosophical comprehension of the whole.”7(p.2) In this process, the
individual strives to overcome “despair” and to achieve “integrity,” a state of wisdom only
reached by fully and unconditionally accepting oneʼs life with all its highs and lows. More recent
academic work on Eriksonʼs stage eight of development stresses the existence of different
statuses of integrity7: Integration (where people are overall optimistic and content with their
experiences and achievements) and despair (where people are depressed and regretful about
perceived failures and missed chances in life). Hearn et al.7 proposed two additional
intermediate positions—nonexploratory and pseudointegrated—that are consistent with Eriksonʼs
own observations. Nonexploratory people are individuals who are generally content, but have
mentally withdrawn to a superficial comfort zone characterized by little introspection and a lack of
curious involvement in the world. Pseudointegrated people, on the other hand, appear to have
reached the state of integration, but their overly emphasized satisfaction with life is a surface
construct supported by a vehement denial of any potentially self-damaging aspect of their lives.

The relevance of stage theories for clinical practice

Although the notion of lifelong learning and development can no longer be considered a
novel insight, stage theories of development demonstrate the importance of understanding an
older personʼs well-being from a life course perspective. As explained in more detail by
Hasworth and Cannon,2 the life course approach “points to the importance of context—
historical, cultural, and social—for development and aging and provides a more nuanced
perspective of how social forces and individual agency interact to shape aging outcomes.”8(p.44)
In other words, our current physical, mental, and social well-being results in large parts from life
trajectories, including environmental influences such as the people we interact with and the
behaviors we adopt. In clinical practice, recognizing the influence of an older individualʼs
context facilitates the identification of more effective support and treatment plans.
 I. Wernher, M.S. Lipsky / Disease-a-Month 61 (2015) 480–488 483

At the same time, stage theories of human development remind us that, even in older age,
there is an opportunity for continued development and psychological growth. Emphasizing an
individualʼs lifelong ability to learn and to adapt to new challenges counteracts the widespread
assumption that advising an older person to adopt new behavioral patterns is a hopeless cause.
In fact, this pessimistic assumption may be a highly prevalent self-stereotype among older
adults, fostering negative thoughts, facilitating self-fulfilling prophecies, and undermining
therapeutic adherence. Thus, practitioners can improve treatment outcomes by strengthening
their older patientsʼ confidence in their ability to make changes conducive to their health and
well-being. For example, even individuals with lifelong tobacco use should still be encouraged
to quit smoking.
From Eriksonʼs model, we can neither infer that aging automatically goes along with the
acquisition of a Zen-like state of universal wisdom, nor that it unavoidably evokes perpetual
despair and resignation. The developmental stages and their intrinsic crises show that the later
years in life, much like the earlier ones, have their specific challenges. These challenges can—
depending on our attitudes and introspective skills—lead either to greater or to lesser life
satisfaction. The idea of overcoming the conflict between despair and integrity as a person turns
to reflect on the trajectories and turning points of a life lived is closely connected to the
underlying principles of interventions known as “life review” or “reminiscence therapy.” These
interventions focus on autobiographic memories and the way in which they shape peopleʼs
perceptions of the meaning of their lives; the process usually involves actively confronting
distressing memories in order to come to terms with the less pleasing aspects of oneʼs life. Life
review, reminiscence therapy, and other guided autobiographic interventions are used in a wide
variety of settings, including palliative care and the treatment of depression, but they can also be
used in healthy older adults to increase their emotional well-being, life satisfaction, and
biographic memory. Overall, these interventions prove to be fairly effective9,10 and can therefore
be considered as a therapeutic option if a clinical practitioner believes that a patient could
benefit from a constructive confrontation with particular unresolved life events. However, life
review as an active process of balancing out positive and negative life experiences is
contraindicated in individuals with dementia or with cognitive impairment who can no longer
process complex chains of thought. In these individuals, reminiscence with an emphasis on
positive memories is more effective.11

Cognition in later life

Age and intelligence: the classic aging pattern

Despite controversy about its definition and measurement, intelligence remains one of the
most intensely studied phenomena in psychology. While intelligence is not the same as
cognition, both concepts are closely related in that cognitive processes, such as attention,
working memory, and reasoning, are needed to develop the ability to “intelligently” understand
the world. In the 1960s, Raymond Cattell introduced the distinction between fluid and
crystallized intelligence.12 Fluid intelligence describes a personʼs cognitive flexibility that is
inherent, for example, in the ability to reason abstractly and to solve problems in novel
situations; fluid intelligence is equated with “native intelligence” and exists independently of
knowledge acquired through experience and learning. Crystallized intelligence, on the other
hand, describes acquired knowledge and skills, such as vocabulary and social judgment. Many
studies demonstrate that older adults tend to perform more poorly than their younger
counterparts when it comes to tasks that require fluid intelligence; however, they perform
equally well or better in situations requiring the use of crystallized intelligence (Fig.).12,13 This
phenomenon is referred to as the “classic aging pattern”1(p.181) and is due to normal age-related
decline in our information processing speed. Another noteworthy finding with regard to fluid
intelligence is that more recently born cohort groups tend to perform better in cognitive tests
484 I. Wernher, M.S. Lipsky / Disease-a-Month 61 (2015) 480–488

Fig. Age gradients of fluid intelligence, crystallized intelligence, processing speed, and processing robustness i.e., the
degree of performance stability (Li et al.13 used with permission). The T score is a standardized expression of the study
participants’ mean composite scores in different psychometric tests for the different age groups.

when compared to earlier-born cohorts of the same age. Recent research indicates that this
historic trend may not only apply to younger people, but can persist well into older age.14

Implications for clinical practice

One reason why older adults experience losses in their fluid intelligence is because age-
related physical changes lead to decreases in information processing speed, attention, memory,
and learning capacity. In our fast-paced, achievement-oriented Western societies, the ability to
perform quickly often equates with the perception of a personʼs cognitive capacity, or
intelligence. What is often overlooked is that, if the time factor is eliminated, older adults
perform equally well as younger people, particularly in tasks related to acquired skills and
knowledge. In clinical practice, this means that care providers should be aware that older adults
may simply need more time to complete a task, such as completing forms or responding to
complex questions. Practitioners who administer cognitive tests like those used to screen for
dementia need to compare the test scores to a reference population of similar education and age
to avoid misinterpreting the results. Patients who are concerned about cognitive decline often
find relief in the reassurance that a certain degree of slowing down is a normal part of aging and
not a sign of dementia. Older adults in particular may also benefit from auxiliary strategies, such
as the use of mnemonics to acquire new knowledge or the manipulation of their environment to
facilitate undisturbed, selective attention to the task at hand.

Cognitive plasticity and cognitive reserve

Cognitive plasticity is a multi-faceted concept that describes a personʼs ability to adapt to

varying conditions and refers to the “contrast between an individualʼs current average level of
[cognitive] performance under normative conditions and oneʼs latent potential.”15(p.297) As
Willis et al.15 point out, cognitive plasticity is closely connected to a life course perspective since
it emphasizes human development as a lifelong process of adaptation to changing circum-
stances. While our capacity to adapt to changes—including age-related losses—is naturally
limited, there is agreement among scientists that this capacity can be enhanced through training
and experience. This assumption is supported by a clinical observation known as “cognitive
reserve”—a sort of “backup capacity” that enables individuals to function on an adequate
cognitive level even in the face of pathological changes in the brain. In the case of passive
cognitive reserve, the threshold for expressing clinically significant symptoms is increased (i.e.,
the expression of symptoms is delayed). Active cognitive reserve, on the other hand, refers to the
brainʼs capability of actively compensating for losses through the application of alternative
processes and strategies. For example, a person who is highly skilled in processing information
efficiently at a younger age will most likely be able to more effectively cope with cognitive losses
than a person with the same level of decline who never developed such skills.
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Implications for clinical practice

Similar to the life course perspective, the concept of cognitive plasticity underlines both the
existence and importance of lifelong adaptability and learning. While experiencing natural
losses with aging, older individuals are also capable of experiencing gains. A clinician should not
discourage an older patient from adopting new cognitive strategies or from drawing on existing
skills to maintain an adequate and/or satisfying day-to-day performance. However, evaluating a
patientʼs cognitive status carefully helps direct interventions. For example, in the case of an
underlying illness, such as Alzheimerʼs disease, a patient may not be able to acquire new
strategies. In this case, the focus should shift to retaining skills and supporting existing abilities.
Dementia also clinically illustrates the principle of cognitive reserve. While a higher level of
education cannot prevent Alzheimerʼs and related diseases, it is considered a protective factor
because the onset of clinically relevant symptoms can be delayed. One important implication is
that for highly educated individuals, even if a cognitive screening test such as the Folstein MMSE
score falls within the normal range, a dementing process cannot be excluded. In those with high
educational attainment, close attention needs to be paid to any changes a patient reports
regarding their “usual” performance. If in doubt, referral to a neurologist or psychiatrist for more
detailed testing should be considered. Another example of the impact of (passive) cognitive
reserve in dementia is that oftentimes, family caregivers report that the cognitive condition of
their loved ones drastically worsened “overnight,” after going on a trip, staying at the hospital, or
being otherwise taken out of their daily routine. According to the cognitive reserve hypothesis,
the sudden decline can be a sign that a personʼs threshold capacity for cognitive compensation
has been exceeded. It may be beneficial for the caregiver to understand that abrupt declines in
the patientʼs clinical status can occur as part of the illness and that a change in routine, while
causing the underlying deterioration, can rapidly deplete a personʼs cognitive resources and
unmask a significant decline in functional ability. On the other hand, sudden mental
disorientation and changes in mood and attention—especially in the hospital setting—can be
signs of delirium, which is often confused with dementia. In contrast to dementia, delirium is a
state of acute, temporary confusion with fluctuating symptoms. It is usually reversible and
can be caused by a variety of conditions, including infections, drug interactions, and de-
hydration. Since the underlying causes may require immediate intervention, differential
diagnosis is crucial, yet particularly difficult when the delirium is superimposed on preexisting
dementia.16

Emotional self-regulation in later life

The positivity effect

Similar to personality traits, emotional functioning and the importance of social integration
change very little as we age. We may perceive emotions differently than in the earlier stages of
our lives, but they continue to have an impact on both mental and physical well-being: “In late
life, as at earlier times, the experience of negative emotions affects physiological functioning and
ultimately physical health.”17(p.384) For the longest time, the widespread belief existed—and
often still exists—that the later years are characterized as an accumulation of physical, cognitive,
and emotional loss and decline and that consequently people reaching this phase will naturally
enter a state of continuous sadness, resignation, and despair. Recent research reveals that this
gloomy image of aging does not appear to be true.18 In fact, there seems to be a relationship
between older age and the tendency to prefer positive over negative information with regard
to attention and memory processes. This observation, described in detail by Mather and
Carstensen,19 is referred to as “positivity effect.” In a recent meta-analysis of 100 studies with
over 7000 participants, Reed et al.20 found that the positivity effect in older adults could reliably
be observed.
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Cognitive control and emotional well-being

A variety of approaches exist to explain why older adults seem, or actually are, happier than
their younger counterparts. Most of these theories share in common the assumption that older
adults regulate conflict and emotions better than their younger counterparts, either by using
more effective control strategies (e.g., adjusting oneʼs expectations to the situation rather than
solely trying to change the situation to match oneʼs expectations), the possession of greater
“wisdom and virtue,” or the application of strategies conducive to healthy aging, such as physical
exercise and social engagement.18 Based on the fact that our cognition and emotions are strongly
related, many researchers emphasize the role of cognitive control as an important factor for
emotional well-being in later life.21 For example, in the face of increasing losses and decline in
older age, individuals can employ cognitive strategies to down-regulate their affect when
presented with negative information, for instance, by “selecting a situation by its expected
emotional outcome, modifying the emotional impact or meaning of a situation, focusing on
select aspects of a situation, and altering an ongoing emotional response.”21(p.329) This kind of
active cognitive control of oneʼs emotions is an executive function associated with the prefrontal
region of the brain.

The theory of socio-emotional selectivity

Carstensen et al.22 presented an explanation for the positivity effect by hypothesizing that as
their remaining time to live decreases with age, older adults change their personal goals from
knowledge-oriented to emotion-related experiences and tend, among others, to become more
selective with their social interactions; relationships that have proven to be emotionally
rewarding in the past are intensified while conflictual or ambiguous relationships are avoided.
This process of emotional regulation is known as “socio-emotional selectivity.”

Implications for clinical practice

The positivity effect is a clear indication that sadness, frustration, or despair should not be
considered as normal signs of aging; a recent review of the research on the relationship between
age and depression supports this observation.23 However, this does not mean that mood
disorders do not exist among older adults. On the contrary, it is crucial that practitioners pay
close attention to the presence of anxiety and depressive symptoms in older patients because
this population may be reluctant to report symptoms of depression for a variety of reasons,
including the false belief that all people inevitably feel insecure and unhappy as they age.
Consequently, clinical practitioners should proactively address this stereotype and encourage
their older patients to report symptoms. Likewise, clinicians should avoid a similar bias and
should carefully evaluate symptoms suggesting depression and not attribute those symptoms to
the aging process.
The theory of socio-emotional selectivity is valuable for clinical practice in that it illustrates
that it is not just the number of social contacts that matters, but more importantly, the quality of
the individual relationship. There is no denying that social networks become smaller as people
age due to an increased mortality among their peers, geographically scattered families, mobility
issues, etc. Hence, it is even more important than in younger adults to pay attention to those
relationships in an older personʼs social network that are emotionally beneficial as well as to
those that are detrimental to the personʼs well-being. Another noteworthy aspect of
Carstensenʼs theory is the recognition that a personʼs sense of time (e.g., remaining years to
live) may play an important role with regard to his or her choice of behavior. When working
with older patients, practitioners should be aware that as we age, our motivation and goals
might shift from a future-oriented perspective to a stronger focus on the present.
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Behavioral regulation in later life

The model of selective optimization with compensation (SOC)

Another well-known theory concerned with the selection and pursuit of goals from a life
course perspective is the model of selective optimization with compensation (SOC). Baltes and
Baltes24 introduced the SOC theory as a developmental model of successful aging. It can be
understood as a strategy to cope with age-related constraints, such as decreases in energy or
cognitive capacity. According to the model, a successfully aging person is able to redefine his or
her personal goals to adapt to the naturally occurring loss of resources. For example, personal
goals can be restructured in a way that allows for a reduction of the number of domains or
activities that the person wishes to engage in by selecting those domains or activities that seem
most rewarding, meaningful, or otherwise relevant. To achieve the desired outcomes in the
selected domains, the person then devotes his or her remaining resources (e.g., time and energy)
toward the optimization of those outcomes. If a person refuses to abandon a goal that has
become unattainable with the currently available resources, the person can also attempt to
acquire new resources or to activate unused ones to compensate for the experienced losses.
Although the SOC model was developed in the context of successful aging, it obviously does not
only apply to older adults but to any situation where the loss of previously possessed resources
creates a new, challenging life situation that a person needs to adjust to.

Implications for clinical practice

Selection, optimization, and compensation describe a set of behavioral choices in the face of
age-related (or other) changes. Optimally, the process of goal and domain selection is the result
of a personʼs rational and/or emotional appraisal of their available options. For several reasons,
this is not always the case. For example, stereotypes around aging may limit an older personʼs
choices to those activities commonly perceived as age appropriate without taking into account
individual preferences. Well-meaning family members may take over tasks for an older person
without considering the potential importance those tasks may have with regard to a personʼs
role identity and self-esteem. With this in mind, practitioners can help restore their older
patientsʼ sense of control over their lives by facilitating a conscious, proactive process of goal
definition that accounts for both available resources (internal and external) and individual
preferences. Rather than dwelling on abilities lost, a personʼs well-being can be enhanced by
emphasizing remaining strengths and identifying additional sources of support. Hence, selective
optimization with compensation is, in theory and practice, particularly suited to foster a
resource-oriented rather than loss-oriented perspective on aging.

Conclusion

This article provides an overview of aging from a psychological perspective by discussing

some key psychological theories and concepts of aging. Although there is a rich literature about
aging and psychological theories, these brief descriptions should help practitioners to
understand the mechanisms behind their older patientsʼ cognition, emotion, and behavior
and to support them in the best possible way.
While cognition, emotion, and behavior can be seen as separate aspects of human existence,
they are strongly interrelated. For example, this can be clearly observed with the SOC model
where cognitive and emotional processes both contribute to shaping a personʼs behavior.
Regulation in all three realms is crucial for the successful adaptation to new situations
throughout a personʼs life. Practitioners who understand their older patientsʼ adaptation
processes as an “interplay between assimilating the environment to existing forms of thought
488 I. Wernher, M.S. Lipsky / Disease-a-Month 61 (2015) 480–488

and accommodating oneʼs thought to the environment”15(p.296) can help them to find the right
balance in this complex psychological interplay.

Acknowledgments

The authors want to acknowledge and thank Dr. Diana White for her thoughtful review and
critique of the manuscript.

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