can provide an exemplar of use of the Roy
Adaptation Model in nursing research.
Problem and Significance
Hearing loss is one of the most common conditions
affecting older adults. One in three people older
than 60 and a half of those older than 85 have hear-
ing loss (National Institute on Deafness and Other
Communication Disorders, 2001). The degree and
types of hearing loss in older persons vary, ranging
from decreased sensitivity to high frequency tones,
to peripheral loss, sensorineural loss, presbycusis,
or tinnitus (Maguire, 1985; Ritter, 1991). Older per-
sons with presbycusis, for example, have more dif-
ficulty filtering out background noises (Von Wedel,
Von Wedel, & Streppel, 1990). Tinnitus, a common
hearing problem, is characterized by the symptoms
of ringing, buzzing, hissing, whistling, or swishing
sounds arising in the ear, and it affects nearly 11
percent of the elderly population (American
Tinnitus Association, 1996).
Hearing serves as a sensory input necessary for
one’s interaction with the changing environment
and for a number of critical adaptive functions. It
provides the individual with cues of oncoming
threats that can be heard only. The sense of hearing
augments visual cues for orienting individuals in
space and for locating other people and objects.
Loss of hearing can have profound psychological
effects on one’s life, including feeling insecure, re-
jected, and depressed; family stress; social isolation;
and a decline in one’s overall self-concept (Chen,
1994; Salomon, 1986; Whitbourne, 1985; Zhan,
1993b). One elderly man described that “the great-
est annoyance of hearing loss is in the subtle aspect
of daily living with a partner who also has a hearing
loss. You have to constantly repeat what you said;
you have to raise your voice since your partner can-
not hear well; after all, you are in your own silent
world” (Zhan, 1992).
The core problem of hearing loss lies in com-
munication failures and relationship stress, which
in turn affects one’s self-concept and well-being.
Older people with hearing loss therefore face a
major task that involves coping with and adapting
to hearing impairment so as to maintain their
senses of self. Roy & Andrews (1991) indicates that
either sensory deprivation or overload can initi-
ate one’s cognitive efforts or cognator subsystem.
It is through cognitive efforts that effective adap-
tation takes place. One effective adaptive response,
as described by Roy, is the maintenance of self-
consistency. Roy’s basic theoretical premises are
that individuals are rarely passive in the face of
what happens to them. They are adaptive, self-
protective, and functional in the face of setbacks,
and seek higher levels of adaptation by enhancing
person and environment interactions. People seek
to change things if they can, and when they cannot,
they may use cognitive adaptation processes to
change the meaning of the situation in order to
protect themselves and enhance their selves and
their world (Lazarus, 1991; Roy & Andrews, 1999;
Taylor, 1983). To empirically validate Roy’s generic
theoretical proposition relating the cognator
processes to adaptation, the author conducted a
quantitative study to examine the relationship be-
tween cognitive adaptation processes and the main-
tenance of self-consistency in older persons with
impaired hearing.
Study Design
Based on Roy’s Adaptation Model—specifically, on
the cognator subsystem of the individual—hearing
loss in this study was viewed as a focal stimulus.
In the elderly person, hearing loss during aging
initiates cognitive coping efforts to bring about
the effective adaptation: the maintenance of self-
consistency. Personal characteristics and social,
cultural, and environmental factors influence
maintenance of self-consistency through coping
and adaptation processes.
Research Hypotheses
The usefulness of a model for research depends
on the model’s ability to generate testable hypothe-
ses. Within a larger study, the following hypoth-
esis was tested: There will be a positive correla-
tion between coping and adaptation processes
and self-consistency in older persons with hearing
impairment.
Sample
The nonprobability sample consisted of 130 sub-
jects who were age 64 or older, who manifested
hearing loss (defined for this study as an elevated
threshold equal to or larger than 26 dB in the speech
frequencies of 1000, 2000, and 3000 Hertz), with the
onset at age 40 or older, who had no cognitive im-
pairment, and who resided in the northeastern part
of the United States. Subjects were drawn from two
nonprofit organizations for hard-of-hearing people276 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration