As we age, we’re constantly experiencing change. Some of us manage this change better than others, but we all go through it. Our bodies respond differently as we request the same performance. Our minds take us instantly to our first date, but lose track of the most recent location of our keys. Our peers face the same things, though at different rates, with the common consequence of making our social networks smaller and more distant. Patient engagement in care can be challenging upon the presentation of one or more of these changes. But by understanding the three domains of successful aging, you’ll be able to craft a care plan to keep your patient supported through all of life’s changes. And, you’ll have an engaged patient as a partner in the process.
A Focus on Successful Aging
Recently, new research by Young, Fan, Parrish and Frick found that existing strengths, or extra support in one domain of successful aging could improve a patient’s sense of overall well-being, even when a second domain may be in grave condition. They’d explored the interplay of the three domains earlier, arriving at the following definition of successful aging:
“A state wherein an individual is able to invoke adaptive psychological and social mechanisms to compensate for physiological limitations to achieve a sense of well-being, high self-assessed quality of life, and a sense of personal fulfillment even in the context of illness and disability.”
You should be able to categorize each aging-related challenge as belonging to the physiological domain, the psychological domain, or the sociological domain. Philips Lifeline’s ebook, The Changing Keys to Successful Aging, provides a tool devised in the above research to assess your patient’s fitness in each of the three domains. Once you’ve got a baseline, you’ll have a better idea where to start making interventions.
This work can be especially valuable when dealing with low levels of patient engagement. Often, poor patient engagement flows from a patient feeling burdensome, worthless, useless, etc. Helping your patients relate to their conditions and manage their feelings can go a long way towards building the doctor-patient partnership that will serve your patients best.
The Physiological Domain
“Josh” is an elderly gentleman whose degenerative hip condition has recently confined him to a wheelchair. He’s a poor candidate for surgery, and it’s unlikely that he will regain the ability to walk. Josh is having a hard time dealing with the restrictions, and has fallen a few times while trying to move around without his wheelchair. He’s generally not receptive to his family’s attempts to have him see a therapist to discuss his feelings about his condition.
Using the assessment tool linked above, it’s evident that Josh has difficulty with many of the physiological performance variables such as stooping, bending and kneeling, ascending or descending stairs, and walking short or long distances. He’s also facing Osteoarthritis and disk disease. His physiological domain score will work out to a zero. Psychologically, it seems that his cognitive function is excellent, though he’s experiencing situational depression. But socially, Josh is floundering. When asked the five questions in the assessment, Josh revealed that he had volunteered as a little league baseball coach for many years, and since his retirement he’d been the commissioner of the league. He’d emcee the annual banquet and pass out jerseys to kids each spring. Now that he could no longer walk, he’d felt forced to give up his little league responsibilities.
Losing the strengths of both his physiological and sociological domains all at once had left Josh feeling worthless and disconnected. Helping Josh reconnect with his little league community and find a new way to give his time and energy will help him relate to his physical limitations differently. He’ll improve his successful aging score, and be more likely to engage in his care plan. Since low successful aging scores are predictive of eventual nursing home confinement, this is work well worth doing.
