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. 2020 May;13(1):4–10. doi: 10.2174/1874609812666191023130117

The Concept of Successful Aging: A Review Article

Fatemeh Estebsari 1,*, Maryam Dastoorpoor 2, Zahra Rahimi Khalifehkandi 3, Azadeh Nouri 4, Davoud Mostafaei 5, Meimanat Hosseini 6, Roghayeh Esmaeili 7, Hamidreza Aghababaeian 8
PMCID: PMC7403646  PMID: 31657693

Abstract

Background

With the increasing number of elderly people in the world, usage of concepts and terminology related to this phenomenon has substantially increased. One concept in this context is successful aging. The purpose of the present study is to extract and introduce a common concept to be used in studies on measuring successful aging.

Methods

This is a review study. First, by searching the databases of Magiran, Noormags, Medlib, Irandoc, Iranmedex, Barakat Knowledge Network System, Civilica, SID, ISI Web Of Science, PubMed, Scopus, Science Direct and search engines, Google Scholar and Elmnet as well as using standard keywords such as elder, elderly, aging, and successful aging, all related published articles during the period 1995 to 2017 were retrieved. A total of 3417 documents were retrieved. By removing 3390 unrelated, duplicate and unusable documents, 27 articles were included in the study after quality control.

Results

The findings of the study were categorized in three areas: “defining successful aging by focusing on dimensions”, “successful aging principles” and “factors influencing successful aging”. Reviewing various studies, we found that the definition of successful aging deals with cognitive action, perception, control, life satisfaction, and ethics. Successful aging is also defined as having inner feelings of happiness and satisfaction with life for the present and the past. Sometimes successful aging is also considered to be survival with health.

Conclusion

Health care professionals as community health supporters can use the results from the present study for providing the grounds for successful aging. Then, they can use the designed successful aging program for preserving and promoting active and healthy aging for every elderly person in old age.

Keywords: Elder, aging, elderly, successful aging, cognitive action, Iranmedex

1. Introduction

Aging is a period in the life cycle experienced by everyone [1]. The world population is aging rapidly, and the global proportion of people aged 60 and over will reach from 11% in 2006 to 22% in 2050 [2, 3]. In 2050, the world's elderly population is estimated to be multiplied by children under the age of 5, and in the next 50 years, the elderly population will reach two billion worldwide [3]. Iran is estimated to face a sudden increase in the elderly population between 2030 and 2040. As a result, after experiencing epidemiological changes in diseases, Iran must prepare itself for managing the elderly wave in the upcoming decades [4].

According to the UN definition, when a population over 60 years old reaches beyond 7% in a country, that country is considered to be aged [5]. These facts and figures will hopefully orient the attention of authorities to the phenomenon of aging and the need to predict its consequences [2]. A better understanding of an aging society helps us better understand the issues that older people and families face [6]. Due to physiological and anatomical changes resulting from the increase in biological age, retirement and reduced social activities, the death of relatives and friends, separation from children due to marriage, work or immigration, the elderly feel more isolated, where the prevalence of depression increases in them. All these causes make them more vulnerable to multiple risks [7]. In order for the elderly to take this course well and adopt a healthy life, they must take into account the general competence criteria for having a good life in both the youth and old age. They should also focus on a purposeful life based on ideal, meaningful goals and incentives, be in close contact with others, and improve their sense of self-esteem [8]. That is why, in recent years, we have seen a rise in various terms such as successful aging, active aging, healthy aging, positive aging, productive aging, and proper elderly [4, 6, 8, 9], which provoke a good and positive life in the aging period. Each of these concepts represents a different approach to the benefits and potentials of aging [9, 10]. The most commonly used term in recent decades in the United States has been successful aging [9, 11-13]. However, defining and measuring successful aging is difficult due to a variety of characteristics that the elderly require at old age [14, 15]. There are many differences in the definition and measurement of successful aging. The important thing is to understand the genetic effects, the initial experiences, and the actual behavior of individuals as factors affecting the elderly [2, 15, 16]. By the early 1950s, because of focusing on biological problems, senescence was considered to be the same as illness, disability, and dependence, and the older people were referred to as an unproductive population. In the 1980s, positive and successful aging came into focus and WHO called 1999 the Year of the Older Persons [17, 18]. At the same time, it should be noted that the proportion of people with subjective claim of successful aging is higher than the share of individuals categorized as “successful aging” by objective indicators. Successful aging has received much attention in recent years, which is due to the attractiveness and importance of the issue of aging in the modern world [19]. The debate about successful aging involves searching for the factors and conditions that help us better understand the potential of the elderly and identify ways to change the nature of aging [20]. Because of the heterogeneity of the aging process, the definition of successful aging does not follow a particular pattern [21] for which there is neither definite criteria nor the index for measurement [4, 19, 22, 23]. So far, everyone has dealt with it from different perspectives, which has led to various outcomes and achievements, while also contributing to different definitions [13, 24, 25]. There are a number of measurement tools for assessing the status of the elderly in terms of successful aging. Part of them is in the form of research entitled “Self-Report” and includes self-reports of the elderly on their health status and activities [26, 27]. A series of studies has focused on the health conditions of elderly people carried out in the form of a checklist which is more comprehensive than self-reporting [28]. Other series of measurements are related to the activities of daily living, which examine the physical conditions of the elderly. Further, there are measurement tools for the personality of the elderly to measure their (positive or negative) view of life and society as well as the environment [29]. According to the above-mentioned points, we can say that there is no single and integrated definition for successful aging, and the definitions given above depend on the cultural context of the studied community. Due to the increasing number of elderly people and the prevalence of the concept of successful aging, achieving an integrated concept can resolve ambiguity and confusion among researchers and provide the grounds for planning to develop and advance successful aging.

2. Methods

This review study was designed and implemented in Shahid Beheshti University of Medical Sciences in 2017 with the aim of presenting a comprehensive outline of published studies related to the concept of successful aging. In the first step, the search strategy was designed using the standard keywords including: Aging, Successful Aging, Indicators of Successful Aging, Principles of Successful Aging, Criteria for Successful Aging, and Predictors of Successful Aging. The search strategy was designed with Magiran, Noormags, Iranmedex, Medlib, Irandoc, and Civilica, and the Scientific Information Database (SID). In this way, attempts were made to compile all internal articles related to the subject matter. In the next step, ISI's Web of Science, Scopus, PubMed and Science Direct databases were searched using standard keywords to find English-language articles. Also, the search engines, Google Scholar and ELEMENT were searched further. As Persian articles in the field of successful aging were limited and the first Persian article was published in a reputable scientific Iranian journal in 2005, the period of 2001 to 2017 was considered for Persian articles. Since the first paper on successful aging was published in 1997, for English-language articles, the period 1995 to 2017 was chosen to track the world's most authoritative scientific databases.

In this way, articles, abstracts and documents related to the study were collected. Keyword selection was done based on the review of literature and experts' opinions. The search for Persian and English articles in various databases resulted in a total of 3417 documents. The bibliographic information (title, author name, magazine name, year of publication, period, and number) was entered to the EndNote software, and duplicates were removed using Find Duplicate. At this stage, with the elimination of duplicate studies, 1568 documents remained. The next step was to study the exact title and abstract for recognizing eligible documents for inclusion in the study and removing unrelated documents from the study. At this stage, the title and abstract of the articles were obtained and examined by two experts in the field of aging to ensure that they are related to the area of study. One hundred seventeen articles were approved at this stage. The next step was to carefully study the full text of the articles to determine their relevance to the research purpose. In this way, 86 unrelated articles to the research purpose and 4 other duplicates were excluded. Finally, 27 articles were included in the study.

3. Results

The findings of the present study can be categorized into three areas of the definition of successful aging in various areas and dimensions, principles of successful aging, and factors affecting successful aging.

3.1. Successful Aging, Definition

In some studies, the concept of aging is associated with Health-Related Quality of Life (HRQL), flexibility, activity, and the number of close friends [2, 16, 30-33]. McLaughlin et al. investigated the prevalence of successful aging among the elderly based on the Row and Kahn’s model (Fig. 1).

Fig. (1).

Fig. (1)

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The Rowe and Kahn’s successful aging model in 1997. (A higher resolution / colour version of this figure is available in the electronic copy of the article).

The factors considered in their study included Disease and disability, cognitive and physical function, social communication, and productive activities [33, 34]. In some other studies, factors such as age, lack of smoking, non-disability, arthritis, and diabetes have been considered in relation to successful aging [31, 35, 36]. More physical activity, more social communication, self-assessment of better health, lack of depression and cognitive impairment, limited medical status were approved as factors influencing successful aging. On the other hand in other studies, the impact of gender, income, education, and marital status on successful aging was not found to be significant [37, 38]. In some other studies, three features included the low likelihood of illness, high mental and physical activity, and active involvement with life was considered as successful aging criteria [39, 40]. Based on a new definition of successful aging, self-acceptance factors, positive relationships with others, autonomy, control over the individual's environment, and having goals in life were significant [9, 11, 13, 41]. Meanwhile, prevention of disability and prevention of cognitive decline are of great importance for successful aging [42]. Some believe that successful aging is related to spiritual well-being and can be improved with interventions focusing on education and spirituality [43]. Havighurst has defined successful aging as having inner feelings of happiness and satisfaction with the present and the past [44, 45]. Ryff [1989] enumerated the criteria for successful aging; they cover both life satisfaction and explicitly refer to progression in aging. His definition includes six positive action dimensions which are: self-acceptance, positive relationships with others, self-determination, control over the environment, purposefulness in life, and personal development. The belief that aging is an evolutionary process in which growth and excellence are still possible was first introduced by Ryff (1989) [45, 46]. On the other hand, Jopp and Smith (2006) found inner well-being, life satisfaction, and longevity as good indicators of aging [47]. In addition, Almeida et al. (2006) defined successful aging according to Mini-Mental State Examination (MMSE) as scoring 24 and above, and defined Geriatric Depression Scale (GDS) as scoring 5 and below [48]. Freund (2008) has conceptualized successful aging as the optimal use of resources for proper confrontation with losses [49]. In a review study by Depp and Jeste in 2006 on definitions of successful aging, 29 different definitions of the concept of successful aging were examined, each focusing on one aspect as criteria for successful aging: 26 definitions on functional disability/functional performance, 13 definitions on cognitive function, 9 definitions on life satisfaction/welfare, 8 definitions on productive/social engagement, 6 definitions on not having a disease, 4 definitions on longevity, 3 definitions on self-report health, 2 definitions on environment/finance and finally, and 2 definitions on self-report successful aging [42, 50]. Some other researchers have emphasized the role of health-promoting behaviors as other criteria for healthy aging [9, 51, 52]. Health-promoting behaviors are one of the key determinants of individual health which can promote a healthy lifestyle, if adopted by the elderly [2, 6, 53]. According to Baltes and Baltes, the adoption of a healthy lifestyle facilitates the conditions for successful aging [49, 51, 54]. Successful aging standards can be achieved through the introduction of health-promoting behaviors and the adoption of a healthy lifestyle [2, 16]. Performing health- promoting behaviors will improve the quality of life of the seniors during the elderly [55]. Interventions in a healthy lifestyle and moving towards healthy aging will empower seniors during their elderly and increase their self-care during this period [2, 16]. In some studies, various definitions of successful aging have focused on cognitive function, perception, control, and life satisfaction [9, 56]. Others believe that successful aging involves improving cognitive action and describe cognitive action as a combination of verbal meanings, spatial orientation, inductive reasoning, and narrative validity [9, 13, 57]. Rowe and Kahn presented a model for successful aging in 1997. As displayed in Fig. (1), the successful aging model presented by them consists of three components: Reducing the disability and illness line; continuous engagement with life, and maintaining physical and cognitive functioning [58]. In 2002, Crowther et al. revised the model and added the factor, maximization of positive spirituality, which is shown in Fig. (2) [59].

Fig. (2).

Fig. (2)

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Rowe and Kahn's successful aging model revised by Crowther [61]. (A higher resolution / colour version of this figure is available in the electronic copy of the article).

In a study conducted by Depp and Jeste in 2006 entitled “Definitions and Predictors of Successful Aging”, numerous factors had been suggested by researchers as predictors of successful aging [42]. Sometimes the concept of successful aging was taken as life satisfaction or being ethical [9, 11, 42]. Sometimes it was considered equivalent to healthy survival. A more comprehensive definition of successful aging focused on the combination of three elements of survival (life span), health (lack of disease), and life satisfaction (happiness) [50, 60, 61]. Four aspects of keep learning and keep moving; constant activity and mobility; keep connected and social participation; were included in the principles proposed by researchers in the senescence field for passing a successful aging [28, 62]. Kahn and Rowe are two scholars who began their research in the field of successful aging since 1987 [58]. With regards to cognitive and physical functions of old persons, they referred to four categories: minimizing risk and disability; maximizing physical and mental abilities; maximizing positive spirituality, and engagement in active life [28, 59, 62].

3.2. Principles of Successful Aging

Successful aging does not follow any universal standards and forms. It, however, depends on what we have to compromise, namely, losses, defects, constraints, selective opportunities, and existing resources [63]. Elderly scholars and theorists have recommended the following principles for successful aging: to be transparent about the realities of their own circumstances and their lives; to accept these facts and see them in the best possible state [45]; to be able to cope effectively with these realities; to be able to make up for the losses and deficiencies and accept them; to Actively engage in a purposeful effort; to maintain close relationships with others; to maintain a positive self-respect against deficiencies and failures [45, 64, 65].

3.3. Factors Affecting Successful Aging

Success in aging is not influenced by constant factors, such as the genetic status of an individual; rather it is more influenced by factors such as physical activity level, social interactions, and attitudes of the elderly [29, 66-68]. Psychologists believe that unusual serious events, major negative changes that occur during adolescence and even childhood, can affect the adaptation in older people, especially during senescence [68]. Meanwhile, pleasant experiences and satisfying events bloom in personality in various ways. It is important for the elderly to understand that they can still learn and be active. In a successful aging, a part of the well-being during elderly depends on the old person themselves. The issues of self-care, such as education and raising awareness, etc., fall in this area [2, 16, 69]. One part of social tasks is related to communities’ responsibilities. It is important to realize how successful aging thinking has been influenced within the society. It is also important to know how to direct this process in the community. Both the community and the family are important here. So, the elderly, family, social system along with healthcare services provided by the society for the elderly are influential [70].

4. Discussion

Today, successful aging is an indispensable part of development programs. To achieve successful aging, all aspects of the health of the elderly should be taken into account. Many of the elderly problems are the result of an unhealthy lifestyle adopted in this period. Focusing on successful aging in the light of adopting healthy lifestyle behaviors can help prevent and reduce age-related problems, and consequently decrease the cost of disease burden in this period. Definitely, it should not be forgotten that elderly people need information, support, and encouragement to be empowered for successful aging. Health professionals as community health supports need to provide the grounds for successful aging through designing comprehensive plans for healthy aging to preserve and promote a healthy and active life during the old age. It is, therefore, recommended to begin to further enhance the education related to healthy lifestyle behaviors many years before aging and even childhood. This study can be used as a basis for designing a suitable tool for measuring successful aging, and its findings can lead to new research, including qualitative, quantitative, integrated, and interventional research on successful aging.

CONCLUSION

According to the findings of the present study, the concept of successful aging depends on the cultural context of the community. Therefore, it is recommended to pay attention to this concept, considering the cultural, social and religious conditions of each society.

Acknowledgements

Declared none.

Consent for Publication

Not applicable.

Funding

This study was funded by the School of Nursing and Midwifery of Shahid Beheshti University of Medical Sciences (project No. IR. SBMU. RETECH.1398.019).

Conflict of Interest

The authors declare no conflict of interest, financial or otherwise.

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