To define the concept ‘Successful Ageing'. To explore the historical development of this concept.

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2. Successful Ageing
Dr Rekha Elaswarapu

3. Aims of Session
• To define the concept ‘Successful Ageing’.
• To explore the historical development of this
concept.
• To evaluate successful ageing from a
bio-psycho-social research/theory
perspective.

4. What is Successful Ageing
• No one definition.
• How do we define and measure it?
– Biopsychosocial Approach
– Life course approach
– Criteria
– Models
– Concepts

5. Happiness
Personality
Perception
of Control
Coping
skills
Physical &
Mental
Health
Successful Ageing
Longevity
Cognitive skills
Resilience
Social Support

6. Today’s Ageing Population
• More people aged 70s and 80s than ever before
in today’s population:
http://www.statistics.gov.uk/hub/population/ag
eing/older-people
• Led to a growing interest in improving older
peoples Quality of Life (Bowling, 2008).
• Active or Successful ageing is difficult to define.
– It is a multidimensional concept – activity, health,
independence and productivity in older age (WHO,
2001)
– Empowerment, participation and meaningful pursuits
which contribute to well-being (Walker, 2002).

7. What changes have occurred over
the last Century?
• Substantial increase in life expectancy at birth
• Substantial increase in longevity over last century
• Enormous medical advances Time of the old woman
•Escalating health & social care costs Decline and Fail Goya’s Les Vielles
• Higher expectations for old age
= Interest in:
How to promote a healthier old age?
How to age successfully? PPS
Bowling & Dieppe (2005)

8. What is Successful Ageing?
Most popular biomedical model:
Absence of risk of disease and disease-related
disability, high mental and physical
functioning, and active engagement with
life, including maintenance of autonomy &
social support.
(Rowe and Kahn, 1987, 1998)
Some biomedical models also include
longevity as an indicator of SA rather than as
an outcome.
(Bowling 2007)

9. Encyclopaedia of Ageing
(Palmore,1995)
‘Successful Aging defined as:
– Survival (longevity)
– Health (lack of disability)
– Life Satisfaction (happiness)
Medical perspectives incorporate:
– Survival
– Mental and physical health
– Functioning
– Sometimes social engagement is added.
(Rowe, & Kahn, 1998)

10. Biomedical Theories
SA -Optimisation of life expectancy while
minimising physical and mental deterioration
and disability.
Focus on:
• Absence of chronic disease
• Absence of risk factors for disease
• Good health
• High levels of independent physical
functioning, performance and mobility
• Good cognitive functioning.

11. MacArthur Studies (1988)
3 Longitudinal Studies of SA
American Biomedical Studies
‘Usual Ageing’ (normal decline in physical, social and
cognitive functioning with age)
‘Successful Ageing’ in which functional loss is
minimised (little or no age related decrement in
physical and cognitive functioning with age).
(Rowe & Kahn, 1998: 1549 Bowling & Dieppe, 2005)

12. MacArthur Studies
Confirmed SA as:
• Absence or avoidance of disease or risk
factors for disease.
• Maintenance of physical & cognitive
functioning
• Active engagement with life (including
maintenance of autonomy and social
support)
What are the problems with this model?

13. Failure of Biomedical Model
• Fails to address the implications of the
fact that a disease-free older age is
unrealistic for most people.
• Fewer than 20% of older people can be
categorised as having aged successfully
by this traditional biomedical model.
• Even though over 50% would report
themselves as having aged successfully.

14. Criticisms of Biomedical Approach
to SA
• Narrowness – given high prevalence of morbidity
in old age most people are ‘unsuccessfully’ ageing
• SA realistic only for a few
• Lack of continuum
• Failure to address adaptation/disease
management
• Neglect of life course dynamics
• Neglect of earlier Psychosocial
evidence/research.
(Bulow & Soderqvist, 2014)

15. What can affect SA:
• Older adults are exposed to normative
developmental challenges:
– Stressors of social losses
– And increasing frailty
• Which can affect their Quality of Life (QOL)
(Kahana & Kahana, 2003).

16. Theories of Successful Ageing
• Disengagement Theory (Cummings & Henry, 1961)
– Ageing naturally and inevitably entailing a gradual withdrawal from society
– Preparing to die.
– Discredited and outdated by 1980s (Achenbaum, 2000, cited in (Bulow &
Soderqvist, 2014)
• Activity Theory (Havighurst, 1961, 1963)
– Adhering to activities/attitudes of middle age; substituting roles lost by ageing.
– Added happiness and satisfaction in present and past life.
– Similar to Erikson’s Psychosocial theory (Integrity vs despair).
• Continuity Theory (Atchley, 1972)
– Successful agers are those who carry forward their values, lifestyles
and relationships from middle to later life.

17. Theories of Successful Ageing (2)
• Ryff (1989) satisfaction with one’s life, growth
and progress in older age- 6 dimensions of
positive functioning:
– Self-acceptance
– Positive relations with others
– Autonomy
– Control over one’s environment
– Purpose in life
– Personal Growth

18. Led to One Core Idea of SA
• Ryff (1989) – core idea that ageing is:
– a developmental process
– whereby growth is still possible.
• Good Health and High Functioning (Rowe &
Kahn, 1987, 1997), they suggest:
– Avoid disease, & disease-related disability, by
adopting a healthier lifestyle.
– Maintain a high cognitive and physical functional
capacity.
– Above enabling: – prolongation of active engagement
with life.

19. Expansion of SA definitions
Vaillant (2002): Successful Ageing:
– Longevity
– Healthy ageing
– Retirement
– Play
– Creativity
– Generativity, (vs despair - Erikson)
– ‘to love, to work, to learn…to enjoy’.
Erikson – Ego integrity vs despair
Kane (2003): Successful Ageing:
– Broader, includes but transcends health
– + ‘generativity’
– + life course approach to include people who
‘age successfully’ despite illness and
limitations.

20. Psychosocial Approaches to Explaining SA
A different emphasis:
• Adaptation
• Self-acceptance
• Productivity and activity
• Optimising life expectancy
• Independence or autonomy
• Life satisfaction
– Having a purpose in life.
• Personal growth
• Social participation and functioning:
– Positive relations with others
• Psychological resources, including personal growth.
– Personality??
– Good mental Health – What makes you happy?
(Fisher, 1992, cited in Bulow & Soderqvist, 2014))

21. Psychosocial Definitions
Emphasise:
– Reaching one’s potential
– Psychological and social well-being (Gibson,
1995)
– Adaption
– Control
– Productivity
– Social competence
– Self-mastery
– Cognitive efficiency
– Social functioning
(Baltes & Baltes, 1990)

22. Psychological resources for SA
• Positive outlook and self-worth
• Self-efficacy or sense of control over life
• Autonomy or independence
• Effective coping and adaptive strategies in the face
of changing circumstances.
• E.g. in face of ill health – need to activate strategies
to find new activities and maximise ones reserves.
(Baltes & Baltes, 1999)

23. Last 20 Years – Shift in Emphasis
• From Criteria to models of growth.
• Lifespan Model of Selective Optimization with
Compensation Model (SOC-Model) (Baltes &
Baltes, 1990):
– A heterogeneous process with many different
pathways and (successful) outcomes.

24. Sociological-Model
• People select life domains important to them.
• Optimise the resources that facilitate success in
these domains
• Compensate for losses in these domains in order
to adapt to biological, psychological and socio-
economic changes throughout their lives,
• And to create an environment for lifelong
successful development.

25. • Stressors such as declining health may multiply
with age.
• Resources decrease in later life.
• Selection, optimisation and compensation
processes become increasingly important during
ageing.
• To maintain positive balance between gains and
losses (Freund and Baltes, 2000).
• Can be through conscious / unconscious / active /
passive mechanisms.

26. • SA is not about not having to face any losses,
but about dealing successfully with these
negative changes, associated with ageing.
• SOC-model stresses importance of creating
environments in which success is possible
• By choosing between life domains and
prioritizing goals.

27. Research using SOC-model
• Gignac et al. (2002) -SOC-model can explain how
older adults adapt to disability.
• 248 adults over 55yrs with Osteoarthritis
• Found behavioural strategies such as supportive
devices indicating compensation most often
employed.
• Optimization measured by behavioural activities
e.g. Planning activities and walking to avoid pain
= next most frequent strategy.

28. Proactivity Model of SA
(Kahana & Kahana, 1996; 2003)
• Developed to emphasise the potential of all
older adults to meet challenges of ageing
through the use of enacted resources in the
form of proactive adaptation.
• Explores pathways to maintenance of
psychological well-being and engagement in
social activities, even for older adults exposed to
stressors of illness, frailty and social losses.
= normative stressors of ageing that threaten QoL
of older people.

29. Proactive Ageing Study
(Kahana et al., 2012)
• This study investigated how internal and
external resources contribute to the
maintenance of psychological well-being and
social activities among older adults who
experience normative stressors of ageing,
using the Proactivity Model of SA, with 1000
older adults in Florida.
• Longitudinal – 5 annual interviews.

30. Proactive Ageing Study
(Kahana et al., 2012) Results
• Results indicated that:
– stressors negatively influenced QoL 4yrs later
– Internal & External resources led to better QoL 4yrs
later, through proactive adaptations (exercise,
planning ahead, marshalling support and planning for
the future).
• Findings suggest that older adults can maintain
SA even in the face of health-related stressors by:
– invoking accumulated resources to deal actively with
the challenges of ageing.

31. Successful Ageing
• Seen as a dynamic process, as the
outcome of ones development over the
life course
• And as the ability to grow and learn by
using past experiences to cope with
present circumstances
• Whilst maintaining a realistic sense of
self

32. Aim of study: Bowling (2007)
To identify perceptions of successful ageing
among people in middle and older age groups.
Method:
British population survey of a random sample
of 854 community dwelling men and women
aged 50+ – Office for National Statistics
Omnibus Module.

33. Response rates:
• 62%
• 1703 interviews
• Of these, 854 respondents were aged 50+

34. Respondents characteristics:
• Mean age: 64
• <50% males.
• 75% married/cohabiting.
• 75% lived with others, mainly spouses.
• 50% had no educational qualifications.
• 33% reported a limiting longstanding illness.
• >80% reported their health as ‘Excellent’, ‘Very good, ‘Good’.
•
• >80% also rated their quality of life as ‘So good…’/‘Very good’/ ‘Good’.

35. Table 2. Summary of Q1: ‘What do you think are
the things associated with successful ageing?’
Main themes: Total (n=854)
% (no.)
Health and
functioning 66 (565)
Psychological factors 47 (397)
Social roles and
activities 35 (302)
Financial
circumstances 30 (258)
Social relationships 26 (224)
Neighbourhood 10 (83)
Work 6 (51)
Independence 4 (30)

36. Are you ageing successfully so far? Random sample of
people aged 50+ in Britain

37. Self-rated successful ageing:
• 76% of respondents rated themselves as
ageing successfully (‘Very well’ or ‘Well’)
using their own perceptions of SA.
• <20% were categorised as ‘successfully aged’
using a biomedical model of successful ageing

38. People who rated themselves as successfully
ageing more likely to:
• Rate their health positively (Spearmans rho:
0.498, p<0.01),
• Have no reported limiting, longstanding illness
(Spearmans rho: 0.237, p<0.01),
• Rate their quality of life positively (Spearmans
rho: 0.536, p<0.01).

39. Older Adults: Perspective on SA
Viewed SA as:
• A balance between self-acceptance and self-
contentedness on the one hand, and,
• Engagement with life and self-growth in later life
on the other.
• Supports the concept of wisdom as a major
contributor to SA.
Interventions to enhance SA may include:
• Those that promote productive and social
engagement, together with:
• Effective coping strategies.
(Reichstadt et al., 2010)

40. Conclusion:
• Most older people consider themselves to have aged
successfully where classifications based on traditional medical
models do not.
• A biomedical perspective of successful ageing needs balancing with a
psycho-social perspective, and vice versa, and include lay views.
• Successful ageing is an interdisciplinary concept, transcending
boundaries.
– Interaction between biopsychosocial contexts and life choices.
– Lifecourse perspectives and experiences of older people.
– Optimisation and prevention strategies.
Bulow & Soderqvist (2014)

41. References
Baltes, P. & Baltes, M. (1990) Successful Ageing: Perspectives from the Behavioural
Sciences. New York, Cambridge University Press.
Blanchflower, D. & Oswald, A. (2008) "Is well-being U-shaped over the life cycle?," Social
Science & Medicine, 66(8), pages 1733-1749.
Bowling, A. & Dieppe, P. (2005) What is successful ageing and who should define it? BMJ,
331: 24-31.
Bowling, A. & ILIFFE, S. (2006) Which model of successful ageing should be used? Baseline
findings from a British longitudinal survey of ageing Age and Ageing 2006; 35: 607–614.
Bulow, M. H. & Soderqvist, T. (2014) Successful ageing: A historical overview and critical
analysis of a successful concept. Journal of Aging Studies. 31, 139-149.
Gignac, M. Et al. (2002) Adaptation to disability: Applying selective optimization with
compensation to the behaviours of oder adults with osteoarthritis. Psychology and Aging.
17. 520-524.
Kahana, E., Kelley-Moore, J. & Kahana, B. (2012) Proactive aging: a longitudinal study of
stress, resources, agency and well-being in late life. Aging and Mental Health. 16 (4) 438-
451.
Reichstadt, J., Sengupta, G., Depp, C., Palinkas, L., & Jeste, D. (2010) Older Adults’
Perspectives on Successful Aging: Qualitative Interviews. American Journal of Geriatric
Psychiatry. 18:567-575.
Rowe, J. & Kahn, R. (1998) Successful Ageing. New York. Pantheon Books.

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