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Successful Aging

With people living longer now and with better health, there has been a greater focus on what it means to successfully age.[1] [2] Researchers, in general, have looked at the physical, psychological and social aspects of aging (including the effects of heredity and gene composition), [3][4][5] and have utilized the concepts of subjective well-being, life satisfaction and happiness to gauge whether a person has successfully aged. Some researchers have believed that older people, in general, are happier than, or just as happy as, younger adults.[6] This has been true even though there has existed within the United States a negative stereotype about the effects of aging.[1] While older people have lived with one or two chronic illnesses,[7] most have been able to function effectively and productively.[8][9] However, there have been some researchers who believed that by focusing on successful aging, important inequities between people have been overlooked and that excluded people have been inappropriately targeted and labeled.[10]


Definition

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To date, there has not been a universal definition for successful aging.[10][11] While researchers have for many years tried to create such a definition, nothing really took hold until the late 1990's. At that time the following definition (adopted by researchers Rowe & Kahn) started to become the operative standard: A person was deemed to have successfully aged if the person (1) lived free of disability or disease; (2) had high cognitive and physical abilities; and (3) was interacting with others in meaningful ways[12] This definition was followed for a significant period of time, but, in the last ten years, its usefulness started to be questioned.[9]

Physical and Mental Health

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Initially, researchers, questioned the first listed criteria -- living free of disability or disease. Although disease was decreasing,[13] this factor was viewed as too restrictive. For older adults, life was no longer based on ego or endeavors. Life was different. Erickson referred to this stage of life as "Integrity," when a person comes to terms with the meaning of life.[14] It was found that people adjusted to their respective ailments or diseases and gained a resiliency which allowed them to function in productive ways. This has been true for both physical and mental health. [5] The term "successful adaptation" had become synonymous with successful aging.[14] The key for older adults has been to effectively manage their chronic illnesses or disorders, whether physical or mental. They, to a large extent, do so through the use of "resiliency." [8] Even if a person had some physical restrictions, such a people could still lead a very productive life.[9] Further, research found that more and more older people retained their physical abilities through exercise, among other health related factors.[15] [16] With respect to mental health, studies have shown that depression and strain can be as detrimental as poor physical health.[8][17]

Cognitive Functioning

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Next, the concept of high cognitive functioning was further analyzed. While it was widely acknowledged that some of a person's cognitive ability decreases after age 65[12], two factors exist that mitigate against the effects of the decrease. First, most older adults maintain enough cognitive ability to retain their ability to function well.[18] To successfully age, a person must retain sufficient cognitive abilities, which include not only neuropsychological domains, such as memory and executive function, but also must retain cognitive schemas. While a older person may lose some processing speed, attention, concentration, and memory performance, such person's "crystallized intelligence," which covers previous verbal learning and a general fund of knowledge, remains fairly stable during a person's full lifetime.[19] This level of retention while far from perfect, has been sufficient for many older adults to thrive during their retirement years.[20] Second, researchers introduced a new concept -- namely, "cognitive reserve" (see below) which supports the proposition that the brain can still grow and expand with older people.[21]

Social Interaction

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The last factor -- meaningful interaction with others -- has been widely accepted (i.e. social interaction is at the heart of human existence).[9] [12] But, the level of importance of this factor has increased.[9] In addition, its importance has been reinforced by studies relating to "loneliness." In these studies, researchers have established that loneliness creates a significant risk factor for the decline in physical activities -- a negative sign with respect to successful aging.[22] Further, the studies analyzing "cognitive reserve" -- see below -- have also supported this conclusion. Researchers have found that the richer the environment in which a person experiences life, the more the brain changes structurally.[21] Our social interactions can be viewed in a variety of ways. First, a person's social network, including, spouse, families, friends, etc., can be analyzed.[23] [24] We can also view social interaction based on quality and quantity of interactions. Many researchers believed that quality has been most important.[25] People need others for support and encouragement, as well as for feeling good about themselves.

Other Relevant Personal Attributes

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As stated above, the two most important internal personal attributes that affect a person's ability to successfully age are a person's level of physical and cognitive ability. However, there are additional factors that come into play: (1) the relevance of past events in early years or during middle age; (2) actual level of physical activities; (3) interrelationship of two or more factors; (4) level of education; (5) economics; (6) drive to pursue goals; (7)ability to cope; (8)life management strategies; (9) wisdom; and (10) ability to overcome limitations and adapt.[7] [16][26][27][28]

Social Support

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A person's ability to interact with others has been consistently viewed as vitally important to successful aging.[9][12] While the network size for older people decreases with age,[29] the overall quality of the remaining social connections becomes stronger.[25] When a person lacks such interaction, he/she will very well feel "loneliness," which has been viewed as one of the primary factors preventing a person from achieving successful aging.[30] Individuals utilize social networks for two primary reasons: to receive emotional support and to enhance engagements with others. However, an increase or decrease in social engagement, but not in social support, over a period of years, has the greatest effect on a person's quality of life and such person's ability to successfully age. [25] Many researchers have believed that social relationships have become the single most important factor in measuring a person's psychological well-being or happiness. [24]

Subjective well-being and Happiness

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Most researchers have measured whether a person has successfully aged by assessing (primarily through the use of self-reports) whether the effect of relevant factors (such as the factors referred to above) created a significant increase in "subjective well-being, "life satisfaction," and "happiness." [31] These terms have been used, in many cases, interchangeably. Specifically, for example, studies have shown that people who have been "happier" throughout their lives, live longer.[32]

Cognitive Reserve

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Although many older adults experience some level of deterioration in their cognitive abilities,[33] new research has found that some older adults are better able to adapt to these potential changes through the application of a concept called "cognitive reserve." [21] Underlying this concept is the observation that the extent of brain pathology or brain damage does not correlate to clinical manifestations of a disease. In other words, cognitive reserve develops the ability to use alternative cognitive strategies in order to maximize or optimize performance on cognitive tasks. [2] [33][34] In essence, the relationship between neuropathology and clinical symptoms is not necessarily proportional.[2] So, how does this work? Researchers have believed that the greater the education level achieved, the more neuropathology is necessary before clinical symptoms are experienced. [2][21] Further, some researchers have believed also that academic achievement (rather than just education) is a very important factor. Others have concluded that frequent cognitive activity (such as playing chess or visiting a library) is also associated with creating a reduced risk for dementia. [2] Still others, however, have focused on the level of social engagement (measured by size of a person's social network) -- as a main factor that creates such disparities.[21] When "cognitive reserve" exists, a person's executive function is enhanced.[2] Through this mechanism, a person is able to think with a greater amount of flexibility and function adaptively to novel environments.[35] For normative and preclinical person's, cognitive training can be extremely instrumental in a person's ability to successfully age.

Criticism

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Since there are so many ways in which successful aging has been studied, some have suggested that the results and points of emphasis are based, to a large extent, on the theories and approaches of the researcher. Some researchers approach it as the absence of negativity, while others emphasize the positivity of psychological well-being and happiness. [36] In order to create viable policies in the area, both approaches will need to be reconciled.[36] Others have argued that most of the "Successful aging" research disregards factors relating to socio-economics differences.[10]


References

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  1. ^ a b Tergeson (2015). "To age well, change how you feel about aging". Wall Street Journal.
  2. ^ a b c d e f Puente, Lindbergh, & Miller (2015). "The relationship between cognitive reserve and functional ability is mediated by executive functioning in older adults". The Clinical Neuropsychologist. 29(1).{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  3. ^ Lee, Lan & Yen (2011). "Aging Successfully: A four-factor model". Eductional Gerontology. Volume 37 (3). {{cite journal}}: |volume= has extra text (help)
  4. ^ Bowling & Dieppe (2005). "What is successful ageing and who should define it". BMJ. volume 331: 1548-51. {{cite journal}}: |volume= has extra text (help)
  5. ^ a b Depp, Vahia, and Jeste (2007). "The intersection of mental health and successful aging". psychiatrictimes.com. {{cite web}}: Missing or empty |url= (help)CS1 maint: multiple names: authors list (link)
  6. ^ Lacey, Smith & Ubel (2006). "Hope I die before I get old; Mispredicting happiness across the adult lifespan". Jounal of happiness studies. 7(2).
  7. ^ a b Wikman, Wardle & Steptoe (2011). "Quality of life and affective well-being in middle aged and older people with chronic medical illnesses". Plos One.
  8. ^ a b c Jeste, MD; et al. (2013). "Association between older age and more successful aging: critical role of resilience and depression". Am J Psychiatry. {{cite journal}}: Explicit use of et al. in: |last1= (help)
  9. ^ a b c d e f Gow, Mortensen, & Avland (2012). "Active participation and cognitive aging from age 50 to 80 in the glostrup 1914 cohort". Journal of the American Geriatrics Society. 60(10).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ^ a b c Katz (2014). "Critical Perspectives on Successful Aging: Does it "appeal more than it illuminates"". The Gerontologist.
  11. ^ Phelan, Anderson, LaCroix, & Larson (2004). "Older adults' views of "successful aging" -- how do they compare with researchers' definition?". American Geriatrics Society (JAGS). 52(2).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ a b c d Rowe & Kahn (1998). Successful Aging. Dell Publishing.
  13. ^ Fries, James, F. (2002). "Reducing Disability in OIder age". JAMA. Volume 288, No.24. {{cite journal}}: |volume= has extra text (help)CS1 maint: multiple names: authors list (link)
  14. ^ a b Corbett, L. "Successful Aging: Jungian contributions to development in later life". Psychological Perspectives. 56(2).
  15. ^ Westtermeyer, J.F. (2013). "Predictors and characteristics of successful aging among men". The International Journal of Aging & Human development. 76(4): 323-345.
  16. ^ a b Vaillant, G. E. (2007). Aging Well. Little Brown & Company.
  17. ^ Chen & Feeley (2013). "Social support, social strain, loneliness, and well-being among older adults: An analysis of the health and retirement study". Journal of Social and Personal Relationships.
  18. ^ Infurna, Gerstorf & Ryan (2011). "Dynamic links between memory and functional limitations in old age: longitudinal evidence for age-based structural dynamics from the ahead study". Psychology and Aging. 26(3).
  19. ^ Ardila (2007). "Normal aging increases cognitive heterogeneity: analysis of dispersion in WAIS-III scores across age". Archives of Clinical Neuropsychology. 22.
  20. ^ Forstmeier & Maercker (2008). "Motivational Reserve: Lifetime motivational abilities contribute to cognitive and emotional health in old age". Psychology and Aging. 23(4).
  21. ^ a b c d e Cozolino (2008). The healthy aging brain (first ed.). W.W. Norton & Company.
  22. ^ Capioppo & Patrick (2008). Loneliness: Human nature and the need for social connection. W. Norton & Co.
  23. ^ Fuller-Iglesias, Webster, & Antonucci (2015). "The complex nature of family support across the life span: implications for psychological well-being". Developmental Psychology. 51(3).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  24. ^ a b Caunt, Franklin, Brodaty, & Brodaty (2013). "Exploring the causes of subjective well-being: a content analysis of peoples' recipes for long-term happiness". Journal of Happiness Studies. 14.{{cite journal}}: CS1 maint: multiple names: authors list (link) Cite error: The named reference "Caunt" was defined multiple times with different content (see the help page).
  25. ^ a b c Huxhold, Fiori, & Windsor (2003). "The dynamic interplay of social network characteristics, subjective well-being and health". Psychology and Aging. 28(1).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  26. ^ Arlelt, M. (2003). "Empirical assessment of a three-dimental wisdom scale". Research on aging. 25(3)
  27. ^ Jopp & Smith (2006). "Resources and life-management strategies as determinants of successful aging: the perspective effect of selection, optimization and compensation". Psychology and Aging. 28(4).. {{cite journal}}: line feed character in |volume= at position 13 (help)
  28. ^ Andrews, Clark, & Luszcz (2002). "Successful aging in the Australian longitudinal study of aging: applying the MacArther model cross-nationally". Journal of Social Issues. 58(4).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. ^ Gurang, Taylor, & Seeman (2003). "Accounting for changes in social support among married older adults: insights from the MacArthur studies of successful aging". Psychology and Aging. 18(3).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. ^ Morack, Ram, Fauth & Gerstorf (2013). "Multidomain trajectories of psychological functioning in old age: a longitudinal perspective on (uneven) successful aging". Developmental Psychology. 49(12).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  31. ^ Jayawickreme, Forgard & seligman (2012). "The engine of well-being". Review of General Psychology. 16(4).
  32. ^ Koopsman, Geleijnese, Zitman, & Giltay (2010). "Effects of Happiness on all-cause mortality during 15 year follow-up: The Arnhem Elderly Study". Journal of Happiness Studies.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  33. ^ a b Giogkaraki, Michaelides, & Constantinidou (2013). "The role of cognitive reserve in cognitive aging: Results from the neurocognitive study on aging". Journal of Clinical and Experimental Neuropsychology. 35(10).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  34. ^ Richards & Deary (2005). "A life course approach to cognitive reserve: A model for cognitive aging and development". Annals of Neurology.
  35. ^ Daffner (2010). "Promoting successful cognitive aging: a comprehensive review". Journal of Alzheimer's disease. 19.
  36. ^ a b Bowling, Dieppe (2005). "What is successful aging and who should define it". BMJ. 331.
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