Rapporti ISTISAN 09/49 ISTITUTO SUPERIORE DI SANITÀ Ageing ...

Rapporti ISTISAN 09/49
holistic and integrated point of view, the different research contributions given in this field on
the exploitation of personal, physical, cognitive and social resources, functional to the
development of wellbeing and of individual autonomy, even if they do not consider some limits.
One of the critical points to be referred to theoretical models is that they cannot always be
applied in the training intervention of operators working with the elderly. We must consider that
this new approach, oriented to the development of wellbeing is relatively recent (also as regards
its application, it has developed over the last ten years) and that the change from the traditional
medical model to the bio-psychological-social model is still in course. The process of a new
substantial revision of the traditional model is often considered as topical, because of the lack of
suitable methodologies shared by operators. To this a not clear conceptual definition of the
different levels of analysis and intervention is to be added. We are still in the stage of
construction of a virtuous circle which systematically takes into account theoretical studies and
field practice. The most crucial problem is not only a cultural problem, but is linked to the speed
of changes of an age and to the variety of variables intervening and which cannot be always
controlled. We must however underline that the bio-psycho-social model results to be
historically important, above all because it has caused the emergence of the problem of the
complexity of health, giving strength to the many voices emerging from psychology and
sociology besides biology (Bertini, 1999); but such model, beyond “good intentions”, just for
the difficulty deriving from the above said complexity of this field, runs the risk of “becoming
generic”, because instead of an interactive co-evolution of the different levels of behaviour
(biological, psychological and social), we often observe a failed relationship between
dimensions and levels (Romano, 1999).
As regards the evaluation of this model (in terms of adoption of the model itself), it would
seem that today the idea that psyche and body are inseparable and that physical disorders have
an influence on the psyche and vice versa, is widespread. A tendency to underline the dynamic
character of the relationship between individual and environment (underlining the instability of
such relationship) seems to be possible. By the adoption of this model, the influence of
environmental and social factors is further underlined.
“Health” is then intended not only as wellbeing deriving from the good functioning of the
body, but is also the result of the interaction between the environment and the individual. Such
interaction aims at balance and has adaptive purposes. By the term “balance” we want to refer to
the importance which wellbeing, the lack of stress, psychological wellbeing and good
relationships with the others within one’s own personal and evolution condition, have. Personal
inclinations can produce vulnerability to specific environmental factors which cause diseases.
Environmental and personal variables can influence the onset of a disease through physiological
mechanisms. Health outcomes are linked to social support, bad disposition of the individual and
job stress. The subjective perception of a situation as stressing results to be more decisive in
influencing the state of health than the mere exposition to stressing events (Baum & Posluszny,
1999). Theoretical approaches are generally starting to adopt holistic and systemic points of view,
in which the interpretation of individual psychological and interpersonal variables tend to be
interrelated to each other. We should also more deeply study the dynamics of the contexts to
which the elderly belong. We also find a too big fragmentation of individual and contextual
factors of the elderly and an exaggerated medication, even and above all in the international
scientific literature. Unlike Italy, the USA and the European countries like Great Britain, seem to
still emphasise with a marked pragmatic approach, the moment of therapy, the disease and
lifestyles. In this case we see the necessity of carrying out a positive new interpretation of the idea
of the elderly, emphasising not their competencies which undergo a decrease or need to be
developed to foster a good transition to old age, but rather the already owned competencies and
environmental resources, which can represent a trigger factor on which new study models and
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