Aspirations for Older Age in the 21st Century: What is Successful Aging?

Aging well socially through engagement with life: adapting Rowe and Kahn's model of successful aging to Chinese cultural context

Although aging well socially (engagement with life) is as important as aging well personally (illness avoidance and functioning) (Rowe & Kahn, 1998), it has received less research attention. A caring (CE) and a productive (PE) form of engagement were derived from an analysis of Chinese cultural meanings of engagement, and combined with illness avoidance and functioning to form a 4-factor model. Confirmatory factor analysis based on 2970 Hong Kong Chinese (40 to 74 years) showed a good model fit that was replicated a year later with 2120 of the original sample. Further analysis led to a more parsimonious model where illness avoidance and functioning converged into a single second-order factor whereas CE and PE remained as distinct first-order factors. The results supported the differentiation of Rowe and Kahn's engagement with life component into caring and productive engagements.

Developing theoretical understandings of dementia and their application to dementia care policy in the UK

This paper discusses theoretical models for understanding dementia and how these are emerging in the formation and development of dementia care policy across the UK. Dementia attracts multi-disciplinary and multi-professional questions and responses. Three broad theoretical models underpin dementia care policy (as well as practice and research): biomedical, psycho-social and social-gerontological. These are critically assessed and discussed in relation to illustrative examples of dementia policy across three policy regions of the devolved UK. The contribution and implications of theoretical models of dementia policy highlight the importance of recognising how different theoretical understandings of dementia influence dementia policy. The development and improvement of policy and practice in the area of dementia care require an understanding of the often implicit theoretical approaches to dementia.

Successful ageing and development: the contribution of generativity in older age

This paper examines the contributions that generativity in older age may make to the concept of successful ageing. To this end, two perspectives on successful ageing are described: successful ageing as a set of clinical criteria, and successful ageing as the application of adaptive processes aimed at achieving efficient functioning. After showing the limitations of the first perspective, particularly from a developmental point of view, the paper argues that the adaptive version of successful ageing helps to put ageing into a developmental frame, but needs to be complemented by identifying specific content and goals that guide these adaptive processes and establish new feasible gains for older people. Generativity in older age could play that role and provides a conceptual framework that enriches the concept of successful ageing, both by emphasising the social context in which people age and by highlighting a personal growth component.

Psychological approach to successful ageing predicts future quality of life in older adults

BACKGROUND

Public policies aim to promote well-being, and ultimately the quality of later life. Positive perspectives of ageing are underpinned by a range of appraoches to successful ageing. This study aimed to investigate whether baseline biological, psychological and social aproaches to successful ageing predicted future QoL.

METHODS

Postal follow-up in 2007/8 of a national random sample of 999 people aged 65 and over in 1999/2000. Of 496 valid addresses of survivors at follow-up, the follow-up response rate was 58% (287). Measures of the different concepts of successful ageing were constructed using baseline indicators. They were assessed for their ability to independently predict quality of life at follow-up.

RESULTS

Few respondents achieved all good scores within each of the approaches to successful ageing. Each approach was associated with follow-up QoL when their scores were analysed continuously. The biomedical (health) approach failed to achieve significance when the traditional dichotomous cut-off point for successfully aged (full health), or not (less than full health), was used. In multiple regression analyses of the relative predictive ability of each approach, only the psychological approach (perceived self-efficacy and optimism) retained significance.

CONCLUSION

Only the psychological approach to successful ageing independently predicted QoL at follow-up. Successful ageing is not only about the maintenance of health, but about maximising one's psychological resources, namely self-efficacy and resilience. Increasing use of preventive care, better medical management of morbidity, and changing lifestyles in older people may have beneficial effects on health and longevity, but may not improve their QoL. Adding years to life and life to years may require two distinct and different approaches, one physical and the other psychological. Follow-up health status, number of supporters and social activities, and self-rated active ageing also significantly predicted QoL at follow-up. The longitudinal sample bias towards healthy survivors is likely to underestimate these results.

How "successful" do older Europeans age? Findings from SHARE

OBJECTIVES

We estimate comparable prevalence estimates of "successful aging" for 14 European countries and Israel, adding a new cross-nationally comparative perspective to recently published findings for the United States.

METHODS

Measures for a variety of specific successful aging criteria were derived from baseline interviews of respondents aged 65+ who participated in the Survey of Health, Ageing, and Retirement in Europe (n=21,493). A multivariate logistic model was run for our global successful aging measure.

RESULTS

Our analysis revealed substantial cross-country variation around a mean value of 8.5%: Although as many as 21.1% of older Danes meet our successful aging criteria, the respective proportion in Poland is only 1.6%. Age, gender, and socioeconomic status are shown to bear highly significant associations with individuals' odds of successful aging.

DISCUSSION

The observed cross-national variation in successful aging-which continues to exist if population composition is controlled for-highlights the importance of taking into consideration structural factors at the societal level. It also suggests a potential for policy interventions supporting individuals' opportunities for successful aging.

Indicators of "healthy aging" in older women (65-69 years of age). A data-mining approach based on prediction of long-term survival

Background

Prediction of long-term survival in healthy adults requires recognition of features that serve as early indicators of successful aging. The aims of this study were to identify predictors of long-term survival in older women and to develop a multivariable model based upon longitudinal data from the Study of Osteoporotic Fractures (SOF).

Methods

We considered only the youngest subjects (n = 4,097) enrolled in the SOF cohort (65 to 69 years of age) and excluded older SOF subjects more likely to exhibit a "frail" phenotype. A total of 377 phenotypic measures were screened to determine which were of most value for prediction of long-term (19-year) survival. Prognostic capacity of individual predictors, and combinations of predictors, was evaluated using a cross-validation criterion with prediction accuracy assessed according to time-specific AUC statistics.

Results

Visual contrast sensitivity score was among the top 5 individual predictors relative to all 377 variables evaluated (mean AUC = 0.570). A 13-variable model with strong predictive performance was generated using a forward search strategy (mean AUC = 0.673). Variables within this model included a measure of physical function, smoking and diabetes status, self-reported health, contrast sensitivity, and functional status indices reflecting cumulative number of daily living impairments (HR ≥ 0.879 or RH ≤ 1.131; P < 0.001). We evaluated this model and show that it predicts long-term survival among subjects assigned differing causes of death (e.g., cancer, cardiovascular disease; P < 0.01). For an average follow-up time of 20 years, output from the model was associated with multiple outcomes among survivors, such as tests of cognitive function, geriatric depression, number of daily living impairments and grip strength (P < 0.03).

Conclusions

The multivariate model we developed characterizes a "healthy aging" phenotype based upon an integration of measures that together reflect multiple dimensions of an aging adult (65-69 years of age). Age-sensitive components of this model may be of value as biomarkers in human studies that evaluate anti-aging interventions. Our methodology could be applied to data from other longitudinal cohorts to generalize these findings, identify additional predictors of long-term survival, and to further develop the "healthy aging" concept.

Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people

AIM

This paper is a report of a study to evaluate the psychometric properties of the Chinese version of the Insomnia Severity Index.

BACKGROUND

Despite the high prevalence of insomnia in older people and its detrimental impact on well-being and healthcare costs, this problem is almost always undetected and consequently under-treated. The Insomnia Severity Index is psychometrically sound in measuring perceived insomnia severity. However, it has had very limited application in non-White populations.

METHODS

An instrument validation study was carried out between October 2008 and April 2009. The Insomnia Severity Index was translated into Chinese using Brislin's model and administered to a convenience sample of 585 older Chinese people recruited from three community centres for elders. Other instruments were also administered, including the Chinese version of the Pittsburgh Sleep Quality Index and the Geriatric Depression Scale.

RESULTS

Cronbach's alpha of the Chinese version of the Insomnia Severity Index was 0.81, with item-to-total correlations in the range of 0.34-0.67. Construct validity was supported by its moderate relationship with the Chinese Pittsburgh Sleep Quality Index and sleep efficiency. The Chinese version of the Insomnia Severity Index also indicated more severe level of insomnia in older people who reported depressed mood on the Geriatric Depression Scale. Discriminant validity was supported as the Chinese version of the Insomnia Severity Index could discriminate poorer sleepers from normal sleepers. Exploratory factor analysis identified a two-factor structure for the Chinese version of the Insomnia Severity Index in measuring the severity and impacts of insomnia on the Chinese older people.

CONCLUSION

The Chinese version of the Insomnia Severity Index is a culturally-relevant and psychometrically-sound instrument for assessing severity and impact of insomnia in Chinese community-dwelling older people. Nurses can use this tool to assess older people's perceptions of insomnia.

Cross-cultural comparison between academic and lay views of healthy ageing: a literature review

The aim of this study is to specify the concept of ‘healthy ageing’ from both western and non-western cultural perspectives, and to compare the views of academics and lay older people. Thirty-four published peer-reviewed full papers in English and Chinese (traditional characters) were identified using electronic database searches. The key components of their definitions of healthy ageing were extracted and categorised into 12 domains. The results show that, in general, lay definitions (as described in 11 studies) included more domains (independency, family, adaptation, financial security, personal growth, and spirituality) and more diversity in the healthy ageing concept than academic views (which tend to focus more on physical and mental health and social functioning in later life). Certain domains were valued differently across cultures. As shown in previous studies, the findings affirm that healthy ageing is a multi-dimensional and complex concept and that there are substantial differences in different cultures. Moreover, we found that there are pronounced variations in the conceptualisation of healthy ageing as between academic and older lay people. Generally, older lay people perceive healthy ageing more broadly than the maintenance of physical, mental and social functioning. We suggest that academic researchers should integrate the more holistic perspectives of older lay people and cultural diversity into the classical ‘physical–mental–social’ healthy ageing concept.

A two-factor model of successful aging

OBJECTIVES

To propose and test a conceptual two-factor model of successful aging that includes objective and subjective components.

METHODS

Data were derived from 5,688 persons aged 50-74 years living in New Jersey who participated in the ORANJ BOWL panel. Participants were recruited using random digit dial procedures and interviewed by telephone. A measurement model was developed and tested using data from two independent samples (each n = 1,000); a structural model examining the effects of age and gender was tested using data from another 3,688 people.

RESULTS

Confirmatory factor analyses provided support for a multidimensional model incorporating objective criteria and subjective perceptions. Age and gender were associated with objective but not subjective success.

DISCUSSION

Results add rigor to the measurement of a construct that has intrigued philosophers and scientists for hundreds of years, providing the empirical foundation on which to build research about successful aging.

Sexual activities, sexual and life satisfaction, and successful aging in women

INTRODUCTION

Sexuality for women at all ages is a vital aspect of life satisfaction and is based upon continuing growth, development, and adaptation. The successful aging model includes physical, mental/emotional, and social well-being. There is no known published literature on the topic of sexual activities of older women and its implications on life and sexual satisfaction.

AIM

To investigate the sexual activities of older women in Israel, their levels of sexual satisfaction and life satisfaction, and to examine the relationship between the level of sexual activities, sexual satisfaction, and life satisfaction.

MAIN OUTCOME MEASURE

Components of the Derogatis Sexual Functioning Inventory, and the Life Satisfaction Index.

METHODS

A descriptive, correlational study guided by the theory of "successful aging" by Havighurst (1961) was conducted using a convenience sample of 127 women who attended a menopause clinic for routine and follow up care.

RESULTS

The research findings described older women as being involved in varied, though limited, sexual activities. There was no significant relationship discovered between the number of sexual activities and age. The level of sexual satisfaction of the studied sample was found to be above the mean score. Most of the women reported good sexual/intimate communication with their partners. Women were not satisfied with the limited variety in their sex life. Women reported a high level of life satisfaction. Ultimately, a positive significant correlation was discovered between sexual satisfaction and level of current sexual activity, and between sexual satisfaction and life satisfaction.

CONCLUSIONS

Older women are interested in continuing their sexual activities. It is a component of life satisfaction. The desire for sexual variety suggested an important area for patient education. Couple communication was deemed a priority. Health providers should include sexual health issues in their discussions with clients of all ages.

Reliability and Validity of the Health Enhancement Lifestyle Profile (HELP)

The Health Enhancement Lifestyle Profile (HELP) is a self-report measure for examining various aspects of health-related lifestyle in older adults through seven scales (Exercise; Diet; Work, Education, and Social Participation; Leisure; Activities of Daily Living; Psychological Wellness and Spiritual Participation; and Other Health Promotion and Risk Behaviors). The current study examined the reliability and validity of the HELP scales through classic test theory. The resultant alpha coefficients ranged from .75 to .92 among the scales, indicating acceptable to good internal consistency reliability. Construct validity was also supported by the interrelationships found among the HELP scales and the statistically significant correlations shown between HELP results and global health status (i.e., number of chronic conditions, self-related health). HELP scales can help occupational therapists identify and monitor health promotion occupations and risk behaviors and measure the outcome of services aimed at promoting healthy lifestyles in older adults.

The concept of ‘ageing well’ in ten Latin American and European countries

A review of several studies examining the lay concept of successful ageing and related concepts leads to the conclusion that elders from different cultures appear to agree on most of the components identified in the literature. From the research emerges a multidimensional conceptualisation of ‘successful ageing’ that is described on the basis of physical, emotional, cognitive and social domains, and which coincides with most theoretical and empirical definitions. The main goal of the present research is to study similarities and differences between concepts of ‘successful ageing’ in several Latin American and European countries and in two different age groups, and also to examine whether a similar structure of the lay concept can be found across both continents. The results show minor differences at item levels among countries, continents and age groups, and a similar internal structure across them.

The Consistency of Definitions of Successful Aging Provided by Older Men: The Manitoba Follow-up Study

Sans une définition universellement accepté du vieillissement réussi, chercheurs examiner plus en plus les vues profanes et définitions du vieillissement des personnes âgées. Pour utiliser les définitions non initiés dans les études de vieillissement, cependant, les chercheurs doivent aborder le cohérence de ces définitions. En 2004, les membres survivants de la cohorte mâle du Manitoba Suivi Study (âge moyen : 83 ans) ont été deux fois demandé leur définition du vieillissement réussi. Une échelle de cohérence a été définie, et une catégorie de cohérence a été attribuée sur la base de la similitude des thèmes dans chacune des 654 paires de définitions. Au moins la moitié des thèmes principaux étaient similaire dans 70 pour cent de la définition de paires; 80 pour cent des répondants ont répété au moins un thème. Événements de santé positive ou négative dans l’intervalle de quatre semaines entre les définitions et les caractéristiques spécifiques des répondants n’ont pas variés de catégories. Cette preuve de cohérence confirme notre dépendance continue des définitions du vieillissement réussi.

Perceptions of active ageing in Britain: divergences between minority ethnic and whole population samples

OBJECTIVE

to identify perceptions of, and associations with, active ageing among ethnically diverse and homogeneous samples of older people in Britain.

DESIGN AND SETTING

cross-sectional and longitudinal surveys of older people living at home in Britain.

MEASURES

active ageing, health, psych-social, socio-economic circumstances, and indicators of quality of life.

RESULTS

respondents defined active ageing as having health, fitness, and exercise; psychological factors; social roles and activities; independence, neighbourhood and enablers. The ethnically diverse sample respondents were less likely to define active ageing as having physical health and fitness, and were less likely to rate themselves as ageing actively, than more homogeneous sample respondents. The lay-based measure of quality of life used was independently and consistently associated with self-rated active ageing in each sample

CONCLUSION

Policy models of active ageing were reflected in lay views, although the latter had a more multidimensional focus. Lay definitions of active ageing were also more dynamic, compared with definitions of quality of life and successful ageing. Differences in self-rated active ageing and perceptions of this concept by ethnic group need further exploration.

Validation of a novel successful aging construct

PURPOSE

Assess the validity of our previously published multidimensional concept of Successful Aging that integrates physiological, psychological, and sociological domains of health.

DESIGN

Three distinctly different populations were used to assess the discriminant and predictive validity.

METHODS

Data included 1438 women age 65 and older who participated in the Women's Health and Aging Studies I and II (WHAS-I and WHAS-II) and 302 participants in a continuing care retirement community (CCRC) study. Outcome measures included ADL and IADL function, self-reported health status, and number of hospitalizations.

RESULTS

Within the CCRC, the Successful Aging construct discriminated participants with regard to ADL and IADL function and self-reported health status. In both WHAS-I and WHAS- II samples, the construct predicted functional ADL and IADL change over time, and in WHAS-I, it predicted hospitalizations.

IMPLICATIONS

The Successful Aging construct appears valid and warrants further research and refinement among the general population.

Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging

For the past 4 decades, many studies seeking to develop a definition and identify critical determinants of successful aging have been published. To date, there is still no consensus on a standard definition or measure of "successful aging." Most constructs have been one dimensional; although a few have been multidimensional, none has emerged as standard. The most serious limitation of contemporary successful aging constructs is the undue focus on physiologic aspects of aging. To move beyond this limited perspective that stresses disease and impairment, we postulate that successful aging may coexist with diseases and functional limitations if compensatory psychological and/or social mechanisms are used. With this premise, this article presents a new definition and conceptual framework of successful aging, together with an operational definition (measurement) that delineates our successful aging concept. We discuss how the proposed multidimensional measurement may be used as a screening tool, and address its relevance for health services research and health care delivery.

Successful skeletal aging: a marker of low fracture risk and longevity. The Study of Osteoporotic Fractures (SOF)

Successful aging is multidimensional, and many phenotypes have been proposed. We examined a biomarker of aging based on repeated measures of BMD for up to 15 yr and hypothesized that maintenance of BMD will be associated with low fracture risk and disability and improved survival. We studied 9704 women recruited at four U.S. clinical centers and enrolled in the Study of Osteoporotic Fractures, a longitudinal cohort study. Of these, 8224 women had at least one hip BMD measurement. Hip BMD was measured a maximum of five times over 15 yr. Random effects regression was used to determine a BMD slope for each subject. Three groups were formed-"maintained" BMD: slope >or=0, n = 724 (9%); "expected" BMD loss: slope <0 to <1 SD below mean, n = 6478 (79%); and "accelerated" BMD loss: slope >or=1 SD below mean, n = 1022 (12%). Cox proportional hazards models were used to compare the relative hazard (RH; 95% CI) of fracture, incident mobility disability, and mortality in the maintained and accelerated groups compared with the expected. A 1 SD decrease in the BMD slope was associated with an increased risk of all outcomes. In multivariate models, the RH of nonspine fracture was 0.81 (0.71-0.93) and of hip fracture was 0.36 (0.25-0.53) for women in the maintained compared with the expected group. The incidence of mobility disability was lower in the maintained versus expected group (RH = 0.70; 95% CI = 0.59-0.83), but this was largely explained by other factors. Women who experienced accelerated bone loss were more likely to develop disability (RH = 1.56; 95% CI: 1.33-1.84). Mortality risks were lower in the maintained compared with the expected group (RH = 0.49; 95% CI: 0.42-0.58). In conclusion, a subset of older women maintained their BMD up to 15 yr, suggesting that bone loss is not an inevitable consequence of aging. These women experienced a lower risk of fractures, disability, and mortality, suggesting that this phenotype may be a marker of successful aging.

‘I am notthatold’: inter-personal experiences of thriving and threats at a senior centre

The high cultural valuation of youthfulness and fitness in the mass media and more generally in western consumer society is the contextual frame for this study. It examines older people's attitudes towards their own ageing and towards people who are older or frailer than themselves. Participant observation was conducted of the attitudes, actions and interactions of the users of a senior centre in Norway. The users held two sets of attitudes that led to quite different activities and actions at the centre. On the one hand, they saw the centre as helping them ‘thrive’, which was associated with involvement in the community and participation in the structured daily activities to promote the senses of belonging and being useful. On the other hand, some perceived the centre and particularly the other users as ‘threats’ – as reminding them that they were getting old and increasingly vulnerable to sickness and disability. To some, the centre was for old people with disabilities, and they used subtle strategies to distance themselves from this group. Some users' attitudes and behaviour were in tension: they wished to participate in the valued activities but also to distance themselves from frailer users, while not denying their own ageing. The distancing strategies and behaviour amounted to age discrimination in interpersonal relations and interactions at the centre. This behaviour accepts rather than challenges the cultural valuation of youthfulness and the negative representation of old age.

Can the past keep life pleasant even for old-old trauma survivors?

OBJECTIVES

This study examined the relative effect of positive and negative autobiographical aspects in later life as a function of the traumatic experience of the Holocaust and age.

METHOD

Old (age <or=80) and old-old (age >80) participants who were identified as Holocaust survivors (n = 225), and comparison of pre-war (n = 103) and post-war (n = 254) European-descent immigrants referred to their past in a biographical interview. The participants depicted personally perceived outstanding life periods defined as anchor periods (Shmotkin, D. (2005). Happiness in face of adversity: Reformulating the dynamic and modular bases of subjective well-being. Review of General Psychology, 9, 291-325). They rated their happiness and suffering during major anchor periods ('the happiest period' and 'the most miserable period') as well as their life satisfaction.

RESULTS

The findings suggest that even after massive trauma and under accelerating decline associated with old-old age, the past can keep life pleasant, as indicated by the stronger association of past happiness, compared to that of past suffering, with life satisfaction. Nevertheless, past suffering was associated with life satisfaction among the Holocaust survivors and manifested a stronger effect among most of the old-old participants.

CONCLUSION

Holocaust survivors demonstrated a greater difficulty to compensate for age-related losses while the comparison groups showed a greater optimization of satisfaction through narrative means in old-old age.

Lifestyle and Successful Aging: An Overview

Since the 1950s, the phrase successful aging has been used increasingly to represent the factors and conditions underlying healthy aging and is often attributed to the healthy elderly. In this short review, the authors discuss the transformation in the social theories of aging that allowed for the evolution of successful aging as a construct and ultimately a theoretical basis for investigation. Because of the multifactorial nature of the psychosocial and biomedical domains, there is no clear consensus on the definition of successful aging or its determinants. What is clear, however, is that successful aging is related to the human health span, or healthy life expectancy. Moreover, the accumulating information from multidimensional studies suggests that many age-associated changes in physiological and cognitive functioning can be explained by such modifiable lifestyle factors as smoking, physical activity, and nutrition choice. The evidence presented supports the promotion of a healthy lifestyle as an effective strategy for successful aging.

Successful aging: the contribution of early-life and midlife risk factors

OBJECTIVES

To test whether early-life factors (education, height, father's social position) and midlife social, behavioral, and psychosocial factors were associated with entering older age without disease and with good functioning.

DESIGN

A longitudinal, British civil service-based cohort study. Participants were followed for 17 years to assess successful aging. This was defined as being free of major disease and in the top tertile of physical and cognitive functioning measured in 2002 to 2004.

SETTING

Twenty London-based Civil Service departments.

PARTICIPANTS

Four thousand, one hundred forty men and 1,823 women, free of major disease at baseline in 1985 to 1988 (mean age 44, range 35-55).

MEASUREMENTS

Behavioral, biological, and psychosocial risk factors; physical and cognitive functioning; and disease outcomes.

RESULTS

Five hundred forty eight (12.8%) men and 246 (14.6%) women were successfully aging at follow-up. Midlife socioeconomic position strongly predicted this (age-adjusted odds ratio, highest vs lowest=7.1, 95% CI=3.4-14.6, for men and 7.7, 95% CI=4.9-12.1, for women). Height, education (in men), not smoking, diet, exercise, moderate alcohol (in women), and work support (in men) were related to a favorable older life after adjustment for age and socioeconomic position.

CONCLUSION

Interventions to promote healthy adult behavior may attenuate harmful effects of less-modifiable risk factors and reduce social inequalities.

Enhancing later life: how older people perceive active ageing?

OBJECTIVE

To identify older people's perceptions of active ageing, and to compare them with the literature, and with older people's perceptions of successful ageing and quality of life.

DESIGN

Face-to-face interview survey with 337 people aged 65+ living at home in Britain.

RESULTS

The most common perceptions of active ageing were having/maintaining physical health and functioning (43%), leisure and social activities (34%), mental functioning and activity (18%) and social relationships and contacts (15%). A third rated themselves as ageing 'Very actively', and almost half as 'Fairly actively'. Independent predictors of positive self-rated active ageing were optimum health and quality of life.

DISCUSSION

Main sub-themes of active ageing included exercising the body and mind in order to maintain health and functioning. People's views focussed on basic definitions such as social, physical and mental health and activity, probably reflecting the novelty of the concept to them, thereby excluding frail older people from active ageing. Comparisons with definitions of successful ageing and quality of life showed overlap, but the latter were portrayed as 'states of being'. This is consistent with models which propose quality of life as the end-point of active ageing.