Dorris



IS SUCCESSFUL AGING THE ABSENCE OF DISEASE ALONE?

  SUBJECTIVITY AND PERCEPTION

  SELF EFFICACY

Do we all have the Same Opportunity to Age Well?
  WHAT HAS SPARKED INCREASED INTEREST IN SUCCESSFUL AGING?
  One Such Initiative

Another Initiative

  Brain Growth

Exercise

Worry About the Wrong Things

  Middle Aged Strong Grip and Fitness in Later Life

  Tomatoes

  Women and Work

Infection and Ulcer Risk

  REFERENCES

RESOURCES/LINKS
 


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What is Successful Aging?


What is considered successful? How do we define success?

One of our Missourians claims,
"If I'm alive, I'm successful!"

IS SUCCESSFUL AGING THE ABSENCE OF DISEASE ALONE? Among the features people identify with successful aging are the following (although some may prioritize these differently):

  • physical health
  • financial security
  • productivity and employment
  • independence.
  • coping well and an optimistic outlook 
  • staying involved in activities and with people who bring meaning and support
Creative expression and spirituality

The concept of "wellness" has been associated with successful aging and is often confused with the notion of health. Wellness represents balance among the environment, emotional, spiritual, social, physical and cultural aspects of the individual's life. Health is a part of wellness. New definitions of successful aging continue to be developed as research and practice with the older adult population progresses.

Gerontologists debate the factors which lead to aging well. Many concepts have been studied over the last half of the twentieth century. Early research on aging reflected the concern with adapting to the physical, psychological, and social losses of aging. Cumming and Henry (1961) posed the disengagement theory at a time when life expectancy was shorter and mandatory retirement was in place. They posited that older persons naturally and voluntarily withdrew from society as they lost ability and interests while society simultaneously pulled back from them so that their death would not be so disruptive to the social group. 

Many positive studies have taken place since 1961.

  • Theories and perspectives such as activity, continuity, consolidation, and busy ethic developed to describe the diversity of interests and tendency of older persons to remain active and engaged in different ways. 
    • (Eckerdt, 1982; Atchley, 1999)
  • Scientists have verified the wide diversity within populations and have taken different focuses to study older adults.
    • Some suggested that personal goals lead an individual from one stage to another.
    • Others measured actual ability of older adults to function or perform.
    • Some examined successful aging with an emphasis on adding meaning or richness
    • Still others explored the idea of control or power over one's course of life.
    • Other psychological approaches suggested coping, choice and adapting as predictors of success.
  • Other scientists examined how the environment affects our "well being" and how we perceived the experiences of our lives. They created ways to measure "life satisfaction" and the "quality of life."


SUBJECTIVITY AND PERCEPTION

"The glass is half full or half empty"

Subjective and objective aspects of aging well are important in our discussion of successful aging. One can perceive experiences positively or negatively. Research claims that 85% of older adults are satisfied with their lives/aging. Levels of life satisfaction tend to be stable over time. Life satisfaction is strongly related to health, socioeconomic status and relationships with family and friends. Persons who age well are likely to perceive their objective circumstances as rewarding and positive.

We expect life satisfaction and positive perceptions of aging to follow financial security, ability to function, freedom from chronic disease, and quality relationships with friends and family. These elements and our perceptions of them, however, are complex and vary greatly among individuals--complicating research. 

    SELF EFFICACY

    ". . .in the eyes of the beholder."

                  (Wordsworth)
How we view ourselves in later life influences our perception of well being. "Stronger" persons survive stresses. "Hardier" individuals -- those with a strong self efficacy -- are more apt to:
  • retain control
  • feel competent
  • seek opportunity in challenges
  • have compassion
  • maintain a sense of humor 
                         (Ebersole & Hess, 1998, p. 44-45)

How we approach life or define our role may affect how satisfied we feel. We may react to life through the eyes of others rather than creating and advocating for our own value and role. Hence, an older adult may define how successful he/she is by the criteria and judgments of others.

Even researchers second-guess their own family's experiences and motivations. Some misinterpret the meaning of the extraordinary talents and activities of older adults who dance, weight train, climb mountains, write books, etc. One researcher found that his mother did not "perform" to attract attention, but rather to maintain her free will, self-mastery and creativity so that others will not regard her as "aged," dependent, and needy.

Do We All Have the Same Opportunity to Age Well?

One could argue that all populations have the opportunity to age well. However, consider the following factors that illustrate that large numbers of Americans are at high risk for NOT aging successfully!

  • As many as 43 million Americans possess no health insurance and millions more have inadequate coverage.
  • Financial problems (and lack of health insurance) will limit access to medical care.
  • The absence or limited prenatal care may create lifelong and costly health problems.
  • Social and economic circumstances currently place minority elders at higher risk for poverty, malnutrition, and substandard housing and poor health.
  • Older women who live alone are more likely to be poor than are couples or older men (59% of minority older women over 85 years are poor). 
          • Austin, 1991)
These factors make a compelling argument that all persons DO NOT have equal chances to age well. The circumstances of elderly individuals reflect an accumulation of opportunities and lifestyles. Hence, a large and growing population is at risk for not aging well due to lack of access to services and opportunities along the life cycle. Populations underserved and at greatest risk include:
  • Low income older persons -- especially women
  • Minority elderly
  • Frail and impaired older persons
  • Abused/neglected elders
  • Rural elderly
  • Mentally retarded and developmentally disabled older adults
  • Homeless individuals
  • Older adults living alone and/or homebound
    •                                             (Austin, 1991)
The delivery of health care is complex and fragmented at best. There is poor coordination among ambulatory, acute and long-term care. Populations which have lifelong risks for aging poorly are further in jeopardy with a system that may not respond and restricts choice and access.

The health care delivery system continues to change. This uncertainty, particularly the instability of reimbursements and eligibility and entitlement criteria in our federal and state governments, portends further challenges to choice and access.

While external circumstances stymie aging well for particular populations, factors within culture and family may do so also. Familial lifestyle habits such as eating, smoking, and lack of exercise may limit healthy aging prospects. Values and cultural customs may influence lifestyle. Family relationships and responsibilities may also limit health-seeking behaviors. Culture and family influence our support network and relationships. Research has proven the value of social supports in aging well. (See also web site topic Relationships.)

WHAT HAS SPARKED INCREASED INTEREST IN SUCCESSFUL AGING?

One such initiative has been Healthy People 2000

In 1991 the United States Department of Health and Human Services reported a commitment to preventive wellness and quality of life for older adults through the initiative, Healthy People 2000. This effort studies and monitors the health of older adults with an impact target of 13% by 2000 and 22% by 2030.

Healthy People 2000 aims to:

  • lengthen the healthy lives of Americans
  • improve the functional independence of older adults
  • encourage older adults (and all Americans) to take responsibility for their own health
  • decrease the disparity among Americans
  • promote access for preventive services for all
In 1995 a Healthy People 2000 report described:
  • An increase of home delivered meals
  • Little difference in the level of activity in older adults
  • A decline in the rate of difficulty in performing activities among older adults
This initiative should contribute significantly to the motivation, monitoring and measurement of success in aging for our older adult population.
                                                  (Ebersole & Hess, 1995)

Another Initiative Has Been New Findings Related to Successful Aging

Brain Growth

For the last century studies have led us to believe that brain cells not be replaced. However, last November Swedish neurologists discovered in the hippocampi of hospital patients, deceased from a variety of causes, relatively young cells. This finding implies that there may be elements that preserve or improve mental function as we age if they can discover how these new cells are produced.

Exercise

The Salk Institute made equally significant and interesting discoveries. Mice, who were grouped by a variety of activities, demonstrated differences in brain growth. After six weeks mice who swam, played or were active within their cages showed little difference. However, those who ran on a wheel for hours daily exhibited remarkable cell growth. Henriete van Praag, author of the study, said, "The brain may be more capable of self repair than we think."

"Time may make you older, but perhaps workouts make you wiser."

    -- Health Magazine, (1999)

Worry About the Wrong Things

Americans are pessimistic about their health. The Harvard School of Public Health found through a survey that most people believe their risks of injury, disease, or death to be considerably higher than actual figures. Some examples of those mistaken beliefs are seen in the following beliefs:

     
      Risk of:          Perceived:         Actual:
         
          Car accident        50%                    5%
          Breast cancer      40%                  10%
          Prostate cancer   33%
Perceived chances of stroke, diabetes and HIV were also doubled from actual fact.

Scientists at the Harvard School of Public Health claim that we are focused on the wrong factors. Smoking, inactivity and obesity are much more significant risks.

Middle Aged Strong Grip And Fitness In Later Life

An epidemiological study of over 3000 Japanese Americans in Hawaii found a correlation between a strong handclasp in middle age and overall fitness 30 years later. (Guralnik, Jack M., 1998) In re-examining the same men recently, NIH researchers found that compared to those with weaker grips, others were more capable of walking, lifting, and self care.

Guralnik identified a "deadly spiral" in more than 1000 women. Those who lost muscle decreased their activity. This further weakened them and led to disability in many. Hence, women especially should build and maintain muscel with resistance training.

Tomatoes

Epidemiologists at Harvard (Giovannucci, Edward, 1998), examined the correlation between the incidence of cancer and tomato consumption. Giovannucci found high blood levels of lycopene in tomato eaterrs, with a 40% lower risk of cancer. While its role in deterring cancer is unknown, lycopene is recognized to be twice as potent an antioxidant as beta-carotene. Lycopene is best absorbed as cooked tomatoes.

Women and Work

Working more hours is a good predictor for moving up the corporate ladder, right? WRONG! McDermid, a family studies researcher at Purdue studied the work careers of more than 80 women. He found that more than a third of those who had cut an average of 18 hours off their work week were promoted after the cutback. McDermid surmised that companies were more flexible with schedules to retain skilled workers.

Infection And Ulcer Risk

A study of more than 2000 Medicare patients with ulcers revealed that only half had been screened for a bacterium, Helicobacter pylori, which accounts for more than 80% of ulcers. A simple blood, breath, or stool test can inexpensively and easily identify the bacteria. Treatment of an antibiotic and antacid for two weeks can successfully cure the condition. Unfortunately, these tests are less frequently administered.

    REFERENCES

    Austin, C. D. (1991). Aging well: What are the odds? Generations. 15(1), 73-75.

    Bearon, Lucille (1996). Successful Aging: What Does the Good Life Look Like? The Forum, vol. 1. No. 3.

    Bond, L. A., S. J. Cutler, and A. Grams (1995). Promoting Successful and Productive Aging. Thousand Oaks, CA: Sage Publications, Inc.

    Generations, In-depth view of Issues in Aging: Reasons to Grow Old: Meaning in Later Life.  (2000). 23(4) pp. 1-96.

    Herzog, A. R. and J. S. House (1991). Productive activities and aging well. Generations. 15 (1), pp.49-54.

    Rowe, J.W.,  and R. L. Kahn (1998) Successful Aging. New York: Pantheon Books.

    Schultz, R., and J. Heckhausen (1996). A Life span model of successful aaging. American Psychologist. 51(7), pp. 702-714.