Defining Successful Aging: A Tangible or Elusive Concept?
Defining Successful Aging: A Tangible or Elusive Concept?
Aging has been viewed through various lenses throughout history, and over the last 50 years the definition of successful aging has evolved from early theories of activity and disengagement to theoretical approaches with a more direct focus. The major definitions are summarized in Table 1. Some approaches focus more on physical and other approaches more on psychosocial components of successful aging. More recently, successful aging approaches attempt to integrate both into a biopsychosocial approach.
Additional directions are found in nursing and geriatric education (Wykle & Gueldner, 2010) and by incorporating distal experiences, which also define a person's level of "success" (Martin & Martin, 2002). The developmental outcome of life-long experiences could be overall life satisfaction or a well-rounded personality. Appropriately, the focus on experience with a temporal component would bring researchers back to the original definitions first introduced by Havighurst and Neugarten.
Rowe and Kahn (1998) chose "successful" as the counterpart to "usual," rather than a term that better serves as an antonym of usual, such as extraordinary or exceptional. Using extraordinary or exceptional would perhaps be more accurate and less of a value judgment. Missing from Rowe and Kahn's definition is a subjective component. Also, they did not take into account preexisting limitations on "individual choice and effort," such as life-long disability, poverty, and so forth. These latter dimensions are addressed in proactivity-based models such as those proposed by Kahana and Kahana (1996, 2003).
Given the brief history, some of the questions for the next generations of gerontologists interested in providing more parsimonious understanding of successful aging are as follows: (a) What are the minimal definitions needed to describe successful aging? (b) How do we reconcile the various models of successful aging in our research? (c) How important are individual perceptions in the measurement of successful aging? (d) What are some of the primary interactions (e.g., gene and environment, environment and personality, and so forth) that should also be emphasized?
Where is successful dying in the discourse on successful aging? To the extent that successful aging inevitably is followed by death, it behooves us to consider perspectives on success in achieving a good death. Thus far, there have been few if any linkages between a good old age and a good death. The literature on advance care planning primarily offers nursing and medical perspectives, and few psychologists and gerontologists have addressed this issue from a broader perspective, beyond planning for end of life care.
The New England Journal of Medicine recently conducted a poll on physician-assisted suicide among the journal's readers in which people (primarily health care providers) from 74 countries responded. About 65% of votes were against the idea of permitting physician-assisted suicide. The authors concluded that the way in which patients die and the role of palliative care will remain issues of much debate. However, there was general agreement among respondents about the importance of palliative care, including hospice, for helping terminally ill patients (Colbert, Schulte, & Adler, 2013). These critical issues should be an integral piece of the successful aging conversation.
The successful aging literature also lacks much interface with the literature on disability. Although it is increasingly acknowledged that successful aging may be possible even for those with chronic and disabling illness (Phelan et al., 2004), we have not seriously explored the meaning of successful aging for those living with disabilities. Kahana and Kahana's (2001) work on successful aging with HIV/AIDS illustrated the growing scientific interest in this question. This brings us back to Glass's thesis (2003): that successful aging must ultimately be about what older adults value, rather than the chimera of younger adult health in an older adult body.
Our final illustration relates to the need to glance into the future of successful aging in light of rapid social changes propelled by technology and globalization. Future generations of older adults are likely to benefit from major advances in biomedical research, including stem cell research. Will the face of successful aging be very different for healthier and networked elders of the future, who can age in place with the help of mechanical and virtual intelligences, social media, and other technology?
Definitions of successful aging have stimulated research on physical and psychosocial aging over the past 50 years. This is an important accomplishment. The focus on this and similar terms has also provided a background for studying positive aging. Hopefully, the next decades of research on successful aging will further refine definitions of this very important gerontological concept and provide relevant applications.
Summary and Conclusion
Aging has been viewed through various lenses throughout history, and over the last 50 years the definition of successful aging has evolved from early theories of activity and disengagement to theoretical approaches with a more direct focus. The major definitions are summarized in Table 1. Some approaches focus more on physical and other approaches more on psychosocial components of successful aging. More recently, successful aging approaches attempt to integrate both into a biopsychosocial approach.
Additional directions are found in nursing and geriatric education (Wykle & Gueldner, 2010) and by incorporating distal experiences, which also define a person's level of "success" (Martin & Martin, 2002). The developmental outcome of life-long experiences could be overall life satisfaction or a well-rounded personality. Appropriately, the focus on experience with a temporal component would bring researchers back to the original definitions first introduced by Havighurst and Neugarten.
Rowe and Kahn (1998) chose "successful" as the counterpart to "usual," rather than a term that better serves as an antonym of usual, such as extraordinary or exceptional. Using extraordinary or exceptional would perhaps be more accurate and less of a value judgment. Missing from Rowe and Kahn's definition is a subjective component. Also, they did not take into account preexisting limitations on "individual choice and effort," such as life-long disability, poverty, and so forth. These latter dimensions are addressed in proactivity-based models such as those proposed by Kahana and Kahana (1996, 2003).
Given the brief history, some of the questions for the next generations of gerontologists interested in providing more parsimonious understanding of successful aging are as follows: (a) What are the minimal definitions needed to describe successful aging? (b) How do we reconcile the various models of successful aging in our research? (c) How important are individual perceptions in the measurement of successful aging? (d) What are some of the primary interactions (e.g., gene and environment, environment and personality, and so forth) that should also be emphasized?
Where is successful dying in the discourse on successful aging? To the extent that successful aging inevitably is followed by death, it behooves us to consider perspectives on success in achieving a good death. Thus far, there have been few if any linkages between a good old age and a good death. The literature on advance care planning primarily offers nursing and medical perspectives, and few psychologists and gerontologists have addressed this issue from a broader perspective, beyond planning for end of life care.
The New England Journal of Medicine recently conducted a poll on physician-assisted suicide among the journal's readers in which people (primarily health care providers) from 74 countries responded. About 65% of votes were against the idea of permitting physician-assisted suicide. The authors concluded that the way in which patients die and the role of palliative care will remain issues of much debate. However, there was general agreement among respondents about the importance of palliative care, including hospice, for helping terminally ill patients (Colbert, Schulte, & Adler, 2013). These critical issues should be an integral piece of the successful aging conversation.
The successful aging literature also lacks much interface with the literature on disability. Although it is increasingly acknowledged that successful aging may be possible even for those with chronic and disabling illness (Phelan et al., 2004), we have not seriously explored the meaning of successful aging for those living with disabilities. Kahana and Kahana's (2001) work on successful aging with HIV/AIDS illustrated the growing scientific interest in this question. This brings us back to Glass's thesis (2003): that successful aging must ultimately be about what older adults value, rather than the chimera of younger adult health in an older adult body.
Our final illustration relates to the need to glance into the future of successful aging in light of rapid social changes propelled by technology and globalization. Future generations of older adults are likely to benefit from major advances in biomedical research, including stem cell research. Will the face of successful aging be very different for healthier and networked elders of the future, who can age in place with the help of mechanical and virtual intelligences, social media, and other technology?
Definitions of successful aging have stimulated research on physical and psychosocial aging over the past 50 years. This is an important accomplishment. The focus on this and similar terms has also provided a background for studying positive aging. Hopefully, the next decades of research on successful aging will further refine definitions of this very important gerontological concept and provide relevant applications.
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