Successful Aging: History and Prospects
Summary and Keywords
While the factors that influence the well-being of individuals in late life have long been a major concern of research in aging, they have been a particularly active area of research and debate since the 1980s and continue to have a prominent role in gerontological research and debate. Early research on aging (from the 1920s to the 1960s) focused largely on examining typical problems that come with aging. The term successful aging was initially used to describe those who aged better than expected. In the 1980s, the MacArthur Network on Successful Aging, concerned that the field of gerontology had become preoccupied with disease and disability to the neglect of studies of the factors that fostered doing well in late life, conducted a series of studies of high-performing older persons and formulated the MacArthur theory of successful aging, which included three principal components: avoidance of disease, maintenance of physical and cognitive function, and engagement with society. Since its initial publication, the concept of successful aging has been applied to many subpopulations of older persons based on geography (East vs. West), socioeconomic status, race and ethnicity, religion, cognitive or physical function, and disease states.
The subject of successful aging has provided a durable framework for guiding a significant portion of gerontological research over the past several decades. This emphasis seems to be increasing, as evidenced by the fact that two major flagship gerontology journals (the Journal of Gerontology and The Gerontologist) have published special issues dedicated to innovative research in the area of successful aging. As shown in Figure 1, there has been near-exponential growth in the articles published on the subject of successful aging.
This growth suggests that successful aging continues to serve an important role in influencing research on aging. This article provides an historical context for the emergence of successful aging in gerontological literature, describes ways that successful aging research has evolved and continues to shape new research with innovative applications, and highlights important ways that this research can inform development of policies and programs that facilitate successful aging of both individuals and societies.
In the early 20th century, life expectancy at birth was about five decades. Research on aging in the first half of the 20th century focused on the typical biological/physiological changes that occur as people age and was particularly concerned with the way bodies break down and how individuals becomes senile and frail (see Hall’s Senescence: The Second Half of Life, 1922, and Cowdry’s Problems of Aging, 1939). This focus made sense given that, by the fourth decade of the 20th century, two-thirds of older adults required financial assistance and 58% were categorized as disabled (Lawton, 1939).
The early research gave way to discoveries about variations associated with aging processes in other fields. The introduction of the Gerontological Society of America and, subsequently, the Journal of Gerontology in 1946 sought to provide a forum for scholarly work about aging from a range of fields (biology and medicine to the social and behavioral sciences). The purpose was to cross-fertilize ideas from various disciplines in order to better understand the problems that come with aging and to cultivate a stronger assessment of the factors shaping variations in aging processes (Frank, 1946). Although those involved in medicine and biology initially guided scholarship related to the former, leading the way with respect to the latter goal were psychologists. Psychologists particularly observed that, although some older people were downtrodden by the problems of aging, others aged more “successfully.” Psychologists explained the observations largely in relation to how people use their time (i.e., maintaining engagement in meaningful activities) and in relation to their social roles and relationships with others (i.e., continuing to be useful to others; Pressey & Simcoe, 1950). Others further demonstrated that, despite the decline in “personality functioning” that was viewed as a normal process of aging, research showed that the average older person, even during this historical period, seemed to maintain reasonably good cognitive function, emotional stability, and ability to adapt to new situations (Granick, 1950).
A shared interdisciplinary agenda for the broader goals of gerontological scholarship began to emerge in the 1950s and 1960s. The Kansas City Study of Adult Life and the subsequent tenets of disengagement theory based on the study’s data─that is, that “aging naturally involves an inevitable, ubiquitous and progressive withdrawal from social institutions and social roles and loss of the individual” (Cumming & Henry, 1961; Rowe & Cosco, 2016, p. 539)─played a particularly important role in shaping gerontological discourse during this period. The response of gerontologists discrediting disengagement theory led to what might arguably be viewed as the emergence of the first distinct paradigm of successful aging research in gerontology.
Havighurst published a chapter called “Successful Aging” in Process of Aging: Social and Psychological Perspectives (Williams, Tibbitts, & Donohue, 1963), and in the inaugural issue of The Gerontologist during the same year (1961). Although successful aging had a very different meaning than subsequent frameworks introduced later, the publications noted that “the purpose of gerontology is to help people live better in their later years” (p. 299), that disengagement was a maladaptive process, and that staying active in later life was a key pathway to delaying negative health effects of aging (Hendricks, 1994; further articulated through empirical study, notably by Lemon, Bengtson, & Peterson, 1972).
Gerontology began to pivot from a prior focus on merely understanding aging processes to research with the practical goal of enhancing the quality of the lives of older adults. During the 1960s and 1970s, new frameworks emerged regarding variations in the growing population of older people (Neugarten, 1974) and informing major social policies (Guillemard, 1975). For the United States, passage of the Older Americans Act (OAA) in 1965 facilitated community-based programming designed to help older adults stay active, engaged, and integrated in society after retirement, and the program worked in partnership with newly established health care programs. The OAA program was never large, but working with Medicare, it served a larger purpose as a national investment in the physical and social needs of older adults.
The MacArthur Model
By the 1980s, the older population was healthier and wealthier at any previous point in human history. Despite these improvements, the overwhelming focus of aging researchers and funders continued to be primarily on the critical problems facing persons in very advanced age (i.e., those age 85+), with the challenges facing the “young-old” being largely ignored (Neugarten, 1974). Ironically, the stereotyping of older adults as a homogeneous group has been blamed on the political rhetoric that helped usher in the very age-based social policies that contributed strongly to the improvements in health and wealth of older people in the United States. Scholars have argued not only that treating older adults as a homogeneous, dependent group perpetuated ageist ideas that older adults are dependent, in poor health (Estes, 1979), and not capable of contributing productively to society (Bass, Caro, & Chen, 1993), but also that scientific efforts seeking to understand factors that relate to more positive outcomes in later life were also constrained.
In this context, perhaps the most well-known and influential efforts to understand successful aging were born. The MacArthur Foundation awarded funding (running from 1985 to 1996) to support a network of 16 respected scholars on aging across a range of disciplines in developing a comprehensive interdisciplinary framework for aging research. The early conceptual work of the MacArthur Foundation Research Network scholars (Rowe & Kahn, 1987) addressed several factors that the group felt were limiting progress in the field, including: the view that older adults were a homogeneous group, lack of interdisciplinary frameworks, a prevailing focus on disease and disability, the definition of “success” in later life as lack of failure, the view that function in old age was primarily genetically determined, and the general assumption that function could not be improved/enhanced in later life.
To address these limitations, the group explored interindividual differences related to mental and physical functioning in old age using a biopsychosocial approach, with particular attention to understanding factors that relate to vitality (i.e., robust health) and resilience (i.e., the ability to recover from health-related setbacks). They observed age-related increases in heterogeneity in advanced age in terms of various physiological functions, including cardiac, immunologic, pulmonary, renal, and respiratory function, as well as glucose homeostasis and the like. Based on a series of studies, their work led them to conclude that relative to pathological aging, those experiencing “normal” aging should not be simply differentiated as being without diseases (i.e., experiencing nonpathological aging). Rather, they concluded that normal aging involves two different types of aging processes. First, they viewed usual aging as partially preventable and related to external and lifestyle factors, such as diet, smoking, alcohol use, exercise, and pollution. In other words, usual aging involves risk of disease and disability, a process that is mediated by environmental and lifestyle factors. Second, the process of aging better than expected was described as successful aging. Successful aging was not just about accumulation of fewer health problems; it also involved potential improvement in health and well-being during later life. The idea that older adults had potential for improvement in later life had not previously been considered.
The Network conducted several studies with the goal of determining the degree to which aging-related outcomes were genetic and to determine the nongenetic factors driving positive outcomes in late life. In one longitudinal study of an initially homogeneous sample of high-functioning elders (known as the MacArthur Study of Successful Aging), research showed that, as time passed, the study subjects showed significant variation in health. Many older adults lost function, about half experienced no change in function over time, and one quarter actually experienced improved function with advancing age. Several factors predicted stable or improved performance with aging, especially: entering later life with high levels of mental and physical function to start with, access to emotional support, regular physical activity (moderate or strenuous), good pulmonary function, and higher levels of self-esteem (Albert et al., 1995; Berkman et al., 1993; Seeman et al., 1994).
To better understand the relative impact of heredity versus environmental/lifestyle-related factors on health in later life, MacArthur scholars examined a large cohort of twins drawn from the Swedish National Twin Registry. One sample was comprised of twins who were reared apart, and this sample was matched with a sample of twins of the same sex, zygosity, and age who were reared together. The investigators determined that heritability explained about 30% of the physiological changes and 50% of the cognitive and psychological changes associated with aging. Subsequent research has replicated their findings, further supporting evidence that, although genetics do play a role, aging processes are influenced predominantly by lifestyle and environmental factors.
The major findings stemming from work by the MacArthur Foundation Network on Successful Aging provided a compelling accumulation of knowledge about the potential for interventions that could greatly enhance the overall health of older people. Based on nearly a decade of research, this interdisciplinary effort led to articulation of three primary criteria for successful aging (in contrast to usual or pathological aging): (1) low risk of disease and disease-related disability, (2) maintenance of high mental and physical function, and (3) active engagement with life, including relations with others and engagement in productive activities (i.e., working for pay and volunteering). The Network’s scholars further determined that the high levels of heterogeneity in the population of older people suggested the potential for a higher proportion of the population to age successfully, and they suggested the need to leverage access to resources needed to enhance the health of the growing population of older adults (Rowe & Kahn, 1997, 1998).
At the same time that the MacArthur Foundation Network on Successful Aging was at work in the 1980s and 1990s, psychologists and sociologists were also advancing research that has contributed in important ways to successful aging research. With respect to psychological research related to aging, Bernice Neugarten (1974) raised concerns about the problem-based focus dominating a significant proportion of the research. She argued that a growing accumulation of evidence showed that chronological age was a poor predictor of various forms of function in later life and that new frameworks for differentiating older adults were needed. Her suggestion to distinguish older people who were more capable of experiencing gains and growth from those facing high risk of frailty and decline was met by an overly simplistic categorization of the “young-old” and the “old-old.” However, these ideas inspired subsequent research examining developmental processes occurring in later years and ways to address the needs of the highly heterogeneous older population (Neugarten, 1986). In the field of psychology, two primary frameworks emerged to explain heterogeneity in development with aging and factors that shape cultivation of successful aging: the life-span developmental psychology model─which included the selection, optimization, and compensation (SOC) meta-theory─and socioemotional selectivity theory.
Paul and Margaret Baltes and colleagues at the Max Planck Institute for Human Development involved in the Berlin Aging Study made important contributions to the advancement of the life-span developmental psychology model. This approach emphasizes commonalities, interindividual differences, and intra-individual plasticity in the process of successful development (Baltes, Reese, & Lipsitt, 1980). Baltes and colleagues are most well known for the SOC meta-theory. The SOC model of successful aging explains how individuals respond to changes in their physical and cognitive function as they age. It specifically describes how successful development involves the selection of functional domains on which to focus one’s resources, optimization of developmental potential (i.e., maximizing gains), and compensation for losses in order to maintain function and to minimize the effects of the losses experienced with aging (Baltes & Baltes, 1989, 1990).
The SOC model of successful aging emphasizes the role of personal goals (Baltes & Smith, 2003). That is, the process of selecting, optimizing, and compensating is the process leveraged by an individual in order to achieve particular personal goals that relate to the person’s well-being. The extent to which individuals successfully achieve their goals (by way of SOC processes) explains the degree to which they age “successfully” and describes a process of resilience in facing a range of changes that come with aging. For example, as speed of processing declines in later life, individuals may choose to focus their attention on activities that rely more heavily on crystallized intelligence to maximize function.
Although the SOC model continues to provide an important framework for understanding the fundamentals of life-span developmental psychology, many psychologists have expressed interest in, and have proposed, modifications to the SOC model (Abraham & Hansson, 1995; Baltes & Carstensen, 1996; Garfein & Herzog, 1995; Lang & Tesch-Romer, 1993; Schulz & Heckhausen, 1996). In more recent years, the model has expanded to include application to broader aging and developmental processes (Hahn & Lachman, 2015; Zacher, Chan, Bakker, & Demerouti, 2015; Remillard, Fausset, & Fain, 2017).
The second theoretical advancement in psychology related to successful aging is Carstensen’s socioemotional selectivity theory (SST). SST builds on several key aspects of the SOC model, particularly in relation to achievement of personal goals. SST describes the tendency of individuals to redefine their personal goals as they near the end of their lives. Specifically, as people age and their future time perspective shortens, their focus shifts to personal goals that involve emotionally meaningful activities (Carstensen, 1992; Carstensen, Isaacowitz, & Charles, 1999). This explains why, as we get older, we tend to shift our attention to more positive emotions in comparison to negative emotions. Furthermore, cultivation of more positive emotions relates to overall motivations to participate in particular activities. For example, in comparison to younger people, older adults tend to be more motivated to give back to others in later life for generative reasons, rather than for development of skills and/or advancement (Yamashita, Keen, Lu, & Carr, In Press). Continued research on the relevance of SST to successful aging research has provided insights into the importance of meaningful social relations and unique skills and abilities accumulated with aging.
In sociology, studies of successful aging have been integrated with foundational principles of sociological research: the life-course perspective and broader discussions related to structures of inequality. Drawing from macro-level observations of the patterned differences in groups of people based on chronological age and birth cohort, as well as how historical events differentially shape people’s lives, sociologists introduced a multidisciplinary framework for understanding aging processes and outcomes known as the life-course perspective. The life-course perspective provides a larger framework for sociological research on aging, with early work by Glenn Elder in the 1970s and 1980s proposing several important principles that relate to how we age, including the importance of life-span development, human agency, historical and geographic place, the timing of one’s decisions and opportunities, and the relevance of how our lives are linked with those in our social environment (Elder, 1974, 1998; Settersten, 2003).
The life-course perspective has played a major role in demonstrating important factors that explain how individuals’ lives are influenced not only by individual activities and changes, but also by external forces. These macro-level factors largely determine the resources and opportunities available to individuals from birth to death, and the varying resources and experiences together shape how long we live and how well we live.
Building on the life-course perspective, several theories have emerged that inform successful aging research. Namely, during the 1980s, sociologists led the way in exploring the factors contributing to significant heterogeneity of older adults’ health and well-being through structures of inequality. Early work by Dannefer (1987) on cumulative advantage and disadvantage theory (CAD) was in process during the same time as the MacArthur studies (Rowe & Kahn, 1987). Building on the work of Merton (1968), Dannefer proposed that, in order to understand why there are so many significant variations in the health and well-being of older adults, it is necessary to consider the role of lifelong trajectories. CAD explained the impact of factors like being born into, and remaining in, persistent poverty and its relation to early onset of disability, or, alternatively, having highly educated parents and subsequently obtaining high levels of education and occupational success and their relation to good health in later life. Early disadvantages and advantages accumulate over time to shape later life outcomes. The contributions of research demonstrating the importance of understanding how later life outcomes are related to lifelong trajectories have greatly influenced successful aging research and have been a common theme of subsequent critiques of the MacArthur model.
Evolution of Successful Aging Research: Critiques and New Developments
Interdisciplinary research has been a key feature of broader discussions about successful aging in social science research. Thus, it is not surprising that the application of successful aging research has emerged in a range of disciplinary fields by way of theoretical and empirical efforts and practice considerations (Bulow & Soderqvist, 2014; Depp & Jeste, 2006; Dillaway & Byrnes, 2009; Jeste & Depp, 2010; Katz & Calasanti, 2015; Martin et al., 2015; Martinson & Berridge, 2015; Rubinstein & de Medeiros, 2015). The original MacArthur model, for instance, has been tested with a range of social and demographic groups, such as among groups varying by race and ethnicity, among people with HIV/AIDS (Kahana & Kahana, 2001), among persons with disability (Molton & Yorkston 2017), and among the LGBT population (Fredriksen-Goldsen, Kim, Shiu, Goldsen, & Emlet, 2015). The studies have helped elucidate some of the ways successful aging processes are applicable to varying groups. For the MacArthur model alone, more than 100 articles have been published that respond to the model, propose revisions to it, and offer modifications of it (Cosco, Prina, Perales, Stephan, & Brayne, 2014). The publications have cultivated broader discussion about the role of successful aging research in gerontology and have offered useful insights into how the future of successful aging research may evolve to continue playing an important role in gerontological scholarship, with respect to both theoretical development and policy solutions.
The most common critiques related to successful aging research include: the need to include social factors and their influence on the life-course, calls for a subjective component in the definition of success, and calls for less exclusivity.
Critiques of Successful Aging
Some of the earliest and most common critiques of successful aging relate to concerns about the overall focus on individual-level characteristics. Critics suggest successful aging research lacks full consideration of the social forces involved in shaping individual outcomes. As noted by the well-regarded social gerontologist Matilda White Riley, the MacArthur model did not acknowledge that “changes in lives and changes in social structures are fundamentally interdependent,” and, therefore, successful aging “involves the interplay between lives and the complementary dynamic of structural change” (Riley, 1999, p. 151). Riley further encouraged Rowe and Kahn to address this limitation in their future work. Many scholars, particularly sociologists, raised this concern as well, noting that without the acknowledgment proposed by Riley, the model emphasized personal choice while neglecting social and environmental factors and their impact on such choices (Kahn, 1998, 2002).
An important solution to this criticism includes greater awareness and integration of the life-course perspective. Several scholars proposed suggestions for ways to better integrate social factors and utilization of the life-course perspective in successful aging research. For example, Kahana and colleagues (Kahana & Kahana, 1996; Kahana, Kelley-Moore, & Kahana, 2012) proposed the “proactive aging” model of successful aging. This model takes into consideration the value of proactive adaptations in the face of various stressors, which shape one’s ability to engage socially and/or productively. The same concerns were raised initially with the psychological theories described earlier.
Greater use of the life-course perspective makes it possible to acknowledge the role of various resources (especially fiscal, social support, human, and psychological) and contexts (structural, social, and cultural) in shaping individual outcomes at various phases of the life-course, as well as broader improvements in health across cohorts over time. For instance, birth cohort studies, such as the MRC National Survey of Health and Development (Kuh et al., 2011), make it possible to understand how certain aspects of early life provide an anchor for individuals to gain access to successful aging. It is also possible to explore more fully the heterogeneous paths into successful aging using population-based studies. For instance, scholars in the United Kingdom have used longitudinal analytic techniques to identify latent trajectories, exploring the relationship between educational attainment and successful aging (Cosco et al., 2017).
Theoretical advancements in this area have been emerging, with interdisciplinary applications of the life-course framework leading to better ways of understanding how individuals arrive in later life with varying abilities to age more or less successfully. Of particular note, Ferraro and his students (Ferraro, Shippee, & Schafer, 2009) introduced cumulative inequality theory as a framework for exploring ways in which early life factors translate into later life outcomes. Rather than focusing exclusively on availability of resources and contexts, cumulative inequality theory has become an important tool for exploring variations in expected health outcomes, with particular attention to family lineage, genetic factors, and early life exposures to risks and opportunities, as well as the potential for resiliency in spite of these exposures. Application of this kind of scholarship promises to expand the value and potential of future successful aging research.
The second major critique of successful aging research focuses on the subjective nature of “success” in the term successful aging. For many scholars, the lack of consideration of individuals’ perspectives on what it means to age successfully has been problematic. Several important studies, relying strongly on qualitative methods, have interviewed a range of different social groups about their own perspectives of what it means to age successfully, and have produced a broad range of definitions. As observed in several studies (Cho, Martin, & Poon, 2015; Jopp, Jung, Damarin, Mirpuri, & Spini, 2016; Strawbridge, Wallhagen, & Cohen, 2002), in general, individuals describe successful aging as a consequence of overall well-being, largely determined by the ability to do what makes an individual feel fulfilled, to remain engaged socially, to live independently, and/or to maintain autonomy and personal control, as well as factors related to self-esteem. The factors displayed more nuances when studies examined individuals in particular social categories; however, the general perception was that the ability to attain these goals was important.
Individuals’ perceptions of how much they are able to engage in meaningful activities resonate more strongly with the psychological approach to successful aging, which emphasizes personal goal attainment and resilience to aging processes. A recent report that reviewed 26 published studies that included surveys asking, “What is your definition of successful aging?” All studies included psychosocial components, suggesting the importance of how individuals feel about their lives as a critical component of what makes for a “successful” later life (Martin et al., 2015).
The third major critique of successful aging research relates to the tendency to identify individuals who are aging successfully as an exclusive group. In line with those who point out the lack of focus on subjective aspects of successful aging, several gerontologists have criticized the term successful in relation to the fact that the proposed criteria for success suggest a relatively small proportion of individuals qualify (Holstein & Minkler, 2003). Scholars have offered alternative suggestions for what being successful or unsuccessful may include. For instance, Strawbridge, Wallhagen, & Cohen (2002) summarized a range of surveys that suggest that a large proportion of the older population consider themselves to be aging successfully, suggesting an inconsistency with the MacArthur model. Other critical gerontologists expressed concerns with the criteria for the MacArthur model as applied to individuals who have a disability (Minkler & Holstein, 2008). They argued that such an approach results in a “blame the victim” perspective and excludes individuals who have a disability.
As noted by Martinson and Berridge (2015), any normative model like the MacArthur model is by definition exclusionary. Cosco and colleagues (2014) also pointed to the great variability associated with successful aging depending on the application of the criteria in a given population. In reviewing the literature, they observed that the proportion of older adults aging successfully varied from 0.4% to 91.7%, with the median being 23.1%, and the unweighted mean 28.3%. They noted that studies using researcher-defined measures found an average of 26.0% aging successfully, while studies using self-reports found that an average of 71.3% of respondents indicated that they are aging successfully. This suggests that no single model applies to everyone; different models are needed in order to expand the reach and inclusivity of successful aging criteria. Additional models may be useful for redefining success, and it would be valuable for models to use more subjective components.
The critiques, modifications, and application of successful aging models by gerontologists, along with scholarship in other disciplines, have provided important advances in successful aging research since the 1980s. As mentioned, The Gerontologist and Journals of Gerontology Series B: Psychological Sciences and Social Sciences both published special issues related to advances in successful aging research, emphasizing the ongoing influence of the MacArthur model in particular. The advancements, and the studies published in top gerontology journals, have broadened discussions about the relevance, role, and application of successful aging research in addressing important challenges now and moving forward in a rapidly aging society.
In addition to the areas of focus that have intentionally addressed limitations of research on successful aging, there has been a surge of scholarship on successful aging that is driving new areas of development. A special issue of The Gerontologist published in 2015 examined successful aging and its relevance to current gerontological scholarship. The special issue inspired a deeper conversation among gerontologists about modern applications of successful aging research. In the issue, the editor acknowledged the extent to which the MacArthur model (Rowe & Kahn, 1987, 1997, 1998) played a key role in redirecting gerontology from a field focused on loss to one focused on heterogeneity and potential for growth. The purpose of the special issue was to invite authors to offer novel conceptual, empirical, and review articles oriented to policy and practice implications, with the goal of inspiring a new generation of theory, research, and policy in this area. Several important contributions were made in the issue, with the vast majority designed to enhance or modify how we think about successful aging and its application to various social groups.
Several criticisms were reflected in the special issue, especially the problems of exclusivity and lack of subjective orientations to successful aging, and novel orientations were proposed (Baker, Buchanan, Mingo, Roker, & Brown, 2014; Fabbre, 2015; Fredriksen-Goldsen, Kim, Shiu, Goldsen, & Emlet, 2015; Jopp et al., 2016; Katz & Calasanti, 2015; Martinson & Berridge, 2015; Rubinstein & de Medeiros, 2015). For example, Baker and colleagues (2014) acknowledged the unique subjective perspective of successful aging for the strong black women archetype. However, other papers discussed implications of successful aging at a policy level. Golant (2015) noted the importance of considering one’s environment in shaping the potential for successful aging and proposed that successful aging is adaptation to changes in aging. Foster and Walker (2014) described the policy application of successful aging in Europe, describing the “active aging” paradigm, and the limitations of a simplistic orientation to applications of successful aging at a societal level. In general, the broader goals of the articles in the issue were that future research needs to take more seriously development of interventions that enable more people to age successfully, particularly marginalized social groups.
In part as a response to many of the articles published in the special issue of The Gerontologist, Journals of Gerontology Series B: Psychological Sciences and Social Sciences (JGSS) published a special issue on successful aging in 2017. Furthermore, Rowe and Kahn (2015) published a description of the changes in successful aging scholarship since their original introduction of the MacArthur model and encouraged authors to consider ways to further advance the concept in order to address current societal challenges. Responding to Rowe and Kahn’s new approach, which they called “successful aging 2.0,” several scholars offered novel empirical contributions that reflected some of the ways that research may help build on the work advanced in the second MacArthur Network. These publications, along with several other recent studies, offer applications useful for the next generation of successful aging research.
Some of the themes of the JGSS special issue resonated with previous critiques of what might be called “successful aging 1.0,” namely the need to better understand ways to acknowledge and include subjective aspects of successful aging. The articles largely explored ways that subjective and objective approaches to identifying successful aging are important for examining successful aging across a range of cultural and social contexts, as well as the broader meaning behind successful aging (Feng & Straughan, 2016; Jopp et al., 2016; Pace & Grenier, 2016). However, some of the particularly novel contributions in the JGSS special issue related to efforts to identify pathways to successful aging. For instance, Mejía, Ryan, Gonzalez, and Smith (2017) tested measures from the MacArthur model (absence of disease and disability, high cognitive and physical functioning, social embeddedness) both individually and as a broader index, as well as how they related to three different (objective and subjective) successful aging outcomes 4 years later (global well-being, experienced well-being, and vital status). The researchers noted that a cumulative index of successful aging (using a score related to all three criteria) was useful for understanding the role of a range of resources on successful aging, and the way some external factors, such as person−environment congruence, allow individuals to compensate for deficits in resources. This approach has potential for informing policy and interventions related to improving the health and well-being of older adults in a given society. In the article by Kok, Aartsen, Deeg, and Huisman (2017), the influence of early life factors on later life outcomes was examined. The scholars noted that, using social stress theory, they examined how early life stressors relate to successful aging, and how exposure to early life stressors differentially impacts individuals across different socioeconomic positions. This research, too, greatly informs the potential of interventions to enhance successful aging in individuals who faced stressful events early in life that had the potential for shaping later life health.
A common theme in many of the articles in the JGSS issue related to the potential link between successful aging and resilience. One of the greatest challenges to understanding the known relationship between successful aging and cumulative inequality is that, despite being faced with stressful life events, many individuals manage to recover, and in some cases they grow stronger and experience enhanced likelihood of successful aging, against all odds (Pruchno, Heid, & Wilson-Genderson, 2015). Several papers led to questioning the differences between successful aging and resilience, which is a central feature of the SOC model (Baltes & Carstensen, 1996). Some of the articles described groups of people who would not normally be categorized in the MacArthur model as successful agers, but who demonstrate resilience (Molton & Yorkston, 2017; Tesch-Romer & Wahl, 2017). Other papers described the ways that resilience can be cultivated to promote successful aging (Carpentieri, Elliot, Brett, & Deary, 2017; Kail & Carr, 2017). Interestingly, the articles suggested an important pathway for future cultivation of interventions or policy changes that could enhance successful aging at the societal level, which resonates with many of the five proposed criteria put forth by the second MacArthur Network societies.
Subsequent to the publication of the special issues of The Gerontologist and Journals of Gerontology Series B: Psychological Sciences and Social Sciences, it has become evident that gerontologists continue to explore novel applications of the successful aging framework in their work. For instance, Remillard, Fausset, and Fain (2017) applied the SOC model to better understand how individuals with mobility impairment adapt to aging processes and overcome their limitations to continue living a high-quality life. Manierre (In Press) tested the validity of a new measure of successful aging in which individuals are scored from 0 to 5 on scales that include physical, psychological, and sociological dimensions. Manierre examined the measure’s ability to predict mortality risk over time and showed that the measure offers a useful tool for predicting how well older people are likely to age. Although they did not include any initial empirical evaluation, Hartley and colleagues (2018) proposed that successful aging can and should play an important role in shaping cognitive gerontology, particularly as a pathway to assessing the efficacy of cognitive interventions.
Directions for Societal Frameworks and Social Policy
Much of the gerontological research examining successful aging has focused predominantly on how individuals experience aging processes and the factors that lead to better or worse outcomes. Although the studies often consider the role of societal factors─such as socioeconomic status, geographic location, and factors related to race, class, and gender─in the future, there is growing need to think about social policies that set up larger populations to age well and for societies to adapt more effectively to the aging of populations. Acknowledgment of some of the areas that need greater consideration in the United States and globally led the MacArthur Foundation to support a second round of funding for successful aging research (2008 to 2017), which included an interdisciplinary group of scholars drawn from the United States and Europe. The purpose of the Successful Aging Society Network,1 influenced in part by suggestions and responses to the MacArthur model, was to consider the broader societal and social structural factors involved in shaping individuals’ access to successful aging lifestyles and opportunities. Specifically, the goals of the second network moved beyond the United States to a global level. The focus shifted to the implications of increased life expectancy and declining fertility rates, with the proportion of older persons in many countries, especially in developed economies, rising to previously unimagined levels. The aging societies present special challenges, many of which are based on the simple fact that their core institutions (including their workforce and retirement policies, as well as educational, health care, and social welfare systems) were simply not designed to support a population with their emerging age distribution. With this in mind, the network sought to broaden the perspective of successful aging from a focus purely on the individual to a perspective that includes the aging of communities and entire societies.
The first principle when considering societal aging is to resist the temptation to focus narrowly, often using economic measures, and instead to include a broad array of factors that influence the capacity of older persons to age successfully, such as social, medical, and other factors that are critically important. For instance, in the United States, policymakers and pundits are increasingly preoccupied with the negative economic impacts of an aging population on health and pension entitlements, including Medicare and Social Security, to the neglect of other critically important issues related to the aging of America, including future intergenerational relations and tensions, socioeconomic disparities and inequalities, changes in the structure and function of the family and its capacity to serve as the traditional safety net, the impact of technology, and the critical importance of adaptation of core societal institutions—including education, work and retirement, housing, transportation, and even design of the built environment. Equally important, there is almost no acknowledgment of the substantial positive contributions and potential productivity of an aging society.
Since 2008, the Network on an Aging Society has conducted a robust program of research on the factors that are central to successful adaptation of societies to population aging. The work used a life-course perspective, included considerations relevant to all age groups (not just older adults), was mindful of the influence of structural lag in institutional adaptation, and focused on human capital considerations and the benefits as well as the risks associated with societal aging. Based on the decade of work, the Aging Society Network identified five core areas by which societies should be judged with respect to the effectiveness of their adaptation to the demographic transition. They include:
• Productivity and engagement of older persons, including participation of older persons in either work for pay or volunteerism;
• Well-being of older persons, including both objective and subjective measures;
• Societal cohesion, including structural and functional status of families and relationships between generations;
• Equity, including the distribution of resources across the older population; and
• Security, including both financial security as reflected in household income and measures like net pension wealth, and measures of physical safety.
With these measures in mind, and with additional financial support from the Hartford Foundation, the Network developed an Index of Societal Aging, which provides scores on each of the domains for all Organization for Economic Co-operation and Development (OECD) countries (Goldman et al., 2018). The measure was designed to provide a useful guide for identifying specific areas within countries that are ripe for policy changes that may enhance the capacity of older individuals to age successfully.
The next phase of successful aging research, in addition to continued elucidation of factors underlying heterogeneity in aging trajectories of individuals, will likely center on ways to optimize conditions for successful aging by influencing policy or development of interventions that affect a large group of people. This approach is the opposite of what was initially criticized as a concept relying on and/or blaming individual agency. The second MacArthur Network has produced a range of important scholarship that is useful for guiding this work. For instance, in a Health Affairs publication titled “Substantial Health and Economic Returns from Delayed Aging May Warrant a New Focus for Medical Research” (Goldman et al., 2013), the team argued that biological research that helps delay aging processes is likely to have a greater potential for enhancing health in later life than research addressing any single disease, such as cancer, with economic benefit of $7.1 trillion. In addition, the differences in the success of countries in adapting to the demographic transition, as reflected in the Aging Society Index, may help identify specific policies and programs that have been especially effective.
Two additional themes that may become increasingly important in assisting individuals to control risk, manage changes in function, and age successfully are technological developments and the emergence of precision medicine. Technological developments range from individual monitors to devices that can enhance a variety of functions, including communication, social interactions, and engagement, which are critical to successful aging. Precision medicine, which is rapidly becoming the cutting edge of modern medicine, is the application of genetic and other person specific information to tailor prevention and treatment to the specific risks and conditions of the individual patient, while avoiding many of the adverse effects of prior treatment modalities.
In early 2018, a two-part initiative by the National Academy of Sciences of the United States launched a series of “Grand Challenges in Health and Medicine,” with the first effort being the “Grand Challenge in Healthy Longevity.” The effort includes a series of grants and ultimately a major prize in recognition of the development of breakthrough science (biologic, medical, social, or behavioral) to foster successful aging in humans and a companion major international commission dedicated to development of a “Global Roadmap for Healthy Longevity.” With this type of recognition and commitment, it seems the field of successful aging is truly coming of age.
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(1.) The Aging Society Network is an interdisciplinary group of scholars assembled by the MacArthur Foundation in 2008. The group includes representation from demography, psychology, sociology, economics, political science, public policy, and public health. The group was charged with exploring the opportunities and challenges associated with aging at the societal level.