Successful Ageing Ann Bowling

BACKGROUND

Population ageing and increases in life expectancy in the developed world have led to international interest in how to age ‘successfully’. But there is no interdisciplinary agreement on what successful ageing is. The literature reveals that conceptual definitions and measurement of successful ageing vary both within and between disciplines; there is little interdisciplinary cross-referencing. Biomedical models emphasize physical and mental functioning as successful ageing, while sociopsychological models focus on social functioning, life satisfaction and psychological resources. Older people themselves adopt multifaceted definitions of successful ageing^1,2. Moreover, research shows that older people consider themselves to have aged successfully, but classifications based on traditional, narrower domain models do not^1-3. This suggests that a model of successful ageing needs to be multidimensional, cut across disciplines, and incorporate a lay perspective for social significance. Moreover, there is overlap, and lack of clarity, in the literature between concepts of successful ageing, active ageing and quality of life. Analysis of overlap between lay perceptions of these concepts in surveys using comparable methods showed that lay perceptions of active ageing emphasized striving to maintain health, functioning, and wider well-being (e.g. exercising the body and/or mind in order to maintain health and functioning), while lay definitions of successful ageing and quality of life focused on the existence of a state, rather than the striving for its achievement (e.g. the having health and ability per se⁴). This distinction is consistent with the literature on active ageing, which portrays quality of life, and also having ‘successfully aged’, as the end points, although ‘successful ageing’ can also be viewed as a dynamic process.

An earlier interdisciplinary systematic review of the literature by this author^1,3 found that the most common definitions of successful ageing were based on theories of social functioning, life satisfaction, psychological resources and biomedical approaches. A small body of literature focused on lay views. The distinction between concepts as either predictor or constituent variables was not always clear. The survey with the highest citations for successful ageing was the MacArthur Foundation studies of successful ageing^5-7, which are based on a biomedical model, broadened to include active engagement with life.

SOCIAL FUNCTIONING

Social functioning has been conceptualized and measured in many different ways, including social engagement, social roles, participation and activity, social contacts and exchanges, and/or positive social relationships. The main theoretical approaches relating to successful ageing and social functioning are disengagement, activity and continuity theories, although each suffers from limitations, and all are now outdated (see Bearon for critique⁸).

LIFE SATISFACTION

A smaller number of authors included life satisfaction, well-being or their elements in their conceptual and empirical definitions of successful ageing. Components of life satisfaction include zest, resolution, fortitude, relationships between desired and achieved goals, self-concept and mood, including happiness^9-11. Havighurst¹¹ (p. 305) stated, ‘a person is aging successfully if he feels satisfied with his past and present life’, thus arguing that life satisfaction is an attribute of successful ageing, although others have argued that it is a condition for its achievement. Feelings of well-being were an outcome indicator of successful ageing in the Berlin Aging Study¹². There is lack of consistency about the status of life satisfaction, in particular, as an indicator or constituent variable.

PSYCHOLOGICAL RESOURCES

Few investigators have included psychological resources as their study definition of successful ageing, and again it was not always clear whether the concepts used were predictor or constituent variables. Psychological models include possession of the resources of personal growth, creativity, self-efficacy, autonomy, independence, effective coping strategies, sense of purpose, self-acceptance and self-worth. These models have been criticized for their emphasis on autonomy, thus marginalizing frail older people¹³.

Baltes and colleagues¹⁴ developed a strong theoretical model based on the need to employ compensatory strategies when facing the dynamic between challenges and depleting reserves: selective

optimization with compensation (SOC). With this model, it is proposed that individuals can contribute to their own successful ageing: when selected activities can no longer be performed, strategies are needed to find new ones, and to maximize reserves. There is some supportive evidence from the Berlin Aging Study that people who use these strategies have better well-being than others¹².

Ryff’s theoretical model of successful ageing emphasizes a life course approach, and holds that a developmental focus is required^15,16. She argues that successful ageing includes ‘positive or ideal functioning’ and is related to development over the life course. Fisher¹⁷ also emphasized adaptability and coping, and defined successful ageing as an ability to continue to grow and learn by using past experiences to cope with present circumstances and set goals for development.

BIOMEDICAL THEORIES

Biomedical or decline theories generally define successful ageing as the optimization of life expectancy, while minimizing physical and mental deterioration. The MacArthur Foundation in the USA commissioned a major study of successful ageing led by Rowe, which comprised a three-site longitudinal study of adults living in the community aged 70-79 in 1988. It was rooted in Rowe and Kahn’s^5-7

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