Examining Rowe and Kahn’s Concept of Successful Aging: Importance of Taking a Life Course Perspective

Abstract

Purpose of the Study:

This article critiques Rowe and Kahn’s conceptualization of successful aging using tenets of the life course perspective.

Design and Methods:

A review and synthesis of the literature on successful aging and studies that use a life course perspective.

Results:

We draw on life course principles that view development as a dynamic lifelong process, embedded in historical time and place, and influenced by the web of relationships individuals are linked to, as well as more distal social structural factors. This discussion questions the relatively static nature of Rowe and Kahn’s successful aging model, its emphasis on personal control over one’s later-life outcomes, and neglect of historical and cultural context, social relationships, and structural forces in influencing later-life functioning.

Implications:

Caution in using the model in its current formulation is needed, and we promote thinking about how successful aging can better align with micro- and macrolevel issues through utilization of a life course perspective.

Our goal is to summarize and advance a critique of John Rowe and Robert Kahn’s (1987, 1997, 1998) conceptualization of successful aging (SA) from a life course perspective (Elder, Johnson, & Crosnoe, 2003). Introduced over 20 years ago, Rowe and Kahn’s model remains influential and widely cited despite criticism from the academic community. Opportunities to improve Rowe and Kahn’s model through application of life course principles provide the impetus for this article. Although some may feel—after considering the model’s shortcomings—that it no longer has utility, the popularity of the model in the mainstream literature and extensive use in scientific inquiry warrants modification over disposal. Few conceptualizations of positive aging have spurred such energetic academic inquiry and debate. The model’s development over time holds value and represents the process by which science is improved. Therefore, we encourage cautious use of the model in its current formulation and attempt to promote revisions to the SA construct and model as a means of promoting their utility for policy and practice.

Rowe and Kahn’s model (1997), which is arguably the best known and widely applied model of SA (Dillaway & Byrnes, 2009), views “better than average” aging as a combination of three components: avoiding disease and disability, high cognitive and physical function, and engagement with life. Their formulation aimed to eclipse prior thinking about disengagement and unavoidable senescence by focusing on activity and function (Johnson & Mutchler, 2014). Moreover, the model solidified a major turning point in gerontology and offered ample opportunities for funding programs that viewed elders as able, valuable societal members who benefited from engaged lives (see Everard, Lack, & Heinrich 2000 for an example of how the model provided a framework for program development). Their conceptualization of SA also views decline and functional loss as modifiable although largely through an individual’s own actions. Literature on SA, particularly Rowe and Kahn’s conceptualization, is prolific and thousands of articles cite or utilize this model.

One problem with Rowe and Kahn’s model, however, is its sole focus on late adulthood as a point to make a static assessment of an individual’s “successful aging.” Thus, it fails to capture developmental processes and trajectories of continuity and change in function over time. A life course perspective, in contrast, is a dynamic perspective that considers development, history, and the importance of relationships over time. In application, a life course perspective combats the static “snapshot” created by Rowe and Kahn’s conceptualization and offers an enhanced opportunity to understand SA as a developmental process. In this way, a life course perspective acts in concert with Rowe and Kahn’s model, especially with regard to the formulation of research questions and methodologies that may help counter the model’s weaknesses.

Several aspects of a life course perspective (Elder et al., 2003) make it a valuable tool for evaluating this popular model of SA. First, a life course perspective views aging as lifelong and thus facilitates understanding of late-life “outcomes” and the development of effective prevention and intervention approaches (see Berkman, Ertel, & Glymour, 2011). Moreover, a long view of aging, with an emphasis on process and change over time, highlights the potential for growth and adaptation across the entire life span. A life course perspective points to the importance of context—historical, cultural, and social—for development and aging (Dannefer, 2012) and provides a more nuanced perspective of how social forces and individual agency interact to shape aging outcomes. We argue that Rowe and Kahn’s conceptualization relies too heavily upon individual agency.

Additionally, Rowe and Kahn’s model describes physical function as a major characteristic of SA. A life course perspective broadens this conceptualization by acknowledging that diverse experiences may lead to varying interpretations of success, both individually and culturally.

Finally, a life course perspective focuses on linked lives. This concept highlights that, as social beings, individuals’ lives and life progress are influenced by significant others and their life progress. Recognition of such interconnectedness strengthens dialogue on SA.

Successful Aging: Then and Now

Havighurst (1963) was part of early discussions of the concept of SA and distinguished two views of this phenomenon. An “outer” behavioral view focused on enactment of various social roles, whereas an “inner” subjective view emphasized life adjustment or satisfaction. Avoiding a behaviorally based conceptualization that aligned with either disengagement theory or activity theory—competing perspectives on aging during his time—Havighurst favored the latter approach. This individualized, subjective view of SA emphasized developmental continuity. Havighurst argued that the specific lifestyle favored by particular older adults depended on the lifestyles they had established earlier in adulthood. Havighurst (1963) concluded that “Inner satisfaction can be usefully defined and measured as a criterion of successful aging” (p. 311).

This discussion of SA foreshadowed a view of aging that recognizes consistency in adults’ behavioral preferences and lifestyles across the life span (Maddox, 1968), an idea later formalized in Atchley’s (1989) Continuity Theory of Aging. We highlight these ideas because a life course perspective is necessary in discussions of continuity, and processes promoting continuity across adulthood have been articulated by life course scholars (see Caspi & Roberts, 2001). Additionally, Havighurst’s conception rejects the “outer” view of SA assessed by narrow, behavioral measures like the engagement component of Rowe and Kahn’s model. How the long view of aging challenges the health and functioning components of Rowe and Kahn’s SA model is considered next.

Aging as a Lifelong, Intergenerational Process

A life course perspective views aging as a life-span phenomenon and recognizes developmental influences that are launched prior to birth. Among these early influences are genetics, which Rowe and Kahn (1987) also acknowledge as important to aging outcomes. Additionally, environmental conditions and risks (e.g., poverty) are transmitted across generations in a family and ultimately affect development and aging (Ferraro, Pylypiv Shippee, & Schafer, 2009). Consideration of such factors is critical to understanding late-life outcomes, developmental potential, and the effectiveness of interventions targeted at negative outcomes.

The pathways and processes through which early experiences affect late-life outcomes are articulated in three distinct life course models (Berkman, 2009; Berkman et al., 2011; Hendricks, 2012). Early events or conditions may affect aging directly over time if they occur during a highly sensitive or critical period of development. The timing of exposure or the event may yield powerful consequences for subsequent development, illustrated by principle of timing of Elder and colleagues (2003), and may affect the efficacy of later interventions (Berkman, 2009). Other life situations contribute to risks that build over time and gain influence in shaping later outcomes. Cumulative exposure operates differently from processes noted in the first, sensitive period model, but it also leads to outcomes that are deeply embedded in individuals’ lived experience and not easily modified. Finally, early conditions and events may influence later outcomes indirectly by shaping intermediate life situations, conditions, and roles that subsequently affect later-life outcomes. Unlike developmental consequences resulting from the two process models described previously, adult outcomes resulting from this type of “social trajectory model” (Berkman, 2009) may be resolved by altering the intermediate situations that create proximal risk (Berkman et al., 2011).

These models challenge Rowe and Kahn’s assertions that many of the risk factors for SA are potentially modifiable (Rowe & Kahn, 1997) and that individual agency is central to achieving SA (Kahn, 2002). Indeed, Kahn (2002) claimed that a goal in offering the SA model was “that research on successful aging and its biopsychosocial determinants would encourage people to make lifestyle choices that would maximize their own likelihood of aging well, that is maintaining a high quality of life in old age” (p. 726).

Rowe and Kahn’s emphasis on personal agency was welcome in the late 20th century as conventional wisdom about aging had long been characterized by notions of inevitable and irreversible loss and decline. Historic overview of these developments notes how perspectives like the SA model could have promoted more positive views of older adults and aging (Dillaway & Byrnes, 2009). Yet, by stressing personal control and individual agency in old age—at the neglect of early influences and long-term disease and disability processes—Rowe and Kahn’s model creates problems similar to the one-sided view of aging that they attempted to eliminate. A life course perspective offers a more balanced view of aging by recognizing substantial continuity in developmental processes and patterns over time while accounting for personal agency and change within the context of structural constraints (what Settersten 2003, p. 30, calls “agency within structure”).

Several life course studies demonstrate how adult health is significantly shaped by childhood vulnerability or risk exposure. The Dutch Famine Birth Cohort Study revealed that exposure to inadequate maternal nutrition during World War II heightened the risk of coronary artery disease in adulthood among cohorts born during that period (Painter et al., 2006). Similarly, Brandt, Deindl, and Hank’s (2012) multination analysis indicated that economic disadvantage in childhood significantly predicted SA classifications in adulthood (using criteria like those of Rowe and Kahn). These classifications differed from those predicted by respondents’ current socioeconomic status alone. Additionally, Schafer and Ferraro (2012) assessed the impact of childhood influences (e.g., parental abuse) and concurrent adult factors (e.g., smoking) on “disease free” status in old age. These two sets of influences were of comparable strength in predicting this late-life criterion.

Despite ample evidence for continuity in health function and health-related behaviors across the life span (Lee et al., 2010; McCambridge, McAlaney, & Rowe, 2011), research showing modified health risk in conjunction with behavior change also exists (Cox, 2006; Critchley & Capewell, 2003). For example, Pruchno, Hahn, and Wilson-Genderson (2012) compared current and former smokers to determine whether smoking cessation and its timing affected adults’ SA classifications. Smoking cessation did increase former smokers’ chances of a SA classification relative to current smokers, but only if they quit smoking before age 30. The impact of cumulative exposure also was evident, with “pack-years” of smoking reducing the likelihood of SA. Applying a life course lens thus challenges the reversibility of broad SA classifications like that of Rowe and Kahn. Although personal agency and behavioral change may alter single health indicators, the extent to which they can reverse one’s overall SA classification in the Rowe and Kahn model is unknown.

Identifying effective interventions for various late-life conditions is also difficult without employing a long-term view of aging. For conditions shaped directly by early exposure during critical periods, or via cumulative exposure initiated by early events and conditions, it is unrealistic to assume that lifestyle changes can reverse the problem. Berkman and colleagues (2011) argue, “…most of our interventions to improve the health of older populations come too late in the evolution of disease and disabling processes” (p. 338). Thus, Rowe and Kahn’s (1997) vision of SA may be unattainable for many due to early events and circumstances beyond one’s control in later life. Constraints operating at the macrolevel rather than the microlevel are addressed later.

Linked Lives: Expanding the Social Component of Successful Aging

A life course perspective’s emphasis on the interdependence of individuals’ lives improves upon Rowe and Kahn’s (1997) focus on individual decisions and actions in determining aging outcomes. As discussed, family circumstances, relationships, and events represent powerful influences on early development, with potentially long-term consequences (Brandt et al., 2012; Ferraro et al., 2009; Schafer & Ferraro, 2012; Shaw & Krause, 2002). The influence of social contacts for development and aging likely broadens as individuals enter adulthood and social worlds expand.

Christakis and colleagues documented the significant role of social connections in health-related behaviors (e.g., eating, smoking, and sexual risk taking) (Christakis & Fowler, 2009) and health outcomes (Elwert & Christakis, 2008). They found that social network influences extend up to three degrees (i.e., from friends of friends of friends) and that some health conditions are influenced more by friends than by closer relations such as spouses (Christakis & Fowler, 2009).

Yet, the significance of marital ties for adult well-being is firmly established. Among young (Kiecolt-Glaser & Newton, 2001) and older couples (Bookwala, 2005), marital interactions are known to influence health status, physical symptoms, and chronic conditions (Bookwala, 2005). Spouses also affect each other’s social engagement. Curl, Proulx, Stowe, and Cooney (in press) found that if one’s spouse ceased driving, then paid employment and volunteering decreased, even after controlling for one’s own driving status and health.

Spousal similarity also illustrates the interdependent nature of development. Substantial congruence exists in married partners’ physical and social functioning (Ko, Berg, Butner, Uchino, & Smith, 2007), cognitive performance (Gruber-Baldini, Schaie, & Willis, 1995; Ko et al., 2007), and risk for specific chronic diseases (Hippisley-Cox, Coupland, Pringle, Crown, & Hammersley, 2002). Such similarity may result from assortative mating (Buss, 1984) as well as the conditions that couples cocreate and share over their lives (Caspi, Herbener, & Ozer, 1992). Clearly, considering SA a product of individual action and processes alone is problematic.

The life course perspective’s emphasis on linked lives also highlights opportunities for aging interventions involving family and other social relationships. Although Berkman and colleagues (2011) cite several studies in which efforts to alter features of one’s social networks (e.g., network integration) as a means of health intervention were unsuccessful, more effective solutions may result from utilizing established social connections for health interventions. For example, evidence shows that when one partner is enrolled in a weight reduction program, chances of weight loss for the nonenrolled spouse increase as well (Gorin et al., 2008). Thus, it is inadequate to view individuals as solely responsible for health or developmental problems; likewise, it is restrictive to limit intervention efforts to the individual with the targeted problems.

Successful Aging and Historical Time

Historical time is central to a life course perspective, as it describes development as embedded in sociohistorical conditions that change over time. To date, this idea has been neglected in discussions of SA. An exception is work by Dillaway and Byrnes (2009) that analyzed the historical and sociopolitical context when Rowe and Kahn’s model emerged. Neglect of historical time is critical because it puts theorists at risk of formulating and promoting definitions and operationalizations of SA that are historically bound and may quickly become inappropriate. If the SA construct is to guide health policy and programming, the impact of historical time on aging must be considered.

Though several studies document historical shifts in mortality (Crimmins & Beltran-Sanchez, 2011), disability, and health (Seeman, Merkin, Crimmins, & Karlamangla, 2010), we know of only one study that considers cross-time changes in levels of SA. Using a definition of SA model akin to Rowe and Kahn’s model, McLaughlin, Connell, Heeringa, Li, and Roberts (2010) reported a noticeable drop in rates of SA from 1998 to 2004 using the U.S. Health and Retirement Study. The odds of older adults meeting the “successful” classification declined 25% over this period due largely to increased rates of chronic disease and physical impairment. This finding is disconcerting because of public health problems such as obesity in the United States and related warnings about chronic cardiovascular problems and other obesity-related diseases.

Age stereotypes also arise out of existing sociohistorical conditions. A 2009 report by Levy, Zonderman, Slade, and Ferrucci noted effects of age stereotypes on cardiovascular health in later life. They found that holding negative age stereotypes prior to older adulthood predicted cardiovascular episodes later in life, whereas possessing positive age stereotypes provided future protection against such events. In addition to shaping stereotypes, historical conditions influence the mechanisms through which stereotypes are perpetuated, as is the case with social media technology today (Levy, Chung, Bedford, & Navrazhina, 2014).

Heterogeneity in development is another issue emphasized in a life course perspective. Although Rowe and Kahn’s model allows for varying degrees of SA as defined by the model’s three main components, it overlooks heterogeneity resulting from self-rated, subjective success in aging (Romo et al., 2013). This issue of heterogeneity in aging experiences also is tied to historical time. For example, diversity among U.S. elders and their aging experiences is epitomized by the Hispanic and Latino populations, which will continue to grow in proportion and significance within the aging population (Hilton, Gonzalez, Saleh, Maitoza, & Anngela-Cole, 2012). Health inequalities may contribute negatively to the aging experiences of these groups (Villa, Wallace, Bagdasaryan, & Aranda, 2012). As increasingly diverse perceptions and experiences characterize the aging population, we must avoid marginalizing differences and formulate dynamic, inclusive conceptualizations of SA.

Importance of Place

Beyond standing the test of time, useful models of SA will recognize cultural variation and acknowledge potential cultural bias. A life course perspective emphasizes the importance of place in human development and aging. Although Rowe and Kahn’s (1987) early writing referred to cultural differences in various health factors, their model inadequately accounts for them.

Cultural differences may exist in how individuals view their health, what they consider important in life, and meanings of “success.” Hung, Kempen, and DeVries’s (2010) review of 34 “healthy aging” found that personal, family, and spiritual domains of life were mentioned more in lay than academic reports of healthy aging, and family ties and financial stability played a unique role in Eastern cultures. Such variations reflect the salience of the family collective in Eastern cultures and their emphasis on interdependence rather than independence in aging. The value of offspring and importance of family engagement, specifically over “social” engagement, are additional themes in Eastern conceptualizations.

Recent Western conceptualizations of “harmonious aging” represent attempts to acknowledge global differences and accommodate a broader set of values in defining SA (Liang & Luo, 2012). Although not explicit, these authors rely on tenets of a life course perspective to elucidate harmonious aging, acknowledging contextual influences on individuals’ interpretations and achievement of balance in later life. Notably, North American views of social engagement depend more on physical function (which is needed to provide practical support) and that engagement and productivity are defined in capitalist terms in Rowe and Kahn’s SA model (Dillaway & Byrnes, 2009).

Attention to place also highlights elements at the macrolevel that influence aging outcomes. Hank (2011) and colleagues (Brandt et al., 2012) considered the role of country-level income inequality in rates of SA in 14 European countries. Using a conceptualization of SA similar to that of Rowe and Kahn, Hank (2011) documented dramatically higher rates of SA in Northern European (e.g., 21% in Denmark) than Southern European (3.1% in Spain) and Eastern European (1.6% in Poland) countries, which mirrored cross-national differences in income inequality and welfare state provisions. In their later study, Brandt and colleagues (2012) found that country-level differences in SA associated with income inequality remain significant even after accounting for individual-level predictors of SA. Thus, societal level policies that contribute to income inequality affect SA rates at the macrolevel, regardless of individuals’ personal characteristics and lifestyles.

Other cultural variations such as physiological factors (e.g., bone structure) may explain cross-national variability in the disability component of SA (Santos-Eggimann, Cuénoud, Spagnoli, & Junod, 2009), and variable employment and retirement policies across countries may affect rates of productive engagement—a component of SA (Hank, 2011). These distal structural factors shape the more proximal settings in which individuals live and the experiences they encounter.

The Role of Social Structure in Successful Aging

Though life course scholars have yet to fully define the components of social structure, the socially constructed categories of race, gender, and social class are key influences on aging, as are institutional structures and policies that regulate behavior and provide resources when individuals encounter risks across the life course (Leisering & Schumann, 2003; Zagel, 2013). Strengthened by a growing body of empirical findings (e.g., Brandt et al., 2012; Schafer & Ferraro, 2012), substantial criticism (Dillaway & Byrnes, 2009) has been directed at Rowe and Kahn’s model for its neglect of social structure influences and overemphasis on personal action in aging outcomes. By overstating the role of personal causation in both the causes and potential resolution of some health problems, Rowe and Kahn’s model neglects social inequalities that interfere with SA. In Riley’s terms (1998), it also “fails to develop adequately the social structural opportunities necessary for realizing success” (p. 151).

Though Rowe and Kahn (1997) move beyond a solely ontogenetic view of development by emphasizing external and lifestyle factors in their model, their discussion does not look beyond personal lifestyle and microlevel environmental influences. Thus, macrostructural factors, such as one’s status/position in society, are overlooked although they can shape one’s immediate environment and access to health resources (e.g., good medical care or nutritious food) (Holstein & Minkler, 2003). Consequently, sharp social class disparities exist in disease prevalence, frailty, and other health indicators (Crimmins, Kim, & Vasunilashorn, 2010).

The cross-national studies on income inequality (Brandt et al., 2012; Hank, 2011) discussed previously offer convincing evidence that SA outcomes are not accessible to all. At the individual level, structural characteristics like educational attainment consistently predict SA classifications (Hank, 2011; McLaughlin et al., 2010; Pruchno, Wilson-Genderson, Rose, & Cartwright, 2010; Santos-Eggimann et al., 2009), as do race (McLaughlin et al., 2010), financial adequacy (Hank, 2011), and gender (Hank, 2011; McLaughlin et al., 2010; Pruchno et al., 2010; Santos-Eggimann et al., 2009). Evidence that structural factors affect aging does not negate the role of human agency, but it reminds us that agency is restricted by socially constructed opportunities and constraints.

Institutional forces as an aspect of the macroenvironment and social structure that shape individuals’ lives also are not adequately addressed in Rowe and Kahn’s model. Riley (1998) was among the first to point out their neglect of institutional influences, such as the workplace, communities, and schools, on the aging process. She argued that the chances of enhancing one’s health and well-being depended heavily on structural opportunities and that interventions aimed at personal change require structural interventions. In rebuttal, Kahn (2002) noted that their model emphasized “what individuals themselves can do to use, maintain, and perhaps even improve what they have—their physical and mental capacities” (p. 726), whereas Riley focused on what societies can do via institutional and structural interventions. His point, however, overlooks the interplay of microlevel context, mesolevel institutions, and macrolevel structures in individual lives (Riley, 1998).

Finally, some fear the political fallout of models like Rowe and Kahn’s that deemphasizes structural influences and social inequalities while stressing self-determination in aging. Critics note that a model introduced to provoke positive change in the lives of older adults may end up creating further challenges and greater disadvantage for some if those who are sick or disabled are blamed for their condition and seen as undeserving of help (Holstein & Minkler, 2003).

Summing Up

Scholarship on SA largely concentrates on identifying the criteria that constitute positive aging. Improvement in Rowe and Kahn’s SA model is offered by a life course perspective’s emphasis on aging as a lifelong process; contextual influences on development—primarily place (culture), historical time, and social structural/institutional forces; social–relational influences on health and development; and heterogeneity of lives due to complex pathways of development. Although certain components of the SA model (being disease free) are likely favorable to all, other components such as social engagement are subject to individual preference and interest (Hank, 2011). Havighurst’s thoughts on the continuity of development affirm the idea that individuals will age as they have lived and that maintaining lifestyle preferences is key to their evaluation of SA. Thus, at the individual level, a higher degree of subjectivity that allows for older adults’ own perspectives is warranted in formulating notions of SA. A life course perspective is useful when applied in concert with other models and theoretical approaches to gerontological inquiry, including Rowe and Kahn’s SA model.

A macrolevel application of SA is useful for expanded approaches, such as identifying best practices for policy (Hank, 2011). With attention to cultural differences, best practices can be modified and translated across countries or jurisdictions. The useful analysis of cohorts within life course scholarship (Dannefer, 2012) offers another goal for future research that could classify aggregates in terms of their “success” and examine aspects of SA historically or cross-nationally. Analyses of this type would permit clearer assessment of policy and practice initiatives while avoiding individual labeling that may prove detrimental to older individuals who are unable to attain objective measures of SA.

Scheidt, Humpherys, and Yorgason (1999) took issue with the utility of a SA model that poses an objective standard or fixed end point as “successful aging.” Lack of a dynamic view of SA downplays the fluid nature of the life course and the importance of considering lives and change across the entire life span. Informing the SA construct through the use of a life course perspective casts positive aging as an ongoing developmental process that requires both individual effort and societal support. Moreover, process-oriented conceptualizations of SA are favorable because they allow for greater variation in developmental patterns and adjust for a wider variety of experiences and contexts that individuals may encounter over their lifetimes. Such a focus also avoids value-laden judgments of “aging well” that only the most advantaged groups are likely to achieve. The life course perspective captures expected heterogeneity in the process of aging successfully.