Introduction
Initially, scientists viewed successful aging as an oxymoron. For them, it was inconceivable that the aging process, one of deteriorative changes, could be linked in any way to success. However, research results gathered from individuals throughout their life, now show many ways to minimize, adjust and compensate for the effects of aging and, if followed, yield many years of quality living and well being. Hence, the revival of the query, what constitutes successful aging to achieve the best quality of life.
Successful Aging Hypotheses
While there is, at present, no scientific consensus on the exact recipe for successful aging, there are several workable hypotheses with convincing data. The concept of successful aging was introduced 40 years ago (1). From then to now, successful aging has identified 14 separate components. Four areas where at least three independent sets of data agree indicate that successful aging entails:
1. Disease/disability prevention
2. Satisfactory physical and cognitive functioning
3. Engagement in life – society, social relationships and fulfilling activities
4 Subjective aging – perception of aging
Other areas with lesser support but also important, propose inclusion of a) spirituality, b) self-acceptance, c) environmental mastery, d) autonomy, e) personal growth and f) expertise in at least one area (1).
Components of Successful Aging
Rowe and Kahn (1987) (2) distinguished between usual aging and successful aging. These scientists observed that “the effects of the aging process itself have been exaggerated, and the modifying effects of diet, exercise, personal habits, and psychosocial factors underestimated”. Use of these factors or interventions in a positive way ameliorates much of the effects of aging. Later, Rowe and Kahn (1997) (3) proposed that “successful aging is multidimensional, encompassing the avoidance of disease and disability, the maintenance of high physical and cognitive function, and sustained engagement in social and productive activities”. Psychological well being or more broadly, subjective aging has become the fourth domain of successful aging (4).
1. Disease/disability prevention – Key to Successful Aging
There is a wealth of known risk factors for many age-related diseases, such as coronary heart disease, diabetes, chronic kidney disease and some cancers. Most can be addressed by the responsible older adults e.g. smoking cessation, dietary changes. Some risk factors e.g. persistent high blood pressure or elevated fasting blood sugar may require specific life style adjustments or medication that prevent disease progression (5). Various forms of osteoarthritis cause common disabilities for the older adult. Physical therapy, surgical replacements and rehabilitation ameliorate these disabilities (6).
Most age-related diseases and disabilities are managed successfully for many years. However, disease/disability prevention is not only desired but is also possible. It requires individual responsibility and vigilance. Satisfactory physical and cognitive functioning assist in disease/disability prevention.
2. Satisfactory physical and cognitive functioning – Key to Successful Aging.
Numerous prior blogs (insights) discuss the validated and specific interventions to maintain physical and cognitive function. These are lifestyle choices/interventions that have been tested through clinical trials or in the case of dietary choices with findings from epidemiological studies.
Physical activities yielding long term gains are aerobic exercises (e.g. running, walking), resistance exercises (e.g. weights), balance and stretch exercises as discussed in insight 2 Insight 3, Insight 4, Insight 5. Cognitive maintenance and associated requisite sleep are described in insight 6, Insight 7, Brain Health and Sleep (blog 31). Diets promoting health and associated with disease prevention are reviewed in Insight 10-Mediterranean Diet. The interventions discussed in these blogs have been rigorously evaluated with clearly beneficial outcomes.
3. Engagement in society, social relationships and fulfilling activities – Key to Successful Aging.
Although there are 42 different definitions of social participation, it generally refers to “a person’s involvement in activities providing interactions with others in society or the community” (7). This engagement with family, friends, and work (volunteer, part-time, hobbies) enhances coping and compensating strategies (8) and thus, not surprisingly, is associated with better health (9). It is reciprocal with physical activity. Studies show that social engagement increases physical activity which increases social activity. In contrast, isolation produces less physical activity and greater sedentary time, both of which increase health risks (10).
4. Positive subjective aging – perception of successful aging.
Positive subjective aging is supportive of the above three components of successful aging. It works through psychological, behavioral and physiological pathways to prevent diseases/disabilities, optimize physical and cognitive function and encourage social engagement (4).
Subjective aging can be positive or negative. The former, as stated above, links strongly with successful aging (4). It basically encompasses one’s personal view of aging. Generally, positive subjective aging considers oneself as physically and cognitively younger than one’s chronological age.
Positive Subjective Aging
Positive subjective aging yields better health (4) and lower mortality (11). Additionally, positive subjective aging engenders adaptation, positive outlook and greater likelihood of participation in healthy interventions, rehabilitation and exercise and an awareness of disease risk factors and what to do about them (12). Results of longitudinal studies show that those with positive subjective aging exhibit better physical function, less frailty, increased independence, less depression/anxiety and less aging as determined by the degree of inflammation (4). Additionally, many studies associate positive subjective aging with better cognition (13). Although less well studied, positive subjective aging produces an increase in social engagement and less loneliness (9).
Negative Subjective Aging
On the other hand, negative subjective aging accepts the stereotypic view of aging posited by others and accepts society’s ageism (14). This results in negative self perceptions and associated poor health (14). Specifically, negative subjective aging is associated with depression, anxiety, disease, disability (4) and engagement in risky behaviors of excess smoking, drinking, medicine non compliance, and unhealthy diets (14).
Subjective Aging Development
The development of subjective aging is complex and occurs throughout one’s life. An individual’s perception of aging is influenced by many factors. Some of these factors are age, gender, socioeconomic status, education, biologic/health related, general views of aging, life goals, living arrangements, psychological beliefs, coping mechanisms, and cognitive abilities (4). Therefore, the goal is to understand this better so to channel it in a positive direction.
Conclusions
Scientists have uncovered some of the major components essential for successful aging. Successful aging is achieved through prevention of disease and disability, maintenance of optimal levels of physical and cognitive function, active engagement in society and positive subjective aging. All four domains are interconnected and reinforce each other. None of these domains are unrealistic and all are achievable.
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