Lay perceptions of
successful ageing
A. Bowling
University College London,
London, UK
How to age successfully?
Most popular biomedical model:
Absence of risk of disease and disease-related
disability, high mental and physical functioning, and
active engagement with life, including maintenance
of autonomy & social support.
(Rowe
and Kahn, 1987, 1998)
Some biomedical models also include longevity as
an indicator of SA rather than as an outcome.
(Bowling 2007)
Criticisms of R&K model
Narrowness – given high prevalence of morbidity in O/A
most people are ‘unsuccessfully’ ageing
SA realistic only for a few
Lack of continuum
Failure to address adaptation/disease management
Neglect of life course dynamics
Neglect of earlier soc-psych.lit.
Biomedical adaptations of R&K model
Vaillant (2002): SA - longevity, healthy
ageing, retirement, play, creativity,
generativity, ‘to love, to work, to learn…to
enjoy’.
Kane (2003): SA - broader, includes but
transcends health, + ‘generativity’
+ life course approach to include people
who ‘age successfully’ despite illness and
limitations.
(building on Vaillant)
Bowling’s (2007) systematic review of
biomedical, social, psychological SA
170 included papers, included 75 empirical studies.
Most were biomedical, using R&K’s model.
13/75 included social functioning as SA varying in detail
(social engagement, roles, participation, activity, contacts,
exchanges, positive relationships)
[Disengagement, activity and continuity theories of
ageing.]
Bowling’s (2007) syst/review
13/75 included life satisfaction or wellbeing as component* of SA – zest,
resolution, fortitude, gap between desired
and achieved goals, self-concept, mood,
incl. happiness.
* Berlin Ageing Study used life satisfaction
as outcome of SA
(Baltes & Baltes 1990)
Bowling’s (2007) syst/review
8/75 were psychological models
Ryff: Psychological development approach: ‘positive or ideal
functioning’ over life course.
Essential to this:
positive interactions, purpose, autonomy, self-acceptance,
personal growth, environmental fit.
? But emphasis on autonomy marginalised dependent people
Bowling’s (2007) syst/ review
Baltes & Baltes (1990) SOC model:
Precursor of SA: ‘selective optimisation with
compensation’ (SOC):-
When selected activities can no longer be
performed, strategies are needed to find new
ones, and to maximize reserves
Bowling’s (2007) system. review of biomedical,
psychological, social concepts of SA
Lay definitions: 15/ survey, qualitative studies:
mental, physical and social health, functioning and resources
psychological outlook, sense of humour
life satisfaction
having a sense of purpose, productivity, contribution to life
financial security
learning new things, accomplishments,
physical appearance
spirituality
Successful ageing:
Many investigators failed to define successful ageing
Outcomes and constituents not distinguished
Models discipline/culture specific
Lay people rarely consulted about their perspectives
Consequence = policy actions will have less relevance to
the lives of older people themselves
Aim of study:
To identify perceptions of successful ageing
among people in middle and older age groups.
Method:
British population survey of a random sample of
854 community dwelling men and women aged
50+ – Office for National Statistics Omnibus
Module.
Response rates:
Omnibus survey response rate: 62%
1703 achieved interviews overall
Of these, 854 respondents were aged 50+ and
were successfully were administered the
successful ageing module
Respondents characteristics:
Mean age: 64, range of 50-94 (confidence intervals: 63.53 - 64.89),
median: 62.
<50% males.
75% married/cohabiting.
75% lived with others, mainly spouses.
50% had no educational qualifications.
33% reported a limiting longstanding illness.
>80% reported their health as ‘Excellent’, ‘Very good, ‘Good’.
>80% also rated their quality of life as ‘So good…’/‘Very good’/ ‘Good’.
Table 2. Summary of Q1: ‘What do you think are the things
associated with successful ageing?’
Main themes:
Total (n=854)
% (no.)
Health and
functioning
66 (565)
Psychological factors 47 (397)
Social roles and
activities
35 (302)
Financial
circumstances
30 (258)
Social relationships
26 (224)
Neighbourhood
Work
Independence
10
(83)
6 (51)
4 (30)
Are you ageing successfully so far? Random
sample of people aged 50+ in Britain
Are you ageing
successfully so far?
Yes, very well
Yes, well
Yes, alright
No not well
No, not very well
Self-rated successful ageing:
76% of respondents rated themselves as
ageing successfully (‘Very well’ or ‘Well’) using
their own perceptions of SA.
<20% were categorised as ‘successfully aged’
using a biomedical model of successful ageing
Why they rated themselves successfully aged/not (open-end Q):
Having/not having good health, functioning (physical, mental) (50%, 427)
Psychological factors (having/not having life satisfaction, happy outlook)
(45%, 383)
Social roles, activities (having/not having enjoyable social life, activities)
(20%, 169)
Social relationships (having/not having family, friends) (17%, 148)
Finances (having/not having enough money for basic needs) (12%, 104)
Having/not having work enjoyed (8%, 72)
Being independent/not (4%, 32)
Living in a good/bad home, neighbourhood (3%, 29)
People who rated themselves as
successfully ageing more likely to:
Rate their health positively (Spearmans rho:
0.498,
p<0.01),
Have no reported limiting, longstanding
illness (Spearmans rho: 0.237, p<0.01),
Rate their quality of life positively (Spearmans
rho: 0.536, p<0.01).
How do you think getting older/ageing will affect you?
(most common responses shown). Random sample of
people aged 50+ in Britain
50.0
Percent
40.0
30.0
20.0
10.0
0.0
worse
health/functioning
defiant
limitations on life
worse mental health
dependency
QoL survey of random sample of people
aged 65+ in Britain.
Which model of SA? Variables computed to represent:
medical model (health status, diagnosed conditions, physical and
mental functioning)
broader medical model (including social activites)
social model (social functioning – activities and contacts)
psychological model (self-efficacy, sense of purpose/playing useful
part, coping facing up to problems, overcoming difficulties, self
esteem, self confidence, self worth)
Lay model (the above plus income, perceived neighbourhood facilities, services, safety, crime, traffic etc)
National survey of QoL people aged 65+ in
Britain:
Assuming QoL is the end-point of SA: which
model of SA best predicted QoL?
Lay model: strongest predictor of self-rated
global quality of life:
Respondents who were classified as SA with
this model, compared with those not, had
over 5 times the odds of rating their QoL
as good, rather than not good.
Conclusion:
Most older people consider themselves to have aged
successfully where classifications based on
traditional medical models do not
Multidimensional lay models of SA have greatest
predictive power of QoL (used as outcome of SA)
A biomedical perspective of successful ageing needs
balancing with a psycho-social perspective, and vice
versa, and include lay views
Constituent and outcome variables need clarifying in
longitudinal research