What does it mean to age successfully? Take some time to think about this question for yourself. Develop a thorough list of everything it would take for you to say that you
will have aged successfully when the time comes. Then ask this question to several people of different ages and backgrounds. Compare their answers. Do the criteria
differ as a function of age or background characteristics? Discuss your findings with others in your class to see whether your results were typical.
1. What are the most important issues to consider in health promotion and quality of life for older adults?
2. What are the key aspects of a life-span model for maintaining and enhancing competence?
3. What are the major elements in health promotion and disease prevention programs? What are the four types of prevention?
4. What are the key aspects of staying fit and eating right in late life?
14.2 Successful Aging
LEARNING OBJECTIVES • What is successful aging?
arie Chen just celebrated her 100th birthday.
During the daylong festivities, many people asked her whether she believed she had a good life and had, in a sense, aged successfully. She answered everyone the same way, telling them that she had her health, enough money to live on, and her family. What more could she want?
Marie gives every sign of having aged very well. She’s 100 years old, with a loving family, good enough health to live in the community, and enough income to pay her bills. But is there more to it than that? Before you read what researchers have to say about aging successfully, complete the exercise in the Discovering Development feature.
Everyone hopes that his or her later years are ones filled with good health, continued high cognitive
and physical competence, and engagement with life. So important and universal are these beliefs that Rowe and Kahn (1998) considered them to be the foundation on which successful aging is built:
The absence of disease and disability makes it easier to maintain mental and physical function. And maintenance of mental and physical function in turn enables (but does not guarantee) active engagement with life.
It is the combination of all three—avoidance of disease and disability, maintenance of cognitive and physical function, and sustained engagement with life—that represents the concept of successful aging most fully. (p. 39)
Research participants agree. An extensive study of people’s own definitions of successful aging conducted in Canada showed substantial agreement between participants’ definitions and Rowe and Kahn’s three dimensions (Tate et al., 2003). This three-part view of successful aging has become the central theoretical paradigm in gerontology and geriatrics. Rowe and Kahn’s work was grounded in the 10-year, $ 10-million MacArthur Foundation Study of Successful Aging. On this point, Scheidt, Humphreys, and Yorgason (1999) noted that “at least a hundred studies have shown the efficacy of modifications to environmental and lifestyle factors for increasing the likelihood that older individuals might achieve success under this triarchic definition. So what’s not to like?” (p. 277).
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Vaillant (2002) proposed a similar model of successful aging which has six criteria rather than three. He proposes three criteria related to health:
• No physical disability at age 75 as rated by a physician
• Good subjective physical health (i. e., no problems with instrumental activities of daily living)
• Length of undisabled life
Vaillant’s other three criteria relate to social engagement and productive activity:
• Good mental health
• Objective social support
• Self-rated life satisfaction in eight domains: marriage, income-producing work, children, friendships and social contacts, hobbies, community service activities, religion, and recreation/sports
What is important in Vaillant’s model is not only what predicts long life but also what does not. Interestingly, having had long-lived ancestors was important only up to age 60 but not beyond. Stress – related diseases before age 50 were not predictive. Childhood factors that were important predictors of health at midlife did not predict health in late life. Thus Vaillant’s research emphasizes that late life has many unique aspects and may not relate to variables that predict health at earlier points in life.
A related view of successful aging is one we encountered several times throughout the book: the selection, optimization, and compensation (SOC) model (Baltes et al., 2006). Recall that in this model selection refers to developing and choosing goals, optimization to the application and refinement of goal-relevant means or actions, and compensation to substitution of means when previous ones are no longer available. The SOC model can be applied to the proactive strategies of life management. From this perspective, it is adaptive (i. e., a sign of successful aging) to set clear goals, to acquire and invest means into pursuing these goals, and to persist despite setbacks or losses. So the point here, in contrast to a coping strategy, which would emphasize a more passive approach, is that taking positive action to find substitute ways of doing things is adaptive (Freund & Baltes, 2002).
Taking a broad view to defining successful aging permits researchers to establish what is associated with it. Studies indicate that aging successfully is more likely when people have higher levels of education, household income, and personal income (Soong-Nang, Choi, & Kim, 2008).
The increased emphasis on successful aging raises important questions about the quality of life for older adults. For example, researchers have not focused much attention on the issue of whether one can outlive one’s expected longevity, that is, how long you think you will live. For example, if you think you will not live past age 75, perhaps because no one in your family ever has, you may map out your life based on this assumption. But what do you do when you celebrate your 76 th birthday? The birthday wasn’t planned, and you may feel confused as to what you should be doing with yourself.
Rowe and Kahn’s view of successful aging also assumes certain things to be true: that people have the resources to live a healthy life, have access to health care, live in a safe environment, have had life experiences that support individual decision making, and so forth (Holstein & Minkler, 2003). Not all older adults’ lives meet these assumptions (Soong-Nang et al., 2008). For example, poverty, widowhood, and differential social expectations based on gender influence whether a person will be able to exert individual control and decisions over health.
Successful aging is a subjective experience that each person decides individually.
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There is another, more serious concern with Rowe and Kahn’s model. By equating health and successful aging, they imply that older people who have health problems have not aged successfully (Holstein & Minkler, 2003). By suggesting that people who have disabilities or health limitations signify failure, or at best “usual” aging, the message that only the fit and vigorous are successful is a negative one. It can also inadvertently reinforce the antiaging stereotype for physical beauty as well as a stereotype for the “active older adult.”
Holstein and Minkler (2003) point out that we should return to an ancient question: What is the good life—for the whole of life—and what does it take to live a good old age? When she was in her late 60s, the late poet May Sarton (1997) wrote this about the imminence of death: “[P]reparing to die we shed our leaves, without regret, so that the essential person may be alive and well at the end” (p. 230).
Sarton’s view may remind you of another, related perspective. Erikson (1982) talked about successful aging as ego integrity, a point made by some researchers as well (Chang et al., 2008). Successful aging may be the ability to pull one’s life together from many perspectives into a coherent whole and to be satisfied with it. From this perspective, successful aging is assessed more from the older adult’s vantage point than from any other (Bowling, 2007). In this sense, older adults may say that they are aging successfully while others, especially those who adopt a medical model, would not say that about them. But who is to say which perspective is “correct”?
In this book, you have seen a snapshot of what adult development and aging are like today. You have learned about their complexities, myths, and realities. But more than anything else, you have seen what we really know about the pioneers who have blazed the trail ahead of us.
In a short time, it will be your turn to lead the journey. The decisions you make will have an enormous impact on those who will be old: your parents, grandparents, and the people who taught you. The decisions will not be easy ones. But you have an advantage that the pioneers did not. You have the collected knowledge of gerontologists to help. With a continued concerted effort, you will be able to address the problems and meet the challenges that lie ahead. Then, when you yourself are old, you will be able to look back on your life and say, “I lived long—and I prospered.”
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A digital rectal exam should be done at the same time as sigmoidoscopy, colonoscopy, or double-contrast barium enema. People who are at moderate or high risk for colorectal cancer should talk with a doctor about a different testing schedule. Adapted from the American Cancer Society (2008d).