6210 Week 7 Discussion
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6210Week7HowDoOlderAdultsDefineSuccessfulAging_AScopingReview.pdf
Article
How Do Older Adults Define Successful Aging? A Scoping Review
Barbra Teater 1 and Jill M. Chonody
2
Abstract
Successful aging is a prominent theory that describes the aging process and the
expected activities and behaviors older adults should engage in or exhibit to age
successfully. Although this theory is used to gauge the extent to which older adults
are aging successfully, older adults’ experiences and perspectives of what successful
aging means to them are missing from the theory. A five-step scoping review frame-
work was used to explore and synthesize the existing research that investigated
older adults’ perspectives on successful aging. Twelve main themes were found
and ranged from the importance of social relationships and interactions to having
a good death. Findings indicated older adults do not define successful aging as strictly
as is found in the literature. Old age and the aging process from the views of older
adults provide future directions for theory development and research.
Keywords
aging, successful aging, older adults, scoping review, aging theory
1 Department of Social Work, College of Staten Island, City University of New York, Staten Island,
NY, USA 2 Boise State University, Boise, ID, USA
Corresponding Author:
Barbra Teater, College of Staten Island, 2800 Victory Blvd. 2A, 201, Staten Island, NY 10314, USA.
Email: [email protected]
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600 The International Journal of Aging and Human Development 91(4)
Aging is a socially constructed phenomenon and how it is perceived and expe- rienced is influenced by culture, societal expectations, and individuals’ lived experiences (Brooks, 2010; Chonody & Teater, 2018). Old age has historically
been defined through governmental policies by establishing a specific chrono- logical age to denote an “older person” and is used to determine eligibility for
particular services (e.g., age 67 to receive Social Security benefits in the United States if born after 1960). Likewise, expectations and explanations of behaviors of people who are classified as “older” adults have been presented through
sociological, psychological, and gerontological theories, including disengage- ment theory (Cumming & Henry, 1961), productive ageing (Bass, Caro, &
Chen, 1993), activity theory (Havighurst, 1961), healthy ageing (White House Conference on Ageing, 2015), successful ageing (Rowe & Kahn, 1997), and active aging (World Health Organization, 2002). However, over the past 15 to
20 years, successful aging has become a prominent aging paradigm in the sub- stantive literature, yet a close examination of successful aging reveals that the
voices of older adults are missing. This is a significant flaw in theory develop- ment in that older adults’ experiences and perspectives play an essential role in understanding and explaining aging. Therefore, this scoping review aims to
review the literature to explore and synthesize the existing research that inves- tigated older adults’ views and definitions of successful aging.
Literature Review
Theories and Frameworks of Aging
Historically, the coming of old age was seen as a time associated with disease and disability and as disengagement theory proposed, a period of withdrawal or
disengagement from social interactions and activities (Cumming & Henry, 1961). Relatedly, activity theory purports that old age is a time when older
adults adjust, redefine, and substitute their roles and activities in an attempt to maintain their sense of self (Havighurst, 1961). Over time, theorists began rejecting these premises, and positive theories of aging that focused on health
and activity were proposed. Productive aging is one such theory and argues that older adults needed to remain active and productive through engagement in
social activities and through the production of goods and services via paid and volunteer employment, thus reducing their reliance on social services (Bass et al., 1993). The more recent concept of healthy aging, which is defined
as “living a long productive, meaningful life and enjoying a high quality of life” (White House Conference on Ageing, 2015), also aims to maximize older adults’
physical, social, and mental well-being to promote independence and reduce burdens on others. Yet, both of these theories fail to consider social and
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Teater and Chonody 601
environmental factors that contribute to the extent to which one can age “healthy” (Mendes, 2013).
More current aging theories, such as active aging and successful aging, were developed as a counter response to theories that focused on decline, loss, and disengagement. Active aging is a positive policy framework that focuses on the connection of health and activity through six determinants: health and social services; behavioral; personal; physical; social; and economic, with cross-cutting determinants of culture and gender. Active aging was developed by the World Health Organization (2002) as a policy framework to assist governments in promoting and supporting active aging, which they defined as:
[T]he process of optimizing opportunities for health, participation, and security in
order to enhance quality of life as people age [ . . . ] The word ‘active’ refers to
continuing participation in social, economic, cultural, spiritual, and civic affairs,
not just the ability to be physically active or to participate in the labor force. [. . .]
Active aging aims to extend healthy life expectancy and quality of life for all people
as they age, including those who are frail, disabled, and in need of care. (p. 12)
Finally, successful aging is achieved when individuals exhibit the following: (a) low probability of disease and disability, (b) high cognitive and physical func- tional capacity, and (c) high social activity and engagement in social relation- ships (Rowe & Kahn, 1997). Many argue that this theory pushed too far in the other direction whereby older adults are being held to unrealistic standards in order to be “successful” (Foster & Walker, 2015; Martinson & Berridge, 2015; Morell, 2003; Rubinstein & de Medeiros, 2015; Teater & Chonody, 2017; Walker, 2009). Furthermore, the focus on remaining free of disease and disabil- ity fails to acknowledge the natural changes that occur in an aging body (Teater & Chonody, 2017) and implies “hostility toward ageing bodies” (Morell, 2003, p. 69). In addition, successful aging assumes that “through individual choice and effort” one can age successfully and remain physically and socially active (Rowe & Kahn, 1997, p. 37). This individualist view supports reduction in governmen- tal policies that “provide social and other supports for [older adults] . . . and, notably, to address the social and structural inequalities that create illness and disability in the first place” (Martinson & Berridge, 2015, p. 63).
Although successful aging aims to take a more positive view of aging by focus- ing on health promotion, activity, and the positive features of aging, it was devel- oped without the input of older adults’ views and experiences or an evaluation of the extent to which the theory’s principles and premises adequately depict the lived experiences of older adults. Without exploring “how the social meanings ascribed to aging interact with individuals’ lived experiences of the aging process,” aging is being socially constructed and defined by culture instead (Brooks, 2010, p. 238).
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602 The International Journal of Aging and Human Development 91(4)
Measuring Successful Aging
Successful aging has been used to explain the aging process but has also been
used as the basis for determining the extent to which older adults are aging
successfully. For example, Kim (2008) developed a 31-item instrument to mea-
sure successful aging on a 5-point Likert-type scale (1 ¼ never; 5 ¼ always), which was comprised of items on autonomous life, self-realization, active par-
ticipation in life, satisfaction with children, self-acceptance, and acceptance of
others. Phelan, Anderson, LaCroix, and Larson (2004) developed the successful
aging questionnaire where 20 factors of successful aging, consisting of aspects of
psychological, social, physical, and functional health, were identified from the
existing literature where older adults rated on a 3-point Likert-type scale how
important they believed each attribute was to successful aging (1 ¼ not impor- tant, 2 ¼ neutral, and 3 ¼ important). The older adults in Phelan et al.’s study reported that health, freedom from disability, life satisfaction, close personal
relationships, staying active and involved, maintaining independence, meeting
needs, adapting to aging-related changes, self-acceptance, and mastery were
most important, which supported the successful aging theory. Both Kim and Phelan et al.’s studies assessed successful aging by predefining
the factors versus asking older adults to define successful aging themselves,
which may create an inaccurate picture of reality. Hilton, Gonzalez, Saleh,
Maitoza, and Anngela-Cole (2012) highlighted a weakness in Phelan et al.’s
study, which is the failure to include financial security and religiosity/spiritual-
ity; factors older adults often mention as important to their well-being. The
potential incongruence between predefining the factors of successful aging and
self-assessment by older adults was underscored in a mixed-methods study
where quantitative scores on physical, social, and psychocognitive functions
indicated lower levels of successful aging among a group of older adults who
qualitatively considered themselves to have aged successfully (von Faber et al.,
2001). In addition, Montross et al. (2006) found 92% of community-dwelling
older adults aged 60 years and older to perceive themselves as aging successfully
despite experiencing a disease or disability. Such studies point to the need for
more open-ended measures given that the current views on aging are not
informed by older adults’ perspectives but, rather, by what others—often
academic researchers—think older adults need (Clarke & Warren, 2007).
The Subjective Experience of Older Adults in Defining Successful Aging
The incongruence found between predefined measures of successful aging and
self-assessment may be related to variations among older adults given they are a
heterogeneous group. Therefore, theories of aging should incorporate differing
views of the aging experience based on gender, culture, health status, and
other identities as such dimensions could help or hinder the aging process
4 The International Journal of Aging and Human Development 0(0)
Teater and Chonody 603
(Martinson & Berridge, 2015). For example, older adults in non-Western soci- eties may not subscribe to the ideals of successful aging as they may value interdependence and family relations more than the promotion of autonomy, independence, and individual responsibility (Amin, 2017). Moreover, accessibil- ity to resources is not equitable, which can shape how people age. Narrative or life history research may be useful in further capturing how aging is understood among different groups of older adults, and “allow for the examination of how perceptions of aging may vary at different times and across the shifting contexts of people’s lives” (Dionigi, Horton, & Bellamy, 2011, p. 416). Such knowledge allows for a more accurate representation of experiences, referred to as bio- graphical aging, which enables older adults to adapt to or cope with life chal- lenges while also creating alternative meanings of the aging process based on experience and understanding of the self (Chapman, 2005; Dionigi et al., 2011). Acknowledging individual life stories allows for alternative explanations of aging and the aging process that can be valued and accepted among different groups of older adults, thus refuting the belief that all older adults should be held to one standard of “successful” aging.
This scoping review aims to begin this challenge by (a) identifying any exist- ing research that examined the perspectives of older adults on their views of successful aging, (b) summarizing the themes found in this research, (c) com- paring older adults’ views and definitions to successful aging, and (d) providing future directions for the conceptualization of old age and the aging process based on the views of older adults.
Methodology
A scoping review framework was used to explore existing research on older adults’ perspectives of successful aging. A scoping review is “a form of knowl- edge synthesis that addresses an exploratory research question aimed at map- ping key concepts, types of evidence, and gaps in research related to a defined area or field by systematically searching, selecting, and synthesizing existing knowledge” (Colquhoun et al., 2014, pp. 1292–1294). The aim of a scoping review is not to critique the methodology of the studies reviewed but rather to synthesize the evidence on a topic of interest (Arksey & O’Malley, 2005).
The five steps in conducting a scoping review were followed as described by Levac, Colquhoun, and O’Brien (2010). The first step is to identify the research question, which was as follows: How do older adults define successful aging?” Given our interest in how participant driven research yields a conceptualization of successful aging, we delimited our research question to exclude researcher- driven ideas of successful aging. The second step in this process was to identify relevant studies. For this review, academic databases (Academic Search Premier; Abstracts in Social Gerontology; Family & Society Studies Worldwide; PsycINFO; Social Work Abstracts) were searched using the following search
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604 The International Journal of Aging and Human Development 91(4)
terms: successful aging, active aging, productive aging, healthy aging, attitudes, older adults. The positive aging theories of active aging, productive aging, and healthy aging were included in the search to review whether the studies were exploring successful aging in addition to these other positive theories, for exam- ple, asking older adults to define or provide examples of successful aging (see Lewis, 2013). Articles were limited to those available in English and published from 2002 to 2017. The search of the literature yielded 366 articles.
The third step in a scoping review is to determine whether each of the studies met the inclusion criteria. In addition to the parameters set around publication years and availability in English, the inclusion criteria included research on successful aging from the perspective of older adults through open-ended ques- tions to determine older adults’ definitions, experiences, and perspectives of successful aging (e.g., “What does successful aging mean to you?”; “What is involved in the process of successful aging?”). Articles where the researchers predefined successful aging were excluded, for example, when researchers uti- lized preexisting measures of successful aging or predefined the possible key elements of successful aging. Both researchers independently reviewed all 366 abstracts identified in the search. Once this process was complete, 56 articles were identified for possible inclusion. The researchers discussed this list together and reviewed the abstracts again to resolve any uncertainties of whether to include or exclude the article. After this process, 42 articles remained, and the full articles were downloaded. Upon reviewing these articles, an additional 12 articles were excluded primarily because upon closer examination, it was found that the researcher versus participants were delineating the definition for successful aging.
The fourth step involved charting the data or findings of the review. For this review, a data extraction form was created to chart the data, which included demographics of the sample, research design, instruments used, questions asked, sampling method, data analysis, and findings. The researchers worked together to develop this form, and then each researcher independently extracted data from the first two articles in the final list. This process helped to determine whether extraction was aligned with the research question (Levac et al., 2010). These extractions were discussed, and then the researchers divided the remaining articles for independent extraction. Once this process was complete, researchers discussed their extractions and once again explored how each article aligned with the purpose of the review. An additional eight articles were found to be slightly off topic; that is, the findings were focused on an element of aging, such as the meaning of death, but participants were not asked to provide their per- spective on successful aging. Thus, the final sample of articles used in this review was 22. Table 1 provides a summary of these studies.
The final fifth step involved collecting, summarizing, and reporting the results. To summarize and synthesize the findings, the researchers each indepen- dently reviewed all the data extraction forms and created a list of themes found
6 The International Journal of Aging and Human Development 0(0)
605
T a b le
1 . A
S u m m a ry
o f th e S tu d ie s In c lu d e d in
th e R e v ie w .
A u th o r( s)
D e m o g ra p h ic s
D e si g n /A n a ly se s
Q u e st io n s
M a jo r T h e m e s (s u b th e m e s)
A m in
(2 0 1 7 )
7 M a le s; 5 fe m a le s
M e an
a g e ¼ 7 1 .5
ye a rs ;
ra n g e : 6 0 – 9 0
B a n g la d e sh i
C o m m u n it y d w e ll in g
S e m i- st ru c tu re d in te r-
v ie w s (f a c e -t o -f ac e o r
o ve r th e p h o n e )
G ro u n d e d th e o ry ; th e -
m at ic c o d in g st ra te g y
1 . W
h e n yo u th in k a b o u t yo u r li fe ,
w h at
th in g s d o yo u li k e le a st a b o u t
b e in g th e a g e yo u a re ?
2 . W
h a t w o u ld
m ak e yo u sa ti sf ie d in
o ld
a g e ?
3 . W
h a t d o yo u th in k it m e a n s to
a g e
w e ll ?
4 . W
h a t d o yo u th in k o n e n e e d s to
fe e l c o n te n t in
o ld
a g e ?
A d a p ta ti o n to
th e a g in g b o d y ; fi n a n c ia l
se c u ri ty ; fa m il y a n d in te rg e n e ra ti o n a l
c ar e ; so c ia l p a rt ic ip at io n
C h e n (2 0 1 5 )
1 4 F e m a le s
M e an
a g e ¼ 7 3 .2 8 y e a rs ;
ra n g e : 6 0 – 9 0
T a iw a n
C o m m u n it y d w e ll in g
O p e n -e n d e d , in -d e p th
se m i- st ru c tu re d in te r-
v ie w s
In d u c ti v e a n a ly si s w it h
c o n st a n t c o m p a ra -
ti v e m e th o d
N o t p ro v id e d
B e in g h e a lt h y ; n o fi n a n c ia l w o rr ie s;
m ai n ta in in g c o n n e c ti o n s w it h fa m il y
a n d fr ie n d s; a g o o d d e a th
C h o n g, N g ,
W o o , a n d
K w a n (2 0 0 6 )
4 0 F e m a le s; 1 8 m al e s (6 0 þ)
2 0 fe m a le s; 1 7 m a le s
(m id d le
a g e d ;
ra n g e : 4 0 – 5 9 )
H o n g K o n g
M ix tu re
o f c o m m u n it y
d w e ll in g a n d re si d e n -
ti a l c a re
F o c u s g ro u p s w it h 5 – 8
p a rt ic ip a n ts
e a c h
“ In d iv id u a l u n it s o f m e a n -
in g ” w e re
re c o rd e d b y
tw o m e m b e rs
o f
re se a rc h te a m
a n d
th e n c o m p a re d
“ A t e a c h fo c u s g ro u p , th e p a rt ic i-
p a n ts
w e re
in v it e d to
a rt ic u la te
th e ir n o ti o n s o f p o si ti ve
a g e in g , to
g iv e p e rs o n a l e x a m p le s, a n d to
id e n ti fy
th e fa c to rs
th a t w o u ld
a ff e c t h o w
th e y a g e d w e ll o r p o s-
it iv e ly ” (p . 2 4 8 )
U n d e rs ta n d in g o f p o si ti ve
a ge in g: g o o d
h e a lt h ; h av in g a p o si ti ve
a tt it u d e ;
a c ti v e p a rt ic ip a ti o n ; h av in g g o o d so c ia l
a n d fa m il y su p p o rt ; fi n a n c ia l se c u ri ty
Fa ct o rs
a ff e ct in g p o si ti ve
a ge in g: g e tt in g a n
e a rl y st a rt ; a d o p ti n g a h e a lt h y li fe st y le ;
th in k in g p o si ti ve ly ; p ro m o ti n g fa m il y
a n d in te rp e rs o n a l re la ti o n sh ip s; b u il d -
in g u p fi n a n c ia l re so u rc e s; p re fe rr e d
li v in g a rr an g e m e n ts
C o ll is a n d
W a te rf ie ld
(2 0 1 4 )
3 F e m a le s; 3 m al e s
M e an
a g e ¼ 7 9 ye a rs ;
ra n g e : 7 5 – 9 0
E n g la n d
C o m m u n it y d w e ll in g
In te rv ie w s
G ro u n d e d th e o ry -o p e n
c o d in g ; a x ia l
c o d in g in te rv ie w s;
E x p lo re d :
1 . W
h a t ‘s u c c e ss fu l a g in g ’ m e a n t to
th e p a rt ic ip a n ts
2 . W
h y th e y fe lt th e y h a d a g e d
su c c e ss fu ll y
U n d e rs ta n d in g p a in ; p e rc e p ti o n s o f a g in g
(p e rc e p ti o n s o f o th e rs ; a tt it u d e s o f
h e a lt h c a re
p ro fe ss io n a ls ; d is a b il it y ;
a d a p ta ti o n )
(c o n ti n u e d )
7
606
T a b le
1 . C o n ti n u e d .
A u th o r( s)
D e m o g ra p h ic s
D e si g n /A n a ly se s
Q u e st io n s
M a jo r T h e m e s (s u b th e m e s)
3 . R e c o ll e c ti o n o f p a in fu l e p is o d e s
4 . M e th o d s o f c o p in g w it h p a in
5 . If a n d h o w
p a in
re so lv e d
6 . H o w
th e y th o u g h t th a t p a in d if fe rs
w h e n yo u n g e r ve rs u s th a n o ld e r
7 . C u rr e n t e x p e ri e n c e s w it h o f p a in ,
if a n y
8 . H o w
th e ir e x p e ri e n c e o f p a in
c o m p a re d w it h th a t o f o th e r o ld e r
p e o p le
9 . In
th e li g h t o f th e ir u n d e rs ta n d in g
o f su c c e ss fu l a g in g , h o w
th is m ig h t
b e in h ib it e d b y p a in
D io n ig i e t a l.
(2 0 1 1 )
2 1 F e m a le s
M e an
a g e ¼ 8 3 .3
ye a rs ;
ra n g e : 7 5 – 9 2
M id d le
c la ss
C a u c a si a n s
C o m m u n it y d w e ll in g
In -d e p th
in te rv ie w s
In d u c ti ve
a n al y si s
a p p ro a c h ; n a rr a ti ve
c o n te n t a n al y si s
In c lu d e d :
1 . D o yo u h av e a n y h o b b ie s o r re g -
u la r a c ti v it ie s th a t y o u e n jo y ?
P le a se
d e sc ri b e .
2 . W
h a t d o e s su c c e ss fu l a g in g m e a n
to yo u ?
3 . W
h a t d o e s th e te rm
o ld
m e a n to
yo u ?
4 . P le a se
d e sc ri b e yo u r c u rr e n t
h e a lt h st a tu s”
(4 0 6 ).
P e rc e p ti o n s o f b e in g o ld ; d e fi n it io n s o f
su c c e ss fu l a g in g
G u e ll , S h e fe r,
G ri ff in , a n d
O g il v ie
(2 0 1 6 )
1 2 F e m a le s; 1 5 m a le s
1 0 w e re
6 5 – 6 9 ye a rs
o ld ;
7 w e re
7 0 – 7 4 ; 1 0
w e re
7 5 – 8 0
N o rf o lk , E n g la n d
C o m m u n it y d w e ll in g
S e m i- st ru c tu re d in te r-
v ie w ; th e m a ti c d a ta
a n al y si s
O p e n c o d in g sy n th e si ze d
in to
c a te g o ri e s
E x p lo re d : e ve ry d ay
a c ti v it ie s a n d
m o ti v a ti o n s; li fe st y le
o p p o rt u n i-
ti e s; c h o ic e a n d m o ti v a ti o n s
a c ro ss
th e se a so n s a n d th e ir li fe
c o u rs e ; a sp ir at io n s in to
o ld e r a g e
A sp ir a ti o n s o f a c ti v e li v in g (p o si ti ve
a tt i-
tu d e , k e e p in g b o d y a n d m in d a c ti v e ,
te n si o n b e tw
e e n st ay in g b u sy
a n d
st ay in g a c ti ve ); p ra c ti c e s o f a c ti v e
li v in g (b e in g o u t a n d a b o u t, p u rp o se fu l
a c ti v it ie s, a d a p ti v e a c ti v e n e ss ); so c ia l
c o n te x t o f a c ti v e li v in g (s o c ia l m o ti -
v at o rs
a s fa c il it a to rs , so c ia l li m it a ti o n s
a s b a rr ie rs )
(c o n ti n u e d )
8
607
T a b le
1 . C o n ti n u e d .
A u th o r( s)
D e m o g ra p h ic s
D e si g n /A n a ly se s
Q u e st io n s
M a jo r T h e m e s (s u b th e m e s)
H il to n e t a l.
(2 0 1 2 )
3 8 F e m a le s; 2 2 m a le s
M e an
a g e ¼ 6 1 ;
ra n g e : 5 0 – 8 4
L a ti n o (a )
W e st e rn
st a te s in
th e
U n it e d S ta te s
F a c e -t o -f ac e in te rv ie w s to
fi ll o u t q u e st io n n ai re
(m a in ly c lo se
e n d e d
q u e st io n s)
G ro u n d e d
th e o ry ; d e sc ri p -
ti v e st a ti st ic s
D e m o g ra p h ic s a n d h e a lt h st a tu s;
P h e la n ’s sc a le
o f su c c e ss fu l a g in g ;
a n d “ W
h e n yo u th in k a b o u t a g in g
w e ll , w h at
c o m e s to
m in d ? P le a se
te ll u s w h a t su c c e ss fu l a g in g m e a n s
to yo u .”
G o o d h e a lt h ; in d e p e n d e n c e ; st ay in g
a c ti v e a n d in vo lv e d ; fa m il y a n d so c ia l
re la ti o n sh ip s; se lf -c a re ; a c c e p ti n g th e
a g in g p ro c e ss ; p o si ti ve
a tt it u d e s; c o g -
n it iv e fu n c ti o n in g; fi n a n c ia l w e ll -b e in g ;
sp ir it u a li ty
a n d tr an sc e n d e n c e
H o rd e r, F ra n d in ,
a n d L a rs so n
(2 0 1 3 )
9 F e m a le s; 1 5 m a le s
M e an
a g e ¼ 8 1 ;
ra n g e : 7 7 – 9 0
W e st e rn
S w e d e n
C o m m u n it y d w e ll in g
In d iv id u a l in te rv ie w s
C o n te n t a n al y si s
E x p lo re d th o u g h ts
a n d fe e li n g s re la t-
e d to
su c c e ss fu l a g in g; o p e n in g
q u e st io n : “ P le as e te ll m e w h a t
su c c e ss fu l a g in g m e a n s to
yo u .” (3 )
S e lf -r e sp e c t th ro u g h a b il it y to
k e e p fe ar
o f fr a il ty
a t a d is ta n c e (h av in g su ff ic ie n t
b o d il y re so u rc e s fo r se c u ri ty
a n d
o p p o rt u n it y ); st ru c tu re s th a t p ro m o te
se c u ri ty
a n d o p p o rt u n it ie s (s a ti sf a c -
ti o n w it h o n e ’s fi n a n c ia l si tu at io n ;
se c u ri ty
a n d o p p o rt u n it ie s in
th e
c lo se st
c o n te x t) ; fe e li n g v a lu a b le
in
re la ti o n to
th e o u ts id e w o rl d (f e e li n g
n o ti c e d a n d a p p re c ia te d in
so c ia l
re la ti o n s; e n g a g e m e n t in a c ti v it ie s th a t
p ro v id e p le a su re
o r b e n e fi t) ; c h o o si n g
g ra ti tu d e in st e a d o f w o rr ie s (c h o se
g ra ti tu d e fo r n o t b e in g a s b a d a s
o th e rs ; d e n y in g d if fi c u lt ie s; a c c e p ti n g
th in g s yo u c a n n o t c h a n g e )
H su
(2 0 0 7 )
4 8 .1 %
fe m a le ; 5 1 .9 %
m al e
(N ¼ 5 9 4 )
3 0 .3 %
w e re
6 5 – 6 9 ye a rs ;
2 4 .7 %
w e re
7 0 – 7 4 ;
2 4 .8 %
w e re
7 5 – 7 9 ;
2 0 .2 %
w e re
8 0 þ
T a iw a n
C o m m u n it y d w e ll in g
S u rv e y s c o n d u c te d v ia
fa c e -t o -f ac e in te rv ie w s
C o n te n t a n al y si s;
fa c to r a n al y si s
2 3 p re d e te rm
in e d it e m s a b o u t su c -
c e ss fu l a g in g a n d “ W
h a t d o yo u
th in k a re
th e e ss e n ti a l c o m p o -
n e n ts
o f a n id e a l a n d sa ti sf a c to ry
o ld -a g e li fe ?”
P h y si c a l h e a lt h (4 7 .4 % ); fa m il y a n d so c ia l
su p p o rt
(2 8 .7 % ); e c o n o m ic se c u ri ty
(1 7 .8 % ); sp ir it u a l w e ll -b e in g (1 6 .9 % );
e n v ir o n m e n t a n d so c ia l p o li c y (1 1 .7 % );
e n g a g e m e n t w it h li fe
(7 .5 % )
(c o n ti n u e d )
9
608
T a b le
1 . C o n ti n u e d .
A u th o r( s)
D e m o g ra p h ic s
D e si g n /A n a ly se s
Q u e st io n s
M a jo r T h e m e s (s u b th e m e s)
Jo p p e t a l.
(2 0 1 5 )
N ¼ 2 9 1 (1 5 1 A m e ri c a n s;
1 5 5 G e rm
a n s) ; g e n d e r
w a s n o t sp e c if ie d
U .S . sa m p le ¼ 2 1 %
A fr ic a n
A m e ri c a n ; 7 %
A si a n
A m e ri c a n ; 6 6 %
W h it e
G e rm
a n sa m p le ¼ 1 0 0 %
W h it e
A g e ra n g e : 1 5 – 9 6 (1 0 3
“ y o u n g p e o p le ” ; 9 2
“ m id d le -a g e d ”; a n d
9 6 “ o ld e r a d u lt s” )
M ix tu re
o f c o m m u n it y
d w e ll in g a n d re si d e n -
ti a l c a re
In d iv id u a l in te rv ie w s;
g ro u n d e d th e o ry
O p e n
c o d in g , c lu st e ri n g , a n d
th e m e id e n ti fi c a ti o n
1 . W
h a t is su c c e ss fu l a g in g in
yo u r
v ie w ?
2 . W
h a t is in vo lv e d in
th e p ro c e ss
o f
su c c e ss fu l a g in g ?
H e a lt h (8 1 7 % ); so c ia l re so u rc e s (6 5 .7 % );
a c ti v it ie s/ in te re st s (5 5 .9 % ); v ir tu e s/
a tt it u d e s/ b e li e fs (5 1 .0 % ); w e ll -b e in g
(4 9 .3 % ); li fe
m a n a ge m e n t/ c o p in g
(3 5 .9 % ); fi n a n c ia l re so u rc e s (3 1 .4 % );
a g in g /a g e a s a to p ic (2 5 .5 % ); in d e p e n -
d e n c e (1 7 .6 % ); m e a n in g in li fe (1 4 .7 % );
g ro w th /m
a tu ra ti o n (1 4 .4 % ); re sp e c t/
st a tu s (1 3 .7 % ); e d u c a ti o n /k n o w le d g e
(1 2 .1 % ); m ic ro e n v ir o n m e n t (9 .5 % );
so c ie ty /m
ic ro e n v ir o n m e n t (8 .2 % );
o th e r (2 .3 % )
L a d it k a e t a l.
(2 0 0 9 )
N ¼ 3 9 6
7 4 .9 %
fe m a le s
D iv e rs e p a rt ic ip a n ts ,
in c lu d in g A fr ic an
A m e ri c a n s, A m e ri c a n
In d ia n s, C h in e se ,
H is p a n ic , V ie tn a m e se ;
W h it e
M e an
a g e ¼ 7 1 .0
U n it e d S ta te s—
9 st a te s
C o m m u n it y d w e ll in g
4 2 fo c u s g ro u p s C o n st an t
c o m p a ri so n m e th o d s
A sk e d to
p ro v id e a d e sc ri p ti o n o f
“ so m e o n e w h o yo u th in k is
a g in g w e ll ”
L iv in g to
a d v a n c e d a g e ; h av in g g o o d
p h y si c a l h e a lt h ; h av in g a p o si ti ve
m e n ta l o u tl o o k ; b e in g c o g n it iv e ly
a le rt ; h av in g a g o o d m e m o ry ; a n d
b e in g so c ia ll y in vo lv e d
L e w is (2 0 1 1 )
1 6 F e m a le s; 1 0 m a le s
1 0 0 % A la sk a n N a ti ve s (A N )
A g e ra n g e : 6 1 – 9 3
6 B ri st o l B ay
C o m m u n it ie s
In te rv ie w s th a t u ti li ze d
th e “ e x p la n a to ry
m o d e l in te rv ie w
p ro -
to c o l”
1 5 q u e st io n s c o ve re d th e se
to p ic s:
“ h o w
A N
E ld e rs
d e fi n e su c c e ss fu l
a g in g ; h o w
th e ir a g in g p ro c e ss
a ff e c ts
th e ir e m o ti o n a l, sp ir it u a l,
F o u r e le m e n ts
w e re
im p o rt a n t to
e ld e r-
sh ip
(r e : su c c e ss fu l a g e in g ): e m o ti o n a l
w e ll -b e in g ; c o m m u n it y e n g a g e m e n t;
sp ir it u a li ty ; p h y si c a l h e a lt h (c o n ti n u e d )
10
609
T a b le
1 . C o n ti n u e d .
A u th o r( s)
D e m o g ra p h ic s
D e si g n /A n a ly se s
Q u e st io n s
M a jo r T h e m e s (s u b th e m e s)
(S W
A la sk a )
C o m m u n it y d w e ll in g
G ro u n d e d th e o ry , in d u c -
ti v e a p p ro a c h ; in te r-
ra te r re li a b il it y
c h e c k e d w it h K a p p a
st a ti st ic (M
¼ .8 7 )
a n d c o g n it iv e w e ll -b e in g ; a n d if
th e ir c o m m u n it y is su p p o rt iv e o f
th e m
a g in g su c c e ss fu ll y ”
L e w is (2 0 1 3 )
1 6 F e m a le s; 1 0 m a le s
1 0 0 %
A la sk a n N a ti ve s
A g e ra n g e : 6 1 – 9 3
6 B ri st o l B ay
C o m m u n it ie s
(S W
A la sk a )
C o m m u n it y d w e ll in g
In te rv ie w s th a t u ti li ze d
th e “ e x p la n a to ry
m o d e l in te rv ie w
p ro -
to c o l”
G ro u n d e d th e o ry , in d u c -
ti v e a p p ro a c h ; in te r-
ra te r re li a b il it y
c h e c k e d w it h K a p p a
st a ti st ic (M
¼ .8 7 )
1 5 q u e st io n s c o ve re d th e se
to p ic s:
“ h o w
A N
E ld e rs
d e fi n e su c c e ss fu l
a g in g ; h o w
th e ir a g in g p ro c e ss
a ff e c ts
th e ir e m o ti o n a l, sp ir it u a l,
a n d c o g n it iv e w e ll -b e in g ; a n d if
th e ir c o m m u n it y is su p p o rt iv e o f
th e m
a g in g su c c e ss fu ll y ”
O p ti m is m
w a s th e k e y fi n d in g ; it w a s
fo u n d in
e a c h o f th e m e s re la te d to
e ld e rs h ip ; th a t is , m ai n ta in
a p o si ti ve
o u tl o o k w a s e ss e n ti a l to
e ld e rs h ip /
su c c e ss fu l a g e in g
M o rt im e r, W a rd ,
a n d W
in e fi e ld
(2 0 0 8 )
1 4 F e m a le s
A g e ra n g e : 6 0 – 8 9
A d e la id e , A u st ra li a
C o m m u n it y d w e ll in g
S e m i- st ru c tu re d in te r-
v ie w s;
T h e m a ti c a n a ly si s w it h
in te rp re ti ve
p h e n o m e -
n o lo g ic al a n a ly -
se s fr a m e w o rk
W h a t d o e s su c c e ss fu l a g e in g m e a n
to yo u ?
P e rs o n a l a g e n c y (a d ap ta b il it y ; n a tu re ;
h e a lt h ; li fe
o f th e m in d ; fi n a n c e ; sp ir i-
tu a l a n d se lf -e x p re ss io n ); so c ia l v al u e
(i n te rp e rs o n a l; g e n e ra ti v it y ; a ff il ia -
ti o n s; v a lu e ); q u a li ty
o f li fe /d e at h (l if e
q u a li ty ; sp ir it u a li ty ; d e a th ; a u to n o m y ;
a u th e n ti c it y )
N g u ye n a n d
S e a l (2 0 1 4 )
2 7 F e m a le s; 1 7 m a le s
2 1 H m o n g ; 2 3 C h in e se
A g e ra n g e : 6 0 – 1 0 0
(C h in e se ), 6 1 – 9 5
(H m o n g );
H m o n g a ll e m ig ra te d fr o m
L a o s to
U n it e d S ta te s;
C h in e se
w e re
a m ix
o f im m ig ra n ts
a n d
U .S .- b o rn
C o m m u n it y d w e ll in g
In te rv ie w s w it h se m i-
st ru c tu re d n a rr a ti ve
in q u ir y
G ro u n d e d th e o ry ; o p e n
c o d in g fo r e m e rg e n t
th e m e s; W
il c o x o n
si g n e d ra n k su m
te st ;
c h i- sq u a re ; d e sc ri p -
ti v e st a ti st ic s
D e sc ri b e so m e o n e yo u k n o w
w h o
yo u c o n si d e r to
b e a g e in g w e ll ;
d e sc ri b e so m e th in g s o r p e o p le
th a t m ak e yo u h a p p y ; sc a le s fo r
se lf -r e p o rt e d h e a lt h , sa ti sf a c ti o n
w it h li fe
H m o n g: p h y si c a l h e a lt h a n d m o b il it y ;
m e n ta l h e a lt h ; h a rm
o n io u s re la ti o n -
sh ip s; p o si ti ve
fa m il y re la ti o n sh ip s;
ta n g ib le
fa m il y su p p o rt ; fi n a n c ia l st a -
b il it y ; so c ia l e n g a g e m e n t; re li g io u s
fa it h
C h in e se : p h y si c a l h e a lt h a n d m o b il it y ;
m e n ta l h e a lt h ; p o si ti ve
a tt it u d e s;
sh e d d in g re sp o n si b il it ie s; p o si ti ve
fa m il y re la ti o n sh ip s; fi n a n c ia l st a b il it y ;
(c o n ti n u e d )
11
610
T a b le
1 . C o n ti n u e d .
A u th o r( s)
D e m o g ra p h ic s
D e si g n /A n a ly se s
Q u e st io n s
M a jo r T h e m e s (s u b th e m e s)
so c ia l e n g a g e m e n t; re li g io u s fa it h ;
a c c o m p li sh m e n ts ; vo lu n te e r w o rk
N im ro d a n d
B e n -S h e m
(2 0 1 5 )
7 2 %
fe m a le s (N
¼ 2 0 7 )
M e an
a g e ¼ 7 8 .7 5 ; ra n g e :
6 5 – 9 3
U n it e d S ta te s
C o m m u n it y d w e ll in g
In te rv ie w s
C o n st ru c ti v is ts
g ro u n d e d
th e o ry
a n d si tu at io n -
a l a n a ly si s
W h a t a d v ic e w o u ld
y o u g iv e m e o n
h o w
to a c h ie ve
su c c e ss fu l a g e in g ?
In ve st m e n ts
m ad e a t e a rl ie r li fe
st a g e s;
p re se rv in g q u a li ti e s c o n tr ib u te s to
w e ll -b e in g ; in te rn a l re so u rc e s th a t
p ro v id e c o p in g st ra te g ie s
R e ic h st a d t, D e p p ,
P a li n k a s, F o ls o m ,
a n d Je st e (2 0 0 7 )
5 3 %
fe m a le s (N
¼ 7 2 )
A g e ra n g e : 6 0 – 9 9
S a n D ie g o , C A
C o m m u n it y d w e ll in g
S e m i- st ru c tu re d fo c u s
g ro u p s w it h “ fu n n e l
in te rv ie w
d e si g n ”
G ro u n d e d th e o ry
H o w
w o u ld
yo u d e fi n e su c c e ss fu l
a g e in g ? W
h a t a re
th e n e c e ss a ry
c o m p o n e n ts
o f su c c e ss fu l a g e in g ?
3 3 F a c to rs
w e re
id e n ti fi e d w it h 4 m aj o r
th e m e s: a tt it u d e /a d a p ta ti o n ; se c u ri ty /
st a b il it y ; h e a lt h /w e ll n e ss ; e n g a g e m e n t/
st im u la ti o n
R e ic h st a d t,
S e n gu p ta ,
D e p p , P a li n k a s,
a n d Je st e (2 0 1 0 )
5 9 %
fe m a le s (N
¼ 2 2 )
M e an
a g e ¼
8 0 ;
ra n g e : 6 4 – 9 6
8 6 %
W h it e
S a n D ie g o ,
C A C o m m u n it y d w e ll in g
In te rv ie w s
G ro u n d e d th e o ry
H o w
w o u ld
yo u d e fi n e su c c e ss fu l
a g e in g ? W
h a t is im p o rt a n t to
a g in g
su c c e ss fu ll y ? H o w
h av e yo u r li fe
e x p e ri e n c e s in fl u e n c e d th e c o u rs e
o f yo u r li fe
a n d h o w
y o u a g e ?
W h a t a re
yo u r su g g e st io n s o n
h o w
to a g e w e ll a n d re c o m m e n -
d a ti o n s fo r sp e c if ic in te rv e n ti o n s
to p ro m o te
h e a lt h y a g e in g ?
S e lf -a c c e p ta n c e /s e lf -c o n te n tm
e n t (r e a li s-
ti c se lf -a p p ra is a l; a re v ie w o f o n e ’s li fe ;
fo c u si n g o n th e p re se n t) ; e n g a g e m e n t
w it h li fe /s e lf -g ro w th
(n o v e l p u rs u it s;
g iv in g to
o th e rs ; so c ia l in te ra c ti o n s;
p o si ti v e a tt it u d e s)
R o m o e t a l.
(2 0 1 2 )
6 4 %
fe m a le s (N
¼ 2 2 )
M e an
a g e ¼
7 8 .3 ;
ra n g e : 5 9 – 9 7
2 3 % A fr ic a n A m e ri c an ; 3 2 %
C h in e se ; 2 0 %
L a ti n o (a );
2 0 %
W h it e
S a n F ra n c is c o , C A
C o m m u n it y d w e ll in g
S e m i- st ru c tu re d , o p e n -
e n d e d in te rv ie w s
G ro u n d e d th e o ry
R e se a rc h e rs
h av e c o m e u p w it h th e
te rm
“ su c c e ss fu l a g in g. ” W
h a t
c o m e s to
m in d w h e n yo u h e a r
th a t te rm
? D o yo u fe e l li k e yo u
h av e a g e d su c c e ss fu ll y ? D o yo u
fe e l o ld ?
A g in g m e a n s “ li v in g in
a n e w
re a li ty ”
(a c k n o w le d g e th is n e w
re a li ty ; re je c t
th e n e w
re a li ty ); su c c e ss fu l a g in g w a s
a c h ie ve d th ro u g h a d a p ta ti o n a n d
c o p in g st ra te g ie s
(c o n ti n u e d )
12
611
T a b le
1 . C o n ti n u e d .
A u th o r( s)
D e m o g ra p h ic s
D e si g n /A n a ly se s
Q u e st io n s
M a jo r T h e m e s (s u b th e m e s)
R o za n o v a , N o u la s,
S o u th w ic k , a n d
P ie tr za k (2 0 1 5 )
9 6 .9 %
m al e s (N
¼ 2 ,0 2 5 )
A g e ra n g e : 6 0 – 9 6
S a n F ra n c is c o , C A
C o m m u n it y d w e ll -
in g ve te ra n s
3 o p e n -e n d e d q u e st io n s
o n a su rv e y
T h e m a ti c a n al y si s “ ro o te d
in a n in d ic a ti ve
a p p ro a c h to
te x tu -
a l d a ta ”
In yo u r v ie w , w h a t fa c to rs
a re
m o st
im p o rt a n t to
su c c e ss fu l p h y si c a l,
e m o ti o n a l, a n d c o g n it iv e a g e in g ?
“ W
h a t yo u d o ” (h e al th
b e h av io rs ; so c ia l
e n g a g e m e n t; m ai n ta in
g o o d fu n c ti o n )
w a s th e m o st
p ro m in e n t th e m e fo r
e a c h o f th e th re e q u e st io n s; th e
se c o n d m o st
c o m m o n th e m e w a s
“ w h o yo u a re ” (p e rs o n a li ty
a n d
e x p la n a to ry
st y le ; m o ra l c o m p a ss ;
e m o ti o n a l d is p o si ti o n ); e x te rn a l fa c -
to rs
(e .g ., h e a lt h c a re ) w e re
la st
c o m m o n a c ro ss
th e d o m a in s
T a te , L a h , a n d
C u d d y (2 0 0 3 )
1 0 0 %
m al e s (N
¼ 1 ,7 7 1 )
C an a d a
C o m m u n it y d w e ll in g W
W II
C a n a d ia n A ir
F o rc e ve te ra n
O p e n -e n d e d q u e st io n o n
su rv e y
C o n te n t a n al y si s
W h a t is yo u r d e fi n it io n o f su c c e ss fu l
a g e in g ? W o u ld
y o u sa y yo u h av e
su c c e ss fu ll y a g e d ?
2 0 C o m p o n e n t th e m e s; m o st
fr e q u e n t
th e m e s p ro v id e d : h e a lt h a n d d is e as e ;
p h y si c a l, m e n ta l, a n d so c ia l a c ti v it y a n d
w e re
m o re
li k e ly to
b e fo u n d in
d e fi -
n it io n s th a t in c lu d e d in te re st ; h av in g
g o a ls ; fa m il y ; o r d ie t
T a te , S w if t, a n d
B ay o m i (2 0 1 3 )
1 0 0 %
m al e s (N
¼ 1 ,7 4 5 ;
5 ,8 9 8 n a rr a ti ve s)
C an a d a
C o m m u n it y d w e ll in g W
W II
C a n a d ia n A ir
F o rc e ve te ra n
O p e n -e n d e d q u e st io n o n
su rv e y
C o n te n t a n al y si s
W h a t is yo u r d e fi n it io n o f su c c e ss -
fu l a g e in g ?
2 1 T h e m e s w it h 8 6 su b th e m e s: h e a lt h —
g e n e ra l; h e a lt h — p h y si c a l; h e a lt h —
c o g n it iv e ; h e a lt h sy st e m ; a tt it u d e ;
h a p p in e ss ; li v in g a n d d y in g ; p h y si c a l
a c ti v it y ; le is u re
a c ti v it y a n d in te re st s;
li fe st y le ; b e in g p ro d u c ti v e o r c o n tr ib -
u ti n g ; c o p in g ; a d ju st m e n t; a c c e p ta n c e ;
a d a p ta ti o n ; sp ir it u a li ty /f ai th ; re la ti o n -
sh ip s—
in ti m a te ; re la ti o n sh ip s—
in ti -
m at e ; re la ti o n sh ip s—
fa m il y ;
re la ti o n sh ip s—
c o m p an io n sh ip ; re la -
ti o n sh ip s—
so c ie ty ; in d e p e n d e n c e ; li fe
e x p e ri e n c e ; q u a li ty
o f li fe
13
612 The International Journal of Aging and Human Development 91(4)
across the studies. The researchers compared their lists and discussed their findings to ensure that the data were represented and summarized appropriately. Table 2 provides these themes alongside the article author(s).
Findings
As Table 2 illustrates, there were 12 main themes that were identified across the
22 studies exploring older adults’ views and definitions of successful aging. Each of the 12 themes is described in detail later.
Social Relationships and Interactions
Elements of social relationships and interactions were present across 19 of the 22 studies where older adults defined successful aging as consisting of or incorpo- rating the following: maintaining connections with family and friends; having
good family and social support; family and intergenerational care; social engagement and participation; social resources; and having status, appreciation, and respect in social relations. In describing the importance of social relation-
ships and interactions, the older adults highlighted the need to have good rela- tionships and engagement with spouses, family, friends, and children (Amin, 2017; Chong et al., 2006; Dionigi et al., 2011; Hilton et al., 2012; Mortimer et al.,
2008; Nguyen & Seal, 2014; Rozanova et al., 2015; Tate et al., 2003, 2013) and, for some, friendships were even more indispensable than family (Chen, 2015).
The need for help and support from partners/spouses, children, neighbors, and friends as one grows older was highlighted, but also an opportunity to have a sense of belonging and being needed through caretaking, particularly for grand-
children (Amin, 2017) or being taking care of by their children by living with them, having support from them, or receiving frequent visits from them (Hsu, 2007; Nguyen & Seal, 2014). For some older adults, receiving support and feel-
ing loved enabled them to keep from worrying (Horder et al., 2013) and family well-being was viewed as related to their healthy aging experience and good health (Nguyen & Seal, 2014) as well as useful in adjusting to changes in later
life (Nimrod & Ben-Shem, 2015). Social engagements in the community were also important and provided self-
satisfaction, an opportunity to gain respect, and social inclusion or belonging (Amin, 2017; Jopp et al., 2015; Lewis, 2011; Mortimer et al., 2008; Reichstadt et al., 2010; Rozanova et al., 2015; Tate et al., 2013). The older adults described
having access to social supports and providing social supports to family, friends, and neighbors helped to ward off boredom and loneliness and was a source of
encouragement or motivation in staying healthy (Guell et al., 2016; Laditka et al., 2009; Nguyen & Seal, 2014) even when such activities were undertaken because of social expectations (e.g., keeping up the house; watching grandchil-
dren; Guell et al., 2016).
14 The International Journal of Aging and Human Development 0(0)
Teater and Chonody 613
Table 2. Themes of Successful Aging.
Themes Frequency Authors
1. Social Relationships
and Interactions
19 Amin (2017); Chen (2015); Chong et al. (2006);
Dionigi et al. (2011); Guell et al. (2016); Hilton
et al. (2012); Horder et al. (2013); Hsu (2007);
Jopp et al. (2015); Laditka et al. (2009); Lewis
(2011); Mortimer et al. (2008); Nguyen and Seal
(2014); Nimrod and Ben-Shem (2015); Reichstadt
et al. (2007, 2010), Rozanova et al. (2015); Tate
et al. (2003, 2013)
2. Positive Thinking,
Attitude, and
Optimism
17 Chong et al. (2006); Collis and Waterfield (2014),
Dionigi et al. (2011); Guell et al. (2016); Hilton
et al. (2012); Horder et al. (2013); Jopp et al.
(2015); Laditka et al. (2009); Lewis (2011, 2013);
Nguyen and Seal (2014); Nimrod and Ben-Shem
(2015); Reichstadt et al. (2007, 2010); Rozanova
et al. (2015); Tate et al. (2003, 2013)
3. Being Healthy 15 Chen (2015); Chong et al. (2006); Dionigi et al.
(2011); Hilton et al. (2012); Horder et al. (2013);
Hsu (2007); Jopp et al. (2015); Lewis (2011);
Mortimer et al. (2008); Nguyen and Seal (2014);
Nimrod and Ben-Shem (2015); Reichstadt et al.
(2007); Rozanova et al. (2015); Tate et al.
(2003, 2013)
4. Financial Security 13 Amin (2017); Chen (2015); Chong et al. (2006);
Hilton et al. (2012); Horder et al. (2013); Hsu
(2007); Jopp et al. (2015); Mortimer et al. (2008);
Nguyen and Seal (2014); Nimrod and Ben-Shem
(2015); Reichstadt et al. (2007); Rozanova et al.
(2015); Tate et al. (2003)
5. Acceptance and
Adaptation
13 Amin (2017); Collis and Waterfield (2014); Guell
et al. (2016); Hilton et al. (2012); Horder et al.
(2013); Hsu (2007); Jopp et al. (2015); Laditka et al.
(2009); Mortimer et al. (2008); Romo et al. (2012);
Rozanova et al. (2015); Tate et al. (2003, 2013)
6. Engagement
with Life
13 Chen (2015); Chong et al. (2006); Guell et al. (2016);
Hilton et al. (2012); Horder et al. (2013); Hsu
(2007); Jopp et al. (2015); Mortimer et al. (2008);
Nimrod and Ben-Shem (2015); Reichstadt et al.
(2007, 2010); Tate et al. (2003, 2013)
7. Spirituality 11 Amin (2017); Hilton et al. (2012); Hsu (2007); Jopp
et al. (2015); Lewis (2011); Mortimer et al. (2008);
Nguyen and Seal (2014); Nimrod and Ben-Shem
(2015); Rozanova et al. (2015); Tate et al.
(2003, 2013)
(continued)
Teater and Chonody 15
614 The International Journal of Aging and Human Development 91(4)
Positive Thinking, Attitude, and Optimism
Elements of positive thinking, attitude, and optimism were present in 17 studies and included maintaining a positive attitude and mental outlook, celebrating and accepting old age, being happy and satisfied with life, choosing gratitude instead of worries, having peace of mind, maintaining emotional well-being, engaging in positive thinking and being optimistic, having self-acceptance and self-contentment, focusing on the present, acknowledging accomplishments, investing in oneself, and engaging in humor and happiness. The older adults described the need to maintain a positive attitude despite changes due to aging, such as not being able to perform the same activities that one could when younger (Chong et al., 2006). When faced with physical changes and challenges, such as illness or chronic pain, the older adults described the need to let go and accept the illness or pain and not let it affect one’s emotions or feel sad about one’s circumstances (Chong et al., 2006; Hilton et al., 2012; Laditka et al., 2009; Nguyen & Seal, 2014). The utilization of coping strategies (Collis & Waterfield, 2014) and taking a “get on with it” approach (Guell et al., 2016) where one looks forward not backwards and experiences contentment, investment in oneself, and celebrates and accepts old age (Dionigi et al., 2011; Nimrod & Ben-Shem, 2015; Reichstadtet al., 2007, 2010; Tate et al., 2013) were important when coping with aging-related changes.
Older adults also described accepting life the way it is, which includes both happiness and sorrow (Horder et al., 2013) and maintaining an optimist outlook (Lewis, 2011, 2013; Reichstadt et al., 2007) and positive attitude to move through grievances and stressful situations (Nguyen & Seal, 2014; Tate et al., 2003). In doing so, one can have peace with oneself, less worry, better health due
Table 2. Continued.
Themes Frequency Authors
8. Environment and
Social Policy
7 Hsu (2007); Jopp et al. (2015); Mortimer et al.
(2008); Nimrod and Ben-Shem (2015); Reichstadt
et al. (2007); Rozanova et al. (2015); Tate
et al. (2013)
9. Autonomy and
Independence
7 Hilton et al. (2012); Jopp et al. (2015); Mortimer
et al. (2008); Nguyen and Seal (2014); Nimrod and
Ben-Shem (2015); Tate et al. (2003, 2013)
10. Cognitive Health 6 Hilton et al. (2012); Laditka et al. (2009); Nguyen and
Seal (2014); Rozanova et al. (2015); Tate et al.
(2003, 2013)
11. Physically Active 6 Amin (2017); Dionigi et al. (2011); Guell et al. (2016);
Laditka et al. (2009); Tate et al. (2003, 2013)
12. Having a Good
Death
2 Chen (2015); Horder et al. (2013)
16 The International Journal of Aging and Human Development 0(0)
Teater and Chonody 615
to less distress when problems arise, and the ability to live fully and enjoy life
(Jopp et al., 2015; Lewis, 2011, 2013; Reichstadt et al., 2007). Finally, the older
adults reported the importance of acknowledging and reflecting on their accom-
plishments of the past and feeling a sense of pride (Nguyen & Seal, 2014; Tate
et al., 2013) and the importance of keeping a good sense of humor (Nimrod &
Ben-Shem, 2015; Rozanova et al., 2015; Tate et al., 2003, 2013).
Being Healthy
Being healthy was described by older adults as contributing to successful aging
across 15 of the 22 studies where having good physical and mental health, self-
care, sufficient bodily resources for security and opportunities (e.g., mobility),
and engaging in healthy behaviors was viewed as important. Being healthy was
described as the ability to take care of oneself and everyday life, such as being
able to eat, get to places, sleep and to get out of bed, maintain good mobility—
even with assistance—maintain a sense of independence, and keeping busy and
engaged in life (Chen, 2015; Chong et al., 2006; Dionigi et al., 2011; Horder
et al., 2013; Hsu, 2007; Nguyen & Seal, 2014). Being healthy involved making
healthy lifestyle choices, such as participating in exercise, eating healthy, main-
taining a good weight, stress management, vitamin use, medication manage-
ment, avoiding the sun, not smoking, and drinking alcohol in moderation
(Hilton et al., 2012; Nguyen & Seal, 2014; Nimrod & Ben-Shem, 2015;
Reichstadt et al., 2007; Rozanova et al., 2015; Tate et al., 2003, 2013). It is important to note that some older adults did not equate being healthy
with no disease or medical problems (Chen, 2015; Lewis, 2011; Reichstadt et al.,
2007) and some form of chronic illness was seen as a natural part of growing
older (Nguyen & Seal, 2014). Rather, being healthy meant the ability to adapt
and cope with the changes that come with disease, disability, chronic illness, and
pain by maintaining a sense of independence and ability to self-care to some
degree. Yet, for other older adults, particularly those who were described as
being moderately to highly physically active, being healthy did encompass
aspects of exercise and regular physical activity as important (Dionigi et al.,
2011; Mortimer et al., 2008), and the absence of aches and pains, disease, and
major illness (Hilton et al., 2012; Horder et al., 2013; Jopp et al., 2015; Tate
et al., 2013), especially when it could significantly impede upon mobility
(Nguyen & Seal, 2014) and place a burden on close friends and family
(Horder et al., 2013; Hsu, 2007).
Financial Security
Financial security was cited among the older adults as important to successful
aging in 13 studies. Financial security included the following: no financial wor-
ries; financial resources and well-being; satisfaction with one’s financial
Teater and Chonody 17
616 The International Journal of Aging and Human Development 91(4)
situation; economic security, particularly from environmental and social poli-
cies; and tangible support from family members. Financial security was partic-
ularly important in terms of having enough money through paid employment or
retirement/pension, to support oneself in meeting basic needs, meet living
expenses, access and maintain health insurance, and maintain a sense of inde-
pendence (Chen, 2015; Chong et al., 2006; Hilton et al., 2012; Horder et al.,
2013; Hsu, 2007; Jopp et al., 2015; Nguyen & Seal, 2014; Nimrod & Ben-Shem,
2015; Rozanova et al., 2015; Tate et al., 2003). There was an exception to this
among a group of Hmong older adults who reported the need to have tangible
support from family members where they expected their children to provide
financial assistance in buying groceries and paying bills (Nguyen & Seal,
2014). Having financial security was reported by the older adults to contribute
to one’s ability to have less worries and more a sense of security, to be able to
engage in life and participate in activities one enjoys (Horder et al., 2013;
Reichstadt et al., 2007), and to have good care in old age (Mortimer et al., 2008).
Acceptance and Adaptation
Elements of acceptance and adaptation as contributing to successful aging was
included by older adults across 13 of the 22 studies, which was defined by the
following: adapting to the aging body, accepting the aging process, life manage-
ment/coping, living in a new reality, growth/maturation, and living to advanced
age. The older adults stressed the need to adapt to the normal physical changes
of the body, such as graying hair, changes to eyesight and hearing, mobility, and
chronic diseases (e.g., diabetes, arthritis) without much complaint and being
able to take 1 day at a time and accept the new role of “old” with dignity by
having realistic expectations (Amin, 2017; Guell et al., 2016; Hilton et al., 2012;
Mortimer et al., 2008; Rozanova et al., 2015; Tate et al., 2003, 2013). Even when
older adults experienced chronic pain, they discussed being able to age success-
fully by leading a normal life and accepting that pain is a consequence of aging
that one can accept and adjust by making adaptations to lessen the pain or
discomfort (Collis & Waterfield, 2014). Adaptations to the physical changes
associated with aging could include using assistive devices, engaging in lower
impact activities, reducing activities at a gradual level to keep one’s self-respect,
and replacing activities all together (Guell et al., 2016; Horder et al., 2013; Tate
et al., 2013). Many older adults also reported the need to continue to live, mature, and
work on oneself in old age by setting goals, taking up new challenges, and
resolving difficulties (Jopp et al., 2015; Laditka et al., 2009; Rozanova et al.,
2015). This involved not viewing age as a punishment, but accepting age and
aging and living for many years in a new reality where physical changes occur,
but such changes merely require the older adult to perceive situations
18 The International Journal of Aging and Human Development 0(0)
Teater and Chonody 617
differently; those who are able to react and adapt were more likely to view aging as successful (Romo et al., 2012; Tate et al., 2013).
Engagement With Life
In 13 studies, older adults mentioned engagement with life as important to successful aging, which included continuing to be productive and contribute to society, being out and about, staying active and involved, engagement in activities that provide pleasure or benefit, and goals. Remaining active in activ- ities that one likes to do, such as hobbies, reading, journaling, writing, philos- ophizing, and travel, and being involved in the community, such as through volunteering, engagement with cultural activities, church, or senior citizen’s association, or providing child care to grandchildren was viewed as important to successful aging (Chen, 2015; Chong et al., 2006; Hilton et al., 2012; Horder et al., 2013; Hsu, 2007; Jopp et al., 2015; Mortimer et al., 2008; Nimrod & Ben- Shem, 2015; Reichstadt et al., 2007, 2010; Tate et al., 2003, 2013). The older adults reported that being engaged and active did not necessarily mean being physically active, but more getting out of the house and being busy and engaged and trying new things, which could include a combination of physical and sed- entary activities (Guell et al., 2016; Reichstadt et al., 2010). Being engaged in life was related to feeling valuable, and being able to contribute gave a sense of satisfaction and a purpose in life (Horder et al., 2013; Nimrod & Ben-Shem, 2015; Reichstadt et al., 2007).
Spirituality
Spirituality, which encompassed spiritual well-being, meaning in life, moral compass, and religious faith, was discussed as an element of successful aging in 11 studies. The older adults defined spirituality as finding peace in later life (Amin, 2017); having spiritual understanding and relying on God (Hilton et al., 2012); celebrating one’s spirit and connecting with something beyond oneself (Mortimer et al., 2008; Tate et al., 2013); and feeling joy, a sense of tranquillity, security, hope, and to be happy and peaceful (Hilton et al., 2012; Hsu, 2007; Nguyen & Seal, 2014; Nimrod & Ben-Shem, 2015; Tate et al., 2003). Some older adults expressed that getting old was a gift from heaven and being involved in church, religion, and spirituality was important, gave meaning or a sense of purpose in life, and helped in preparing for the end of life (Jopp et al., 2015; Lewis, 2011; Rozanova et al., 2015).
Environment and Social Policy
Older adults in 7 of the 22 studies reported the importance of environmental and social policy to successful aging, which included education, security and stability in one’s living environment, nature, housing, health care, and having basic needs
Teater and Chonody 19
618 The International Journal of Aging and Human Development 91(4)
provided. Many older adults expressed the importance of the environment in contributing to the extent to which they could age successfully. For example, the importance of quality health care, receipt of free or affordable health care, access to work, governmental pensions to assist in meeting basic needs, and having a good education to help in understanding the world and what it means to be an adult (Hsu, 2007; Jopp et al., 2015; Rozanova et al., 2015; Tate et al., 2013). One’s living environment also contributed to successful aging whereby the environment was safe in terms of design (e.g., no stairs; Nimrod & Ben-Shem, 2015) and gave access to nature (Mortimer et al., 2008), or where supports and resources, such as housekeeping, meals, and activities, were accessible and pro- vided (Nimrod & Ben-Shem, 2015; Reichstadt et al., 2007).
Autonomy and Independence
Older adults mentioned autonomy and independence, including personal dignity and authenticity, as an important element to successful aging across 7 of the 22 studies. Autonomy and independence was described as being able to do things that one likes to do without help, living independently, taking care of oneself without depending on others, and maintaining good mobility and well- functioning motor skills, or if needing assistance with mobility, not being bed- bound (Hilton et al., 2012; Jopp et al., 2015; Nguyen & Seal, 2014; Nimrod & Ben-Shem, 2015; Tate et al., 2003, 2013). Autonomy and independence was equated with having a sense of freedom, enabled the older adults to maintain personal dignity, and contributed to the retention of the authentic self (Horder et al., 2013; Mortimer et al., 2008).
Cognitive Health
Cognitive health was mentioned as important aspects of successful aging in six studies, which included good cognitive functioning, being cognitively or men- tally alert, and keeping active mentally. Cognitive health was defined as having minimal memory loss, remaining alert, retaining mental activity, and having an active mind (Hilton et al., 2012; Nguyen & Seal, 2014; Tate et al., 2013), includ- ing remembering details from the past (Laditka et al., 2009). The older adults reported that maintaining cognitive health required them to engage in certain activities, such as mental exercise, reading, playing games, learning new things, challenges oneself, and engaging in hobbies and creative activities (Rozanova et al., 2015; Tate et al., 2003).
Physically Active
In six of the studies, engaging in physical activity and keeping active as impor- tant to successful aging was reported. Some of the older adults described the need to keep physically active by keeping physically fit and working out, such as
20 The International Journal of Aging and Human Development 0(0)
Teater and Chonody 619
participating in sports or golf (Tate et al., 2003, 2013). Individuals who were
found to be more moderately or highly active described a sense of self-
responsibility for their health in older age and believed that keeping physically
active by getting out and doing things would delay old age whereas individuals
who were found to be inactive did not mention physical activity or exercise as
important to successful aging (Dionigi et al., 2011). Keeping physically active
was not always necessarily about exercise but, rather, having an engaged and
active life where engagement in physical activity was part of socializing, work-
ing, or for a purpose, such as walking to get a newspaper (Guell et al., 2016;
Laditka et al., 2009).
Having a Good Death
Having a good death was mentioned by older adults in 2 of the 22 studies, which
was defined not necessarily as longevity but, rather, as “being able to die at
home surrounded by family members in comfort and warmth” (Chen, 2015,
p. 224). Older adults not only mentioned their own death but also the threat
they experienced by the health, well-being, and death of close relatives and
friends and, especially, a spouse (Horder et al., 2013).
Discussion
The results of this scoping review address a gap in the literature by providing a
synthesis of the research on older adults’ definitions and descriptions of success-
ful aging. Through a greater understanding of older adults’ lived experiences
and perspectives, the basic premises of successful aging can be further evaluated
for its ability to capture the aging process. Across the 12 main themes found in
the 22 studies included in this review, older people identified both internally
and externally controlled elements of aging. That is, older adults relayed their
experience of and perspective on successful aging as a combination of social,
psychological, physical, financial, environmental, and spiritual aspects. While
they included good health and mental, physical, and social well-being, they also
acknowledged that getting older comes with changes, such as decreased mobil-
ity, sensory impairments, disease, disability, chronic illness, and pain; things that
are often beyond one’s control. However, successful aging can still be achieved
when positive thinking, spirituality, adaptation, and acceptance are used.
Moreover, external resources, such as finances and environmental factors may
also help or hinder one’s ability to successfully age. The findings provide a
holistic view of older adulthood that encompasses a large number of facets
that may be influencing an older person’s individual experience of aging.
As we have seen with past theoretical models, reductionism does not facilitate
understanding and can promote oppressive thinking, such as the premises of
Teater and Chonody 21
620 The International Journal of Aging and Human Development 91(4)
disengagement theory, which suggests that older adults should leave the social and economic arena.
In fact, when comparing this study’s findings to successful aging, a wider range of factors is found than those suggested by the theory, which focuses primarily on what one does. “Success” is denoted by a low probability of disease and disability, high cognitive and physical functioning, and high engagement in social relationships (Rowe & Kahn, 1997), and individual responsibility is placed in high regard as a preventative measure for physical, cognitive, and social decline The older adults in this study do not report that high physical functioning is equated with successful aging, but, rather, engaging in social, cognitive, and physical activities are important while also being realistic and accepting that one will experience changes and challenges to engaging in such activities due to natural changes in the aging body. Therefore, one needs to accept such changes as natural and normal and make adaptations versus merely giving up and concluding they are unsuccessful at aging. Furthermore, the absence of internal factors that facilitate to assist one in coping and accept- ing challenges and changes that occur in the “natural” and “normal” aging process misses key resilience and protective factors present in older people. This is a limited view of aging and one that also assumes a level playing field in making healthy choices and access to services and resources. This study’s findings highlight this gap in theory in that older adults point out that aging successfully is dependent on external factors, such as financial security, the envi- ronment, and social policies to meet basic needs, have safe housing, and gain access to health care. Such external factors influence the extent to which one can engage in social activities, address health concerns and changes, make healthy choice (e.g., purchase healthy meals), and engage in life, including physical activities. The message from the older adults appeared clear in that aging comes with natural changes and difficulties that cannot always be avoided, but aging successfully requires the utilization of their social and psychological supports to adapt, accept, move forward, and maintain a sense of self, pride, and dignity.
Implications for Future Research and Theory Development
This scoping review has highlighted that successful aging is more complex and varied across older adults than has been described through aging theories, which points to several implications for future research and theory development. First, future aging theories should continue to explore the elements of aging that are of importance to older adults and the factors that they have experienced or per- ceive as contributing factors to aging in a positive way instead of relying on factors identified by theorists and academic researchers. As the findings from this review highlight, there is variation among older adults on the factors that contribute to aging successfully or positively with a strong focus on social
22 The International Journal of Aging and Human Development 0(0)
Teater and Chonody 621
relationships and interactions and one’s state of mind over being free of disease and disability and maintaining high levels of social, cognitive, and physical activity. The older adults also acknowledged external factors of financial secu- rity and the environment and social policy as factors that mediate one’s ability to age successfully. Future theories should reflect more realistic experiences of aging, including natural changes that will occur, such as graying hair, sensory changes, and decreased mobility, versus viewing successful or positive aging as avoiding or fighting such changes. In addition, theories should reflect how older adults’ access to financial resources, their environments, and social policies help or hinder their ability to age positively versus viewing aging as the sole respon- sibility of the individual.
Second, future research exploring the experiences and perspectives of older adults should carefully consider the way questions are asked and how this makes a difference to the way in which older adults will respond. For example, Hilton et al. (2012) found:
when asked to describe someone who is aging well, older adults mention things like
longevity, how good a person looks for his/her age, good genes in the family, and
being able to do things one would not expect of a person that age. Yet, when they
were asked about their own aging, older adults describe a different set of more
personal characteristics. (p. 197)
Using a biographical approach, such as narrative and life history research that utilizes open-ended questions can encourage older adults to talk about what is important to them. For example, asking questions such as “Can you tell me how you feel about growing older?” (Clarke & Warren, 2007, p. 468) or “Please tell me what successful aging means to you” (Horder et al., 2013, p. 3) would elicit greater depth and allow for discovery of meaningful factors that positively sup- port the aging process.
Third, future research should solicit the experiences and perspectives of older adults among differing groups that explores and highlights intersectionality issues, such as race/ethnicity, nationality, social class, social identity, gender identity, sexual orientation, disability status, health status, and geographical location. The findings from this review demonstrated variations among what older adults found to be contributing factors to, and their definitions of, suc- cessful aging based on their demographics and characteristics, and it is impor- tant for theory to give voice to those who may be marginalized or vulnerable due social structural barriers. One theory of aging may not be sufficient to adequate- ly explain the aging process or positive aging for all but, rather, several theories across differing groups of older adults may be warranted. Beginning with a theory that incorporates the perspectives and lived experiences of older adults provides a foundation for creating new theory to address intersectionality or apply existing theory (e.g., critical race theory, queer theory) when applicable.
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622 The International Journal of Aging and Human Development 91(4)
Finally, theorists should consider the naming of aging theories and the explic-
it and implicit messages they relay. Successful aging is a strengths-based theory
of aging, but it also implies particular meanings through its name alone. For
example, Jopp et al. (2015) recognizes successful aging combines “aging—typi-
cally associated with retirement, reduced activity, and various forms of loss—
with success, signifying strength, achievement, and productivity,” which creates
“an illusory standard and unrealistically encourage[es] older adults to maintain
the achievement orientation of their youth” (p. 92).
Conclusion
Giving voice to older adults and their views on aging elevates theory develop-
ment and research by creating a context whereby older people are not just
written about, but rather, they are included in the process. Old(er) age is a
goal that most hope to achieve, and in turn, most would concur that they
would like to maintain their ability to self-determine. Part of that self-
determination is defining aging in one’s own terms and implementing strategies
that help one meet challenges headlong, just as we would do at any other age.
The findings from this review suggest that we elevate the strengths and resilience
found in older people while also supporting changes that occur during the aging
process through progressive approaches to care, support, programing,
and policy.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publica-
tion of this article.
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Author Biographies
Barbra Teater is professor of Social Work and MSW Program director at the College of Staten Island and is affiliated with the Graduate Center at the City University of New York.
Jill M. Chonody is associate professor of Social Work and MSW Program director at Boise State University.
Teater and Chonody 27
