Module 15: Social Aspects of Late Adulthood

Learning Activity 1: Competence, Environmental Press, and Healthy Aging

Healthy Aging for Older Adults -- Photo collage of happy older Americans and their families.

Centers for Disease Control and Prevention

Late adulthood is characterized by a fair amount of diversity, which means that we really have to consider individuals’ needs when providing health care or interacting with elders – one approach can’t possibly work with all older adults. WAY back in Chapter 1, you read about how the competence-environmental press theory effectively integrates aspects of the biopsychosocial model into the person-environment relation framework. This theory is extremely useful for helping to account for diversity in patterns of aging. Here’s a quick synopsis:

Competence generally refers to how well an individual can perform across 5 key domains: physical health (e.g., disease status), sensory-perceptual skills (e.g., hearing, seeing), motor skills (e.g., walking), cognitive skills (e.g., memory), and ego strength (related to Erikson’s notion of integrity).

Many assessment instruments can be used to help evaluate competence. Lawton and Brody’s (1969) Instrumental Activities of Daily Living (IADL) Scale is used to help assess older adults’ ability to engage in IADLs. IADLs refer to everyday activities that require some intellectual competence and planning (e.g., using the telephone, paying bills; see Chapter 15 for more details) – such activities typically reflect competence across the majority of the 5 key domains. The Medical School at Brown University also offers a Toolkit for Assessing functional status and competence levels in older adults.

Environmental press , on the other hand, reflects the person-environment relation. It refers to physical, interpersonal, or social demands that the environment “presses” upon people.

Both competence and environmental press change as people age. Compare the levels of competence and environmental press associated with the gentleman suffering from Parkinson’s Disease in the “Nursing Home” video seen in this module’s Web Activity with the following case:

Click for video

An individual’s adaptation level results when press level is average for that person’s level of competence. At this point, behavior and affect are normal.

When environmental press increases slightly above the adaptation level, people’s performance tends to increase slightly – this is the zone of maximum performance potential. (Déjà vu flash – this should remind you of Vygotsky’s zone of proximal development reviewed back in Chapter 4!)

When environmental press is decreased below adaptation level, this is called the zone of maximum comfort. Here people can function comfortably without needing to worry about whether they can cope with environmental challenges (at least until competence decreases).

REFLECTION : Outside of these “zones” of performance, behavior becomes maladaptive and people experience negative mood or affect. Can you think of situations in which an older adult with low competence might experience too high a level of press? When might someone with fairly high competence end up in an environment with too few demands? How might health care providers best assist people in these kinds of situations?