A lines-of-defense model for managing health threats: a review

As older individuals face challenges of progressive disease and increasing disability and approach the end of their lives, their capacity for controlling their environment and own health and functioning declines. The Lines-of-Defense Model is based on the Motivational Theory of Life-Span Development and proposes that individuals can adjust their control striving to the progressive physical decline in distinctly organized cycles of goal engagement and goal disengagement that reflect sequentially organized lines of defense. This organized process allows individuals to hold onto and defend still feasible levels of physical health and functioning in activities of daily living, while adjusting to increasing impairments. As physical constraints become more severe towards the end of life, avoiding psychological suffering becomes the focus of individuals' strivings for control. The Lines-of-Defense Model can also be applied to the inverse process of growth in functioning during recovery and rehabilitation.