Successful and unsuccessful aging what makes the difference

One of the hot topics for discussion was the use of language associated with aging. With funding from the MacArthur Foundation, Dr. John Rowe and Robert Kahn conducted research to better understand successful aging. These were the common characteristics of the 1, successful agers they studied. Some say the definition is exclusionary. It implies that one is either successful or unsuccessful in aging.

For example, what if an individual had a stroke and could not walk? Is that person aging unsuccessfully because of a disability? And if some older people can no longer drive, preventing them from attending their book group meetings or religious services, are they aging unsuccessfully because of less engagement with life? If someone dies at 62, is that unsuccessful aging? A geriatrician presenting at the meeting suggested an alternative to successful aging — optimal aging.

At the outset of their work, they enumerate these misconceptions: old people are sick; cannot learn new things; cannot make lifestyle changes that would matter to physical and cognitive health at that point in life, or that genetics are the most important predictors; that old people lack sexual energy; and that old people are dependent p.

It is this negative vision and ageism that they seek to change, by pointing to the positives related to aging, and, using evidence from a variety of scientific studies, demonstrating that one can, indeed, age successfully p. Far more than is usually assumed, successful aging is in our own hands. Their book is thus geared at demonstrating that individuals can achieve successful aging by making the proper choices.

All these factors are critical to our view of aging which…we regard as largely under the control of the individual. In short, successful aging is dependent upon individual choices and behaviors. It can be attained through individual choice and effort.

I focus on two key aspects of their framework. The second relates to their belief that countering the discourse of disease and decline through the promotion of successful aging framework will reduce ageism. While the former aspect appears fairly straightforward, a short discussion of ageism both provides greater context for examining the latter and challenges the individual emphasis. Ageism is thus a negative stereotype; a belief or attitude that can be changed through education.

Here we present each myth with a glimpse of the scientific evidence that corrects or contradicts it. The only other two mentions of ageism in the book implicitly relate to exclusionary behavior on p. In all instances, the focus remains on individual-level beliefs about aging and rectifying these.

Equating ageism with attitudes or individual actions, as Rowe and Kahn do, is not uncommon. But it is noteworthy as it has an impact on how we challenge ageism.

This aspect of discrimination— systematic exclusion —is critical. Of course, the emphasis on attitudes and beliefs could be viewed as a causal mechanism by which such exclusion occurs, but the point is that the accuracy of negative stereotypes is not the issue.

Ageism involves behaviors, and such behaviors need not be intentional, based on individuals, or on the veracity of negative stereotypes. The association of ageism with sexism and racism prods us to think somewhat differently about ageism.

Scholarship on sexism and racism has made clear the power relations by which groups are advantaged or oppressed; it has also revealed their embeddedness in social institutions such that sexism and racism are not dependent upon individual actions or beliefs.

The same case can be made for ageism. Like power relations based on gender, race, or ethnicity, the concept of age relations conveys the ways that age serves as a social organizing principle such that different age categories gain identities and power in relation to one another for a longer discussion, see Calasanti, Further, those who are not old serve as the normative standards against which people are judged.

This brief overview of ageism and age relations gives a somewhat different view from Rowe and Kahn concerning how to alleviate ageism. From the standpoint of age relations, their attempt to attack ageism by dismantling myths or pointing to a positive model of successful aging likely will not succeed because it does not directly address the sources of ageism, the underlying age relations. Their successful aging model seeks to show that as people age, they can retain physical and mental functioning, avoid disease, and stay socially engaged.

They do not challenge the cultural devaluation of aging itself, or the fact that physical, mental, or social losses should warrant exclusion. This issue takes on added significance in light of the emphasis on individual choice and lifestyle in the successful aging paradigm.

That is, to the extent that Rowe and Kahn argue that individuals can age successfully, that it is dependent upon individual choices and behaviors noted previously , then this takes on a moral dimension as well.

This study explores these issues by examining the extent to which successful aging is a construct that people recognize; a goal that they feel is within their control; and a positive vision that counters the narrative of decrement and disease, thereby alleviating fear of aging and ageism. I focus on a group of middle-aged individuals for several reasons. First, middle age is often a time of relatively privileged status though the extent to which this holds varies by intersecting statuses , one in which individuals have garnered enough experience to be respected and, if in the paid work force, better earnings , on the one hand, and not lose authority due to age, on the other.

Second, bodies serve as a principle marker of age Laz, Rowe and Kahn , p. I conducted all the interviews but one which was conducted by a graduate assistant in and Overall, the sample was relatively privileged, although there is some diversity by gender, class, and sexuality; in some respects their privilege might situate them better to work toward successful aging see Lamb, All are White; 16 were heterosexual, and 3 were nonheterosexual.

Three of the men had never married; of the remainder, 1 man and 3 women were presently divorced. Of the 19, 17 had some college or more including graduate and professional degrees ; the other 2 had completed high school. Finally, all were employed; 15 were employed in professional and semiprofessional fields, whereas 2 were in pink collar occupations, and 2 others 1 man and 1 woman were working in primarily physical labor. They described their health as good to excellent, and generally free of major disability.

We began with an open-ended code sheet that recorded first-level codes in response to questions that asked, for instance, how respondents would define successful aging. When I asked what it would mean to age successfully, there was little hesitation, indicating familiarity with the notion, at least on a popular level. Typical responses included:. Next, I examine the extent to which respondents felt personally responsible for aging successfully.

Exploring the mandate to control their aging involves addressing two related questions: whether they feel they can they control their aging, and whether they should do so. Given that the interviews often focused on their bodily changes, it is not surprising that participants reflected on their feelings and responses to these throughout, and not just in response to questions about successful aging.

For the most part, their comments reflect a strong belief in the importance of lifestyle and changes therein to influence their bodies and, hence, aging, even if they sometimes felt that not all was within their control. You can certainly do that. The lone exception to this narrative of control comes from Darryl, a working-class man who had labored in construction until back injuries prevented his continued employment in the field.

He discussed successful aging as somewhat beyond individual control, though not entirely. They made some good choices when they were younger. At the same time that most respondents expressed their general belief in individual control and the responsibility to enact it, tensions also emerged.

Their comments showed that they often felt unable to exert the control they thought they should, and they sometimes wrestled with how to view this.

The following longer excerpts show the struggles some respondents faced in simply talking about these issues. Why should it bother me? I mean … how long do we have to keep trying to keep everything up?

Others expressed similar tensions. Your body is gonna change. These tensions indicate that despite their individual efforts, respondents were highly concerned about their ability to control the aging process.

And the anxieties they expressed demonstrated that they still harbored both fears about aging, and ageism. Indeed, and despite the relatively privileged statuses of most of them, some were beginning to feel that they were being marginalized, losing power, and becoming invisible.

But both men and women also see this invisibility in their work lives. I am a senior member of the group, or a senior in every dimension. It means, okay, one-foot-out-the-door sort of member of the group, or…maybe even gone-before-long member of the group. They still saw old age as negative. Indeed, many noted that they dreaded growing older:. Maggie: I am not looking forward to it.

I mean all the people who are quite a bit older … they all say growing old is the pits. I used to want to live to be really, really old, and now I am thinking I am not sure.

Nobody wants to get old. If we can help it, we want to be young and youthful as long as we can. No one expressed the belief that someone with limited mobility could be valued. Ageism, and age relations, underlies much of their discussion. The physical changes they feared would not just hinder them, but also mark their bodies as different from those of younger age categories. And unlike some other physical changes that happen to us in life, such as puberty, this difference is not valued and thus marks one for exclusion.

I worry about that. Certainly the loss of freedom and power, if you want to put it that way [worry me]…. I want to be in the middle of it. They discussed various strategies for not growing older, including using an array of antiaging products and services, despite uncertainty on the part of some that such consumption would have the desired impact.

Again, their use was gendered in that only women spoke of using products that promise to make one more attractive, that is, cosmetics and cosmeceuticals.

If we were getting younger every day, life would be awesome, you know? Further, it represented a more positive discourse about later life. Even those respondents with less privilege believed successful aging was worthwhile, possible, and that they should seek to achieve it; and they engaged in activities aimed at reaching this goal. In these respects, then, this study concurs with Flatt et al. At the same time, however, successful aging was not successful in alleviating ageism among my respondents, as their awareness of a burgeoning inability actually to control their aging increased tensions for most of them.

Their belief in successful aging did not decrease their ageism or fears of aging. Instead, rather than supplanting the later-life disease and decline rhetoric, the successful aging paradigm simply became another discourse that existed in tandem with it.

In this sense, ageism was not challenged so much as displaced, redefined, and perhaps intensified. Instead of accruing to chronological age, ageist exclusion is based on proximity to the successful aging paradigm. First, it adds to the burdens individuals face as they age. While perhaps inadvertent, it places the blame on individuals for having bodies that do not live up to successful aging ideals, while it also deflects attention from the social nature of group differences, such as those that exist between old people and younger age groups.

Second, and related to this, the emphasis on individual control justifies ageism. If one can avoid disease, maintain physical and mental function, and stay socially engaged, and yet is not doing so, then exclusion is justified. The prevalence of successful aging, as was defined using SF, was Elders with chronic diseases or other health-related problems had a lower prevalence of successful aging compared with those without such health issues.

All elderly people who had had a stroke, for example, were considered to be unsuccessfully aging. We adopted the five components of frailty defined by Fried et al.

A previous study had reported that frailty in elders is an important clinical state that is distinct from normal aging and a strong predictor for disability [ 11 ]. In this study, frailty was found to be an independent determinant of successful aging. Among frail elders, only one 0.

These results indicated that gauging successful aging using SF is not only easy but also reflects actual health conditions. A noteworthy additional study by Theou et al. The prevalence of successful aging among previous community-based studies ranges from 0. In general, those studies using a single-item, self-rating scale reported a higher and more variable prevalence of successful aging, ranging from The focus of many studies on successful aging has shifted from disease status and functional decline to multidimensional health status, which encompasses physical, functional, psychological, and social health [ 21 ].

Early published reports defined successful aging using only one or two dimensions of health, such as the absence of chronic diseases, longer longevity, independent physical functioning, social life engagement, and mental health [ 14 , 16 , 17 , 19 ].

However, more recent studies have focused on the concept that successful aging is more multifaceted and complex [ 5 , 7 ]. Studies using the absence of major disease as one of the domains to define successful aging in elders reported a lower prevalence of successful aging [ 15 , 18 , 20 ] compared with those not using this domain [ 5 , 7 , 12 , 15 ].

To obtain a comparable prevalence of successful aging among elders and to explore the associated determinants, there is a need for a simple, standardized and multidimensional tool to be used across studies.

Age is a commonly identified determinant of successful aging. Consistent with the results reported in previous studies [ 5 , 23 , 24 ], younger age was one determinant of successful aging among elders in this study. We also found that the ability to see relatives and friends at will as a variable related to social support was an independent determinant for successful aging among the elderly. Pruchno et al.

Our findings on the associations among sleep disorders, fall histories, and successful aging were similar to those in prior research [ 25 ]. Elderly persons with sleep disorders were at a higher risk of unsuccessfully aging compared with those without sleep disorders. This finding provides evidence supporting a previous study by Andrews et al. In our findings, a history of falling was associated with a lower likelihood of successful aging, as those with such a history tend to restrict outdoor activity out of a fear of falling [ 26 ].

In general, the fear of falling has tended to impede elderly participation in healthy activities and leads to decreased mobility, resulting in diminished quality of life [ 27 , 28 ]. Previous studies have reported that chronic diseases—such as arthritis, diabetes, stroke, and hypertension—were all associated with successful aging.

Among these chronic diseases, stroke had a major impact on successful aging; all elders who had a history of stroke in this study were found to be unsuccessfully aging. Strokes were not, however, added to the final multivariate model due to problems with statistical convergence. We observed lower physical component scores in elders with stroke histories compared with those without stroke histories; no significant differences were observed in mental component scores.

Consistent with the findings of Okonkwo et al. In contrast to our findings on stroke effects, Haley et al. One possible explanation for these different findings is that the elders in our present study had already coped with their conditions, allowing for better mental health. The effect sizes of other factors including age, seeing relatives and friends at will, fall histories, and sleep disorders were small, between 0. The two determinants of pain problems and frailty were found to have greater relative association with successful aging.

The present study has certain limitations that should be taken into account when interpreting the results. First, owing to the nature of the cross-sectional study, we cannot explore the possible causal relationships between the health conditions considered in this study and successful aging.

Second, the findings of our work are not generalizable to rural elders because this study sample was a group of metropolitan elders. Finally, the prevalence of successful aging in urban elders may have been overestimated due to the exclusion of elders who were diagnosed with dementia, had cognitive impairment, and were unable complete the SF questionnaire.

The following conclusions can be drawn from the present study: the higher proportion of successful aging in elders was found among those who were relatively younger, had social support, not frail, and had no pain, sleep impairment, and fall history. These findings revealed the importance of considering suitable intervention to improve the frailty, pain, and sleep problems among the elders. However, the causal relationships between these factors and successful aging will require further investigations.

US Census Bureau. Article PubMed Google Scholar. Depp CA, Jeste DV: Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry. J Clin Epidemiol. Google Scholar. PLoS One. J Aging Res. Arch Intern Med. Am J Epidemiol. J Am Geriatr Soc. J Soc Issues. Article Google Scholar. J Patient Saf. Age Ageing. Brouwer B, Musselman K, Culham E: Physical function and health status among seniors with and without a fear of falling.

Qual Life Res.