Developing a dimensional model for successful cognitive and emotional aging

Definitions of Ageing According to the Perspective of the Psychology of Ageing: A Scoping Review

In the last decades, the scientific interest in ageing has increased due to the progressive ageing of the global population and due to the importance of guaranteeing the elder people and the next generations a good quality of life and biopsychological well-being. However, nowadays, there is not a common and accepted definition of ageing. This situation may refer to the complexity and relevance of the ageing topic and it means that the concept of ageing needs to be understood in a deeper way as a multidimensional and complex process that includes different elements distinctive. The main goal of this review is to explore the definitions and conceptual models of ageing according to a psychological point of view, through a biopsychosocial approach, that integrates biological, psychological, and social aspects with the main goal of a better understanding of the complexity of the process itself.

METHODS

We conducted a review of the literature through PubMed, Scopus, Web of Science and Google Scholar databases, and we followed the PRISMA-ScR guidelines, analysing papers written in English between 2002 and 2023.

RESULTS

The review showed different conceptual models of ageing, including Rowe and Kahn's successful ageing model, the World Health Organization's models, and others like the "Selection, Optimization and Compensation" Model. Also, the determinants and predictors of ageing have been analysed highlighting the individual variability and the multidimensional nature of ageing. The geographic diversity of the included studies allowed for the analysis of cultural, socioeconomic, and environmental differences in the conceptualisation of ageing.

CONCLUSIONS

The results emphasise the importance of targeted interventions and programs aimed at promoting well-being during ageing, considering the complexity and multidimensionality of the ageing process.

Resilience and successful aging: A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis investigates the relationship between successful aging (SA) and resilience in older adults, focusing on individuals aged 60 and above, to address a significant gap in understanding how resilience contributes to SA.

METHODS

Following the Cochrane review guidelines, we conducted searches in databases such as Web of Science, PsycNet, and PubMed up to December 2021 and used PRISMA as a tool for reporting the results. Our inclusion criteria were studies on psychological resilience and SA in older adults aged 60 and above. Exclusion criteria included studies on physical resilience, medical outcomes of SA, other indicators not used in screened studies (e.g., prevalence, means), populations with suicidal ideation or chronic/palliative illnesses, studies considering resilience as an indicator of SA, and qualitative studies on the association between resilience and SA.

RESULTS

A total of 21 studies were included and assessed for risk of bias using funnel plot and trim-and-fill methods. The meta-analysis revealed a medium effect size indicating a positive relationship between resilience and SA. However, high heterogeneity warrants a cautious interpretation of these results. No significant differences were found between older adults in the general population and those in retirement communities, nor were geographical variations (Asia, Europe, America) found to moderate this relationship.

DISCUSSION

The findings highlight the intrinsic link between older adults' attitudes towards aging, their subjective evaluations, and their level of psychological resilience. Resilience acts as a protective factor against psychological and physical adversities, underscoring the importance of resilience-enhancing strategies in interventions aimed at promoting SA. The conclusions drawn from this analysis should be approached with caution due to the heterogeneity of the included studies.

Extending Normative Data of the Paced Auditory Serial Addition Test to Account for Preliminary Psychometric Properties among Elderly Individuals in Taiwan

OBJECTIVE

The Paced Auditory Serial Addition Test (PASAT) is widely used to assess cognitive performance in clinical settings. However, availability of normative data for Revised Version of PASAT (PASAT-R) is often constrained by sample size among elderly individuals. In this study, we sought to establish normative data for PASAT-R for elderly individuals in Taiwan.

METHODS

This study recruited 166 individuals aged over 65 years stratified in accordance with the general population in terms of demographic characteristics, including age, educational level, and sex. We assessed PASAT-R test results in terms of psychometric properties.

RESULTS

PASAT-R demonstrated good internal consistency and test-retest reliability. Performance on PASAT-R was correlated with performance on the criterion tests. Performance on PASAT-R was negatively correlated with age and positively correlated with educational level. This study provides normative data for PASAT-R for elderly Taiwanese individuals.

CONCLUSIONS

PASAT-R is applicable to neuropsychological assessment among elderly Taiwanese individuals.

Four-Year Trajectories of Internal Strengths and Socioemotional Support Among Middle-Aged and Older Adults with HIV

Positive psychological attributes are associated with better health outcomes, yet few studies have identified their underlying constructs and none have examined their temporal trajectories in clinical vs. non-clinical samples. From data collected over 4 years from people with HIV (PWH) and HIV-uninfected (HIV-) participants, we identified two latent factors (internal strengths; socioemotional support) based on responses to seven positive psychological attributes. Internal strengths increased over 4 years for PWH, but not for HIV- comparisons. Socioemotional support did not change significantly in either group. Lower internal strengths and worse socioemotional support were related to greater depressive symptoms. We speculate that improvement in internal strengths in PWH could reflect their being in care, but this requires further study to include PWH not in care. Given the apparent malleability of internal strengths and their association with improved health outcomes, these attributes can serve as promising intervention targets for PWH.

Psychosocial Mechanisms of Self-rated Successful Aging with HIV: A Structural Equation Model

This study tested a conceptual psychosocial model of self-rated successful aging (SRSA) with HIV. Our sample (n = 356) included older women living with HIV (OWLH): average age 56.5 years, 73% Black. SRSA was assessed using a research-based 10-point scale (higher scores = better outcomes). We conducted adjusted structural equation modeling. The global model included two latent variables-protective attributes (composite of positive psychosocial factors: resilience, personal mastery, optimism, spirituality) and psychological distress (composite of negative psychosocial factors: anxiety, depression, loneliness, internalized HIV-related stigma). The model showed good fit (χ²(58) = 76, p = 0.06; RMSEA = 0.03; CFI = 0.99). Increased protective attributes were associated with improved SRSA both directly and mediated by improved coping with stress. While psychological distress did not have a direct effect on SRSA, it was indirectly associated with worsened SRSA via diminished protective attributes and via decreased coping with stress. Findings suggest the need for interventions enhancing positive and mitigating negative psychosocial factors in OWLH.

The role of intraindividual cognitive variability in posttraumatic stress syndromes and cognitive aging: a literature search and proposed research agenda

OBJECTIVES

Cognitive impairments are directly related to severity of symptoms and are a primary cause for functional impairment. Intraindividual cognitive variability likely plays a role in both risk and resiliency from symptoms. In fact, such cognitive variability may be an earlier marker of cognitive decline and emergent psychiatric symptoms than traditional psychiatric or behavioral symptoms. Here, our objectives were to survey the literature linking intraindividual cognitive variability, trauma, and dementia and to suggest a potential research agenda.

DESIGN

A wide body of literature suggests that exposure to major stressors is associated with poorer cognitive performance, with intraindividual cognitive variability in particular linked to the development of posttraumatic stress disorder (PTSD) in the aftermath of severe trauma.

MEASUREMENTS

In this narrative review, we survey the empirical studies to date that evaluate the connection between intraindividual cognitive variability, PTSD, and pathological aging including dementia.

RESULTS

The literature suggests that reaction time (RT) variability within an individual may predict future cognitive impairment, including premature cognitive aging, and is significantly associated with PTSD symptoms.

CONCLUSIONS

Based on our findings, we argue that intraindividual RT variability may serve as a common pathological indicator for trauma-related dementia risk and should be investigated in future studies.

Family resilience, perceived social support, and individual resilience in cancer couples: Analysis using the actor-partner interdependence mediation model

PURPOSE

This study aimed to examine the impact of family resilience on the individual resilience of couples during cancer and explore the potential mediating role of perceived social support and the moderating role of sex in this association in cancer patient-spouse dyads.

METHOD

The participants were 272 cancer patients and their spouses (N = 544) who completed the Family Resilience Assessment Scale, the Perceived Social Support Scale and the Resilience Scale. We adopted the actor-partner interdependence mediation model to examine whether and how patients' and their spouses' family resilience was associated with their own and their partners' perceived social support and individual resilience.

RESULTS

The results indicated that the patients' and their spouses' level of family resilience was positively associated with their own individual resilience directly and indirectly by increasing their own perceived social support. The family resilience of the spouses was associated with an increase in the patients' individual resilience only indirectly by increasing the patients' perceived social support. The spouse-actor effects between family resilience and individual resilience differed significantly by sex.

CONCLUSION

Enhancing family resilience and perceived social support within the family can improve individual resilience. The findings regarding the sex differences serve as a rationale for gender-based approaches to improving individual resilience in the family context.

Testing a Model of Successful Aging on Masters Athletes and Non-Sporting Adults

Purpose: To test confirmatory factor analyses of successful aging composed of physical, psychological, cognitive, and social functioning factors in masters athletes (n = 764) and non-sporting adults (n = 404), and compare the physical, psychological, cognitive, and social functioning of masters athletes versus non-sporting adults. Method: Self-reported cross-sectional data were analyzed with confirmatory factor analyses. Results: Physical, psychological, cognitive, and social functioning latent factors significantly loaded onto a higher-order successful aging latent factor (p < .05). Masters athletes had higher physical and social functioning than non-sporting adults (p < .05). Psychological and cognitive functioning did not differ between groups. Conclusions: Successful aging should be considered as a multi-faceted construct consisting of different domains of functioning for both masters athletes and non-sporting adults. Masters athletes were aged successfully relative to the non-sporting adults across the physical and social functioning domains. Physical, psychological, cognitive, and social functioning domains constitute an appropriate model to use in future experimental research investigating the effect of masters sport for successful aging.

Older HIV+ and HIV- Adults Provide Similar Definitions of Successful Aging: A Mixed-Methods Examination

BACKGROUND AND OBJECTIVE

As HIV-infected (HIV+) individuals age, there is a need to understand successful aging (SA) from the patient perspective. This study compared SA definitions between HIV+ and HIV-uninfected (HIV-) older adults and then examined correlates of SA categories.

RESEARCH DESIGN AND METHODS

Ninety-three HIV+ and 46 HIV- older (aged 50+) adults provided brief definitions of SA, which was examined using content analysis. We then compared the frequency of SA categories by serostatus and examined the correlates of SA categories within both groups.

RESULTS

Seven SA categories emerged: General Health, Cognitive Health & Ability, Physical/Biological Health & Ability, Social Relationships, Attitudes, Psychological, & Emotional Well-Being, Proactive & Engaged Lifestyle, and Independence. While no significant differences emerged, HIV- older adults were more likely to report General Health and the subcategory of Longevity/Survival, while HIV+ older adults were more likely to report subcategories of Enjoying Life & Fulfillment and Maintaining Balance. Few demographic correlates of SA categories emerged. Mood and HIV characteristics were not associated with SA categories. In both groups, those without neurocognitive impairment were significantly more likely to endorse General Health than those with neurocognitive impairment.

DISCUSSION AND IMPLICATIONS

HIV+ and HIV- older individuals may generally perceive SA similarly, and their definitions parallel with existing models of SA. Yet, living with a chronic illness may cause HIV+ older adults to place greater value on quality of life and life satisfaction than physical health and chronological age. Observational and intervention studies may use similar approaches in evaluating and maximizing SA.

Dying Fit or Not-Physical Activity as Antidote to Death?

Physical activity has increasingly gained attention within palliative care. This article aims to explore how the idea of physical activity influences patients with advanced cancer and health-care professionals' interactions. The empirical material was gathered as part of an anthropological field study about palliative care needs among 16 patients with advanced cancer, consisting of observations and interviews with patients, relatives, and professionals. Two of the patient cases were analyzed, inspired by Goffman's theory, showing how patients and health-care professionals interact in relation to physical activity. The findings show that patients played roles either embracing physical activity or distancing it by postponement. Professionals played expert roles of duty and attachment, stressing the importance of physical activity. Thus, they accepted a minimum of physical activity when patients were close to death. Professionals regarded patients' absence of physical activity as a lack of desire to live; patients regard it as a way to live.

The glass is not half empty: optimism, pessimism, and health among older adults

OBJECTIVES

Optimism and pessimism are distinct constructs that have demonstrated independent relationships with aspects of health and well-being. The purpose of this study was to investigate whether optimism or pessimism is more closely linked with physical and mental health among older adults.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Community-dwelling older adults (N = 272) ages 59-95 in the southern United States.

MEASUREMENTS

The Life Orientation Test-Revised and the Short Form 8.

RESULTS

At the bivariate level, optimism was associated with higher physical health and mental health, while pessimism was associated with lower physical health and mental health. Multiple-regression analyses as well as comparison of correlation coefficients found that pessimism was more closely associated with physical health and mental health than optimism.

CONCLUSIONS

These results add to the literature suggesting that, in terms of older adults' health and well-being, avoiding pessimism may be more important than being optimistic.

Prevalence and related factors of Active and Healthy Ageing in Europe according to two models: Results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

Active and Healthy Ageing (AHA) is the process of optimizing opportunities related to health, participation, and safety in order to improve quality of life. The approach most often used to measure AHA is Rowe and Kahn's Satisfactory Ageing model. Nonetheless, this model has limitations. One of the strategic objectives of the WHO Global Strategy and Action Plan (2016) is to improve Healthy Ageing measurement. Our objectives were to compare two models of assessing AHA and further compare the results by country and sociodemographic variables.

METHODS

This was a cross-sectional, observational analysis of a representative sample of the general population aged 50 years and older in Europe. The data analysed were obtained by the Study of Health, Ageing and Retirement in Europe (SHARE). The dependent variable was AHA and its dimensions, measured using the Rowe and Kahn AHA model (AHA-B) and the authors' model based on the WHO definition (AHA-BPS). A descriptive analysis and multivariate models of binary logistical regression were developed.

RESULTS

The sample consisted of 52,641 participants (mean age 65.24 years [SD = 10.18; Range = 50-104], 53.2% women). Healthy Ageing prevalence in the AHA-B model was 23.5% (95%CI = 23.1%-23.9%). In the AHA-BPS model, this prevalence was 38.9%. In both models, significant variations were observed between countries, and were distributed along a north-western to south-eastern gradient. The sociodemographic variables associated with the absence of AHA were advanced age, female sex, death of spouse, low educational level, lack of employment, and low financial status. Comparing the two models, the strength of association between absence of AHA and advanced age (85 years and older) was four times greater in the AHA-B model.

CONCLUSIONS

Our results showing differences between these two models provide evidence that the AHA-BPS model does not penalize older age and is more likely to characterize AHA from a health promotion perspective.

Successful Aging and Chronic Osteoarthritis

Background: Aging is commonly accepted as a time period of declining heath in most cases. This review aimed to examine the research base concerning the use of the term 'successful aging', a process and outcome deemed desirable, but challenging to attain. A second was to provide related information to demonstrate how health professionals as well as individuals can aim for a 'successful aging' process and outcome, despite the presence of disabling osteoarthritis. Methods: Information specifically focusing on 'successful aging' and the concept of improving opportunities for advancing 'successful aging' despite osteoarthritis was sought. Results: Among the many articles on 'successful aging', several authors highlight the need to include, a broader array of older adults into the conceptual framework. Moreover, conditions such as osteoarthritis should not necessarily preclude the individual from attaining a personally valued successful aging outcome. Conclusions: Pursuing more inclusive research and research designs, and not neglecting to include people with chronic osteoarthritis can potentially heighten the life quality of all aging individuals, while reducing pain and depression, among other adverse aging and disability correlates among those with osteoarthritis.

Positive Psychological Factors are Linked to Successful Cognitive Aging Among Older Persons Living with HIV/AIDS

We aimed to characterize successful cognitive aging (SCA) among older HIV-infected (HIV+) and HIV-uninfected (HIV-) adults, and to determine associations with positive psychological factors and health-related quality of life (HRQoL). Ninety-nine HIV+ and 46 HIV- older adults (≥ 50 years) completed measures of neurocognition, positive psychological factors, and HRQoL. Using study-defined SCA criteria (i.e., no cognitive or everyday impairment or major depressive disorder), we compared positive psychological factors and HRQoL across four groups: HIV+/SCA+, HIV+/SCA-, HIV-/SCA+, HIV-/SCA-. SCA was identified in 29% of the HIV+ sample compared to 61% of the HIV- sample (p < 0.01). HIV+/SCA+ participants had higher scores on 8 of 10 measures of positive psychological factors as well as better HRQoL (ps < 0.05) as compared to the HIV+/SCA- group. Furthermore, the HIV+/SCA+ participants had comparable scores on these factors as HIV- adults. Fewer HIV+ than HIV- participants met SCA criteria; however, the level of positive psychological factors among the HIV+/SCA+ group was comparable to the HIV- sample. Our findings present opportunities for interventions to optimize positive psychological factors and potentially improve SCA among older HIV+ adults.

Testing a Model of Successful Aging in a Cohort of Masters Swimmers

Due to their high physical functioning, masters athletes are regularly proposed to exemplify successful aging. However, successful aging research on masters athletes has never been undertaken using a multidimensional successful aging model. To determine the best model for future successful aging research on masters athletes, we had masters swimmers (N = 169, M age = 57.4 years, 61% women) self-report subjective successful aging, and physical, psychological, cognitive, and social functioning. Using this data we tested one hypothesized and three alternative successful aging models. The hypothesized model fit the data best (-2LL = 2052.32, AIC = 1717) with physical (β = 0.31, SE = 0.11), psychological (β = 0.25, SE = 0.11), and social (β = 1.20, SE = 0.63) functioning factors significantly loading onto a higher order successful aging latent factor. Successful aging should be conceptualized as a multidimensional phenomenon in future masters athlete research.

Comparison of self-rated and objective successful ageing in an international cohort

Understanding predictors of successful ageing is essential to policy development promoting quality-of-life of an ageing population. Initial models precluded successful ageing in the presence of chronic disease/functional disability; however, this is discrepant with self-reported successful ageing. Indicators of social, psychological and physical health in 1,735 people aged 65–74, living in Canada, Columbia, Brazil or Albania, were analysed in the International Mobility in Ageing Study. Multiple logistic regression analysis was performed to estimate the change in self-rated successful ageing in relation to physical health, depression, social connectedness, resilience and site, while controlling for age, gender and income sufficiency. Sixty-five per cent of participants self-rated as ageing successfully; however, this was significantly different across sites (p < 0.0005, range 17–85%) and gender (p = 0.019). Using objective measures, 6 per cent were classified as ‘successful’, with significant variability amongst sites (p < 0.0005, range 0–12%). Subjective successful ageing was associated with fewer (not absence of) chronic diseases, absence of depression and less dysfunction in activities of daily living, but not with objective measures of physical dysfunction. Social connectedness and resilience also aligned with self-rated successful ageing. Traditional definitions of objective successful ageing are likely too restrictive, and thus, do not approximate self-rated successful ageing. International differences suggest that site could be a surrogate for variables other than physical/mental health and social engagement.

Loneliness, Resilience, Mental Health, and Quality of Life in Old Age: A Structural Equation Model

Objectives: In the scientific literature on aging, a recent core issue has been the role of individuals' internal and external resources, which are considered intrinsically connected, in contributing synergistically to physical and psychological quality of life (QoL). The current study investigates the way in which psychological factors-such as, loneliness, resilience, and mental states, in terms of depression and anxiety symptoms-affect the perceived QoL among elderly individuals. Method: Data from 290 elderly Italian participants were used to study the mediation effects of both mental health and resilience to elucidate the relationship between loneliness and psychophysical QoL. Results: The best model we obtained supports the mediation effect of both resilience and mental health between loneliness and mental and physical QoL. These results highlight that loneliness influences mental and physical QoL via two pathways, with the impact of loneliness mediated by mental health and resilience dimensions. Conclusions: The findings suggest the importance of the support that elderly people receive from social relationships. In terms of clinical interventions, the reduction of loneliness could be an important factor in primary prevention or the recovery process. A way to reduce levels of mental distress could be represented by the increasing of resilience and self-efficacy and reduction of loneliness dissatisfaction. A high degree of resiliency contributes to increasing perceived life quality at the physical and psychological levels, and at the same time, reducing anxiety and depressive symptoms.

Successful aging: considering non-biomedical constructs

OBJECTIVES

Successful aging continues to be applied in a variety of contexts and is defined using a number of different constructs. Although previous reviews highlight the multidimensionality of successful aging, a few have focused exclusively on non-biomedical factors, as was done here.

METHODS

This scoping review searched Ovid Medline database for peer-reviewed English-language articles published between 2006 and 2015, offering a model of successful aging and involving research with older adults.

RESULTS

Seventy-two articles were reviewed. Thirty-five articles met the inclusion criteria. Common non-biomedical constructs associated with successful aging included engagement, optimism and/or positive attitude, resilience, spirituality and/or religiosity, self-efficacy and/or self-esteem, and gerotranscendence.

DISCUSSION

Successful aging is a complex process best described using a multidimensional model. Given that the majority of elders will experience illness and/or disease during the life course, public health initiatives that promote successful aging need to employ non-biomedical constructs, facilitating the inclusion of elders living with disease and/or disability.

Erfolgreiches kognitives Altern: Zusammenhang der kognitiven Leistungen mit Aktivität und Zufriedenheit

Zusammenfassung. Für erfolgreiches Altern sind Kognition, Zufriedenheit und tägliche Aktivitäten relevante Faktoren. In dieser Studie werden Zusammenhänge zwischen diesen Faktoren aufgedeckt. Bei 167 Senioren (60 bis 98 Jahre) wurden Aktivität und Zufriedenheit in einem Interview, Kognition durch die Neuropsychological Assessment Battery (dt. Version) erfasst. Alle Faktoren zeigen eine negative Altersentwicklung. Aktivitäten korrelieren mit allen Faktoren; insbesondere stehen Alltagsaktivitäten und kognitive Aktivitäten positiv mit Kognition im Zusammenhang, soziale Aktivität ist davon unabhängig. Die kognitiven Funktionsbereiche Aufmerksamkeit, Sprache und exekutive Funktionen variieren mit Aktivität und Zufriedenheit, Gedächtnis nur mit kognitiven Aktivitäten, Wahrnehmung ist davon unabhängig. Dies könnte bedeuten, dass kognitive Aktivitäten spezifisch mit der kognitiven Leistung und soziale Aktivitäten spezifisch mit der emotionalen Bewertung zusammenhängen und als Schutzfaktoren während der Entwicklung wirken könnten.

The role of income and occupation in the association of education with healthy aging: results from a population-based, prospective cohort study

Background

The beneficial effects of higher education on healthy aging are generally accepted, but the mechanisms are less well understood. Education may influence healthy aging through improved employment opportunities that enhance feelings of personal control and reduce hazardous exposures, or through higher incomes that enable individuals to access better health care or to reside in better neighbourhoods. Income and occupation have not been explored extensively as potential mediators of the effect of education on healthy aging. This study investigates the role of income and occupation in the association between education and healthy aging including potential effect modification by gender.

Methods

Logistic regression was used to explore the association of education, income (perceived income adequacy, life satisfaction with finances) and occupation (occupational prestige) with healthy aging five years later in 946 community-dwelling adults 65+ years from a population-based, prospective cohort study in Manitoba, Canada.

Results

Higher levels of education generally increased the likelihood of healthy aging. After adjusting for education, both income measures, but not occupation, predicted healthy aging among men; furthermore, the association between education and healthy aging was no longer significant. Income and occupation did not explain the significant association between education and healthy aging among women.

Conclusions

Perceived income adequacy and life satisfaction with finances explained the beneficial effects of higher education on healthy aging among men, but not women. Identifying predictors of healthy aging and the mechanisms through which these factors exert their effects can inform strategies to maximize the likelihood of healthy aging.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2504-9) contains supplementary material, which is available to authorized users.

Perceptions of Determinants of Successful Aging Among Older U.S. Veterans: Results from the National Health and Resilience in Veterans Study

OBJECTIVE

To conduct a qualitative study of older American veterans' subjective perceptions of factors that contribute to successful physical, emotional, and cognitive aging.

METHODS

A nationally representative sample of 2,025 veterans aged 60 or older (range: 60-96; 96.9% male, 39.4% combat veterans) participated in the National Health and Resilience in Veterans Study. Using qualitative analysis software, the authors coded responses to three open-ended questions, inductively developed categories, aggregated similar categories into factors, and grouped factors into broader themes.

RESULTS

A total of 53, 56, and 61 categories of responses was identified in response to questions about successful physical, cognitive, and emotional aging, respectively, with 10 aggregate factors linking these categories. The most prominent theme overall was "What you do," which received 2,295, 2,210, and 1,247 mentions for each of these domains of successful aging, with health behaviors the most common factor for both successful physical and cognitive aging and social engagement the most common for successful emotional aging. The theme "Who you are" was the second-most common factor (discerned from 376, 247, and 943 total mentions, respectively), with the factors that comprise this theme-personality and explanatory style, moral compass, and emotional dispositions-more commonly endorsed for successful emotional aging. External factors such as healthcare were least commonly endorsed across all domains.

CONCLUSION

Older U.S. Veterans emphasize health behaviors, social engagement, and dispositional characteristics as key determinants of successful aging. Prevention and treatment initiatives that target these potentially modifiable factors may help promote successful aging in this growing segment of the population.

Complex interplay between health and successful aging: role of perceived stress, resilience, and social support

Psychological and psychosocial resources, including resilience and social support, have traditionally been studied in the context of the stress paradigm and, more recently, in the context of successful aging. This study used moderated mediation analyses to examine the role of perceived stress in the relationships between physical and mental health functioning and self-rated successful aging (SRSA) and whether differences between people in level of resilience and social support changes the role of perceived stress in these relationships. A cross-sectional study of 1,006 older adults (mean age: 77 years) completed scales addressing SRSA, physical and mental health functioning, perceived stress, resilience, and social support. Results indicated that the strength of relationships between both physical and mental health functioning and SRSA were reduced after accounting for variation in level of perceived stress. The role of perceived stress in the association between mental health functioning and SRSA was found to be stronger among participants with the highest levels of resilience, and the influence of perceived stress on the degree of relationship between physical health functioning and SRSA was stronger among those with greatest social support. These findings suggest that interventions to reduce perceived stress may help break the link between disability and poor well-being in older adults. The findings further suggest that the impact of such interventions might differ depending on psychological resources (i.e., resilience) for mental health disabilities and external resources (i.e., social support) for those with physical health problems. The complex interplay of these factors should be taken into account in clinical settings.

Cross-cultural comparison of successful aging definitions between Chinese and Hmong elders in the United States

The purpose of the study was to elicit the definitions of successful aging according to Chinese and Hmong elders living in Milwaukee, WI. In-depth semi-structured interviews were conducted with 44 elders (Hmong n = 21 and Chinese n = 23). Findings show some similarities in the Chinese and Hmong elders' definitions though specific cultural differences exist. Chinese elders emphasized physical health and mobility, mental health, positive attitudes, shedding responsibilities, positive family relationships, financial stability, social engagement, religious faith, and accomplishments and volunteer work. Hmong elders emphasized physical health and mobility, mental health, harmonious relationships, positive family relationships, tangible family support, financial stability, social engagement, and religious faith. Cross-cultural comparisons of the findings highlight the cultural heterogeneity between these two subgroups. Implications for practice are discussed.

Successful aging among older veterans in the United States

OBJECTIVE

To develop a unidimensional latent model of successful aging and to evaluate sociodemographic, medical, psychiatric, and psychosocial correlates of this construct in a nationally representative sample of older veterans in the United States.

METHODS

Data were analyzed from a cross-sectional web survey of 2,025 U.S. veterans aged 60 to 96 years who participated in the National Health and Resilience in Veterans Study. Self-report measures of sociodemographics; subjective physical, mental, and cognitive functioning; and psychosocial characteristics were used. Confirmatory factor analysis was used to construct a unidimensional latent factor of successful aging. Correlates of scores on this factor were then evaluated.

RESULTS

Most older veterans (82.1%) rated themselves as aging successfully. A unidimensional latent factor composed of seven measures of self-rated successful aging, quality of life, and physical, mental, cognitive, and social functioning provided a good fit to the data. Physical health difficulties (β = -0.39) and current psychological distress (β = -0.33) were most strongly negatively related to scores on this latent factor of successful aging, while protective psychosocial characteristics (β = 0.22), most notably resilience, gratitude, and purpose in life, were most strongly positively related to these scores. Additional positive predictors of successful aging included White, non-Hispanic race, being married or living with partner, perceiving a positive effect of the military on one's life, active lifestyle, positive expectations regarding aging, and conscientiousness; additional negative predictors included substance abuse history.

CONCLUSION

Results of this study provide a dimensional approach to characterizing components and correlates of successful aging in older veterans. Interventions and policy initiatives designed to mitigate physical health difficulties and psychological distress and to enhance protective psychosocial characteristics such as resilience, gratitude, and purpose in life may help promote successful aging in this population.

Successful cognitive aging and health-related quality of life in younger and older adults infected with HIV

Neurocognitive impairments commonly occur and adversely impact everyday functioning in older adults infected with HIV, but little is known about successful cognitive aging (SCA) and its health-related quality of life (HRQoL) correlates. Seventy younger (≤40 years) and 107 older (≥50 years) HIV+ adults, as well as age-matched seronegative comparison groups of younger (N = 48) and older (N = 77) subjects completed a comprehensive battery of neuropsychological, psychiatric, medical, and HRQoL assessments. SCA was operationalized as the absence of both performance-based neurocognitive deficits and self-reported symptoms (SCA-ANDS) as determined by published normative standards. A stair-step decline in SCA-ANDS was observed in accordance with increasing age and HIV serostatus, with the lowest rates of SCA-ANDS found in the older HIV+ group (19 %). In both younger and older HIV+ adults, SCA-ANDS was strongly related to better mental HRQoL. HIV infection has additive adverse effects on SCA, which may play a unique role in mental well-being among HIV-infected persons across the lifespan.

A case-controlled study of successful aging in older HIV-infected adults

OBJECTIVE

There is a growing public health interest in the aging human immunodeficiency virus (HIV)-infected (HIV+) population, although there is a dearth of research on successful aging with HIV. This study aimed to understand the risk and protective factors associated with self-rated successful aging (SRSA) with HIV.

DESIGN

Cross-sectional, case-controlled.

SETTING

HIV Neurobehavioral Research Program and the Stein Institute for Research on Aging at University of California, San Diego.

PARTICIPANTS

Eighty-three community-dwelling HIV+ and 83 demographically matched HIV-uninfected (HIV-) individuals, enrolled between December 1, 2011, and May 10, 2012, mean age of 59 years, primarily white men, 69% with acquired immune deficiency syndrome (AIDS), who had been living with an HIV diagnosis for 16 years. Diagnostic criteria for HIV/AIDS were obtained through a blood analysis.

MEASUREMENTS

Participants provided ratings of SRSA, the primary outcome measure, as part of a comprehensive survey that included measures of physical and emotional functioning and positive psychological traits. Relationships between how the different variables related to SRSA were explored.

RESULTS

While SRSA was lower in the HIV+ individuals than their HIV- counterparts, 66% of adults with HIV reported scores of 5 or higher on a 10-point scale of SRSA. Despite worse physical and mental functioning and greater psychosocial stress among the HIV+ participants, the 2 groups had comparable levels of optimism, personal mastery, and social support. Higher SRSA in HIV+ individuals was associated with better physical and emotional functioning and positive psychological factors, but not HIV disease status or negative life events.

CONCLUSIONS

Successful psychosocial aging is possible in older HIV+ individuals. Positive psychological traits such as resilience, optimism, and sense of personal mastery have stronger relationship with SRSA than duration or severity of HIV disease. Research on interventions to enhance these positive traits in HIV+ adults is warranted.

Association between older age and more successful aging: critical role of resilience and depression

OBJECTIVE

There is growing public health interest in understanding and promoting successful aging. While there has been some exciting empirical work on objective measures of physical health, relatively little published research combines physical, cognitive, and psychological assessments in large, randomly selected, community-based samples to assess self-rated successful aging.

METHOD

In the Successful AGing Evaluation (SAGE) study, the authors used a structured multicohort design to assess successful aging in 1,006 community-dwelling adults in San Diego County, ages 50-99 years, with oversampling of people over 80. A modified version of random-digit dialing was used to recruit subjects. Evaluations included a 25-minute telephone interview followed by a comprehensive mail-in survey of physical, cognitive, and psychological domains, including positive psychological traits and self-rated successful aging, scaled from 1 (lowest) to 10 (highest).

RESULTS

The mean age of the respondents was 77.3 years. Their mean self-rating of successful aging was 8.2, and older age was associated with a higher rating, despite worsening physical and cognitive functioning. The best multiple regression model achieved, using all the potential correlates, accounted for 30% of the variance in the score for self-rated successful aging and included resilience, depression, physical functioning, and age (entering the regression model in that order).

CONCLUSIONS

Resilience and depression had significant associations with self-rated successful aging, with effects comparable in size to that for physical health. While no causality can be inferred from cross-sectional data, increasing resilience and reducing depression might have effects on successful aging as strong as that of reducing physical disability, suggesting an important role for psychiatry in promoting successful aging.

A call for a new positive psychiatry of ageing

We propose a new model for geriatric psychiatry to help meet the needs of a rapidly growing population of older adults. This positive old age psychiatry would focus on recovery, promotion of successful ageing, neuroplasticity, prevention, and interventions to enhance positive psychological traits such as resilience, social engagement and wisdom.

Promoting successful ageing through integrated care

The most important step is to improve society’s attitudes towards older people