Successful aging

Successful Ager

Successful aging (American English) or successful ageing (British English) refers to physical, mental and social well-being in older age. The concept of successful aging can be traced back to the 1950s, and was popularized in the 1980s. It reflects changing view on aging in Western countries, where a stigma associated with old age (see ageism) has led to considering older people as a burden on society. Consequently, in the past most of the scientists have been focusing on negative aspects of aging or preventing the decline of youth.^[1][2]

Research on successful aging, however, acknowledges the fact that there is a growing number of older adults functioning at a high level and contributing to the society. Scientists working in this area seek to define what differentiates successful from usual aging in order to design effective strategies and medical interventions to protect health and well-being from aging.^{[1][3][4][5][6][7]} Researchers in ageing studies are critical of the very term 'successful ageing' as it implies failure on the part of those who do not meet arbitrary criteria derived from neoliberal and/or biomedical definitions.^[8]

Definitions

Old People, old postcard

Elderly Gambian woman's face

Previous research into ageing exaggerated the extent to which health disabilities, such as diabetes or osteoporosis, could be attributed exclusively to age, and research in gerontology exaggerated the homogeneity of samples of elderly people.^[9][10] Other research shows that even late in life, potential exists for physical, mental, and social growth and development.^[11]

Definitions focusing on successful emotional and cognitive aging

Recent studies emphasize the importance of adaptation and emotional well-being in successful aging. New data suggests that for most senior citizens, subjective quality of life is more important than the absence of disease and other objective measures relating to physical and mental health. In two recent studies the vast majority of older people rated themselves as aging successfully, even when they did not meet all objective physical and mental criteria for successful aging.^[12][13] Studies which incorporated the perspectives of older adults into the model of successful aging found that optimism, effective coping styles, and social and community involvement are more important to aging successfully than traditional measures of health and wellness. Additionally, recent studies have shown that for most senior citizens, subjective quality of life is strongly tied with psychosocial protective traits such as resilience, optimism, and mental and emotional status.^{[14][15][16][17][18]}

Specific definitions

To date, there has not been a universal definition for successful aging.^[19] While researchers have for many years tried to create such a definition, nothing really took hold until the late 1990s. 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^[20] This definition was followed for a significant period of time, but, in the last ten years, its usefulness started to be questioned.^[21]

Physical and mental health

Initially, researchers, questioned the first listed criteria—living free of disability or disease. Although disease was decreasing,^[22] 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.^[23] 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.^[24] The term "successful adaptation" had become synonymous with successful aging.^[23] 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".^[25] Even if a person had some physical restrictions, such a people could still lead a very productive life.^[21] Further, research found that more and more older people retained their physical abilities through exercise, among other health related factors.^[26][27] With respect to mental health, studies have shown that depression and strain can be as detrimental as poor physical health.^[25][28]

Cognitive functioning

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,^[20] 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.^[29] 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 an 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.^[30] This level of retention while far from perfect, has been sufficient for many older adults to thrive during their retirement years.^[31] 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.^[32]

Social interaction

The last factor—meaningful interaction with others—has been widely accepted (i.e. social interaction is at the heart of human existence).^[20][21] But, the level of importance of this factor has increased.^[21] 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.^[33] 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.^[32] 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.^[34] We can also view social interaction based on quality and quantity of interactions. Many researchers believed that quality has been most important.^[35] People need others for support and encouragement, as well as for feeling good about themselves.

Social support

A person's ability to interact with others has been consistently viewed as vitally important to successful aging.^[20][21] While the network size for older people decreases with age,^[36] the overall quality of the remaining social connections becomes stronger.^[35] 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.^[37] 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.^[35] Many researchers have believed that social relationships have become the single most important factor in measuring a person's psychological well-being or happiness.^[38]

Subjective well-being and happiness

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".^[39] 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.^[40]

Cognitive reserve

Although many older adults experience some level of deterioration in their cognitive abilities,^[41] 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".^[32] 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.^[41][42][43] In essence, the relationship between neuropathology and clinical symptoms is not necessarily proportional.^[42] 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.^[32][42] 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.^[42] 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.^[32] When "cognitive reserve" exists, a person's executive function is enhanced.^[42] Through this mechanism, a person is able to think with a greater amount of flexibility and function adaptively to novel environments.^[44] For normative and preclinical person's, cognitive training can be extremely instrumental in a person's ability to successfully age.

Genetics of successful aging

A number of studies indicate that there are genetic influences on successful aging beyond those that influence longevity alone. Evidence suggests that successful aging is a multifactorial trait influenced by numerous genes and environmental factors, each making a small contribution to the phenotype. Specifically, genes such as APOE, GSTT1, IL6, IL10, PON1, and SIRT3 may to have individual effects on the likelihood of aging successfully. Additionally, the genes contributing to successful aging can be grouped in several main categories (ontologies):

• Genes involved in the maintenance of cholesterol, lipid or lipoprotein levels. Their ability to metabolize and transport molecules such as cholesterol relates to cardiovascular health, which could directly influence physical activity levels and longevity.
• Genes related to cytokines, which influence inflammation and immune responses. These genes could influence successful aging by regulating cellular senescence, determining susceptibility to age-related cancers, or other mechanisms.
• Genes involved in drug metabolism and insulin signaling.
• Genes related to age-associated pathological processes (e.g., Alzheimer’s disease.)

Recently, successful aging has been also linked to expression levels of genes and length of chromosomal telomeres.^{[45][46][47][48][49]}

Aging-associated wisdom

Telomere

In has been found that mental and psychosocial functioning often improve with age, even if physical health, and some elements of memory decline. Physicians, psychologists and gerontologists argue that age-related wisdom might serve to compensate for the biological losses in old age, thereby enabling older adults to better utilize their remaining resources and age successfully. Age-associated wisdom may help to overcome the negative effects of diseases and stressors that are common in late life and lead to improved mental health and psychosocial functioning. Neurological research has demonstrated that brain growth and development continue into old age – the concept known as neuroplasticity of aging.^{[50][51][52][53]}

Social construct

The idea of successful aging is a social construct which aids in our acceptance of the apparent inevitability and pain associated with the aging process. As successful aging tends to be more dependent on behavior, attitude and environment than on hereditary traits, researchers and clinicians are developing strategies to enhance aging well. Current strategies include restricting calories intake, exercising, quitting smoking and substance use, obtaining appropriate health care, and eating healthy. Seeking help for mental illnesses such as depression is critical, as these conditions interfere with nearly all determinants of successful aging.

Criticism of the term

The notion of successful ageing, a term used in global health and the knowledge-making areas related to ageing (mainly gerontology, the caring professions, and organizations such as WHO), is based on liberal ideas favoring individualistic principles of choice over processes of social constraint.^[54] A neo-liberal and entrepreneurial vision of aging, inspired by gerontological ideals about active and successful lifestyles, has entered the health and retirement fields, with practical and policy consequences.^[55][56] This governmental rationality maximizes individual responsibility in order to minimize dependency in Western countries. In this context, successful ageing depends on an individualistic set of practices determined by predictors around smoking, diet, and exercise. While claims of choice and experimentation have opened new avenues of self-definition, such ideals can diminish the more genuine struggles to live successfully^[57][58] and obscure social inequalities. Stephen Katz reminds us that "lifestyle" (a concept informing the notion of successful ageing) was first positioned by social theorists in a myriad of life chances, status hierarchies and social contexts.^[54] For example, falls are assumed to happen to people who lack some physical control. Prevention programs therefore advocate « active ageing », individual behavioral changes such as exercise regimes (and residential modifications like better lighting).^[59] These strategies do not take into account social differences like class and gender, and also require adequate resources. For example, it seems that women fall more often and suffer more fracture-related falls than do men. These falls take place in a context where femininity is culturally coded as more frail and vulnerable than masculinity and where physical strength in women is not encouraged.^[60] Other gendered factors may be causing their falls, such as their greater use of psychotropic drugs, and not their lack of physical strength.^[61] Policies often sustain and reinforce cultural constructs, such as "frailty", and therefore shape experiences. Such cultural constructions of gender and age, the global economic rationale of cost restriction and the biomedical focus on ageing collide as inscriptions on the bodies of older women.^[62]

See also

• Ageism
• Aging
• Geriatric psychiatry
• Gerontology
• Life expectancy
• Longevity
• Psychiatry
• Supercentenarian

References