Aspirations for Older Age in the 21st Century: What is Successful Aging?

Leisure as social engagement: does it moderate the association between subjective wellbeing and depression in later life?

Objectives

To investigate the role of leisure (as social engagement) in moderating the association between subjective wellbeing and depressive symptoms among older Indians.

Methods

The sample included data from 39,538 older adults (aged 55-80) from the Longitudinal Aging Study in India (LASI, Wave-1), 2017-2018. Individual level questionnaire was used to examine the relationship among social engagement, subjective wellbeing, and depressive symptoms. Moderating effects of leisure activities were estimated through interaction analysis and linear multivariable modeling.

Results

Low participation in social engagement activities (or leisure) was associated with greater likelihood of depressive symptoms. Leisure activities positively and significantly moderated the subjective wellbeing among older adults with depressive symptoms. Results suggest a significant wealth gradient where affluent older Indians having a clear advantage in heightened levels of social engagement and subsequently lower likelihood of depressive symptoms. Additionally, being in an urban area, co-residence in a "joint" household and belonging to the dominant social groups in terms of caste and religious categories are associated with gains in wellbeing.

Discussion

The direct and indirect effects of social engagement suggest that depressive symptoms can be mitigated while enhancing overall wellbeing of older adults. This holds promise for social policy in redirecting efforts to develop age-friendly initiatives and social infrastructure that enhance the link between engagement and wellbeing.

60 years of healthy aging: On definitions, biomarkers, scores and challenges

BACKGROUND AND OBJECTIVE

As the proportion of aging people in our population increases steadily, global strategies accompanied by extensive research are necessary to tackle society and health service challenges. The World Health Organization recently published an action plan: "Decade of healthy aging 2020-2030", which calls for concerted collaboration to prevent poverty of older people to provide quality education, job opportunities, and an age-inclusive infrastructure. However, scientists worldwide still struggle to find definitions and appropriate measurements of aging per se and healthy aging in particular. This literature review aims to compile concepts of healthy aging and provide a condensed overview of the challenges in defining and measuring it, along with suggestions for further research.

MATERIALS AND METHODS

We conducted three independent systematic literature searches covering the main scopes addressed in this review: (1) concepts and definitions of healthy aging, (2) outcomes and measures in (healthy) aging studies and (3) scores and indices of healthy aging. For each scope, the retrieved literature body was screened and subsequently synthesized.

RESULTS

We provide a historical overview of the concepts of healthy aging over the past 60 years. Furthermore, we identifiy current difficulties in identifying healthy agers, including dichotomous measurements, illness-centered views, study populations & designs. Secondly, markers and measures of healthy aging are discussed, including points to consider, like plausibility, consistency, and robustness. Finally, we present healthy aging scores as measurements, which combine multiple aspects to avoid a dichotomous categorization and display the bio-psycho-social concept of healthy aging.

DISCUSSION AND CONCLUSION

When deducting research, scientists need to consider the diverse challenges in defining and measuring healthy aging. Considering that, we recommend scores that combine multiple aspects of healthy aging, such as the Healthy Ageing Index or the ATHLOS score, among others. Further efforts are to be made on a harmonized definition of healthy aging and validated measuring instruments that are modular, easy to apply and provide comparable results in different studies and cohorts to enhance the generalization of results.

Prediction of successful aging using ensemble machine learning algorithms

Background

Aging is a chief risk factor for most chronic illnesses and infirmities. The growth in the aged population increases medical costs, thus imposing a heavy financial burden on families and communities. Successful aging (SA) is a positive and qualitative view of aging. From a biomedical perspective, SA is defined as the absence of diseases or disability disorders. This is distinct from normal aging, which is associated with age-related deterioration in physical and cognitive functions. From a social perspective, SA highlights life satisfaction and individual well-being, usually attained through socialization. It is an abstract and multidimensional concept surrounded by imprecision about its definition and measurement. Our study attempted to find the most effective features of SA as defined by Rowe and Kahn's theory. The determined features were used as input parameters of six machine learning (ML) algorithms to create and validate predictive models for SA.

Methods

In this retrospective study, the raw data set was first pre-processed; then, based on the data of a sample of 983, five basic ML techniques including artificial neural network, decision tree, support vector machine, Naïve Bayes, and k-nearest neighbors (K-NN) with one ensemble method (that gathers 30 K-NN algorithms as weak learners) were trained. Finally, the prediction result was yielded using the majority vote method based on the output of the generated base models.

Results

The experimental results revealed that the predictive system has been more successful in predicting SA with a 93% precision, 92.40% specificity, 87.80% sensitivity, 90.31% F-measure, 89.62% accuracy, and a ROC of 96.10%, using a five-fold cross-validation procedure.

Conclusions

Our results showed that ML techniques potentially have satisfactory performance in supporting the SA-related decisions of social and health policymakers. The KNN-based ensemble algorithm is superior to the other ML models in classifying people into SA and non-SA classes.

Cognition in Successful Aging: Systematic Review and Future Directions

Objectives: To characterize the inclusion of cognition in definitions of successful aging (SA) according to empirical studies published in peer-reviewed journals.Methods: A systematic review across ISI Web of Knowledge.Results: Of the 74 included studies, there were 65 studies (87.8%) analyzing cognition as one component of multicomponent SA model (cognitive component studies), and 9 studies (12.2%) focusing solely on successful cognitive aging (SCA studies). Most of the studies operationalized cognition in SA by defining SA group and analyzing single SA indicators. A minority of the studies calculated the SA index. Finally, emergent techniques to operationalize SA as a latent variable and emergent field of cognition in SA in pathology were identified.Conclusions: The results highlight that cognition is being included in SA using different levels of complexity. Even though research investigating SA in pathology is emerging, there is currently a lack of utilization of the concept in pathological and at-risk populations.Clinical implications: The current research of cognition in SA provides several valid options to evaluate if a person is aging successfully. The emerging research indicates that people from at-risk and pathological populations can age successfully.

Aging Well for Indigenous Peoples: A Scoping Review

As life expectancy increases for Indigenous populations, so does the number of older adults with complex, chronic health conditions and age-related geriatric syndromes. Many of these conditions are associated with modifiable lifestyle factors that, if addressed, may improve the health and wellbeing of Indigenous peoples as they age. If models of healthy aging are to be promoted within health services, a clearer understanding of what aging well means for Indigenous peoples is needed. Indigenous peoples hold a holistic worldview of health and aging that likely differs from Western models. The aims of this review were to: investigate the literature that exists and where the gaps are, on aging well for Indigenous peoples; assess the quality of the existing literature on Indigenous aging; identify the domains of aging well for Indigenous peoples; and identify the enablers and barriers to aging well for Indigenous peoples. A systematic search of online databases, book chapters, gray literature, and websites identified 32 eligible publications on Indigenous aging. Reflexive thematic analysis identified four major themes on aging well: (1) achieving holistic health and wellbeing; (2) maintaining connections; (3) revealing resilience, humor, and a positive attitude; and (4) facing the challenges. Findings revealed that aging well is a holistic concept enabled by spiritual, physical, and mental wellbeing and where reliance on connections to person, place, and culture is central. Participants who demonstrated aging well took personal responsibility, adapted to change, took a positive attitude to life, and showed resilience. Conversely, barriers to aging well arose from the social determinants of health such as lack of access to housing, transport, and adequate nutrition. Furthermore, the impacts of colonization such as loss of language and culture and ongoing grief and trauma all challenged the ability to age well. Knowing what aging well means for Indigenous communities can facilitate health services to provide culturally appropriate and effective care.

Exploring the Relationships Between Four Aging Ideals: A Bibliometric Study

When examining research articles on the aging strategies, four ideals (i.e., successful aging, healthy aging, productive aging and active aging) could be explored by conducting bibliometric analyses. For the literature analysis, general information on the four aging ideals was understood through visualization analysis; the intellectual base and research hotspots were intuitively observed. CiteSpace was used as the method to conduct the co-occurrence analysis of keywords in order to obtain research trends and cutting-edge knowledge in the field of aging-related policies. Subsequently, the study revealed the nature of the link between these four aging ideals and disclosed the connection between their fundamental principles. The study ultimately enhanced the understanding of the diverse contexts that have impacted the way in which these ideals influence policy, which has caused dissimilar strategies for policy development. The study also extended the discussion of the definitions of and relationships between these four ideals with the goal of identifying new directions for aging-related practice and providing innovative insights and references for investigators.

Reflections on music therapy with older adults from an ethnographic perspective

Purpose

Older adults often navigate periods of disruptive transition, such as rehousing, that can be understood in terms of ritual transformation, a concept that describes changes to the social self in terms of deconstruction, liminality and reconstruction. Music therapy can assist older adults’ movement through these stages. This paper aims to engage theoretical perspectives on ritual to consider the social and cultural transformation of these residents of a long-term care nursing home.

Design/methodology/approach

Ethnographic theory and literature on the ritual process are used to reflect on one music therapist’s (first author’s) experience providing music therapy to older adult residents of a long-term care nursing home. The therapist facilitated a collaborative “healing story” whose performative aspects engaged the residents in their own healing process. These experiences culminated in a group songwriting experience with a resident choir ensemble.

Findings

The healing narrative involved aspects of the person, selfhood, relationship and culture more than elements of physicality or functional abilities. Music therapists working with older adults may find this theoretical perspective informative in interpreting resident behaviors and needs, identifying and addressing therapeutic goals and fostering a healing narrative.

Originality/value

Care and interventions for older adults are often guided by the biomedical model of aging as an illness. While sociological and psychological theories of aging offer alternatives, these are not always prominent in interventions. This exploration of aging and transition as ritual transformation offers one such needed and insightful perspective to inform practice.

Perceived Time, Frequency, and Intensity of Engagement and Older Masters Athletes' Subjective Experiences

Masters athletes are a unique group of older adults whose experiences may provide valuable insights into the role of sport for successful aging. The purpose of this study was to explore whether masters athletes' social and psychological experiences vary with their time, frequency, and perceived exertion in training and competition. Semi-structured interviews were conducted with 40 men and women older masters athletes, aged 50–79 years (M = 66), who were active at the competitive level across a variety of sports (e.g., volleyball, curling, rowing, dragon boating, running, swimming, and basketball) at the time of the study. Results indicate that all participants experienced social and psychological benefits from engaging in masters sport. Only the high-frequency engagement subgroup (participating five to seven times per week in training and/or competition) reported social downsides, in terms of missing time with family and friends outside of masters sport. However, some participants described the positive family support (e.g., spouse who endorses sport participation) that overrides some of the social costs. These findings have implications for realizing positive experiences with minimal engagement in masters sport, yet an apparent threshold of participation beyond which negative social consequences may be experienced. This is an important consideration for the design and promotion of sport for older adults.

Testing a Model of Successful Aging on Masters Athletes and Non-Sporting Adults

Purpose: To test confirmatory factor analyses of successful aging composed of physical, psychological, cognitive, and social functioning factors in masters athletes (n = 764) and non-sporting adults (n = 404), and compare the physical, psychological, cognitive, and social functioning of masters athletes versus non-sporting adults. Method: Self-reported cross-sectional data were analyzed with confirmatory factor analyses. Results: Physical, psychological, cognitive, and social functioning latent factors significantly loaded onto a higher-order successful aging latent factor (p < .05). Masters athletes had higher physical and social functioning than non-sporting adults (p < .05). Psychological and cognitive functioning did not differ between groups. Conclusions: Successful aging should be considered as a multi-faceted construct consisting of different domains of functioning for both masters athletes and non-sporting adults. Masters athletes were aged successfully relative to the non-sporting adults across the physical and social functioning domains. Physical, psychological, cognitive, and social functioning domains constitute an appropriate model to use in future experimental research investigating the effect of masters sport for successful aging.

Effects of a 12-Week Cycling Intervention on Successful Aging Measures in Mid-Aged Adults

Purpose: To compare the effect of 12-weeks of cycling training and competition versus recreational cycling on successful aging across physical, psychological, cognitive, and social functioning domains in mid-aged adults. Methods: Recreational cyclists were randomly assigned to an intervention (n = 13, M age = 47.18 years) and comparison (n = 13, M age = 46.91 years) group. Analysis of Covariance was used on self-reported pre-post data to determine changes across time and differences between groups on outcomes. Results: The intervention group scored higher on the role limitation due to physical problems measure of physical functioning (p = .045) and the social activity measure of social functioning (p = .008) with large effect sizes (η_p ² > .14). The remaining physical, psychological, cognitive, and social functioning measures were not significantly different (p > .05) between groups with small to medium effect sizes (η_p ² > .01 to ≤ .06). Conclusion: Cycling training and competition promotes better physical and social functioning than recreational cycling. This finding indicates that an intervention that incorporates the training and competition aspects of sport may promote positive outcomes that are above and beyond those that can be gained from participation in recreational physical activity. Objective measurements on larger samples across a broader range of sports are required to confirm and extend these findings.

Effects of subjective successful aging on emotional and coping responses to the COVID-19 pandemic

BACKGROUND

Middle-aged and older adults are more vulnerable to hospitalization and mortality if they are infected with the COVID-19 virus. The present study investigates the longitudinal effects of subjective successful aging on middle-aged and older adults' emotional and coping responses to the COVID-19 pandemic, and explores an underlying mechanism through perceived time limitation during the pandemic.

METHODS

A sample of 311 Hong Kong Chinese middle-aged and older adults (M_age = 64.58, SD = 10.14, Range = 45-90 years) were recruited from an Adult Development and Aging Project and participated in a questionnaire study via an online platform or phone interview. Their levels of subjective successful aging, perceived time limitation, and emotional and coping responses to the pandemic were measured.

RESULTS

The respondents who perceived themselves as more successful in aging process reported more positive and fewer negative emotions compared with their counterparts with lower levels of subjective successful aging. The mediation analysis showed that perceived time limitation could partially account for the effects of subjective successful aging on emotional and coping responses.

CONCLUSIONS

Findings of this study unveil the beneficial effects of subjective views of successful aging on emotional and coping responses to the pandemic through alleviating their perception of time limitation.

Adiponectin/AdipoRs signaling as a key player in testicular aging and associated metabolic disorders

Aging undergoes serious worsening of peripheral organs and vital physiological processes including reproductive performances. Altered white adipose tissue and adipocyte functioning during aging results in ectopic lipid storage/obesity or metabolic derangements, leading to insulin resistance state. Eventually, accelerating cellular senescence thereby enhancing the high risk of age-associated metabolic alterations. Such alterations may cause derangement of numerous physiologically active obesity hormones, known as "adipokines." Specifically, adiponectin exhibits insulin sensitizing action causing anti-aging and anti-obesity effects via activation of adiponectin receptors (AdipoRs). The male reproductive physiology from reproductive mature stage to advanced senescent stage undergoes insidious detrimental changes. The mechanisms by which testicular functions decline with aging remain largely speculative. Adiponectin has also recently been shown to regulate metabolism and longevity signaling thus prolonging lifespan. Therefore, the strategy for activating adiponectin/AdipoRs signaling pathways are expected to provide a solid basis for the prevention and treatment of aging and obesity-associated reproductive dysfunctions, as well as for ensuring healthy reproductive longevity in humans.

Factors associated with successful aging in Brazilian community-dwelling older adults: When physical health is not enough

OBJECTIVES

To determine the main factors (physical, psychological, social and spiritual) associated with successful aging in community-dwelling older adults.

METHODS

A cross-sectional study of older adults was conducted evaluating successful aging (Successful Aging Scale-SAS) and its associated factors (sociodemographics, resilience, religiosity/spirituality, meaning in life, quality of life, social support, self-reported diseases, mental health, medications used, among others) using regression models.

RESULTS

A total of 534 older adults were assessed. Linear regression models showed an association of higher SAS score with greater resilience (Beta = 0.371, p < 0.001), spiritual well-being - meaning (Beta = 0.174, p < 0.001) and quality of life - physical (Beta=0.203, p < 0.001), fewer diseases (Beta=-0.128, p < 0.001), greater meaning in life (Beta=0.116, p = 0.001), less loneliness (Beta=-0.133, p = 0.001), lower tobacco use (Beta=0.080, p = 0.013), greater quality of life - environment (Beta=-0.092, p = 0.013) and more frequent religious attendance (Beta=0.068, p = 0.035).

CONCLUSION

The study results suggested that physical factors, although relevant, were not the main factors associated with successful aging.

Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults' life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.

Determining the importance and feasibility of various aspects of healthy ageing among older adults using concept mapping

Research shows that healthy ageing is defined differently by older adults and researchers, who may put more or less weight on the physiological, psychological, societal and personal aspects of ageing. Although there is growing interest in the research literature on lay models of healthy ageing in socio-cultural context, little work has been done to determine how important or feasible the various components of healthy ageing are viewed to be by older adults. This study asked a convenience sample of 54 older adults in the circumpolar North to rate the importance and feasibility of 36 previously identified components of healthy ageing in their community. Results indicate that seniors in the sample place the most importance on aspects of the social and physical environment, while least important concepts included psychological and individual behaviours. However, most feasible aspects were individual behaviours and least feasible were aspects of the social and physical environment. Although older adults are able to construct a model of what healthy ageing should look like in their community, they do not always view the most important aspects of healthy ageing to be the most feasible to achieve, providing ample opportunity for public and social policy change.

Population Priorities for Successful Aging: A Randomized Vignette Experiment

Objectives

Aging populations have led to increasing interest in “successful aging” but there is no consensus as to what this entails. We aimed to understand the relative importance to the general population of six commonly-used successful aging dimensions (disease, disability, physical functioning, cognitive functioning, interpersonal engagement, and productive engagement).

Method

Two thousand and ten British men and women were shown vignettes describing an older person with randomly determined favorable/unfavorable outcomes for each dimension and asked to score (0–10) how successfully the person was aging.

Results

Vignettes with favorable successful aging dimensions were given higher mean scores than those with unfavorable dimensions. The dimensions given greatest importance were cognitive function (difference [95% confidence interval {CI}] in mean scores: 1.20 [1.11, 1.30]) and disability (1.18 [1.08, 1.27]), while disease (0.73 [0.64, 0.82]) and productive engagement (0.58 [0.49, 0.66]) were given the least importance. Older respondents gave increasingly greater relative importance to physical function, cognitive function, and productive engagement.

Discussion

Successful aging definitions that focus on disease do not reflect the views of the population in general and older people in particular. Practitioners and policy makers should be aware of older people’s priorities for aging and understand how these differ from their own.

Cross-Cultural Comparisons in Implicit and Explicit Age Bias

Most research documenting bias against older adults has been conducted in individualistic and industrialized cultures. In the current study, we examined cultural variation in attitudes toward older adults and subjective age in a large sample of 911,982 participants (M_age = 27.42, SD = 12.23; 67.6% women) from 68 different countries (M_size = 12,077; Mdn_size = 425.5). We hypothesized that age bias would be lower among those living in highly collectivistic countries. We found that living in collectivistic countries was associated with less implicit and explicit age bias, and greater feelings of warmth toward older adults compared with highly individualistic countries. Given the impact of age bias and prejudice on both the targets and perpetrators of bias, further research is needed to examine the causes of and interventions for bias against older adults.

Cross-cultural adaptation and psychometric properties of the Brazilian Portuguese version of successful aging scale in community-dwelling older adults

There is a growing consensus regarding the multidimensional nature of successful aging (SA), including both the biomedical and psychosocial domains of the aging process. The Successful Aging Scale (SAS) is a self-rated instrument addressing both of these components. The aim of this study was to analyze the psychometric properties of the Brazilian Portuguese version of the SAS (SAS-B) with regard to reliability and validity in 949 Brazilian community-dwelling older adults (53.60% women; M = 69.49 years; standard deviation = 7.67). Confirmatory factorial analysis (CFA) was performed to provide evidence on its structural validity. Convergent and divergent validity was studied by means of examining the relationships of SAS-B with scales concerning resilience, life satisfaction, self-esteem, social support, perceived stress, and health, as well as mental health. The CFA showed that the SAS-B is multidimensional with three correlated factors (χ² /df = 2.74; standardized root mean square residual = 0.03; root mean square error approximation = 0.04; comparative fit index = 0.91), and its factors showed adequate reliability (ω = 0.70 for Healthy living habits, ω = 0.69 for Adaptive coping, and ω = 0.70 for Engagement with Life). Convergent and divergent validity was endorsed by correlations with related factors. The SAS-B is a reliable and valid self-rated instrument to measure the SA from a multidimensional perspective.

Aging With Disability: Populations, Programs, and the New Paradigm An Introduction to the Special Issue

Objective: The purpose of this article is to introduce a special issue dedicated to research at the intersection of aging and disability. Method: We provide some context for the importance of cross-disciplinary collaboration among aging and disability researchers and summarize the nine articles in this issue. Results: Articles in the special issue are centered around several overarching themes. These include meaningful social and community participation, goals and values in the context of disability, and the reach and effectiveness of programs and policies on rehabilitation and service utilization. Conclusion: As care models continue to merge aging and disability services, collaboration among traditional aging and disability research networks can lead to improved outcomes for adults aging with long-term disability.

Association between obesity status and successful aging among older people in China: evidence from CHARLS

Background

The paper aimed to examine the association between obesity status and successful aging among elderly adults in China and further find gender differences in the effect of components of successful aging on obesity status.

Methods

The data came from the follow-up survey(2015) of China Health and Retirement Longitudinal Study (CHARLS) and 4019 dwellers age 60 and over are included. Obesity status were defined by the body mass index (BMI) according to Chinese criteria. Successful aging was defined following Rowe and Kahn’s multidimensional model. Multivariable logistic regression was used to estimate the relationship between obesity status and successful aging.

Results

The rate of successful aging in men and women was 18.87 and 9.48% respectively. For BMI, the proportion of population with underweight, overweight and obesity in men was 10.29, 23.04 and 29.63% respectively and that in women was 1.40, 11.69 and 9.47%. Men with obesity (OR = 1.587 95% CI 1.087 ~ 2.316) has an positive relationship with successful aging than normal weight men; Women with underweight (OR = 0.197 95% CI 0.058 ~ 0.824) has an negative relationship with successful aging than normal weight women; Meanwhile, no matter men and women, the relationship between obesity status and successful aging were not significant among oldest adults(≥75 years).

Conclusion

Obesity status was significantly association with successful aging in young older adults (60-74 years), and the components of successful aging differently were related with the obesity status of male and female.

Identity, civic engagement, and altruism: a phenomenological exploration of activity engagement in older adults

BACKGROUND

Older adults' health and quality of life, proxies for aging well, are tied to activity engagement. Recent research indicates studying the perspective of older adults through their personal stories is key to understanding the phenomenon of occupational engagement as experienced day-to-day.

AIM

To uncover the lived experience of older adults within their natural settings to better understand the phenomenon of activity engagement. This new knowledge informs programming options suited to older adults' wants and needs.

MATERIALS/METHODS

Ten community-dwelling older adults (5 female, 5 male mean 79 years) were studied. Researchers performed phenomenological interpretive analysis (IPA) with multiple coders and member cheques to triangulate findings.

RESULTS

Daily activities revolved around three themes: 1) Perspectives of self-identity are viewed as consistent throughout the lifespan; 2) Civic engagement is beneficial for social support and self-efficacy; and 3) Philosophical outlook influences activity choices and outlooks centred on altruism are critical to continued activity engagement. Seven of the ten participants expressed an overall positive outlook on aging. Three participants described a negative outlook on aging, expressed more difficulty with activity engagement, but reported desire to help others.

CONCLUSIONS AND SIGNIFICANCE

These themes provide a basis for programming to increase activity engagement with older adults in the community.

Mental well-being among the oldest old: revisiting the model of healthy ageing in a Finnish context

Purpose: This study aimed to examine how participants aged 80 years old or over describe their mental well-being—exploring the suitability of the model of healthy ageing when outlining the mental well-being concept.

Methods: Six structured focus group interviews with 28 participants were conducted in Western Finland in 2017. Qualitative content analysis was performed, where both manifest and latent content was considered in a process involving meaning condensation and coding, followed by categorization.

Results: The healthy ageing model constituted a useful framework for the conceptualization of mental well-being, illustrating the links between these two constructs. The analysis resulted in a four-dimensional model of mental well-being in oldest old age, the key components being: Activities—enjoyment and fulfilment; Capability—functioning and independence; Orientation—awareness, shifted perspectives and values; and Connectedness—sense of belonging.

Conclusions: Although functional status plays an important role for well-being in general, it is not the principal component of self-reported mental well-being within the heterogeneous group of the oldest old. Further, many persons in this age group do not view themselves as passive or dependent, on the contrary, they underline the importance of empowering attitudes, a positive mindset and actively creating circumstances which support their mental well-being.

Livable Environments and the Quality of Life of Older People: An Ecological Perspective

BACKGROUND AND OBJECTIVES

The WHO "Framework for Policy for Healthy Ageing' (2015) focuses on the broader environment and the support it provides for everyday functioning of older people. The concept of "livability" supports this framework by providing a conceptualization of environments that support good quality of life.

RESEARCH DESIGN AND METHODS

This observational study used an ecological framework of livability to assess cross-sectional relationships between living environments and perceived quality of life among 4,028 respondents, aged 50-89 years who were surveyed in 2016. A 4-step hierarchical model regressed quality of life on individual resources (health, chronic conditions, SES), contextual variables (distance to health care; rural/urban setting), perceptions of housing and neighborhood environments (housing satisfaction, neighborhood quality, neighborhood social cohesion), and interactions between these levels of the ecological model.

RESULTS

As predicted, housing and neighborhood perceptions contributed an additional 5% variance to the model which explained 49% of quality of life. There were significant interactions between the contextual variables and qualities of housing and neighborhood.

DISCUSSION AND IMPLICATIONS

These findings support the importance of material and social provisions of housing and neighborhoods to quality of life among older people. The ecological model highlights critical information provided by taking different levels of the environment and personal circumstances into account. The concept of "livability," focusing on perceptions of the environment, can assist a shift from seeking the universal ideal neighborhood toward understanding the ways in which different communities may achieve quality of housing and neighborhood facilities that meet community members' needs.

Successful Present, Successful Future? Assessment of a Nonbinary Model of Successful Aging

PURPOSE

Though many models of successful aging exist, there is a need for assessments of the empirical validity of these models and their measures. This study tests the validity of the multidimensional model of successful aging presented by Young and colleagues.

DESIGN AND METHODS

Expanding on an earlier validation study, this analysis uses 1,211 respondents from the Americans' Changing Lives (ACL) study to determine predictive and discriminant validity. Respondents were surveyed in 1986, 1989, and 1994, providing an opportunity to assess if a baseline 5-point successful aging scale is associated with present and future outcomes. Validators include self-report items and interviewer recorded observations. In addition, a survival analysis of 24 years of ACL mortality data is conducted to confirm that baseline successful aging decreases risk of all-cause mortality.

RESULTS

Results illustrate that, in some cases as far as 8 years in the future, low successful aging scores correspond with higher risk of future hospitalization and depressive episodes, interviewer observed difficulty moving around, low self-rated health, and decreased life satisfaction. Lowest scorers also had a 356% higher risk of mortality compared to individuals with the highest scores.

IMPLICATIONS

These findings provide further evidence that Young and colleagues' successful aging construct is empirically valid and could be applied in future research and practice. Most respondents had middling scores, suggesting that future analyses should be cautious about concealing heterogeneity by operationalizing successful aging as a binary outcome.

Social Support and Life Satisfaction of Ethnic Minority Elderly in China

Previous studies indicate that Han and ethnic minority groups in China are not homogeneous. However, little research has examined potential heterogeneity in the association between social support and life satisfaction across Han and ethnic minority elderly. Based on data from the 2014 China Longitudinal Aging Social Survey, this study uses ordered logit models with interaction terms to examine the relationship between social support and the life satisfaction of ethnic minority elderly and of elderly Han Chinese. We find that support from families and friends has a stronger association with the life satisfaction of ethnic minority elderly than their Han peers. For ethnic minority elderly, the patterns of family support varied according to rural or urban residence, with family support being less important to the life satisfaction of ethnic minority elderly living in urban communities than in rural areas. Our findings suggest that social policy should take this heterogeneity between ethnic groups into account.

Lifestyle predictors of successful aging: A 20-year prospective HUNT study

BACKGROUND

Lifestyle factors predicting successful aging as a unified concept or as separate components of successful aging are important for understanding healthy aging, interventions and preventions. The main objective was to investigate the effect of midlife predictors on subsequent successful aging 20 years later.

MATERIALS AND METHODS

Data were from a population-based health survey, the Nord-Trøndelag Health Study (HUNT), with an average follow-up of 22.6 years. Individuals free of major disease at baseline in 1984-86 with complete datasets for the successful aging components in HUNT3 in 2006-08, were included (n = 4497; mean age at baseline 52.7, range 45-59, years). Successful aging was defined either as a unified category or as three components: being free of nine specified diseases and depression, having no physical or cognitive impairment, and being actively engaged with life. The midlife predictors (smoking, physical activity, alcohol consumption, obesity and social support) were analysed both as separate predictors and combined into a lifestyle index controlling for sociodemographic variables, using multivariable regression analysis.

RESULTS

Successful aging as a unified concept was related to all the lifestyle factors in the unadjusted analyses, and all except alcohol consumption in the adjusted analyses. The individual components of successful aging were differently associated with the lifestyle factors; engagement with life was less associated with the lifestyle factors. Non- smoking and good social support were the most powerful predictors for successful aging as a unified concept. When the lifestyle factors were summed into a lifestyle index, there was a trend for more positive lifestyle to be related to higher odds for successful aging.

CONCLUSIONS

Lifestyle factors predicted an overall measure of SA, as well as the individual components, more than 20 years later. Modifiable risk factors in midlife, exemplified by social support, may be used for interventions to promote overall health and specific aspects of health in aging.

Before evening falls: Perspectives of a good old age and healthy ageing among oldest-old Swedish men

The late life experiences of men in the oldest-old age group have been under-researched, and their perspectives on ageing successfully neglected. This study explored the perspectives of oldest-old Swedish men on what a 'good old age' and ageing successfully meant to them. A purposive sample of 17 men, aged 85-90 years, was drawn from the Uppsala Longitudinal Study of Adult Men. An interview guide explored participants' perspectives on their ageing experiences and how they viewed ageing successfully. Participants were interviewed twice, with 1-2 weeks between interviews, and both interviews were recorded and transcribed. Content analysis identified four themes: i) Adaptation, concerning the ability to adapt to growing old with increasing limitations; ii) Sustaining Independence, related to financial resources and good health as the foundation for independence; iii) Belongingness, representing close relationships, established friendships, and the significance of the spouse; and iv) Perspectives of Time, also a common thread in all themes, in which past life experiences create an existential link between the past, the present and the future, establishing continuity of the self and enhancing life satisfaction. The participants presented themselves as active agents involved in maintaining meaning and achieving life satisfaction; a process related to the ability to manage changes in life. Our findings have resonance with models of healthy or successful ageing, but also diverge in important ways, since such models do not consider the significance of an individual's life history for their present well-being, and primarily conceptualise health as an outcome, rather than as a resource.

Binary and Nonbinary Measures of Successful Aging: Do They Yield Comparable Conclusions?

Recently, some researchers have employed nonbinary measures of successful aging. Little has been done to determine whether these newer measures yield similar findings compared to traditional binary measures. To test for differences, three measures of successful aging were constructed within five waves of the Americans' Changing Lives data set. A number of demographic, behavioral, and psychosocial predictors were used to predict each outcome, examining whether estimates of effect sizes and statistical significance were similar across measures. Although many effect sizes were similar, conclusions regarding statistical significance were inconsistent. For instance, the binary measure downplayed income gradients, the ordinal measure found more racial disparities, and the continuous measure was most likely to detect effects for stressful life events. These differences may be due to the statistical techniques used to handle each outcome. Results imply that uneven application of operationalization approaches may complicate replication efforts, suggesting a need for consistent measurement standards.

Domains and determinants of a person-centered index of aging well in Canada: a mixed-methods study

OBJECTIVES

The objectives of this study were to explore the perspectives of older adults about the most important domains of aging well and to identify the social determinants of a person-centered index capturing these domains.

METHODS

We conducted a mixed-methods study of 40 semi-structured interviews and epidemiological data from 670 older adults participating in the International Mobility in Aging Study (IMIAS) in Saint-Hyacinthe and Kingston. A composite index capturing the domains of aging well was constructed on the basis of findings from qualitative content analysis. Bivariate and multivariate regressions were carried out to examine the determinants of aging well, including economic determinants, health behaviours, health services, and the social environment.

RESULTS

The qualitative results confirm the importance of symptomatic health conditions and psychosocial components. The index was computed as a continuous score (0 to 100) containing health components (ADL disability, mobility disability, pain, self-rated health, and cognitive function), and psychosocial components (mood, productive activities, social relations, life satisfaction, and self-mastery). Mean scores were 81 among Canadian older adults, and 83 and 79 for men and women respectively. Being male, having sufficient income, doing leisure physical activity, and feeling safe in one's neighbourhood were all significantly associated with a higher score on the aging well index.

CONCLUSION

The composite index highlights important aspects of health and psychosocial well-being that could be augmented according to older adults themselves. Modifiable social determinants of aging well could guide social and health policies to maximize well-being in this population.

[Self-care: New evidence for its measurement in older adults]

INTRODUCTION

A major challenge in today's society is getting older people, not only live longer, but to have a better life, and achieve successful aging. Self-care has been identified as relevant construct in its relation to physical, psychological, and social health. Therefore, this paper aims to provide first evidence of the psychometric properties of a scale to assess self-care in older people.

MATERIAL AND METHODS

The sample consisted of 443 people aged between 60 and 80years (M=66.11, SD=4.72), all of them currently participating in lifelong learning programs. There were 64.2% women, and most participants were married (73.7%). They were asked to complete the Self-Care for Older People Scale (SCOPS), the SF-8 Health Perception scale and, the Life Satisfaction scale (SWLS). Data were analysed using confirmatory factor analysis, and scale correlations between self-care and variables from its nomological network.

RESULTS AND CONCLUSIONS

The tested model provided an adequate fit to the data: χ²(23)=64.257 (P<.001); comparative fit index (CFI)=.936; Tucker Lewis Index (TLI) =.899; standardized root mean square residual (SRMR) =.070; root mean square error of approximation (RMSEA) =.064 (.046-.083), supporting the original structure of three factors: physical, social, and internal self-care. These factors also showed statistically significant correlations with two important variables of their nomological network, perceived health and life satisfaction.

Successful Aging and Chronic Osteoarthritis

Background: Aging is commonly accepted as a time period of declining heath in most cases. This review aimed to examine the research base concerning the use of the term 'successful aging', a process and outcome deemed desirable, but challenging to attain. A second was to provide related information to demonstrate how health professionals as well as individuals can aim for a 'successful aging' process and outcome, despite the presence of disabling osteoarthritis. Methods: Information specifically focusing on 'successful aging' and the concept of improving opportunities for advancing 'successful aging' despite osteoarthritis was sought. Results: Among the many articles on 'successful aging', several authors highlight the need to include, a broader array of older adults into the conceptual framework. Moreover, conditions such as osteoarthritis should not necessarily preclude the individual from attaining a personally valued successful aging outcome. Conclusions: Pursuing more inclusive research and research designs, and not neglecting to include people with chronic osteoarthritis can potentially heighten the life quality of all aging individuals, while reducing pain and depression, among other adverse aging and disability correlates among those with osteoarthritis.

Aging and exercise: Perceptions of the active lived-body

Exploring older people's evocation of their positive experiences of aging has been proposed as a counterweight to the Western stereotype of aging as a process of decline. The aim of this article is to explore how aging women, who participate regularly in group exercise classes, perceive their own bodies and the bodies of others. This article reports on the findings from interviews with 16 women between the age of 70 and 85. We analyzed the data using qualitative content analysis. Two overarching and interrelated themes concerning body perception emerged from the interviews: "The aging body and appearance" and "The body as subject and object." The binary discourse of old age, as either a decline or a success appears in our findings. The training contributes to a sense of well-being experienced through perceived increased physical abilities, self- image and self-esteem. Physical ability was perceived as being more important than appearance by the participants in this study, considering their preconception of an association between declining health, abilities, and older age. Involvement in physical activity appears to play a significant role in the perception of the women's own aging. Although physical attractiveness is a desirable outcome, the most important positive impact of the group exercise was related to increased social belonging and well-being, physical abilities, and capabilities. Thus implications for practice suggests that an intensive group training contributes to the opinion that an aging body is not necessarily a barrier to positive and successful aging.

Testing a Model of Successful Aging in a Cohort of Masters Swimmers

Due to their high physical functioning, masters athletes are regularly proposed to exemplify successful aging. However, successful aging research on masters athletes has never been undertaken using a multidimensional successful aging model. To determine the best model for future successful aging research on masters athletes, we had masters swimmers (N = 169, M age = 57.4 years, 61% women) self-report subjective successful aging, and physical, psychological, cognitive, and social functioning. Using this data we tested one hypothesized and three alternative successful aging models. The hypothesized model fit the data best (-2LL = 2052.32, AIC = 1717) with physical (β = 0.31, SE = 0.11), psychological (β = 0.25, SE = 0.11), and social (β = 1.20, SE = 0.63) functioning factors significantly loading onto a higher order successful aging latent factor. Successful aging should be conceptualized as a multidimensional phenomenon in future masters athlete research.

A qualitative description of successful aging through different decades of older adulthood

OBJECTIVE

To qualitatively examine factors that contribute to successful aging during different decades of older adulthood.

METHODS

Fundamental qualitative description was adopted as the methodological framework. Through purposeful sampling, 42 community dwelling older adults (mean age = 79.6 years, age range = 65-97 years; 19 males) were recruited. Focus groups (6) segmented by decade of life were conducted with participants 65-74 (n = 17) and 75-84 (n = 17) years of age. Semi-structured interviews (16) were conducted with four participants from each decade, as well as participants 85 years of age and older (n = 8). Data analyses were conducted independently for each decade of life and included inductive analysis of textual data through continuous comparisons of meaning units.

RESULTS

Three primary themes related to successful aging were identified across all decades of older adulthood: (1) staying healthy (secondary themes: genetics and lifestyle choices), (2) maintaining an active engagement in life (secondary themes: social engagement and cognitive engagement), and (3) keeping a positive outlook on life. Participants in specific decades of older adulthood identified three additional secondary themes related to maintaining an active engagement in life: finances (65-74 and 85+ years), social support (75+ years), and successful marriage (75+ years). Similarly, only adults 65-84 years of age identified a secondary theme for keeping a positive outlook on life: acceptance and adaptation.

CONCLUSION

Primary themes related to successful aging were agreed upon by participants in all decades of older adulthood, while age-based differences existed among secondary themes. Thus, what it means to age successfully may be age-dependent.

Development of a discussion tool to enable well-being by providing choices for people with dementia: a qualitative study incorporating codesign and participatory action research

OBJECTIVE

To codesign a discussion tool to facilitate negotiation of risk between health professionals, people with dementia and carers.

METHODS

A qualitative approach using codesign. Thematic analysis was used to analyse interviews and focus groups with people with dementia, carers, healthcare staff and healthy older people exploring the issue of risk in dementia, the acceptability and development of a discussion tool.

RESULTS

Sixty-one participants identified the breadth, depth and complexity of risk in dementia care and the need for individualised solutions. They also deemed a discussion tool to facilitate negotiation of risk was acceptable and responses informed the tool development. Twenty-two participants provided feedback that was used to refine the final version.

CONCLUSION

Our discussion tool enables choices for people with dementia by focusing on abilities rather than deficits and assists health professionals to deliver person-centred care. Flash cards prompt concerns and the tool provides a range of strategies to address these issues.

Capturing the Diversity of Successful Aging: An Operational Definition Based on 16-Year Trajectories of Functioning

Purpose of the Study

To determine the prevalence and extent of successful aging (SA) when various suggestions proposed in the previous literature for improving models of SA are incorporated into one holistic operational definition. These suggestions include defining and measuring SA as a developmental process, including subjective indicators alongside more objective ones, and expressing SA on a continuum.

Design and Methods

Data were used from 2,241 respondents in the Longitudinal Aging Study Amsterdam, a multidisciplinary study in a nationally representative sample of older adults in the Netherlands. Latent class growth analysis was used to identify successful 16-year trajectories within nine indicators of physical, cognitive, emotional, and social functioning. SA was quantified as the number of indicators in which individual respondents showed successful trajectories (range 0-9).

Results

Successful trajectories were characterized by stability, limited decline, or even improvement of functioning over time. Of the respondents, 39.6% of men and 29.3% of women were successful in at least seven indicators; 7% of men and 11% of women were successful in less than three indicators. Proportions of successful respondents were largest in life satisfaction (>85%) and smallest in social activity (<25%). Correlations of success between separate indicators were low to moderate (range r = .02-.37).

Implications

Many older adults age relatively successfully, but the character of successful functioning over time varies between indicators, and the combinations of successful indicators vary between individuals.

Negotiations between health and social goals over the lifespan: The role of future time perspective

The interplay between health and social goals in relation to age and future time perspective was examined among 131 older and 131 younger adults via surveys and future time manipulations (limited, unchanged, and expansive). Being older was associated with weaker physical activity intentions and social activity intentions as mediated by a limited future time perspective. Physical activity intentions decreased in the limited condition and increased in the expansive condition, social activity intentions increased in all conditions, and preference toward health (over social) goals decreased in both the limited and expansive conditions. The results suggest that anticipated endings may become salient in all conditions and favor social goals, which are emotionally relevant.

Masters Athletes: Exemplars of Successful Aging?

Global population aging has raised academic interest in successful aging to a public policy priority. Currently there is no consensus regarding the definition of successful aging. However, a synthesis of research shows successful aging can be defined as a late-life process of change characterized by high physical, psychological, cognitive, and social functioning. Masters athletes systematically train for, and compete in, organized forms of team and individual sport specifically designed for older adults. Masters athletes are often proposed as exemplars of successful aging. However, their aging status has never been examined using a comprehensive multidimensional successful aging definition. Here, we examine the successful aging literature, propose a successful aging definition based on this literature, present evidence which suggests masters athletes could be considered exemplars of successful aging according to the proposed definition, and list future experimental research directions.

The Effects of Life Events and Socioeconomic Position in Childhood and Adulthood on Successful Aging

Objectives

Building on social stress theory, this study has 2 aims. First, we aim to estimate the effects of stressful life events in childhood and adulthood on Successful Aging (SA). Second, we examine how unequal exposure to such life events between individuals with different socioeconomic position (SEP) contributes to socioeconomic inequalities in SA.

Method

We used 16-year longitudinal data from 2,185 respondents aged 55-85 years in 1992 in the Dutch nationally representative Longitudinal Aging Study Amsterdam. Measurement of SA was based on earlier work, in which we integrated trajectories in 9 indicators of functioning into an index of SA. Using path analysis, we investigated direct and indirect effects of parental and adulthood SEP as well as of self-reported childhood and adulthood life events on SA.

Results

Almost all included life events had negative direct effects on SA. Parental SEP had no direct effect on SA, whereas adulthood SEP had. Higher Parental SEP increased the likelihood of parental problems and parental death in childhood, resulting in negative indirect effects on SA. Higher adulthood SEP had both positive and negative indirect effects on SA, through increasing the likelihood of divorce and unemployment, but decreasing the likelihood of occupational disability.

Discussion

SEP and particular stressful life events are largely, but not entirely independent predictors of SA. We found that high and low SEP may increase exposure to particular events that negatively affect SA. Findings suggest that low (childhood) SEP and stressful life events are interrelated factors that may limit individual opportunities to age successfully.

Psychosocial health challenges of the elderly in Nigeria: a narrative review

BACKGROUND

Globally, national health systems are challenged to build successful aging models to prepare for biomedical, psychological and social changes. The integral component of psychosocial health in overall quality of life and well-being, however, is underscored and requires greater focus. Changing demographics in Nigeria, in addition to cultural considerations and absence of a social security system, present unique challenges to elderly.

OBJECTIVE

We aimed to review the literature that describes the current situation and challenges in psychosocial health status in the elderly in Nigeria and provide recommendations that promote health and well-being during the aging process.

RESULTS

Four primary factors affect psychosocial health status of elderly Nigerians, namely: changes in family dynamics, increased demand for healthcare services, increased economic stress, and decreased functional independence.

CONCLUSION

Like other developing countries, the Nigerian national system faces similar challenges in preparing a national framework that can maximize coverage to citizens in the midst of demographic changes in aging. By focusing on five target areas such as the educational system, health services, community-based initiatives, local or regional policies and national strategies, current framework in Nigeria can be modified to prepare for changing demographics in aging.

Associations of intelligence across the life course with optimism and pessimism in older age

Maintaining good cognitive function is important for successful aging, and it has been suggested recently that having and optimistic outlook may also be valuable. However few have studied the relationship between cognitive ability and dispositional optimism and pessimism in older age. It is unclear whether associations found previously between cognitive ability and pessimism in older age, are evident across the life course, and are consistent at different points in older age. In the present study we examined associations between dispositional optimism and pessimism measured in the eighth and ninth decade of life and childhood and older age cognitive ability, and lifetime change in cognitive ability. Participants were two independent narrow-age samples of older individuals with mean ages about 73 (n = 847) and 87 (n = 220) years from the Lothian Birth Cohorts of 1936 (LBC1936) and 1921 (LBC1921), respectively. Higher cognitive ability in childhood and older-age, and healthier cognitive change across the lifetime were associated with lower pessimism in older age: age-11 IQ (LBC1936: β = - 0.17, p < 0.001; LBC1921: β = - 0.29, p = 0.001), older-age IQ (LBC1936: β = - 0.18, p < 0.001; LBC1921: β = - 0.27, p < 0.001), cognitive change (LBC1936: β = - 0.06, p < 0.04; LBC1921: β = - 0.15, p = 0.05). Cognitive ability was not significantly associated with optimism in bivariate analyses, and after adjustment for covariates had only small associations with optimism and only in the LBC1936. The results are consistent with differential associations between cognitive functions and optimism and pessimism, and indicate that their associations with cognitive ability are similar in the eighth and ninth decades of life.

Exploring Subjective Well-being in Older Age by Using Participant-generated Word Clouds

Purpose of the study

Previous research has overlooked the heterogeneity in older adults' personal conceptions of subjective well-being (SWB), by not taking into account intradomain differences in the conceptions of SWB for different groups of older adults. The aim of this article is therefore to explore (a) older adults' own views on which aspects, categorized under domains, are important to their SWB and (b) which domains and aspects are important to older adults in different contexts and with different characteristics: to men and women, of different ages, and in different housing arrangements.

Design and methods

Sixty-six older adults (aged 65 and older) participated in our study. We asked the participants to freely nominate aspects of SWB that are important to them, using participant-generated word clouds as our exploratory, qualitative data collection method. The data were analyzed using qualitative inductive content analysis.

Results

We found 15 domains based on our participants' conceptions of SWB. The multidimensional domains of social life, activities, health, and space and place were most important to our participants. The domains and aspects were defined and prioritized differently by different groups of participants.

Implications

SWB should be studied as a multidimensional, individualized, and contextualized process to generate meaningful empirical information for researchers and policymakers.