| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
| ||||||||||||||||||||||||||||||||
Correspondence: Address correspondence to Robert B. Tate, PhD, Director, Manitoba Follow-Up Study, T148–770 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada. E-mail: tate{at}ms.umanitoba.ca
 |
Abstract |
|---|
 TOP Abstract MethodsResultsDiscussionReferences |
|---|
Key Words: Successful aging • Elderly male
Measures of functional status have figured prominently in clinical studies of successful aging. Defined in terms of an individual retaining the ability to function independently, Roos and Havens (1991) stated that 20% of 2,943 elderly persons aged 65–84 years were found to have aged successfully over a 12-year period. Predictors and associated activities of successful aging were researched in a substudy of the Alameda County Study, which consisted of 356 men and women aged 65–95 years old who were followed from 1984 to 1990. Results of this study found that four chronic diseases (diabetes, asthma, arthritis, and chronic obstructive pulmonary disease) and depression reduced the likelihood of subsequent successful aging. Predictors of successful aging included walking for exercise and close personal contacts. Cross-sectional comparisons at follow-up revealed significantly higher community involvement, physical activity, and mental health for those aging successfully (Strawbridge, Cohen, Shema, & Kaplan, 1996). The MacArthur Field Studies have reported that factors such as participation in exercise activity and having social networks of emotional support are positively associated with successful aging (Seeman et al., 1995).
According to Fries (1980), those who live long lives and are vibrant until shortly before death may provide the best possible example of successful aging. The study by Lentzner, Pamuk, Rhodenhiser, Rothenberg, and Powell-Griner (1992) examined quality of life in the year before death as a potentially important measure of the success or failure of life expectancy gains. Many studies (Echevarria, Ross, Bezon, & Flow, 1991; Morley, Mooradian, Silver, Heber, & Alfin-Slater, 1988; Nelson & Franzi 1989; Nolan & Blass 1992) report that change in diet and lifestyle may enhance cognitive functioning and hence support successful aging.
Early psychosocial theories presented highly idealized human states as the adaptive outcomes of old age (M. M. Baltes & Carstensen, 1996). Jung (1931) saw old age as a time when aging people see their lives as "contracting" rather than mounting and unfolding as when they are younger (Novak, 1985). Others conceptualized the acceptance of decline as the adaptive task of old age (Buhler, 1933). Cumming and Henry (1961) offered a disengagement theory that characterized success as acceptance of, and reconciliation with, the loss of power endemic in old age through a mutual withdrawal by elderly people from society and withdrawal by society from elderly people. It was proposed as being universal as well as inevitable. Accordingly, an elderly person who accepts and withdraws from society will successfully adapt to aging, and if he or she does not, then an elderly person is not fulfilling the functional needs of the society and will have a hard time adapting to old age (Nussbaum, Pecchioni, Robinson, & Thompson, 2000). Ryff (1982) proposed an integrative model of successful aging based on six dimensions related to positive functioning: self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth. Erikson's stage model (1984) proposes that psychological peace and ego integrity are the criteria for success, where old age can be viewed as a time to sum life up, a time to look back over the past, tie up loose ends, and see life as good (Novak, 1985). Social–environmental theory (Hendricks & Hendricks, 1986) addresses the functional context surrounding the daily lives of the elderly population. This context or environment is both social and individual. Surroundings are thought to affect successful aging, such as an older person living in a retirement community compared with an older person living in a personal care home (Nussbaum et al., 2000).
The selective optimization with compensation model from P. B. Baltes and Baltes (1990) summarizes a body of research and suggests a series of strategies for aging successfully (Nussbaum et al., 2000). Aging is seen as a lifelong adaptive process, an ongoing dynamic of selective optimization with compensation (SOC) involving the following three elements. First, selection: as increasing restrictions are imposed by physical and cognitive limitations, individuals will select or specialize their efforts into areas of high priority (does not preclude the person setting new priorities or goals in life). Second, optimization: individuals continue to engage in behaviors that enrich and augment their physical and mental reserves. This allows them to continue to maximize their chosen life courses. Third, compensation: an individual compensates by using psychological and technological strategies. Psychological strategies may be external memory aids such as adopting new mnemonic devices, and technological strategies may include using a hearing aid. These three elements interplay with one another so that a person may suffer from a reduction in general capacity and losses in specific functions, but through the process of selection, optimization, and compensation create a transformed and effective life. SOC is a psychological model of successful aging whereby an older person maximizes and attains positive or desired outcomes and minimizes and avoids negative or undesired outcomes. The SOC model provides a general framework for the understanding of developmental change and resilience across the life span (Freund & Baltes, 1998). P. B. Baltes and Baltes (1990) stated that the process of adaptation is constant, never static (Nussbaum et al., 2000). A study examining successful aging using the SOC model was done by Freund and Baltes (1998). Three domains serving as outcome measures of successful aging were as follows: subjective well-being, positive emotions, and the absence of feelings of loneliness. Those that reported SOC-related behaviors were those who also reported more positive functioning in each of the areas they chose to index successful aging.
A recent theory of successful aging was proposed by Rowe and Kahn (1987, 1998), wherein they made a distinction between usual and successful aging as nonpathological states. Their definition of successful aging described elderly individuals who have a low level of disease or disability, a high cognitive and physical functioning capacity, and an active engagement with life. These clinical factors have come to be generally accepted as the items encompassing the distinction between usual and successful aging. It will become increasingly important to understand the "usual" versus successful aging process and to determine factors related to "healthy aging." The difference between successful and unsuccessful aging is not just the difference between health and sickness; however, it is a place from which to start. The implication is that the absence of clinical disease or disability means that all is well and conversely that the presence of disease represents some kind of personal failure. Rowe and Kahn (1998) listed three key behaviors or characteristics of successful agers: (a) low risk of disease and disease-related disability; (b) high mental and physical function; and (c) active engagement with life. They saw their three characteristics as hierarchical because absence of disease or disability make maintaining cognitive and physical function easier, and in turn maintenance of these enables active engagement with life. A combination of all three ultimately represents their concept of successful aging most fully. To them, aging successfully means just what it says: aging well, which is very different from not aging at all. Rowe and Kahn (1998) also pointed out the faults of previous definitions in a 4-point argument: 1, previous theories tended to define successful aging in a narrow fashion, favoring one researcher's ideas rather than making a coherent theory of human development; 2, they treated success as no more than the absence of explicit failure, like treating health as nothing more than the absence of explicit disease; 3, they neglected the positive aspects of aging, and possible gains in old age, as if successful aging were merely aging as little as possible; and 4, they failed to acknowledge the unavoidable place of values in defining what is good or bad, successful or unsuccessful.
There remains no universally agreed-on standard or underlying theme for measuring success of aging. Few studies have attempted to identify the meanings older people attach to this concept (Fisher, 1995). Hence, it is unclear what the concept means in terms of how such older persons live and how they feel (Fisher, 1995; Strawbridge et al., 1996).
In the near future, there will be increases in the relative and actual numbers of seniors in our society. Based on the 1996 census, 12% of Canadians were over the age of 65 years (Shah, 1996). It has been projected that 21% of the Canadian population will be over the age of 65 by the year 2040 (Statistics Canada, 2002). With anticipated longer life expectancies may come not only greater demands on health care resources but also a possible increased awareness and consideration of the quality of lives of older persons. For health care professionals to be prepared to meet the demands of caring for an increasingly elderly population, they should understand what successful aging means to the individuals they will be serving. Although the concept of successful aging has been bantered about for some time in the field of gerontology with many discussions by clinicians, community planners, and care workers, we might ask the following question: What do elderly people themselves accept or understand to be a concept of successful aging? Is there a common perception of its definition among the elderly population to which it is applied? Further, does the concept of successful aging as defined by aging Canadian men reflect the components inherent in some of the clinical definitions and psychosocial theories currently in use?
To begin to understand perceptions of the concept and definition of successful aging in this segment of society, a survey of an established cohort of elderly Canadian males was undertaken. No definition of successful aging was provided within the mailed questionnaire, nor was the phrase "successful aging" used in the questionnaire, until the respondents were asked to define successful aging and further to state whether they felt they had aged successfully. The focus of this paper is to describe the themes that evolved from these definitions and to explore the interrelationship between the themes. Further, the association between the themes and characteristics of the respondents with respect to demographics, functional limitations, self-reported health, and life satisfaction is examined.
|
Methods |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
After 50 years of follow-up to July 1, 1998, 1,873 study members were alive at a mean age of 78 years, and 2,110 study members had died. The mortality experience of this cohort is approximately 70% that of the Canadian male population. When deaths caused by aircraft accidents in the early years of the study were accounted for, the distribution of cause of death is similar to that of the Canadian male. Very few study members, less than 3% of the original cohort, have been lost to follow-up. Ninety-three percent of the surviving cohort are living in Canada.
Questionnaire Development
As a way to examine views of aging and components of successful aging in this cohort, a mailed questionnaire was developed to be self-administered by the study members. Some questions were adapted from the Canadian National Population Health Survey (Statistics Canada, 1994). The SF-36 describing physical, mental, and social functioning (Ware & Sherbourne, 1992) was included. Self-rated health compared to others of the same age and current satisfaction with life were asked on an ordinal 5-point Likert scale and scored as excellent, good, fair, poor, and bad. Questions regarding living arrangements, marital status, alone or with other adults, and type of housing were posed. Questions concerning the ability to perform nine basic activities of daily living (ADLs) were asked, for example, going up and down stairs, bathing, dressing, grooming, and eating. As well, questions concerning the ability to perform 16 instrumental activities of daily living (IADLs) were asked, including, for example, ability to do housework, meal preparation, shopping, and laundry.
Two key open-ended questions were asked at the end of the 11-page questionnaire. These were "What is your definition of successful aging?" and "Would you say you have "aged successfully?" Content analysis of descriptive themes from the definitions of successful aging provided by the study members were manually coded by one author (R. Tate) and verified by another (L. Lah). As key words that identified themes evolved from review of the returned questionnaires, a coding system was developed to record individual themes and combinations of themes reported by each respondent in his definition. This report focuses on the analysis of the definitions.
Quantitative Statistical Methods
Tabulation of descriptive themes from respondents and the extent of self-reported successful aging were described as percentages. Odds ratios relating all pairs of themes from successful aging definitions were calculated. Because of the large number of pairs of odds ratios, 99% confidence intervals (CIs) were calculated rather than the more traditional 95% CI. When relating the likelihood for two different themes to be reported in a successful aging definition, the odds ratio can be used as a summary measure of this association. For example, an odds ratio of 2.5 for Themes A and B can be interpreted as "the chance of including Theme A (or B) in an individual's definition of ‘successful aging’ was 2.5 times more likely if the individual also included Theme B (or A) in his definition." Odds ratios less than 1, say 0.5, relating Themes A and B can be interpreted as "the chance of including Theme A (or B) in an individual's definition of ‘successful aging’ was only half (0.5) as likely to be included in a definition of ‘successful aging’ if the individual also included Definition B (or A) in his theme."
Logistic regression models were used to explore factors related to the different themes from definitions of successful aging. It was postulated that the presence or absence of a theme in a definition might be influenced by a respondent's self-rated health ("How would you describe your health compared to others your age?") or satisfaction with life ("How would you describe your satisfaction with life in general at present?"). Both questions were coded in three categories collapsed from the five responses: excellent, good and fair, and poor or bad. In addition, binary variables identifying having two or more limitations with IADLs, any limitation with basic ADLs, and marital status (married or not) were modeled. Adjustment for the potential confounding effect of age at time of questionnaire response was accomplished through its inclusion as an independent variable in all models. Thus, age-adjusted backward stepwise models were fit separately for dependent variables defined as the presence or absence of each theme in a study member's definition of successful aging. Odds ratios with 95% CI were calculated to quantify the effect of each significant independent variable on each theme.
|
Results |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
Description of Survey Respondents
The mean age of respondents was 78 years, with 21% under the age of 75 years, over half (53%) aged 75–79 years, and 464 (26%) respondents aged over 80 years. Over three quarters, 78%, reported living with other adults. Thirty percent of respondents rated their health compared to others of the same age as excellent, and a further 54% rated their health as good. Eleven percent rated their current satisfaction with life as fair, poor, or bad. A large proportion, 81%, reported no limitations with basic ADLs, whereas 53% reported no limitations with IADLs.
Overall, 83.8% of the 1,821 respondents replied "yes" to the following question: "Do you think you have aged successfully?" All other responses, including "no," "I don't think so," "I don't know yet," and "yes, but," are considered in the "not yes" category for this analysis. There was a difference after 85 years of age in the proportion reporting successful aging, with 84% of men under the age of 85 years and 76% of men aged 85 years and older reporting having aged successfully. An interesting observation can be made, which recognizes that the respondents to the first mailing of the questionnaire were significantly more likely to have self-reported having aged successfully than were the 11% of respondents to the second or third mailing. Likelihood of having aged successfully significantly decreased with increasing number of limitations in daily living, both in basic and instrumental activities. Similarly, likelihood of a self-report of successful aging decreased markedly with declining self-rated health and satisfaction with life.
Definitions of successful aging appropriate for coding for this analysis were received from 1,771 of the 1,821 respondents. The 50 questionnaires not analyzed were in some instances returned by a study member who filled out some pages but not others or did not return all pages of the questionnaire, or the returned questionnaire was received from a family member who completed the entire questionnaire on behalf of the member (in some instances on behalf of a study member who had recently died).
Components and Themes in Definitions of Successful Aging
Twenty component themes evolved from the respondents' definitions of successful aging. Generic labels of five or six letters each were defined for easy reference. The percentage of respondents providing each theme, the labels, and descriptors are provided in Table 1. The most frequent component found in a definition of successful aging, provided by 30% of respondents, related to health and disease (HEALTH). Encompassed in the HEALTH definition were aspects of physical health, described in a positive sense as good health or less pain, visits to physicians, and having check-ups. Mention of being or keeping active was frequently included in a definition. Specifications of physical activity (ACTPHY) in 19.6%, keeping mentally active (ACTMEN) in 12.0%, and socially active (ACTSOC) in 7.5% were coded as separate themes. Additionally, 20.5% of responses included a nonspecific mention of keeping active in general (ACTIVE). A happy life or satisfying lifestyle (SATISF) was mentioned by 28.4%, and ideas related to having a positive outlook on life or having a positive attitude (POSATT) were mentioned by 18.8%. Having close and loving family and friends (FAMILY) is viewed as a component of successful aging by 18.5%. A spiritual component, accepting growing old (ACCEPT), was included in 10.4% of definitions. Independence (INDEPE) encompassing both physical mobility and ability to make one's own decisions was mentioned by 16.7%. Recognition of necessity for moderation (MODERA) including adjustment of capabilities was included in 8.6%. A component encompassing mention of diet or eating (DIET), including mention of ingestibles such as vitamins or alcohol intake, was included by 8.2%. With lesser frequencies, having goals or challenges (GOALS), being financially secure (SECURE), having hobbies or interests (INTRST), being useful (USEFUL), being content (CONTNT), and having a sense of humor (HUMOUR) were also part of definitions. A miscellaneous (MISCEL) category was created to identify 4% of definitions that included phrases such as "waking up everyday," "staying alive," or "I don't know yet, I'm only 85."
|
|
|
|
Discussion |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
There continues to be a paucity of research with respect to the health and functioning of the elderly male. Reasons for this "understudying of men" may arise from many sources, including the fact that in our society the number of elderly women continues to exceed the number of elderly men and that the number of widows continues to exceed the number of widowers. Hence, the extent of needed social support and social programs is deemed less for elderly men than for elderly women (Thompson, 1994). Perhaps the priority for studying elderly male populations is considered low because elderly male populations have traditionally been viewed as homogeneous (Thompson, 1994). We are learning that the health, functioning, and perceptions of the elderly population, both males and females, are not homogeneous, and continued investigation including that described in this paper is warranted. Exploring and understanding these aspects of the lives of young elderly, elderly, and very elderly people of today will provide the needed insight into planning for the "baby boomers," as the boomers bring with them the largest increase in the elderly population soon to be experienced in our society.
This paper reported on definitions of successful aging obtained directly and unprompted from 1,771 men, all members of an established cohort of elderly Canadian males. Twenty themes were derived from their definitions. There was large variation in the frequency of themes reported, ranging from 2% to 30% of responses. Further, there was a degree of clustering found among themes, suggesting that some themes were more likely to be provided along with other themes in an individual's definition of successful aging.
The concept of successful aging has evolved and has been debated, with some overlap, from two main perspectives in the gerontological literature. One perspective, dominant in the work of Rowe and Kahn (1998), is based on clinical standards, that is, an individual's ability to manage, function, and actively engage in a physical world. The other perspective stems from psychosocial theory of successful aging as a lifelong adaptive process. A dominant model in the psychosocial literature was proposed by P. B. Baltes and Baltes (1990). Their model explores the process of aging as a SOC, wherein successful aging is viewed as a dynamic process, that is, a series of choices and adaptations made by individuals.
Many of the themes of successful aging provided by MFUS members are consistent with these two perspectives. Rowe and Kahn's concept of successful aging is embodied in three areas: health and disability, a high cognitive and physical functioning capacity, and an active engagement with life (Rowe & Kahn, 1987). MFUS members' definitions providing themes of "good health, low levels of pain" and "independence," "mobility," and "carry on" describe aspects of Rowe and Kahn's first area. High cognitive and physical functioning capacity is described by MFUS members' themes stated as "keeping active physically" and "keeping active mentally." Further "ability to make one's own decisions" is embodied within a high cognitive functioning. MFUS members' definitions including "being useful, volunteering, helping others, being productive," "having a positive outlook and interest in life," "having hobbies, various interests and activities," and "keeping busy or active (in general)," along with the theme of "keeping busy—socially," all describe an active engagement with life. Other definitions of successful aging provided by MFUS members are more consistent with the psychosocial literature. The components of the SOC model (P. B. Baltes & Baltes, 1990) are reflected through adaptation in the themes involving an individual's attitude toward life and the aging process in general. MFUS members' themes described as "moderation, gradual decline, growing old gracefully or adjusting to capabilities" reflect the concept of adaptation. "Keeping active socially" provides an indication of the importance of social networking throughout the aging process. The MFUS members' theme of having "loving spouse, family and friends" is consistent with recent literature of Rowe and Kahn (1998) in which their initial concept of successful aging was expanded to include supportive family relationships. Others, including Seeman, Singer, Ryff, Dienberg Love, and Levy-Storms (2002), have also reported the relationship between positive social interaction and successful aging.
Some definitions provided by MFUS members provided no surprises. It should be anticipated from early literature that aspects of good health or freedom from disease, keeping busy, being active and useful, and maintaining one's independence would all be found in definitions of successful aging. More recent literature suggests that themes of family and friends, a component of peace with one's self, moderation in activity, adapting, and knowing one's limitations are being recognized. In support of the latter is the recent report by von Faber describing "successful aging of the oldest old" in The Netherlands (von Faber et al., 2001). They concluded that successful aging is more an adaptation than a state of health or well-being. Crowther, Parker, Achenbaum, Larimore, and Koenig (2002) recently have reported "positive spirituality" to be "a forgotten factor" in models of successful aging. Their work is supported by the 10% of MFUS members who included "peace of mind," "tranquility," and aspects of positive spirituality, either from a community focus of religion or a more individualistic view of spirituality (Crowther et al., 2002), in their definitions of successful aging.
Highly prevalent in our survey, but not often discussed in the gerontological literature, the second most frequent component of definitions, after "health," was "happiness, enjoying life, having a satisfying lifestyle, no worries, be happy." Perhaps this component should lead us to speculate that success was in the eye of the beholder, that attainment of success in aging is a personal judgment. Somewhat more tangible, and perhaps also less well described in the literature, are MFUS members' themes of "financial security," "having goals in life including challenges and ability to travel (both physically and financially)," "diet," "having a sense of humor," and, simply put, "contentment." Each of these themes was mentioned with a frequency of less than 10%, but nonetheless was considered part of the definition of successful aging by MFUS members.
Our research provided insight into how some characteristics of individuals (e.g., age, self-rated health, life satisfaction, activity limitations, and marital status) might be related to different concepts of successful aging. Men highly satisfied with life were more than twice as likely to have mentioned having family and friends, being useful, or recognizing limitations in their definitions of successful aging. It was interesting that marital status was only related to one theme (ACTSOC), suggesting that most all of the themes were equally likely to be provided by married and not married study members. A component of spirituality, encompassing peace of mind, acceptance, and growing old gracefully (ACCEPT) was unrelated to self-rated health or life satisfaction, and its chance of being included in a definition of successful aging was not influenced by limitations. Although identified by 1 in 10 men as an important part of successful aging, this theme does not appear to be influenced by these independent variables.
An inherent problem with defining successful aging is that success is a subjective judgment. Success comes with different standards for different people and hence, as we have shown, success can mean many different things. What might be success to one may be failure to another. Successful aging is restrictively contingent upon "the value system of the enquirer—or, their social construction of reality" (Bowling, 1993, p. 449). A society's value system predetermines the way in which successful aging is conceptualized. It is a socially and culturally determined construction (Torres, 1999). Cultural and social norms define the roles that elderly people fill in their community and influence attitudes toward aging (Holmes & Holmes, 1995). Different cultures view aging differently, and this affects the relational world of the elderly population (Nussbaum et al., 2000).
If we can infer that an elderly man's answer to the question "What is your definition of successful aging?" reflects his personal perspectives and priorities at his advanced age, our results defining and understanding successful aging should be viewed as a valuable resource to health care professionals. As appropriate services for the elderly population are planned to promote successful aging in order to enhance the quality of lives, it is important that successful aging be viewed as a broader concept than currently thought by the research community.
As the health care profession adapts to the changing demographic composition of society, more heed must be paid to the voice of the elderly population. The goal of this paper is to provide investigators of the aging process, including general practitioners, internists, and all specialists, the opportunity to look at the meaning of successful aging from the perspective of the elderly male. It is hoped that consideration of these definitions, including some familiar concepts and some less common components in the definition of successful aging, may stimulate further research in this aspect of gerontology.
|
Footnotes |
|---|
1 Department of Community Health Sciences, University of Manitoba, Canada.
2 Faculty of Medicine, University of Manitoba, Canada.
Decision Editor: Linda S. Noelker, PhD
Received for publication September 4, 2002. Accepted for publication February 14, 2003.
|
References |
|---|
|
TOPAbstractMethodsResultsDiscussionReferences |
|---|
This article has been cited by other articles:
 |
|
 |
|
  N. C. Franklin and C. A. Tate Lifestyle and Successful Aging: An Overview American Journal of Lifestyle Medicine, January 1, 2009; 3(1): 6 - 11. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Shooshtari, V. Menec, and R. Tate Comparing Predictors of Positive and Negative Self-Rated Health Between Younger (25-54) and Older (55+) Canadian Adults: A Longitudinal Study of Well-Being Research on Aging, November 1, 2007; 29(6): 512 - 554. [Abstract] [PDF]
|
|
|
|
 |
|
 S.-T. Cheng and A. C. M. Chan Relationship With Others and Life Satisfaction in Later Life: Do Gender and Widowhood Make a Difference? J. Gerontol. B. Psychol. Sci. Soc. Sci., January 1, 2006; 61(1): P46 - P53. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||
| HOME | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
