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...daily living and quality of life. Cognitive remediation interventions have been shown to be successful in improving mental function in older adults in many situations and may increase the number of everyday activities they are able to carry out. Nurses, given their direct contact with older adult patients, are able to inquire about or observe cognitive loss, make appropriate referrals, and emphasize steps such as cognitive remediation and other interventions that promote successful cognitive aging.
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By 2014, the 55- to 64-year-old age group in the United States is expected to increase to 40 million people; by 2029, the youngest of these baby boomers will be 65 years old (U.S. Department of Health and Human Services, 2005). Given the strain this population shift may place on healthcare services, as well as on informal support systems, there is an increasing need to promote successful aging and minimize morbidity toward the end of life. Such efforts can facilitate optimal quality of life for individuals and ensure that healthcare services are not overwhelmed and depleted.
Successful aging means living with the best possible quality of life by compensating for, adapting to, and assimilating declines in function. Rowe and Kahn (1997) present a three-part definition of successful aging: (1) having a low probability of disease, (2) having a high cognitive and functional capacity, and (3) being actively engaged in life. Although the elements of this definition of successful aging are interrelated, cognitive capacity, the amount of mental resources needed to negotiate one's environment, is particularly important.
Cognitive capacity is particularly important because it supports the other elements of successful aging. First, cognitive capacity can help reduce the probability of morbidity. Cognitive ability is needed to plan and arrange doctor's appointments, adhere to complex medication schedules, access health information, implement healthy behaviors, and simply monitor overall health. Insel, Morrow, Brewer, and Figueredo (2006) found that community-dwelling older adults with nonpathological impairments in working memory and executive function are at risk for not taking their medications as prescribed. Working memory is used to keep information in one's consciousness when working on a task; executive function is the ability to plan, reason, and juggle competing mental operations. Thus, working to retain cognitive capacity can help prevent disease progression and maintain overall physical functioning.
Second, cognitive capacity is important for preserving everyday functioning. Even small cognitive declines may tax an older adult's capacity to process information, compromising his or her ability to successfully negotiate the environment. Tabert et al. (2002) observed that older adults with mild cognitive impairment exhibited more self-reported deficits in instrumental activities of daily living (IADL) than normal control adults. Similarly, Royall, Palmer, Chiodo, and Polk (2005) found that even older adults with small declines in executive function but without memory problems still experienced declines in IADLs. Although the effect of subtle cognitive impairment on everyday functioning may not be as profound as that seen in Alzheimer's disease, it can nevertheless impact quality of life, and it may increase fears of developing dementia, because many people with mild cognitive impairment develop Alzheimer's disease at a later date (Nygard, 2003).
Third, cognitive capacity is necessary if one is to actively engage in life. In extreme examples of cognitive loss from Alzheimer's disease, the individual is no longer able to interact with others and maintain the same quality of life. However, reduced engagement is also observed with much less severe forms of cognitive loss (Tuokko, Morris, & Ebert, 2005). For example, McGuire, Ford, and Ajani (2006) found that subtle declines in cognitive functioning without dementia were predictive of poorer performance in preparing meals, managing money, shopping for groceries, doing light housework, taking medications, and using the telephone. It follows logically that the greater one's acumen, the better one will be able to function in one's environment, participate in everyday affairs, and have the freedom to make choices about how to effectively engage in life.
For these reasons, promoting successful cognitive aging is important for facilitating successful aging in general. Successful cognitive aging can be defined as "the extent to which a person is able to interact effectively with the environment (both interpersonal and physical) and adapt to age-related changes" (Teri, McCurry, & Logsdon, 1997, p. 274). However,...
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