Abstract
Several years ago, I taught a doctoral level seminar in the School of Nursing at the University of Minnesota called “Health Behaviors and Illness Responses.” A reading assignment that was particularly profound to me was a chapter by Suls, Luger, and Martin (2010) that emphasized the importance of the biopsychosocial model in advancing the potential of medical science. The biopsychosocial model “refers to the idea that biological, psychological, and social processes are integrally and interactively involved in physical illness and health, medical diagnosis, medical treatment, and recovery” (Suls et al., 2010, p. 18) which is in contrast to the prevailing biomedical model with its heavy (if not sole) emphasis on the biological and physiological determinants of disease occurrence, progression, and “cures.” Suls and colleagues make an eloquent case for the importance of theory, and specifically the adoption of a biopsychosocial framework when advancing health psychology and behavioral medicine. Nonetheless, modern medical science’s devotion to the biomedical model persists.
This issue’s articles in the Journal of Applied Gerontology adopt, to varying degrees, biopsychosocial approaches in exploring how older persons can effectively manage health conditions. The first two articles examine the potential of complementary therapy use. Effoe, Suerken, Quandt, Bell, and Arcury (2017), in a diverse sample of older adults, examined the association of complementary therapy use and medication adherence. Use of complementary therapies in the sample was extensive (nearly nine in 10 participants utilized complementary therapies of various types). However, use of complementary therapies was not associated with significantly greater medication adherence. Rayner and Bauer (2017) utilized focus groups and individual interviews with older adults living in residential care settings, their families and health professionals in Australia. A major barrier to use of complementary therapies was funding restrictions among residents and families, while health professionals were reluctant to advocate for complementary therapy use due to a lack of evidence on safety and efficacy (the latter is an ongoing concern in understanding how, when, and whether complementary therapies can be effectively used or integrated within more evidence-based treatment approaches).
Stone and Baker (2017), in a study situated within a biopsychosocial framework, relied on in-depth interviews to identify barriers and facilitators to exercise among individuals with osteoarthritis (the sample ranged in age from 30 to 85 years). Key facilitators included pain relief, social support, and health-related communication; barriers identified were pain, distress, and lack of medical support. As the authors emphasize, ensuring active lifestyles among those with osteoarthritis necessitates a biopsychosocial lens. Nahm et al. (2017) examined the effects of an 8-week, online, theory-based bone health program for older persons. This large-scale, randomized evaluation (the sample included 866 individuals across the treatment and control groups) found statistically significant improvements in osteoporosis knowledge and self-efficacy for proper intake of calcium and exercise/exercise behaviors. This impressive study and its findings emphasize the potential for delivering bone health programs online, and the efficacy of such a program in enhancing self-efficacy for key behaviors that are crucial when managing osteoporosis or similar conditions.
Another qualitative study featured in this issue explored stressors and coping strategies of older persons with persistent atrial fibrillation (AF) prior to and following cardioversion (Rush et al., 2017). Interestingly, the 16 older adults interviewed indicated the emergence or re-emergence of stressors not related to AF following cardioversion. In addition, participants tended to rely less on coping strategies that were successfully utilized during cardioversion following this procedure.
As I have noted in prior Editorial Introductions (Gaugler, 2017), a core interest of applied gerontology is in translating and implementing evidence into clinical, practice, and other “real-world” settings. Suls et al. (2010) further make the case that the biopsychosocial perspective is core to the “bench to bedside” objective that drives much of biomedical science. The biopsychosocial model includes complex, dynamic, multi-level considerations that demands interdisciplinary collaboration and application. Each of the articles in this issue of the Journal of Applied Gerontology relies upon a biopsychosocial perspective when considering how older adults can effectively manage various health conditions, and is do doing help to hasten the bench to bedside cycle of science.