The Nagi Model Applied for Optimum Aging
By: Amy Blackburn, Msg
Tags: Older Adults, Caregivers, Long Term Care, Optimal Aging, Caregiver Support

Nagi Model of Disablement (Saad Nagi, 1965).

What does it mean to be healthy? When health companies focus on “wellness” what are they referring to? It can be any number of aspects of wellness relating to health care and seeing your doctor; physical activity and exercise; good nutrition or weight loss; mind-body, meditation, and spiritual or energy connection; formal or informal education; social connection; emotional health through therapy or counseling; and being a productive employee in the workplace. Each of these fit into the categories or dimensions of wellness: physical, spiritual, intellectual, sociological, emotional, and vocational. Each one is important, and one might be more important than the other to you — especially if you are missing something as a family caregiver, such as something you always enjoyed and haven’t been able to anymore.

As people age through their forties, fifties, and sixties each of these dimensions of wellness diminish and it’s hard to achieve what some call “successful aging.” Partly, because of the accumulation and interaction of aging changes and chronic and acute conditions; and, because we don’t have the time, or maybe our interests change. When we are seeking to enhance overall health, we need to keep in mind that we do have limitations. It is better to refer to it as “optimal aging” or “optimum aging,” which is the best you can do under the circumstances. This does not mean making excuses or not attempting to enhance your well-being, but it means focusing on specific areas and accomplishing small goals to the best of your abilities.

Generally, when we want to improve health and wellness, we can set a S.M.A.R.T. goal in any one of the areas we choose to target. But when we have a specific ailment, disease, or disorder we are dealing with, it is important to also be specific about the type of self-care intervention we use. One way to do this is to follow the Nagi model and “map out” our aging selves. Dr. Saad Nagi developed a model in the 1970s that shows the pathway to disability as our bodies age. You can visualize the pathway and create a “map” of your various diseases or disorders which could lead to multiple disabilities in your life — ultimately the reason for you ever needing long-term care, or assistance with your daily activities.

The way to any disability starts with a pathology or disease, or it can begin with an unhealthy lifestyle habit, such as being sedentary. If you continue without an intervention, it inevitably leads to a minor limitation. Once you have this limitation, which gets worse if it continues to be ignored (without intervention) it becomes a major physical impairment. At this point during the path to disability, it becomes necessary to consult professional expertise or the physical impairment leads to disability eventually. All previous stages before the disability are either temporary or at least being stalled and the progression to a disability is slowed if an intervention is used. Once one reaches disability, when some form of independence is lost, this is a permanent state.

Let’s examine some common diseases or disorders family caregivers might have that would lead to disabilities: high blood pressure, high cholesterol, type 2 diabetes, obesity, arthritis, depression, chronic stress, and insomnia. Unhealthy lifestyles many family caregivers have are lack of exercise, poor nutrition, excessive drinking or drugs, and possibly smoking. Numerous diseases and disorders could start with those unhealthy lifestyles; so, adding exercise along with good nutrition can act as interventions to prevent or slow multiple possible pathways to disabilities. The more disabilities you attempt to slow or prevent, the better quality of life you will have throughout the aging process. And these pathways to disability typically begin when people are in their thirties or forties, so it is not necessarily something that only older adults should think about.

What types of disabilities could result from those common diseases and disorders that many family caregivers deal with? High blood pressure or high cholesterol could lead to atherosclerosis or heart disease, causing a heart attack or stroke, which often ends in permanent disabilities. Type 2 diabetes often leads to insulin dependence and if not properly managed can leave people disabled due to neuropathy, amputation, organ failure, or blindness. Obesity can lead to debilitating arthritis and vice versa; arthritis often encourages obesity because people are in so much pain they do not want to move. Mental and emotional disorders such as depression, chronic stress, and insomnia indirectly lead to physical ailments, and each one can be the result of the other.

The Nagi model comes to good use when one unhealthy lifestyle or one pathology or disorder is chosen, and you follow the pathway, mapping possible scenarios, ending in different disabilities. As you begin to create this map for your aging self, according to the decade starting with your twenties or thirties, you can come up with specific self-care interventions to halt that pathway to disability. If you are past a decade already (such as something that happened in your 30s), you can still add any important acute or chronic conditions that began in those prior decades because you might still be able to intervene and prevent a future disability, since there is no time frame in this pathway. And depending on other lifestyle factors or pathologies you are dealing with, one or more of those could speed up the process to those disabilities and loss of independence. Figure out what stage in the pathway you are in (such as impairment or functional limitation) and then attempt to either prevent further progression to the disability or at least slow the progression for many years, to achieve optimum health in that area and prolong your quality of life (QOL).

When my mom was having health issues, I mapped out each disease or disorder she was experiencing and how they had all progressed to a disabling condition. This mapping during each decade in her life interestingly began in her forties, which is when most people can apply intervening attempts at preventing long-term disability. One major condition existed in her forties (Rheumatoid arthritis); two or three more in her fifties (joint surgeries, chronic stress, high blood pressure); and four or five more chronic issues in her sixties (Bell’s palsy, arthritic fingers, shingles, hypothyroidism). In charting the pathways of these chronic and acute conditions, with no interventions to halt the progression, multiple disabilities began to accumulate and interact. Mom’s ill-health eventually spun out of control and she died in her late sixties. However, you could consider her lucky, because most people at that time become permanently disabled, with complete loss of independence, and low QOL for many years before they die. Which is why there are so many family caregivers needed.

As you start to figure out your own Nagi model map your aging body and possible future pathways to disabilities, you can begin to establish S.M.A.R.T. goals as small interventions to slow the progression to that loss of independence — or prevent it completely. That way, you don’t end up in the same state that your loved one is in who needs your care. Even if the pathway to a disability is a potential physical disability, you can choose a different dimension of wellness as an intervention; it does not necessarily have to be a physical intervention. Perhaps your solution to being sedentary is meditating in the morning and mindful priorities are set so that you are more productive throughout the day; this, in turn, enhances your emotional or spiritual wellness. Or, your intervention to having high blood pressure is relaxing by reading a book or the newspaper, or playing an instrument, which fulfills intellectual wellness. These creative goals can be used at the beginning stages of a pathway to disability, before the limitation or impairment. However, once one reaches the impairment leading to an inevitable disability, this is when targeted, professional expertise is necessary, such as physical therapy, or seeing a psychiatrist or other specialist healthcare provider. These professionals are the only ones who can halt the pathway and prevent that disability once one is far enough along the path. Even if prevention is not possible, if progression to a disability can be slowed, at least QOL can be sustained longer.

If you have several pathologies, limitations, impairments, or disabilities, optimum health and wellness is achieved by targeting each of those current stages in that Nagi model and by simply doing the best you can. By focusing on as many of the dimensions of wellness as you can and achieving small S.M.A.R.T. goals consistently, you will have the best QOL and satisfaction that you can experience. Otherwise, you will end up in the same shoes as your loved one, and that is what you are trying to avoid as much or as long as possible. For you as the family caregiver, the the takeaway is to have balance in your life, take care of yourself, and learn from the things your loved one did not do.

Planning and developing S.M.A.R.T. goals through targeted interventions using the Nagi model will take more professional expertise and guidance. Yet another instance when accessing the services from an organization with a Family Caregiver Support Program (FCSP); by working with your assigned case manager, gerontologist, social worker, or private professional care manager you can solidify your focus and bring to reality the optimum wellness you are seeking. I have helped clients and their families develop tailored aging maps using the Nagi model to predict possible future disabilities, brainstorm the most effective interventions, and break those down into achievable S.M.A.R.T. goals. Then, optimum aging can be realized because various disabilities throughout life that would have resulted along that pathway can be prevented or slowed. And as family caregivers get older, they can continue to experience satisfaction and happiness, rather than what we often see happening today with our older loved ones who need full-time care. Optimum aging through self-care and developing goals is possible.

S.M.A.R.T. goals are explained in, “The Meaning of Self-Care for Family Caregivers” https://medium.com/selfcaregiver/the-meaning-of-self-care-for-family-caregivers-4dde95675219