To the moderators, thank you for appreciating my personal view about retirement.

Here is my response about your question about what will I do with my fear in being old:

Learning to accept that everyone will grow old over time is the key to cope with aging. Consequences of aging to my health will be inevitable, that’s the truth. But there are ways to slow down aging process like proper nutrition, exercise and positive outlook in life.

It’s still a long journey for me before I reach old age. So I don’t put too much thought on what particular things should I do in preparation for it. Right now, what I do is take care of my body because being healthy while still young is beneficial in aging gracefully. Investing financially is of course one of the most practical thing to do. Having resources for hospitalization in case that old age takes its toll on my health would make me feel secure about my future. Pretty much, my classmates already mentioned what other activities to be done in preparation for retirement. So let’s all remember their advises and let’s all live our life to the fullest!

TO MR. MEDES,

Our group commends your viewpoint concerning depression among elderly people. Depression is something that must be taken into consideration among nurses. But generally, we must provide these people a holistic approach in addressing their needs. Thank you for your very kind and brief discussion on the retirement and role discontinuities.

TO MR. ENRILE,

Thank you for sharing your comment about the applicability of this theory not just on our country's setting but also in the western setting. Our group agrees that the use of this theory is more applicable in the western setting since they are more work-oriented whereas in our country, the retiring population are more engaged with their family which makes them cope easily with role transitions. Our group appreciates your participation. Thank you for your time in participating in our discussion.

TO MR. MEDES,

Our group commends your viewpoint concerning depression among elderly people. Depression is something that must be taken into consideration among nurses. But generally, we must provide these people a holistic approach in addressing their needs. Thank you for your very kind and brief discussion on the retirement and role discontinuities.

TO MR. ENRILE,

Thank you for sharing your comment about the applicability of this theory not just on our country's setting but also in the western setting. Our group agrees that the use of this theory is more applicable in the western setting since they are more work-oriented whereas in our country, the retiring population are more engaged with their family which makes them cope easily with role transitions. Our group appreciates your participation. Thank you for your time in participating in our discussion.

To the moderators,

If I encountered a retired individual who was reluctant to adjustment, I will first establish TRUST to the patient. Just like the nursing process, I will first assess the patient by exploring his feelings, identify what barriers or what hinders him to adjustment. Identifying the support system available will be also vital aspect for helping the patient for adjustment. It is important to collect information from the available sources in order to understand the patient. Nurses need to make an extra effort to elicit information.

It is important for the retired individual to appreciate the support groups available. Family for example, they will prove the long and lasting support to the retired age. Old age calls for interaction with the individuals of all age levels. This can only be possible within the family constellation. Hence, families should strengthen their support, respect for aged parents who have retired from work. It is the living sanctuary and a modeling example of inculcating values to the old parents. Nurses can ask older adults about their accomplishments in areas such as work and family and give positive feedback about meaningful roles.

Aging is pretty much feared by most people. It is something that is not well received and may in fact pose negative health outcomes to patients. Letty Kuan's focuses on the key elements needed to prevent negative adaptation to retiring and aging using both philosophical and practical determinants so that everyone can relate.

The nurse is the major key player in providing health care to our patients. In terms of Erickson's model of developmental stages, the primary goal of the nurse is to maintain and promote ego integrity and avoid circumstances that would lead to despair. Health teaching is very much important and in fact one of the most influential things to the patient. Nurses, due to their close interaction with patients and patients’ perception of their role , are an efficient channel for distributing health messages. For this reason, nurses’ perception and opinions could have an important impact on patient (Corner, 1997). The role of the nurse as a constant entity present to help the client and reassure the client that aging is a normal process which everyone has to go through. That is does not matter if we grow older, as long as we age with grace.


Nurses and other health care professionals alike may provide quality care to our aging patient by being perceptive of the clients needs. Nurses may do this from simple things like allowing the patient to do what he is able to do to promote self autonomy and confidence to something more complex like involving the families of patients in activities where in the patient would feel that he is still an important member of the family. If we, as nurses, assess both subjective and objective cues that our patients are afraid or inability to accept the aging and retirement process, then we can come in and help whatever way we can. Allowing the patient to open up to you for his concerns and for the nurse to have an open ear for these concerns are important. It is also very much important to allow the patient to seek relationships with other people his age, so that that the patient can realize that this really happens to everyone. In this manner, he may even be able to get advice and learn from the experience of other. In terms of severe and drastic emotional or psychological disturbances, perhaps, we can seek the help of a psychological referral. It is also to important to keep in mind that, as nurses, we must not forget to administer maintenance medications of aging clients as well as to maintain physical safety as they are at a high risk for falls, altered skin integrity and contractures secondary to limited range of motion - these are all basic to caring for an elderly - and are very much necessary to make sure that there is a easy transition on their part as both physical and psycho-socio-emotional needs are important to take care of in terms of giving holistic care to be able to allow the patient to age with grace.


I would not only advocate Kuan's theory to my patients, but also myself. Its universality makes it so that it is even applicable to nurses and other people alike in the sense that we all go through changes in life. Everytime we are forced to step out of our comfort zone and experience hardship, no matter how minute or gradual, we are transformed to become better people. By being prepared to face these changes, we are able to adapt successfully and may even become inspiration to our clients in that respect.

Kuan's theory can very much improve the quality of life of aging people. It gives healthcare professionals tried and tested tools which were not available in the past. It gives people a preview of what to expect in the future and what is needed to be prepared for this happening. There is also a great sense of security and comfort knowing what to expect in the future as one of the worst fears of all time is the fear of the unknown.

This theory, although applicable to the Philippine because of its universality, I believe can be more useful in the Western world as most families there are small and work-oriented. It is not uncommon there to see elderly members of the family enrolled in resident villages for the elderly or homes for the aged. In this respect, it is more like that these patients feel more ostracized and alienated in the fact the they are being secluded - very much different from their previous lifestyles. In the Philippines, however, where most of the families are big in the number of members and where most elderly people find a new and fulfilling job as caregivers to their grandchildren, this is something less necessary.

TO MS. MOSQUERA,

Thank you for sharing your personal view on your perception about retirement. It is important that nurses should develop a sense of self-awareness before understanding these individuals who are undergoing retirement and role discontinuities. Based on your discussion, it was noted that your greatest fear would be the thought that you will be a burden to your family by the time that aging takes its toll on your health. How will you cope with this kind of fear when aging comes into your life experiences in the future? Response to this question is well appreciated.

i will advocate the theory not only to my family but to all people whom i will encounter with.

to the moderators:

thank you for commending my comment on your discussion. if i will reach the age of my retirement and the theory of sis. Letty Kuan has no further study to improve or to be added on the purpose, i will indeed be guided by her theory. i will always keep in mind that sis. letty kuan's theory will be very helpful in giving a "fruitful" aging process to my relatives who will reach their retirement age.

TO MS. SARMIENTO,

We commend that Ms. Sarmiento’s review pointed out that nurses really do have a broad function that could facilitate aging people to perceive retirement as a remarkable part of life experiences. The changes, adaptation, personal growth, and cognitive function are aspects of development that may be as important in old age as they are in childhood development in which you indicated how significant the education will be towards development in aging. Also, it is very essential that you indicate that one of the most important aspects of their aging is related to their ability to develop and maintain strong relationships and social support systems.

We would like to ask, if you encounter a retired individual who was reluctant to adjustment, what plans will you make in order to help him to change his outlook on retirement?

After contemplating on Kuan's theory, I singled out a culprit which we call depression. I believe that depression is among the greatest obstacle for elderly to achieve full realization of fruitful and meaningful life.

As a nurse interested in depression, I would like to focus on nursing interventions to help the elderly overcome this challenge.

We cannot deny the likely presence of depression among the elderly, which is brought about by various factors. Studies have shown that loss of physical functioning and independence is associated with depression, as well as physiologic changes like degenerative signs of aging. This makes the elderly at higher risk for suicide than any other segment of the population. (Cantor, 1999; Lenze, 2001; Yeates, 2001)

Late-life depression can have serious repercussions, increasing mortality and disability, higher health care utilization, and longer hospital stays . But a sad sentiment of the elderly toward depression is "ignoring the blackness that has overcome them" because it is hard for them to move away from beliefs borne of their time when depression was judged to be a weakness and a result of flawed character. There is a "what's the use" attitude regarding our elderly, and is aggravated by our present "youth oriented" society which has notions that old age is just the end of life and that the elderly are merely "invisible citizens" (Huisani, 2004; Dixon, 2003).

With these prevalent notions and outlook on aging, as a nurse, I want to emphasize that "being old" had never been synonymous with being useless. I would do everything to make them realize that old age is an integral part of life, bringing fulfillment and self-actualization. Even Dixon (2003) stressed that aging is triumph, a result of strength and survivorship.

A specific nursing intervention I would like to use is the Reminiscent Therapy to help our elderly, for somehow, overcome depression. This therapy consists of having the individual reflect on their life. Through this reflection or reminiscence, individuals are postulated to resolve conflict, deal with past painful experiences, and thus be better able to deal with the present, which can bring forth a reorganization of the personality, and can thereby help alleviate depression (Butler, 1980)

Addressing depression among elderly is a vital nursing responsibility to help these individuals achieve fruitful and meaningful aging.

This poses a challenge for all health care providers most especially the nurses, to be more keen in addressing the needs (not only the physical) of the elderly; to be more caring, patient and thoughtful in every intervention, as what the substance of Kuan's theory dictates for us all.

Putting myself in the shoes of an old person made me think, how does it feel like to be a retiree? How would I adjust from being in the prime of my life to facing the impending idleness because of my old age? Then I felt ambivalent in the idea of this life transition. Because being a retiree means I got all the time in the world. No need to wake up early, no more sleeping disruptions because of the crazy shifting schedule from work, and the best thing of all, I can now spend my full time with my family. Then I realized that by the time I reach that age, my future children may have families of their own. And then it hit me, there’s a possibility that I might live my life alone. Just thinking about it made me feel depressed. No, I’m not ready yet to step outside this comfort zone.

I think to better understand the feelings of the aging people, nurses should listen to their fears first. There are lots of reasons why they are afraid to face retirement. In my case, for instance, my greatest fear would be the thought that I will be a burden to my family by the time that aging takes its toll on my health. Others also consider fear of financial stability. Having a job gives revenue for daily expenses, but for a retiree, it means depending on the money saved from the retirement plan.
The moderators now asked is it feasible for the government to create a pre-retirement program that would allow middle age people to be more ready for retirement?

Currently, our government has GSIS retirement program that “ensures financial freedom for its members”(www.gsis.gov.ph). But as we all know, the benefits that one can get from their program depend on the salary scale of the employee. The pattern of our economy now is said to be dysfunctional (businessweek,2001). So I assume that in the next decades, the benefits of the employee who will retire will not be sufficient for his needs. But this problem has political root so I will not tackle much about it. It is in the government’s position to put more revenue in healthcare to make sure that even those in the poverty class can have the privilege of hospitalization benefits.

Going back to the theory of Letty Kuan, I definitely agree that this can improve the quality of life of aging people going through the process of retirement. This theory has given the explanation about the importance of family in alleviating the shock of role discontinuity. But I would like to recommend that in case when the family is not present, the nurse can play a significant role as a support system for the aging people. As I mentioned earlier, listening to their fears can help us explore their feelings in order to properly educate them about the uncertainties of this life transition. Helping them preserve their self worth can also prevent them having depression. We can give them diversion activities based from their preference. I’ll recommend this theory because it has extensively explained the function of the nurse in helping the aging people deal with their psychological and emotional aspects.

TO MS. MENDOZA,

Thank you for sharing your opinion regarding social indicators as an addition to the determinants of fruitful aging in the theory. Indeed, the social aspect of an individual’s life has a great effect on the emotional and psychological maturity. But if we may ask, how do you think would the author would have measured the social indicators as a determinant as a factor in the pre and post retirement process?

We respect Ms. Reyes' opinions about being reluctant to aging like most people are. Given the mindset of most nurses regarding aging, how do you think the plan of care differ from nurses who see aging in a positive light? We also commend you for suggesting travelling as a way to cope up with role changes because retirees can reflect on their experiences while being able to enjoy by sightseeing. Thank you very much!

In response to the moderator's question regarding how the theory can be applied to the clinical setting, i feel the need for a proper time or schedule for such intervention needs to exist first. with the unjust nurse to patient ratio we have in most hospitals, the program cannot exist without a systematic approach to it.
If time is available on the other hand I feel it would work and flourish immediately, patients would embrace the intervention with reluctance at first but later would embrace it if they get the chance to think and reflect at what they said.

Mr. ARAULLO,

it is good that you understood the theory on another dimension and pointing out negative examples because Sister Letty Kuan's theory only focuses on the positive determinants which will lead to a fruitful aging. We hope that you can use this theory in doing a course of action to another relative of yours who is nearing the retirement stage. Now that you are aware of the positive determinants to a fruitful aging, would you incorporate Kuan's theory in planning for your future?