Adult Health as a Challenge
What is Adult Health
Human adulthood refers to the stages
or phases of the life cycle after childhood and adolescence. It is the longest
period of the life course. Physical, intellectual, educational, occupational,
social, economic, spiritual, and health-related changes characterize the multiple stages of adulthood.
Importance
The changes that take place in adulthood are of
importance to nursing for two reasons.
1:First is that adults, especially older
adults, comprise the largest population served by nurses.
2:Second is that adults
are the parents or guardians of infants, children, and adolescents and the
informal caregivers of elders. Adults make up the “family” that is
the basic unit of nursing care, thus, they are the direct or indirect clients
for essentially all of nursing care.
Ideally, nursing care and client
education about self-care would be designed to produce the maximum positive
benefit for clients. However, nursing actions are rarely designed to fit within
the specific life stage, developmental stage, or personal contextual reality of
adult clients.
Researcher Contribution In Health Care
The study of adult development is a
20th century phenomenon, ostensibly because people did not live long enough to
merit inquiry in previous centuries.
One notable exception was a treatise by
Quileute published in 1842, entitled A Treatise on Man and the Development of
His Faculties. G. Stanley Hall and EL Thorndike were two early 20th century
scholars of the adult years. In the mid-20th century, Erik Erikson (1959)
published a set of life stages that expressed the middle-class norms of the
1940s and 1950s.
Fortunately, he lived long enough to revise them and add
additional stages as people lived ever longer. From 1960 through 1980, Neu
Garten (1968) and other investigators at the University of Chicago generated
much of the work that serves as the foundation of extant theory on adult
development.
Concerns of Researchers
The life-span perspective of adult
development and aging is oriented to the scientific study of adult life stages
and critical situations that most closely fits within the nursing goal to
maximize quality of life for as much of the life span as possible.
The
life-span perspective focuses on change, continuity, and discontinuity over the
life course. Each stage of adulthood has normative patterns, and as one stage
folds into the next, personal changes occur and integration of these changes is
necessary.
This process may produce anxiety, anger, frustration, and
physiological stress responses during the transition while the conflicts
between the old and the new self are resolved and the changes are integrated
into the self-system. These stress responses frequently present to health care
providers in the form of accidents, chemical abuse, violence, or acute or
chronic illness.
The conditions are rarely perceived or treated within the
developmental context. Rather adults are decontextualized by health care
professionals who treat the immediate symptoms or condition while ignoring the
adult context in which it occurs (Stevenson, 1993). Furthermore, health
researchers, including nurse investigators, do not study health or care
phenomena within the context of the adult life course.
Adult Health With Community Health Organizations
A conception of the health of adults
that has wide appeal in the medical community is attributable to Dubos (1965),
who defined health as a state of equilibrium, adaptation, and harmony. Dunn
(1980) went beyond mere equilibrium and devised the new concept of higher-level
wellness.
Dunn’s concept of higher-level wellness embodied the idea of
actualizing and maximizing human potential through the pursuit of three
sub-goals: making progress toward higher level of functioning, having an
open-ended expanding goal to seek a fuller potential, and progressing toward a
more integrated and mature human existence through the entire life course.
Pender (1996; 2002) attempted to incorporate both Dunn’s actualizing focus and
Duboss ‘s concept of health as maintaining stability through adaptation to the
environment. According to Pender’s thesis, health is the optimization of
inherent and acquired human potential through goal-directed behavior, informed
self-care, and satisfying relationships with others.
Adjustments are made as
needed to maintain structural integrity and harmony within the context of the
environment. WHO representatives redefined health as a “resource for
everyday life, not an outcome or end product to be obtained at some definable
point in time.
According to the highly influential WHO Ottawa Charter (Kaplan,
1992), good health is viewed as a resource that goes hand in hand with social,
economic, and personal development, and it is a critically important resource
for attaining and maintaining a high-level quality of life for the entire life
course.
The goal is to “live long and die short; this implies avoiding
chronic diseases and disabilities and dying of old age at the natural end of human
life span. The prevailing theories about physical normality and the adult
stages have changed since the 1960s.
The prolongation of physical well-being
has become a norm as humans are living ever longer, even in third world
countries. Although the stages of adulthood differ by theorist, the middle
stages have been expanded to accommodate the acceleration of longevity.
Young
adulthood lasts from about 18 to about 29; the core or traditional middle years
encompass the years from 30 to 50 (50 was the average life span in 1900); the
new middle years cover the years from about 51 to either 65 or 70, depending on
the theorist.
Young old age covers the period from either 65 or 70 to 75;
middle old age extends to 85, and old-old age, or the frail age, is 85 and
beyond.
The latter three ages are relatively new designations and are evolving.
It is quite likely that during the first 3rd decades of the 21st century, as
the baby boomers move into the higher age brackets, the old-old age designation
will move upward and begin at age 90 or higher.
Different aspects of development are
dominant in different stages of adulthood. The biological self reaches its peak
in the middle 20s, and then a very gradual decline in physiological efficiency
in organ systems occurs during the next 7 or 8 decades.
The rate of change is
mediated by genetics, lifestyle, and environment, but everyone experiences the
decline. There is a rise in cognitive abilities in young adulthood that does
not speak for most until middle age, and these abilities then decline at an
even slower rate than the physical parameters.
Emotional and spiritual
development is postulated to continue well into old age and to peak near death
for the cognitively and emotionally healthy. Any of these norms may be altered
for individuals by genetics, mental or physical illness, catastrophic emotional
events, or other significant situations.
In the ideal world, health
professionals would be cognizant of the developmental stage of each adult
client and formulate care to match the needs and context of that stage
(Stevenson, 1993).
Barriers Or Hurdles
Although much has been learned,
there is great difficulty in trying to separate the impact of lifestyle from
what is ultimately possible for adult health under ideal conditions. This is
true not only for the biological possibilities but also for the socioemotional
realm and for the development of intellect, creativity, and wisdom.
Much of the
extant research is plagued by the inability of researchers to disentangle the
overlay of familial and cultural expectations, cohort-specific life
experiences, the environment, and idiosyncratic tendencies.
What is generally considered
normal for men or women during the major stages of adult life is open to
criticism as being tied to specific historical periods (eg, studies done in the
1950s or the 1980s), to expectations within an age cohort (eg , those whose
childhood occurred during the early years of television versus the internet
age).
Gender differences that were influenced by prevailing values and
expectations (eg, prewomen’s liberation or sexual liberation), or to physical
adult health status in light of varying mores about smoking, fat or
carbohydrate intake, and exercise.
Cultural, cohort, and
gender-expectation biases can be overcome to some extent with cross-cultural or
cross-sequential designs. Nurse researchers were challenged to do more of their
adult health research contextually tied to the specific adult ages and stages
of their subjects (Stevenson, 1993).
Even now, most nursing research either
erroneously lumps three or more distinct adult stages into one group (eg, 25 to
60) or makes up anti-developmental age categories (eg, 25 to 45, 45 to 65, and
65 and above). Developmental and situational confounders abound in data
categorized and analyzed in this anti-theoretical manner.
Findings would be
more valid and reliable, even about purely physiological phenomena, if
scientifically based adult life stages were used as the grouping categories in
research on adult health.