Successful aging

Successful Ager

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

Research on successful aging, however, acknowledges the fact that there is a growing number of older adults functioning at a high level and contributing to the society. Scientists working in this area seek to define what differentiates successful from usual aging in order to design effective strategies and medical interventions to protect health and well-being from aging.^{[1][3][4][5][6][7]}

Definitions

Very successful Ager

Happy successful agers

Definitions focusing on successful emotional and cognitive aging

Recent studies emphasize the importance of adaptation and emotional well-being in successful aging. New data suggests that for most senior citizens, subjective quality of life is more important than the absence of disease and other objective measures relating to physical and mental health. In two recent studies the vast majority of older people rated themselves as aging successfully, even when they did not meet all objective physical and mental criteria for successful aging.^[8][9] Studies which incorporated the perspectives of older adults into the model of successful aging found that optimism, effective coping styles, and social and community involvement are more important to aging successfully than traditional measures of health and wellness. Additionally, recent studies have shown that for most senior citizens, subjective quality of life is strongly tied with psychosocial protective traits such as resilience, optimism, and mental and emotional status.^{[10][11][12][13][14]}

Early definitions

Traditional definitions of successful aging have emphasized absence of physical and cognitive disabilities.^[15] In their 1987 article, Rowe and Kahn characterized successful aging as involving three components: a) freedom from disease and disability, b) high cognitive and physical functioning, and c) social and productive engagement.^[16]

Recently, many scientists have argued that the early definitions are overly restrictive and limit successful aging to an objective judgment made by others, thereby ignoring the seniors' perception.^[17][18][19] Others have pointed out that definitions focusing on physical functioning and freedom from disability are misleading and may lead to the conclusion that a large majority of individuals are getting older unsuccessfully, given the high incidence and prevalence of diseases that are common in later life.^[13]

Genetics of successful aging

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

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

Recently, successful aging has been also linked to expression levels of genes and length of chromosomal telomeres.^{[20][21][22][23][24]}

Aging-associated wisdom

Telomere

In has been found that mental and psychosocial functioning often improve with age, even if physical health, and some elements of memory decline. Physicians, psychologists and gerontologists argue that age-related wisdom might serve to compensate for the biological losses in old age, thereby enabling older adults to better utilize their remaining resources and age successfully. Age-associated wisdom may help to overcome the negative effects of diseases and stressors that are common in late life and lead to improved mental health and psychosocial functioning. Neurological research has demonstrated that brain growth and development continue into old age – the concept known as neuroplasticity of aging.^{[25][26][27][28]}

Cultural differences

Components of successful aging differ across cultures. In a 2004 survey, Japanese older adults were more likely to endorse social belonging as more important, whereas European American ranked independence as more important.^[17]

The idea of successful aging is a social construct which aids in our acceptance of the apparent inevitability and pain associated with the aging process. As successful aging tends to be more dependent on behavior, attitude and environment than to the hereditary traits, researchers and clinicians are developing strategies to enhance aging well. Current strategies include restricting calories intake, exercising, quitting smoking and substance use, obtaining appropriate health care, and eating healthy. Seeking help for mental illnesses such as depression is critical, as these conditions interfere with nearly all determinants of successful aging. Additionally, it is considered important to develop cognitive and psychological strategies such as positive attitude, resilience, and reducing stress. Cognitive and emotional adaptation to chronic illnesses that often impact older adults is also an important aspect. Finally, social strategies, such as seeking and giving social support through volunteering, working in a group, learning a new skill, or mentoring younger individuals, have been found to promote successful aging.[29][30][31]

Although many dietary supplements on the market and advertised as having anti-aging effects, there is a general lack of evidence as for their impact on aging, and some researchers even point to several possible health risks. Currently most of these supplements are not categorized as drugs by the U.S. Food and Drug Administration.[32] The term “ageism” was introduced by Dr. Robert Butler The term was coined in 1971 by Robert Neil Butler to describe discrimination against seniors, and patterned on sexism and racism. Butler defined "ageism" as a combination of three connected elements. Among them were prejudicial attitudes towards older people, old age, and the aging process; discriminatory practices against older people; and institutional practices and policies that perpetuate stereotypes about older people. In his original formulation of ageism Dr. Butler noted that, with respect to age, prejudice could move in other directions, for example, prejudice of the old toward the young.

Criticism of the term

The notion of successful ageing, a term used in global health and the knowledge-making areas related to ageing (mainly gerontology, the caring professions, and organizations such as WHO), is based on liberal ideas favoring individualistic principles of choice over processes of social constraint.^[29] A neo-liberal and entrepreneurial vision of aging, inspired by gerontological ideals about active and successful lifestyles, has entered the health and retirement fields, with practical and policy consequences.^[30][31] This governmental rationality maximizes individual responsibility in order to minimize dependency in Western countries. In this context, successful ageing depends on an individualistic set of practices determined by predictors around smoking, diet, and exercise. While claims of choice and experimentation have opened new avenues of self-definition, such ideals can diminish the more genuine struggles to live successfully^[32][33] and obscure social inequalities. Stephen Katz reminds us that "lifestyle" (a concept informing the notion of successful ageing) was first positioned by social theorists in a myriad of life chances, status hierarchies and social contexts.^[29] For example, falls are assumed to happen to people who lack some physical control. Prevention programs therefore advocate « active ageing », individual behavioral changes such as exercise regimes (and residential modifications like better lighting).^[34] These strategies do not take into account social differences like class and gender, and also require adequate resources. For example, it seems that women fall more often and suffer more fracture-related falls than do men. These falls take place in a context where femininity is culturally coded as more frail and vulnerable than masculinity and where physical strength in women is not encouraged.^[35] Other gendered factors may be causing their falls, such as their greater use of psychotropic drugs, and not their lack of physical strength.^[36] Policies often sustain and reinforce cultural constructs, such as "frailty", and therefore shape experiences. Such cultural constructions of gender and age, the global economic rationale of cost restriction and the biomedical focus on ageing collide as inscriptions on the bodies of older women.^[37]

See also

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

References