Retirement and Role Discontinuities By Letty G. Kuan

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?

In response to the moderator's suggestion regarding a pre-retirement program for the middle-age class, i think it is a good idea for the government to introduce such programs. Everyone would go into retirement sooner or later so why not be oriented earlier about it, so that people would accept the life change much easier. We must also keep in mind that there are other factors as well such as the kind of work they are about to leave, financial security, families to tend to and etc. The government cannot bluntly introduce a program without studying the factors said, it is not a generalized experience for everyone, everyone will have a unique experience that they would go through regarding retirement.
i feel the components involved would be ways on how to live a fruitful retirement life. for example, having a small business to keep being productive, programs that has something to do with socializing and the same sorts. programs that would initiate the fire inside to keep burning and to live a dignified and productive life towards the inevitable death.

thank you posting a reply to my comments.

i actually believe that the government may be able to bring the pre-retirement program down to the grass roots level. the key is to incorporate the perspective of role discontinuity and retiement preparation into existing programs.

looking at how the government was able to launch the NARS program, it wouldn't be impossible to inform people of kuan's ideals. i understand that community health nursing focuses on physical illness, but this is exactly why there is a need for change in the general perspective of health.

i would also like to point out that local government units already have existing livelihood projects such as handicrafts and delicacies. these are very applicable for aging persons. we only need to incorporate its psychodynamic significance in its goals to make eat "palatable" to the retirees.

with the existing government and local programs, there are exsting avenues for us to disseminate information, not just for kuan's proposition, but also for the holistic needs of different age groups. with the surplus of nursing graduates yearly, the government may want to look into utilizing these nurses for more effective health education in the community before they end up in call centers and korean english tutorials.

it would be better if specialized institutions for pre-retirement development would be put up by the government. but this is not an equitable society. we have to make do with what we have.

TO MR. DESOYO,

Our group commends your point regarding the importance of applying the theory of Retirement and Role discontinuities when dealing with the elderly. Care for the elderly is indeed a task that requires careful planning and appropriate skills. Given this case, how do you think will the retirement and role discontinuities theory be applied in the clinical setting in our country?

We commend Ms Liongson's comprehensive response to theory synthesis. There are good points and the suggestions, especially the one that involves the patient in active community participation, are well thought. There is an underlying issue of which the theory can be a good starting point, it is pre retirement.

In your opinion, is it feasible for the government to create a pre-retirement program that would allow middle age people to be more ready for retirement? What do you think would be the components of the program?

I work on a company that comprises of employees not of my age. Most of them are almost 25 years serving our company. As I talked to them, when age comes to the topic, the usual reaction formed is denial. They tried so hard to hide their age and come to the topic of retirement. Though for them, retirement entails money because of all the monetary benefits they may gain. But there are still sentiments and concerns arise. But due to recession, some company have early retirement age, it was indeed a stressor that was abrupt. As a realization, as age progresses, productivity shortened. Companies more preferred to have younger employees which are equivalent to being productive rather that to those adults in senior years.

As adults approach their senior years many aspects of life (physical, social, financial, and employment) are changing. Mostly, the retirement years are anticipated positively and with an expectation of more leisure time and a lessening of demands and responsibilities. In addition, this is the time for the family to spend quality time. Neither seniors nor their families are adequately prepared for the stresses that also accompany aging. The goal during the senior years then is to maximize the positive and develop strategies for coping with the stresses (Brandt, 2000).

As with anything in life, the discrepancy between what one expects and what actually exists can be a set up for disappointment and frustration (Brandt, 2000). Interventions that can help seniors to surpass the disappointments and frustrations are necessary. I strongly believe that instead of psychological effects alone, as what the posting was claiming, it must also focus on social effects, thus the nursing interventions must result to psychosocial adaptation and self-fulfilment. It is therefore important to realistically look at changes which may occur and which may be experienced as losses from life as it was.

The aging process accompanies physical change. Older adults may not feel or look as well as they did. There may be a general slowing down of activity level and cognitive speed. There are also specific losses – of vision, hearing, movement, and memory. Seniors can still do the same things but it can take longer. The changes though, can impact on mobility in terms of going places, driving and pursuing activities (Brandt, 2000).

There are also changes in identity and roles, which accompany retirement. Responsibilities in financial matter and decision making can be uncomfortable either on senior parents and their children. For seniors, giving up decision-making and choice is an affront to their self-esteem. For adult children, it may be embarrassing and arouse anxiety to see their parent as dependant and vulnerable. It is a sensitive issue – to know how much to take over and what to leave in the province of a senior parent. For adult children there is also the challenge of balancing their own lives, families, careers and social needs with that of their aging parent. If not handled well, the issue can lead to tension frustration and conflict between adult children and their aging parent (Brandt, 2000).

Retirement is considered as a transition on a person's life. It is much like taking away something that has been long yours. So as true as the issue of giving up a 'life' the patient had. For other person, work was considered as their life because they took years to live with their work environment. The main problem here is that if retirement is imminent, psychological reactions were form. Retirement used to be a stressor on a person's life that he was trying to adapt. Pre and post retirement can cause anxiety and depression. Retirees suddenly have all this free time with no commitments. Depression can cause several symptoms that may eventually affect patient’s social adaptation. Basically, what is missing on the theory is the consideration in the social aspect of a retiree. Social impact can cause several effects like (sources). Nurses as what the theory was saying should incorporate their caring on this retiree.

Family role and support plays an important role in adaptation. Although the way the family views the world is important during retirement, being affirmed by family members is more important. There is an importance of a positive problem-solving communication style for a positive level of family adaptation. Individual adaptation during retirement was more influenced by family worldview (Smith, 2007).

The theory focuses on the psychological effects on a retiree. It is really a difficult transition in one’s life. But I may suggest that integration of social indicators should also be included. Instead, psychosocial adaptation of a retiree must be a concern of a nurse.

References:
Smith, S. D.,2007. The Retirement Transition and the Later Family Life. Retrieved June 29, 2010 from http://www3.interscience.wiley.com.
Brandt, A.L., 2000. Transition Issues for the Elderly and Their Families. Retrieved June 29, 2010 from http://www.ec-online.net

Upon retirement, a person enters a new phase of his life where he faces Ego Integrity vs. Despair. Erikson posted that ntegrity is achieved as the aging person struggles to maintain wholeness in strength and purpose despite the apparent degeneration of physical capabilities. Havighurst suggested that two of the six tasks of retirees who are in the late maturity stage are “adjusting to retirement and decreased income and adjusting and adapting to social roles in a flexible way” (Hogstel, 2001). With the physical changes and transition of role function, retirees do need holistic support from family, friends and the health care system.

Nursing interventions are vital in helping aging people view retirement positively.
Physically, nurses should actively replace the energy lost by an aging client and should prevent further degeneration of the body, as proposed by Levine’s Conservation Model (Tomey, Alligood, 2002) for him to be able to enjoy retirement. Primarily, nurses, together with other heath disciplines, should monitor the client’s body functions to determine the extent of activities that he may engage into. It is essential to formulate a diet with nutritional contents adequate for the client’s needs and general condition. Encouraging and educating the client about and adherence to pharmacologic treatment or supplements is also our task. Teaching the client exercises that are not too extraneous will also prevent muscle wasting, and promote good circulation and over-all energy. (Kozier, Erb, et.al, 2008)
The cessation of productivity for a person whose job was his source of interest, social life and activities threatens his integrity. The major stressors of a retiree are declining health and vigor, loss of family and friends, reduced income and, all leading to, loneliness. The feeling of loneliness can immediately be addressed by the nurse by listening. It is also reduced by encouraging aging clients to have pets, have some place to go to and have something to look forward to. Psychological well-being can be preserved by helping the client develop interests that are not related to his work, volunteer for a cause, make new friends from all ages and stay active by keeping himself busy. (Judd, 1983)
The way nurses are to deliver health education regarding interventions should involve the family, in congruence to Kuan’s idea of Family Constellation. A retiree enjoys this phase of his life mostly by being able to spend more time with family, especially his grandchildren (Hogstel, 2001). Moreover, people working in groups succeed better in goal attainment than a person working alone (Schultz, 2002).

The major role of a nurse in an aging client’s retirement and role discontinuity is to be the resource person.
According to Hall, nursing requires and interdisciplinary approach in preserving a client’s wholeness (Tomey, Alligood, 2002). The nurse’s hands-on care is the amalgam that holds all the contributions of different professions and disciplines to the adaptation of a patient. A nurse’s role in an aging person’s transition does not only involve collaboration with physicians, dieticians and physical therapists to maintain physical wellness. Ideally, nurses should be able to offer retirees access to community-based psychological health services, outreach programs, volunteer work, support groups, activity and recreation centers and other institutions that will help him discover a new dimension to self awareness and productivity. (Judd, 1983)

As a nurse, I would advocate Kuan’s theory because it has positive impact to the quality of life of aging persons.
Kuan’s theory supports the ideas that nursing should promote wholeness (Rogers, Levine), adaptation (Roy), patients’ discovery of himself and insight (Peplau), and patients’ empowerment (Orem). It also shows that there are difficulties and needs that a nurse should anticipate when a patient is transitioning into retirement stage. This anticipation allows the nurse to intervene with the overt issues that a person is dealing with (Abdellah). (Tomey, Alligood, 2002)
The goal of aging is “to enter into the last half of life determined to make the most out of it” (Judd, 1983). Remaining involved with significant others, interests and benevolent work allows a person to welcome the next stage of his life with confidence, contentment and a balanced perspective. Somehow, Kuan was able to contribute a framework by which a retiree may have a better chance at a quality life.

However, Kuan did overlook some important considerations and there are points of improvement for her theory.
In determining how a person may deal with retirement, his past experiences should also be assessed. Erikson posited that an adult’s completion of past developmental tasks affects his behaviour toward later maturity and retirement (Hogstel, 2001). Personal experiences are unique. Their impact on the lives of people would need to be approached differently. Some aging clients may have had more challenging lives than others and they may need more help. Some retirees may have been more productive than others and may be able to adapt faster. This is something that I would explore so that i may be able to address my client’s facets of insecurity with higher priority. Hence, preparation for retirement should be highly individualized.
Looking at retirement in a positive light may also be more beneficial for an aging person. In Achtley’s Continuity Theory, he proposed that continuity is more potent than role discontinuity. He said that even after retirement, a person does not lose his job-related identity, but the identity of a retired person adds up to it (Hogstel, 2001). For example, I would orient an aging client that the values of being hardworking and committed that he gained from being employed will be enhanced if he utilizes his availability in soliciting donations and goods for orphanages. After all, people adapt more with a positive perspective.

Kuan’s theory may not be applicable with the current health care system, but it may find hope in the inherent Filipino characteristics.
Blaming substandard nursing practice on understaffing is a cliché, and sadly almost a norm. With many diseases and patients flocking in hospitals, health care has been focused on curing physical illness. Nurses are required to do more with less – less time, less resource, less manpower. This scenario belittles the importance of addressing the concerns of those who are not physically sick, such as retirees undergoing identity crisis. To provide holistic assistance to aging persons is almost impossible with our health care system.
What can we do? Educate the primary people in the lives of retirees of Kuan’s theory and similar ideas.
The beauty of the Filipino people is that we are adaptive, quick to learn and highly family oriented. We take care of our elders and we let them live with our own nuclear families. If not, we keep them in close proximity whether literally, on a regular schedule, or by constant communication. Sharing nursing knowledge about the needs of aging persons with their significant others, would increase the probability that they would be assisted during their transition because they are in constant interaction among each other.

Kuan’s “Retirement and Role Discontinuity” does not only provids a picture of ideal nursing care for the aging. On a larger perspective, it reminds us that people who retire once contributed to the economy that sustains us, no matter how barely surviving it is. It is their right to have their unique needs recognized and holistically met.

SOURCES:
“Fundamentals of Nursing Concepts, Process and Practice 8th Edition”, by Audrey Berman, Shirley Snyder, Barbra Kozier and Glenora Erb, 2008
“Nursing Care of the Adult”, by Eloise Judd, 1983
“Gerontology: Nursing Care of the Adult”, by Mildred Hogstel, 2001
“Psychology and Work Today”, by Duane Schultz and Sydney Ellen Schultz, 2002

Retirement exemplifies one of the most important transitions in life. A job provides structure to daily life, adds to a sense of self-worth and self-esteem, and is a means of self-expression, all of which define and identify the person (Kelly NR, et al, 1998). When an individual retires, there is a loss of one role and a beginning of a new one. The prevalent feeling among the groups was that the loss of work friends was very difficult. Old relationships would need to be fostered and new ones developed in the retiree role.
When a person, especially the elderly, will face retirement they will be going to a process called retirement process, which, if processed properly or the retiree prepared for this, there is somehow a big chance that they will have a “fruitful” aging process.
I think the major role of the nurse in the adjustments of retirement and role discontinuities among aging people is to help our patient to understand the retirement process and their new role as a retired individual. Through these, they will prepare and adjust better.
For me, maybe the role of the nurse that will be very applicable to help the elderly people to perceive retirement is to be a nurse counselor to them. Here, we can talk to the individual and know what are their expectations once they retired. The nurse counselor also can prepare the individual somehow if we give information on how to process retirement and to prepare them to face new life afterwards.
I will indeed advocate Sister Letty Kuan’s theory of retirement and role discontinuity because through this, we can prepare our retiring elderly to face new life and to have a fruitful aging process.
My opinion on the impact of the theory to the quality of life among aging people is our retirees will have a peaceful and relax life. They will live their remaining lives happy and contented. They will not think on what will be the life after tomorrow if we nurses prepare them to their retirement.
My opinion on the applicability of the theory on our current situation here in the Philippines is somehow applies.
For me, when a retiring individual have family who has no path or direction in life is one factor why a person will not prepare and will not face a fruitful aging process. This is because the retiring person will always think on how his family will live. So us nurses we will give holistic counseling to the person for him/her be able to prepare him/herself for their retirement. And to face different life transitions easily.
Based on my family experiences like, my grandmother is a retired assistant chief nurse here in the Philippines, after her retirement she is very happy and contented. At her age now she continuously explores life and God’s wonderful gift to us. I asked her about her retirement, like why is she not bothered when she had her retirement stage? She replies that she prepared her retirement process properly so that she will enjoy her retired life as a professional. Transition phase according to her somehow difficult because she missed her daily activities in the hospital and she missed the relationship she established to her staffs and co-workers. But her family helped her to face new life as a retired professional easily.

Recommendation:
I just want to recommend that we should have seminars on aging and retirement for nurses so that we will be counselor ourselves to other people. For me, being a nurse counselor can help more our elderly patient to prepare retirement and give their fruitful aging process. As I research for a nurse counselor for retirement here in the Philippines I wasn’t able to find one. Maybe I just had a lack of time to find some information.

Reference:
Kelly NR, Swisher L., (1998), The transitional process of retirement for nurses.

This theory focuses mainly on role transitions in life. As a novice nurse, I have experienced a role transitions myself, from student to worker then worker to being jobless and now, jobless back to being a student. Fortunately for me, I have coped effectively and managed thru the trials given to me, but it makes me think about the elderly who have medical conditions to think about, family members to tend to, no financial security, etc. They have a lot more to think than I am and I feel it is a big possibility that they would have problems sooner or later regarding major role transitions. This theory readies their psyche for the inevitable to come and prepare them for it in order to have a fruitful retirement and a smooth role transition.
The nurse plays a major role in the theory because he/she is the one who cushions the impact of the retirement with role transition on the elderly. Since the elderly are in some way like our pediatric patients, we have to treat them with special care as well. When providing nursing care, we always have to promote their dignity and well being, it is a cardinal rule for us nurses since they feel “old” and useless because of their advanced age. They need to feel that being old is a prestigious status in life because they all have the knowledge and experience to guide us in the future.
I believe that there is no single intervention that would help the elderly have a positive view of retirement but a mindset is needed; Promoting Dignity and Independence. Dignity is being proud of what you are, the elderly need to feel proud. They have experienced and learned a lot in their years on this earth so the nurses need to appreciative of what they have to offer. Independence is needed for the elderly because in their advanced age, they would experience spells of dependence to us. Addressing their dependence doesn’t mean their independence is taken away from them but you are just assisting them in their needs. Little things that you feel that is important to them you let them do, like eating, ambulating, etc. They need to feel the pride of being an elderly.
I would definitely advocate her theory because I believe that if someone doesn’t regard the past is important, they would not be ready to move to the future. We must give importance to our elderly since they are the ones who helped the shape the present for us, they are the ones who have the keys to the future. It is also a Filipino trait that we take care of the elderly. We need to show them the respect they earned since they have all the knowledge and experienced gained all their lives. We are always grateful to them.

In my opinion, Sister Letty Kuan’s Theory is beneficial to the society we have today. Since we are forever grateful to our elders, it is our obligation to take care of them. With society getting more and more obsessed with themselves, risk that we would take our elders for granted is very high, so the theory grounds us to the reality that our elders need care in the major transition they are going thru in their life. I really admire Sister Letty for her efforts to the people we owe what we have today ours.

Older people’s notion on retirement is either positive or negative facet in their life and their social attitudes towards retirement will be seen on their ambivalent feelings. Some people will welcome retirement and some will see it as unwanted burden and a period of personal crisis where in they see themselves depriving from income, role and status.

The retirement process involves a social modification in which communication is an important element. During the action of retiring a person encounters a stressful phase as they are entering a new freedom when the pressures of meeting their needs are significant to make for a happy retirement. (Atchley, 1987). The role of the nurses will be mostly on giving teaching ways on how to adjust during retirement. Mention different leisure activities like watching tv, learning about computer or watching games or travelling and the importance of it. Mention them that those are important in adjustment ways to take over what was work-related time. These activities develop a common view for people to communicate in unfamiliar social relationships (Nussbaum, 2000). According to Burbank (1992) the quality of relationships was important in finding the essence of life. These activities will also give them time to live on and understand life with a new way, as there are changes in financial and social status, the closeness of spouse, family and friends. Nurses can also help by mentioning positive attitudes about aging by talking about friends and relatives. But nurses should first assess the social support resources of aging adults. Successful retirement is also associated with fulfilling relationships and the ability to bring about determined goals. The nurse can help by assisting the client to plan realistic goals and get into needed resources. Nurses can also give emphasis on their accomplishments in areas such as work and family and give positive feedback about meaningful roles that they had.

As a nurse practitioner, I will advocate the theory of Letty Kuan because she gave the importance of preparing early in life for retirement by cultivating other role options. It is important that the retirement and the old age should be recognize as the fulfillment of every individual’s birthright and must live meaningfully.

The study conducted by Fry (2000), the respondents viewed old age to be a downward trajectory, and very few were willing to accept that with increasing age they would be forced to compromise their quality of life (Fry, 2000a). Kuan’s theory will enlighten the people to construct a holistic pre-retirement preparation program which will take care of the retiree’s different aspects like psychological, emotional and social needs which is normally accompanied with retirement adjustments.
I think Kuan’s theory will be applicable on the current situations in the Philippines. Retirement can be a wonderful and pleasant phase in life when everybody will be aware of the responsibilities in molding the minds of the children towards the concepts if aging. Concepts of aging can be incorporated in Social Studies in grade school, High school and college, for the reason that on that young age they will know that they will serve as the solid bank in terms of support and providing necessary care for the old people.

References:
Atchley, R. C. (1987). Aging: Continuity and change.
Burbank, P.M. (1992). An exploratory study: Assessing meaning of life among older adult clients. Journal of Gerontological Nursing, 18(9), 19-28.
Fry PS (2000a), Guest editorial: aging and quality of life (QOL)-the continuing search for quality of life indicators. Int J Aging Hum Dev 50(4):245-261.
Nussbaum, J. F., Pecchioni, L. L., Robinson, J. D., Thompson, T.L., Communication and Aging. Second edition. Lawrence Erlbaum Associates, Publishers: Mahwah, NY. 2000

Aging is a topic I really hate to discuss about because aging also means maturing. I, like everybody else, don’t want the fact that “I am getting older.” Today, everybody seems to not want to get OLDER. I, myself is afraid of getting older when I entered twenties. People have so many ways to hide their age like going to plastic surgeons or visiting their cosmetologist every now and then or some people tend to be with children to mask their age. Aging is a process of life that no one seems to be saved from. It is a developmental stage that we will all be dealing during our life. According to Erick Erickson’s eight stages of life, individuals need to accomplish a particular task before successfully completing the stage. (Potter and Perry, 2005)

In Kuan’s theory of retirement and role discontinuities, she values the effect of retirement as a phase of one’s life and its accompanying adjustments. She identified the determinants of positive perceptions in retirement and positive reactions toward role discontinuities. Health status, income, work status, family constellation and self-preparation are identified. I think that the most determinant factor of which is the self-preparation considering that all the factors are also important. Self preparation is important especially in dealing with difficult life transitions. It is our way of preparing for the adjustments that we need to deal with in entering to a new stage of life.

The major role of nurse in the retirement and role discontinuities among aging people is helping them to prepare themselves to cope or adapt. According to Roy’s adaptation theory, coping refers to routine or accustomed patterns of behavior employed to deal with daily situations, as well as the development of new behaviors when drastic changes challenge familiar responses. (Robinson & Kish, 2001) Cognator coping mechanisms were identified to bring action to cope with psychosocial stimuli. Cognator-coping responses occur through four cognitive-emotive channels: perceptual/information processing, learning, judgment and emotion. (Robinson & Kish, 2001) These channels will help the person adapt to the change he/she is about to face. According to Andrews and Roy (1991), the goal of nursing is to promote adaptation in each of the four adaptive modes (physiological, self-concept, role function and interdependence), thereby contributing to a person’s health, quality of life, and dying and dignity. (Robinson & Kish, 2001) The nurse should focus in the holistic care of the person in dealing with life transitions.

Elderly people and people undergoing life transitions perceive these changes differently and negatively. Some may view life transitions and retirement positively but it will take some time. A nurse will be able to help these people by helping them identify various factors that may affect themselves when they have had reached that stage. In identifying the factors you can help them delineate the factors that may affect them negatively and focus on how they will be able to deal with it. For example, a 55 years old woman working as an executive secretary of a company will be retiring soon. Her family is already financially stable and her children have their own family already. In your interaction as a nurse, you helped her discover the factors that may affect her as soon as she retires. These factors include social isolation, adjusting from a busy life to a sedentary lifestyle, difficulty to accept changes, stress. Among these factors, through the help of the nurse, she was able to identify that social isolation is the greatest factor that may affect her and through this as a nurse, you may help her identify solutions to the foreseeable problem she may have. You may suggest engaging in different social activities such as ballroom dancing. According to a qualitative study examining women’s perception and interpretations of the impact of retirement on their life experiences, forced redundancy highlights women’s broader life agenda to contribute socially. (Simmons and Betschild, 2001) Women tend to work to contribute socially so losing a job will definitely make a big issue. These interventions will really be of great help for the adjustment and coping of the person undergoing retirement and role discontinuities.

As a nurse, I will advocate Kuan’s theory because it values the developmental stages of life. It can also be adapted to different life transitions like becoming an adolescent, marriage, having a child or being a mother and coping to death in the family. These life transitions are changes that need special preparation not only for the person itself but also his/her family.

Kuan’s theory will definitely improve the quality of life of aging people since it focuses on the adjustments that may take place when drastic change in their lifestyle happens. In the current situation of the Philippines, people view retirement negatively because of the economic status of our country. Maybe we can instill to our countrymen how retirement and life transitions can be viewed positively.

References:
Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th Ed., Vol. 1, pp.160-161). Singapore:Elsevier PTE LTD.
Robinson, D., & Kish, C. (2001). Advanced practice nursing (pp.406-407). Missouri, USA: Mosby, Inc.
Simmons, B., & Betschild, M. (2001). Women’s retirement, work and life paths: Changes, disruptions and discontinuities. Journal of Women & Aging, 13 (4): 53-70