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What is “Successful Aging”?

by Leslie Kernisan, MD MPH

Every May, the Administration on Aging leads the national observance of “Older Americans Month.” The theme this year is “Engage at Any Age.”

But I found myself thinking that this would be a nice opportunity to consider: just what does it mean to “succeed” or do well as an older adult?

This is important, because our understanding of what is “success,” and what to strive for, is fundamental to how we judge ourselves and others.

And for us as a society, articulating what’s involved in experiencing “good” or “successful” aging is important because it can help us understand what kinds of things we should focus on, to help more older adults age well, or otherwise “succeed” in late-life.

So, just as philosophers and others have long debated what it means to “live a good life,” we should ask ourselves what it means to “succeed” as an older adult.

This way, we can know whether we are “succeeding” as a society that supports and values its older population.

I also did a video elaborating on what it means to be “aging successfully”, which can be found on my Youtube channel.

What IS “successful aging?”

This is not a simple question to answer. It has long been the subject of vigorous inquiry and debate in gerontology. In fact, the journal The Gerontologist devoted an entire issue to the topic of “Successful Aging” in 2015.

(FYI: Gerontology is “the comprehensive study of aging and the problems of the aged,” whereas geriatrics is a medical specialty. We are related but not the same!)

I can’t summarize the debates on what constitutes successful aging here, but if you’d like to read more, this article from The Gerontologist offers a long and detailed overview of different ways that scholars have conceived of successful aging: Defining Successful Aging: A Tangible or Elusive Concept?

A common (and problematic) definition of successful aging

One prominent model of successful aging, developed in the 1990s (Rowe and Kahn), proposed that it means:

  • freedom from disease and disability
  • high cognitive and physical functioning
  • active engagement with life

Gerontologists have gone way past this model, but this may be pretty close to what many people have in mind, when they think of “successful aging” or “aging well.”

And it’s certainly what many images of older adults convey: people who may “look older” but otherwise appear to do everything they could do earlier in life.

This is what we see in this AARP “Disrupting Aging” video, in which millennials are confronted with some older adults who are much more able than the millennials had expected.

But there’s an obvious problem with this conception of successful aging: many, if not most, older adults will eventually not be able to meet all three criteria.

So have they failed? And: will we tend to judge that it’s their fault if they don’t remain disease- and impairment-free as they age?

A better lens on “successful aging”

This article describes a newer way to frame successful aging that I find intriguing. (The authors are Eva Kahana, Boaz Kahana, and Jeong Eun Lee.)

The authors describe a model based on the assumption that with increasing age there is an accumulation of health-related and social stressors.”

They note that if it weren’t for common age-related challenges, there would be no need to distinguish successful aging from successful living at any age. (True!)

They propose that those who maintain good physical health, mental health, and engagement in social activities, without any conscious coping efforts, be referred to as “lucky agers”.

But most people will not be lucky, and hence they need to find ways to cope and adapt to age-related stressors, which include:

  • chronic illness
  • social losses
  • “lack of person-environment fit”

Coping with age-related stressors in a purposeful way, and finding ways to maintain quality of life, is called making “proactive adaptations.”

The authors go on to describe how this can be done in a “preventive fashion” (e.g. anticipating a future or impending age-related stressor) and then also in a “corrective” way, which means making adaptations once a stressor or problem has occurred.

To adapt, an older person must marshal both internal resources (attitude, optimism, coping with challenges) and external resources (available social support, finances, etc).

The main quality of life outcomes in this model include:

  • Self-evaluation of success
  • Life satisfaction
  • Meaning in life
  • Positive affective state (which basically means positive mood or emotions)
  • Valued activities

You can see the model diagrammed out in Figure 1 of the article.

In short: in this model, success is not defined as remaining free of disability or disease as one gets older.

Instead, succeeding means finding ways to cope with impending or existing illnesses, losses, and other challenges, by getting help and by marshaling one’s own resilience and internal resources.

In this way, despite experiencing losses and illness and “lack of person-environment fit” (e.g. a house that is a challenge or dangerous to live in), older people often find ways to meet these challenges.

In doing so, they continue to find ways to experience positive outcomes such as life satisfaction, meaning, contentment, and they are still able to participate in valued activities.

Personally, I like this model. (Granted, it’s a little wonky, but that’s true of all substantive academic work.) I especially like the attention to the way that older adults can be proactive and exert their autonomy by anticipating and adapting to common age-related challenges. In the words of the authors, this “reflects human agency directed at stress reduction, resource development, and problem resolution.”

In other words, this model gives credit to those who acknowledge that their lives may or are changing, and purposefully engage in addressing this.

This takes a certain courage. Which, in truth, is what most older adults muster when the time comes. But you’d never know it to see most media images of older adults, which either portray them as free of late-life stressors or instead emphasize their declines without highlighting their successes in adapting, and their ability to find meaning in a new normal.

How can we support older adults in anticipating & coping with age-related challenges?

Most people will encounter losses and impairments as they age.

What if, as a society, we were less afraid of this, and instead embraced it as an opportunity to be proactive, and then to step up to challenges?

What if as a society, we were better at acknowledging and celebrating the remarkable acts of resiliency and problem-solving that many older people are working their way through?

What if older people felt more comfortable getting help when it becomes necessary? What if we were better at providing it?

These are some of the things that I’ll be thinking about during Older Americans Month.

People really can engage at any age.

We need to make sure that message is clear — and actionable — even for those who aren’t among the “lucky agers.”

Now tell me: what comes to mind when you think of “successful aging”? And what could we collectively do to help more older adults feel successful?

Addendum: Here’s an important and relevant excerpt from the FrameWorks’ Institute’s 2015 analysis of the public view on aging:

“The biggest problem with the dominant patterns of public understanding identified in FrameWorksโ€™ research is
the deep assumption that individuals are exclusively responsible for how they age.

In addition, while we know from previous research that the public maintains an ideal vision of aging, this โ€œidealโ€ is uncontested in these stories, leaving people with a view of aging that, according to experts, is deeply unrealistic.

When the media and advocacy organizations fail to link successful aging to policies that enable older adults to remain active and socially engaged, they actually reinforce the publicโ€™s highly individualistic understandings of the aging process. The result is that people will understand the likelihood of successful aging to be about lifestyle choices rather than as affected by supports, larger social structures, or public policies.”

We must find ways to make it easier for aging adults to get the support they need, both to proactively prepare for late-life stressors and to help them adapt when they occur.

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Filed Under: Aging health, Geriatrics For Caregivers Blog

Comments

  1. Alicia says

    August 28, 2018 at 6:34 pm

    I enjoyed reading other comments. I am 75 and have told that I hold a lot of anger towards my youngest daughter. Aside from PTSD, DEPRESSION AND ANXIETY I AM HANGING ON.

    • Leslie Kernisan, MD MPH says

      August 30, 2018 at 5:14 pm

      Thanks for sharing this comment. Sounds like you are demonstrating resilience!

      Sorry to hear about the anger towards family members. I think it’s something that probably many people struggle with. If you get a chance to talk to an expert counselor, clergy member, or other trained person, it is often possible to make some progress in processing the emotions. I would also encourage any older person with depression or anxiety to keep bringing it up to their health provider, to get help.

      The Institute on Aging in San Francisco also offers a Friendship Line, which is the only accredited crisis line with a focus on older people:
      IOA Friendship Line

      Good luck, take care, and thanks for being part of our community!

  2. Joshua Miller says

    June 27, 2018 at 2:48 am

    Nice and impressive article. I think successful aging is live healthy without any disease . Eating healthy foods and practicing regular exercise could be a key factor. Practicing yoga could also be a good option to reverse the age clock up to certain extent significantly. There are several poses in yoga that can help you to regain and maintain your youthfulness.

    • Leslie Kernisan, MD MPH says

      June 29, 2018 at 9:34 am

      Well, it’s certainly nice to get older and remain disease-free, but not achievable for many. A healthy lifestyle is important and helps in many ways, and yet people may still develop chronic illnesses or age-related limitations.
      I don’t think there is evidence for any particular poses in yoga, but overall, it’s good for balance and flexibility. Older adults doing yoga should make sure that the type of yoga is in line with their abilities.

      • Joshua MIller says

        July 4, 2018 at 5:36 am

        Hi Dear,
        I have found one article at NCBI entitled “Impact of Yoga and Meditation on Cellular Aging in Apparently Healthy Individuals: A Prospective, Open-Label Single-Arm Exploratory Study” that shows the delaying in aging.

  3. Ronald Cole says

    May 17, 2018 at 8:11 pm

    I have read many articles and commentaries on aging and the environment that satisfies the diverse ideas of people as they “retire” and the place they want this to happen. My wife and I moved to a CCRC four years ago (she was 76 and I was 78). We are in a very nice independent living duplex which is separate from the main building. We often hear from friends and others investigating such a residence but commonly hear the phrase – “I’m not ready” for such a move. We often wonder what “ready” looks like. Clearly there are diverse needs and ideas about what is needed and what is going to provide a fulfilling final phase of life.
    A very good book that explores many aspects of this topic was written by Joseph Coughlin PhD entitled “The Longevity Economy” published in 2017. Coughlin is the founder of the AgeLab at MIT where the group is exploring many of these questions including what products older people want.
    As an “almost retired physician”, I have developed a keen interest in gerontology which is very appropriate to a community where the median age is 86 and we have almost 100 residents 90 and older. It is a challenging life experience but we have many delightful friendships and can still participate very fully in the many activities afforded the residents.

    Ron Cole MD

    • Leslie Kernisan, MD MPH says

      May 18, 2018 at 12:22 pm

      Thank you for sharing your story. Yes, the question of whether to move and where to is a perennial quandary for many. I’m glad the CCRC has worked out for you so far.

  4. Janice says

    May 7, 2018 at 11:26 am

    Thanks for a great article! You’ve certainly given me a lot to think about, especially your question — What if older people felt more comfortable getting help when it becomes necessary? I hope you’ll share your ideas on ways we might help.

    • Leslie Kernisan, MD MPH says

      May 8, 2018 at 9:28 am

      Glad you found this article interesting. Re how to help older adults feel more comfortable getting help…we’ll have to figure that together I think!

      Right now research suggests that people often have this very bifurcated vision of aging in which you are either valorized as someone who is older but needs no help and can do everything you could do before, or you are very needy and a “burden” on your family and society. We probably need to create a greater awareness that there is this big middle ground, in which people need some help — which society should be prepared to help support — but still are quite vibrant and able to contribute in many ways, especially if we provide them with the support they need. And also the person that looks very needy and “old” may still have more to offer than people realize, plus should be celebrated for all the adaptations and resilience they have demonstrated.

      In short, we need an attitude adjustment towards aging. People who are not yet older need to learn to think about it differently, and people who are themselves older (whether that’s “young-old” or “older-old”) need to think of it differently as well.

      It’s tricky though, because ageism and negative attitudes about aging — along with the judgement that how you age is a reflection of whether you made good individual choices — are quite entrenched.

  5. Stephen Simac says

    May 7, 2018 at 9:17 am

    Although there is an element of luck involved in disability free aging, that kind of fatalistic view and terminology ignores the vast amount of purposeful disease preventive lifestyle changes that have to be individual choices, since our culture certainly doesn’t support them.

    • Leslie Kernisan, MD MPH says

      May 8, 2018 at 9:15 am

      If a person has made “conscious coping efforts” to be proactive and address lifestyle factors, then I don’t think the model would consider them a “lucky ager.” (Lucky agers are the ones who have done nothing differently and are still doing well.)

      It is true that individuals often have to make a choice to pursue these and that our society doesn’t encourage them much. But that can and should be changed! And this starts in part by us not accepting that aging should be up to the individual to address on their own, but rather should be a societal effort.

      A few years ago, through a project called Reframing Aging, a nonprofit conducted an extensive analysis of media and public perceptions of aging. They found that many people assume that it is up to an individual to “succeed” in aging, because people are unaware of the ways in which social supports and structures make a difference (and sometimes encourage or discourage certain individual activities).

      We need to encourage individuals to make better choices AND we need to drum up appreciation and support for the necessary social infrastructure.

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