The term “successful aging” entered the healthcare literature more than 30 years ago. Since then, the search for the determinants of living well into old age has grown in intensity as our …
The term “successful aging” entered the healthcare literature more than 30 years ago. Since then, the search for the determinants of living well into old age has grown in intensity as our population ages. Centenarians are among the fastest growing cohorts in the population. While the definitions of “success” and “aging” remain controversial, there is wide agreement that age alone does not determine success.
Chronological age is a poor predictor of how well a person has aged, and chronic condition or illness does not exclude success. An influential early study followed men and women in their 70s, in the top third of physical and cognitive function, living in three different communities, attempting to find common characteristics of “success.”
The investigators established three common characteristics of those who did well. Simply stated, the successful participants avoided disease, maintained cognitive and physical function, and they remained “engaged with life”.
The prevalence of “comorbidity,” two or more chronic conditions, was common after age 70—found in more than 60 percent of women and nearly 50 percent of men. If the absence of chronic illness alone were the determinant of success, more than half of us would fail.
The Berlin Aging Study followed over 500 subjects, aged 70 to 100, over five years, with similar aims of characterizing this population and defining determinants of success. About half of the study population suffered at least one serious illness after the age of 70. A similar proportion had painful arthritis. Yet at 75, eight out of 10 felt they were in “good health.”
The prevalence of dementia rose from 10 percent at 90 to 50 percent at 95. Fewer positive emotions, loneliness and a loss of autonomy were common after 85.
The strongest predictors of poor aging were difficulty walking, poor vision, depression and dementia.
Nonetheless, two thirds of the participants perceived their health as superior to their peers. This subjective sense of well-being, along with an extended family network and a high level of education, were strong predictors of success. For Bernard Baruch, who aged successfully to 95, old age was always “15 years older than I am.” Feeling healthy may have a role in being healthy.
A study of adult development hoped to establish the elements of successful aging by following Harvard sophomores of 1940 and a matched “core-city cohort” of “non-delinquent” white, African-American and Italian men from early adulthood to late life. The importance of good physical health, avoidance of alcohol and tobacco before age 50, and the absence of major depression was noted, consistent with prior studies. A Harvard education mattered less than the number of years (16 or more) of study at any level. This finding, along with a “warm marriage” and the use of “mature” coping mechanisms highlight the significance of “social capital” in determining success.
The authors’ conclusion gives us all reason to hope for success:
“We have considerable control over our weight, exercise, education and our abuse of alcohol and cigarettes. With hard work and/or therapy, our relationship with our spouse and our coping styles can be modified. A successful old age, Horatio, may lie not so much in our stars and genes as in ourselves.”
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