The Gerontologist
Vol. 43, No. 5, 735–744
Copyright 2003 by The Gerontological Society of America
Definition of Successful Aging by Elderly
Canadian Males: The Manitoba
Follow-Up Study
Robert B. Tate, PhD,1 Leedine Lah, BSc,1 and T. Edward Cuddy, MD2
Purpose: Although the concept of successful aging is
used widely in the field of gerontology, there is no
agreed-on standard or common underlying definition
for measuring success in aging. Our recent survey of
an elderly male population asked respondents to
define ‘‘successful aging.’’ This paper describes the
themes that evolved from those definitions, explores
interrelationships between the themes, and examines
the association between characteristics of respondents and the themes provided in their definition.
Design and Methods: The Manitoba Follow-up Study
has followed a cohort of 3,983 World War II Royal
Canadian Air Force male aircrew recruits since July
1, 1948. At a mean age of 78 years in 1996, the
survivors were surveyed and asked, ‘‘What is your
definition of successful aging?’’ and ‘‘Would you say
you have aged successfully?’’ A content analysis
identified themes emerging from their definitions.
Results: The most frequent of the 20 component
themes from the definitions of successful aging as
provided by 30% of the 1,771 respondents related to
‘‘health and disease’’; ‘‘physical,’’ ‘‘mental,’’ and
‘‘social activity’’ were more likely to be found in
a definition including ‘‘interest,’’ ‘‘having goals,’’
‘‘family,’’ or ‘‘diet,’’ and they were less likely to be
mentioned with themes of ‘‘independence’’ or
This paper is dedicated to the memory of Dr. F. A. L. Mathewson,
whose foresight and determination made the Manitoba Follow-Up Study
a reality. We sincerely acknowledge the 55-year ongoing contribution of
the 3,983 members of this cohort and the financial support received from
these men to help maintain the study. We thank the Manitoba Health
Research Council (Grant 44506) for its support in funding the operation
of the study during this time. Further, we gratefully acknowledge the
invaluable assistance of the research staff, Mrs. Edwina Thomas and
Mrs. Margaret Cuddy, who participated in the administration of this
survey. Thoughtful comment and insight from Mr. Dennis Bayomi,
Professor Evelyn Shapiro, and Professor Betty Havens throughout the
preparation of this paper are sincerely appreciated.
Address correspondence to Robert B. Tate, PhD, Director, Manitoba
Follow-Up Study, T148–770 Bannatyne Avenue, Winnipeg, Manitoba
R3E 0W3, Canada. E-mail: [email protected]
1
Department of Community Health Sciences, University of Manitoba, Canada.
2
Faculty of Medicine, University of Manitoba, Canada.
Vol. 43, No. 5, 2003
735
‘‘health.’’ Many of the themes reflect an individual’s
attitudes toward life and the aging process. Current
life satisfaction, self-rated health, and limitation in
activities of daily living were significantly associated
with an increased likelihood of reporting specific
themes in definitions. Implications: As health care
professionals adapt to the changing demographic
composition of society, it should be of interest to
understand what successful aging might mean to the
elderly males to whom they are attending.
Key Words: Successful aging, Elderly male
The idea of successful aging can be traced back to
Cicero, who, in 44 BC, wrote an essay on the nature
of good aging (Jarcho, 1971). The formulation of
a definition of what it means to age successfully in
Western society has its roots in a decision made in
1944 by the American Social Science Research
Council, which established a Committee on Social
Adjustment to Old Age, thereby making a focus on
‘‘success’’ a distinctly North American construct
(Torres, 1999). Studies on successful aging can be
divided into two components: clinical standards by
which successful aging is measured and psychosocial
theories exploring the process of adjustment to the
aging process. Some studies have combined elements
from both components when examining successful
aging.
Measures of functional status have figured prominently in clinical studies of successful aging. Defined
in terms of an individual retaining the ability to
function independently, Roos and Havens (1991)
stated that 20% of 2,943 elderly persons aged 65–84
years were found to have aged successfully over a 12year period. Predictors and associated activities of
successful aging were researched in a substudy of the
Alameda County Study, which consisted of 356 men
and women aged 65–95 years old who were followed
from 1984 to 1990. Results of this study found that
four chronic diseases (diabetes, asthma, arthritis,
and chronic obstructive pulmonary disease) and
depression reduced the likelihood of subsequent
successful aging. Predictors of successful aging
included walking for exercise and close personal
contacts. Cross-sectional comparisons at follow-up
revealed significantly higher community involvement, physical activity, and mental health for those
aging successfully (Strawbridge, Cohen, Shema, &
Kaplan, 1996). The MacArthur Field Studies have
reported that factors such as participation in exercise
activity and having social networks of emotional
support are positively associated with successful
aging (Seeman et al., 1995).
According to Fries (1980), those who live long
lives and are vibrant until shortly before death may
provide the best possible example of successful
aging. The study by Lentzner, Pamuk, Rhodenhiser,
Rothenberg, and Powell-Griner (1992) examined
quality of life in the year before death as a potentially
important measure of the success or failure of life
expectancy gains. Many studies (Echevarria, Ross,
Bezon, & Flow, 1991; Morley, Mooradian, Silver,
Heber, & Alfin-Slater, 1988; Nelson & Franzi 1989;
Nolan & Blass 1992) report that change in diet and
lifestyle may enhance cognitive functioning and
hence support successful aging.
Early psychosocial theories presented highly
idealized human states as the adaptive outcomes of
old age (M. M. Baltes & Carstensen, 1996). Jung
(1931) saw old age as a time when aging people see
their lives as ‘‘contracting’’ rather than mounting
and unfolding as when they are younger (Novak,
1985). Others conceptualized the acceptance of
decline as the adaptive task of old age (Buhler,
1933). Cumming and Henry (1961) offered a disengagement theory that characterized success as
acceptance of, and reconciliation with, the loss of
power endemic in old age through a mutual
withdrawal by elderly people from society and
withdrawal by society from elderly people. It was
proposed as being universal as well as inevitable.
Accordingly, an elderly person who accepts and
withdraws from society will successfully adapt to
aging, and if he or she does not, then an elderly
person is not fulfilling the functional needs of the
society and will have a hard time adapting to old age
(Nussbaum, Pecchioni, Robinson, & Thompson,
2000). Ryff (1982) proposed an integrative model of
successful aging based on six dimensions related to
positive functioning: self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth. Erikson’s
stage model (1984) proposes that psychological peace
and ego integrity are the criteria for success, where
old age can be viewed as a time to sum life up, a time
to look back over the past, tie up loose ends, and see
life as good (Novak, 1985). Social–environmental
theory (Hendricks & Hendricks, 1986) addresses the
functional context surrounding the daily lives of the
elderly population. This context or environment is
736
both social and individual. Surroundings are thought
to affect successful aging, such as an older person
living in a retirement community compared with an
older person living in a personal care home
(Nussbaum et al., 2000).
The selective optimization with compensation
model from P. B. Baltes and Baltes (1990) summarizes a body of research and suggests a series of
strategies for aging successfully (Nussbaum et al.,
2000). Aging is seen as a lifelong adaptive process, an
ongoing dynamic of selective optimization with
compensation (SOC) involving the following three
elements. First, selection: as increasing restrictions
are imposed by physical and cognitive limitations,
individuals will select or specialize their efforts into
areas of high priority (does not preclude the person
setting new priorities or goals in life). Second,
optimization: individuals continue to engage in
behaviors that enrich and augment their physical
and mental reserves. This allows them to continue to
maximize their chosen life courses. Third, compensation: an individual compensates by using psychological and technological strategies. Psychological
strategies may be external memory aids such as
adopting new mnemonic devices, and technological
strategies may include using a hearing aid. These
three elements interplay with one another so that
a person may suffer from a reduction in general
capacity and losses in specific functions, but through
the process of selection, optimization, and compensation create a transformed and effective life. SOC is
a psychological model of successful aging whereby
an older person maximizes and attains positive or
desired outcomes and minimizes and avoids negative
or undesired outcomes. The SOC model provides
a general framework for the understanding of
developmental change and resilience across the life
span (Freund & Baltes, 1998). P. B. Baltes and Baltes
(1990) stated that the process of adaptation is
constant, never static (Nussbaum et al., 2000). A
study examining successful aging using the SOC
model was done by Freund and Baltes (1998). Three
domains serving as outcome measures of successful
aging were as follows: subjective well-being, positive
emotions, and the absence of feelings of loneliness.
Those that reported SOC-related behaviors were
those who also reported more positive functioning in
each of the areas they chose to index successful
aging.
A recent theory of successful aging was proposed
by Rowe and Kahn (1987, 1998), wherein they made
a distinction between usual and successful aging as
nonpathological states. Their definition of successful
aging described elderly individuals who have a low
level of disease or disability, a high cognitive and
physical functioning capacity, and an active engagement with life. These clinical factors have come to be
generally accepted as the items encompassing the
distinction between usual and successful aging. It
will become increasingly important to understand
The Gerontologist
the ‘‘usual’’ versus successful aging process and to
determine factors related to ‘‘healthy aging.’’ The
difference between successful and unsuccessful aging
is not just the difference between health and sickness;
however, it is a place from which to start. The
implication is that the absence of clinical disease or
disability means that all is well and conversely that
the presence of disease represents some kind of
personal failure. Rowe and Kahn (1998) listed three
key behaviors or characteristics of successful agers:
(a) low risk of disease and disease-related disability;
(b) high mental and physical function; and (c) active
engagement with life. They saw their three characteristics as hierarchical because absence of disease or
disability make maintaining cognitive and physical
function easier, and in turn maintenance of these
enables active engagement with life. A combination
of all three ultimately represents their concept of
successful aging most fully. To them, aging successfully means just what it says: aging well, which is
very different from not aging at all. Rowe and Kahn
(1998) also pointed out the faults of previous
definitions in a 4-point argument: 1, previous
theories tended to define successful aging in a narrow
fashion, favoring one researcher’s ideas rather than
making a coherent theory of human development; 2,
they treated success as no more than the absence of
explicit failure, like treating health as nothing more
than the absence of explicit disease; 3, they neglected
the positive aspects of aging, and possible gains in
old age, as if successful aging were merely aging as
little as possible; and 4, they failed to acknowledge
the unavoidable place of values in defining what is
good or bad, successful or unsuccessful.
There remains no universally agreed-on standard
or underlying theme for measuring success of aging.
Few studies have attempted to identify the meanings
older people attach to this concept (Fisher, 1995).
Hence, it is unclear what the concept means in terms
of how such older persons live and how they feel
(Fisher, 1995; Strawbridge et al., 1996).
In the near future, there will be increases in the
relative and actual numbers of seniors in our society.
Based on the 1996 census, 12% of Canadians were
over the age of 65 years (Shah, 1996). It has been
projected that 21% of the Canadian population will
be over the age of 65 by the year 2040 (Statistics
Canada, 2002). With anticipated longer life expectancies may come not only greater demands on
health care resources but also a possible increased
awareness and consideration of the quality of lives of
older persons. For health care professionals to be
prepared to meet the demands of caring for an
increasingly elderly population, they should understand what successful aging means to the individuals they will be serving. Although the concept
of successful aging has been bantered about for
some time in the field of gerontology with many
discussions by clinicians, community planners, and
care workers, we might ask the following question:
Vol. 43, No. 5, 2003
737
What do elderly people themselves accept or understand to be a concept of successful aging? Is there
a common perception of its definition among the
elderly population to which it is applied? Further,
does the concept of successful aging as defined by
aging Canadian men reflect the components inherent
in some of the clinical definitions and psychosocial
theories currently in use?
To begin to understand perceptions of the concept
and definition of successful aging in this segment of
society, a survey of an established cohort of elderly
Canadian males was undertaken. No definition of
successful aging was provided within the mailed
questionnaire, nor was the phrase ‘‘successful aging’’
used in the questionnaire, until the respondents were
asked to define successful aging and further to state
whether they felt they had aged successfully. The
focus of this paper is to describe the themes that
evolved from these definitions and to explore the
interrelationship between the themes. Further, the
association between the themes and characteristics of
the respondents with respect to demographics,
functional limitations, self-reported health, and life
satisfaction is examined.
Methods
The Manitoba Follow-Up Study
A cohort of 3,983 World War II Royal Canadian
Air Force male aircrew recruits has been followed
since July 1, 1948. The mean age at entry was 31
years, with 90% of the cohort aged 20–39 years. Not
all study members were pilots; some were navigators, instructors, technicians, or ground crew, but all
were found physically fit for aircrew training. At the
end of the war, many returned to civilian occupations and some began or returned to formal
postsecondary education. Approximately half the
cohort remained with aviation throughout their
careers, half of these being pilots either in the
military or with commercial airlines. Annual contact
with the cohort has been maintained by mail. Details
of procedures, data collection, and coding for this
prospective study have been previously reported
(Mathewson, Manfreda, Tate, & Cuddy, 1987).
Briefly, data from routine medical examinations,
including recording of a resting electrocardiogram,
blood pressure, and body build measurement, have
been collected. An initial aim of the study was to
explore the prognostic significance of electrocardiographic abnormalities as they appeared in otherwise
healthy individuals (Mathewson & Varnam, 1960).
In this manner, numerous publications relating risk
factors to incidence of cardiovascular disease,
primarily ischemic heart disease and stroke, have
added to world knowledge in the field of cardiology
(Mathewson et al., 1987).
After 50 years of follow-up to July 1, 1998, 1,873
study members were alive at a mean age of 78 years,
and 2,110 study members had died. The mortality
experience of this cohort is approximately 70% that
of the Canadian male population. When deaths
caused by aircraft accidents in the early years of the
study were accounted for, the distribution of cause
of death is similar to that of the Canadian male. Very
few study members, less than 3% of the original
cohort, have been lost to follow-up. Ninety-three
percent of the surviving cohort are living in Canada.
Questionnaire Development
As a way to examine views of aging and
components of successful aging in this cohort,
a mailed questionnaire was developed to be selfadministered by the study members. Some questions
were adapted from the Canadian National Population Health Survey (Statistics Canada, 1994). The SF36 describing physical, mental, and social functioning (Ware & Sherbourne, 1992) was included. Selfrated health compared to others of the same age and
current satisfaction with life were asked on an
ordinal 5-point Likert scale and scored as excellent,
good, fair, poor, and bad. Questions regarding living
arrangements, marital status, alone or with other
adults, and type of housing were posed. Questions
concerning the ability to perform nine basic activities
of daily living (ADLs) were asked, for example,
going up and down stairs, bathing, dressing,
grooming, and eating. As well, questions concerning
the ability to perform 16 instrumental activities of
daily living (IADLs) were asked, including, for
example, ability to do housework, meal preparation,
shopping, and laundry.
Two key open-ended questions were asked at the
end of the 11-page questionnaire. These were ‘‘What
is your definition of successful aging?’’ and ‘‘Would
you say you have ‘‘aged successfully?’’ Content
analysis of descriptive themes from the definitions of
successful aging provided by the study members were
manually coded by one author (R. Tate) and verified
by another (L. Lah). As key words that identified
themes evolved from review of the returned questionnaires, a coding system was developed to record
individual themes and combinations of themes
reported by each respondent in his definition. This
report focuses on the analysis of the definitions.
Quantitative Statistical Methods
Tabulation of descriptive themes from respondents and the extent of self-reported successful aging
were described as percentages. Odds ratios relating
all pairs of themes from successful aging definitions
were calculated. Because of the large number of pairs
of odds ratios, 99% confidence intervals (CIs) were
calculated rather than the more traditional 95% CI.
When relating the likelihood for two different
themes to be reported in a successful aging
738
definition, the odds ratio can be used as a summary
measure of this association. For example, an odds
ratio of 2.5 for Themes A and B can be interpreted as
‘‘the chance of including Theme A (or B) in an
individual’s definition of ‘successful aging’ was 2.5
times more likely if the individual also included
Theme B (or A) in his definition.’’ Odds ratios less
than 1, say 0.5, relating Themes A and B can be
interpreted as ‘‘the chance of including Theme A (or
B) in an individual’s definition of ‘successful aging’
was only half (0.5) as likely to be included in
a definition of ‘successful aging’ if the individual also
included Definition B (or A) in his theme.’’
Logistic regression models were used to explore
factors related to the different themes from definitions of successful aging. It was postulated that the
presence or absence of a theme in a definition might
be influenced by a respondent’s self-rated health
(‘‘How would you describe your health compared to
others your age?’’) or satisfaction with life (‘‘How
would you describe your satisfaction with life in
general at present?’’). Both questions were coded in
three categories collapsed from the five responses:
excellent, good and fair, and poor or bad. In
addition, binary variables identifying having two or
more limitations with IADLs, any limitation with
basic ADLs, and marital status (married or not) were
modeled. Adjustment for the potential confounding
effect of age at time of questionnaire response was
accomplished through its inclusion as an independent variable in all models. Thus, age-adjusted
backward stepwise models were fit separately for
dependent variables defined as the presence or
absence of each theme in a study member’s definition
of successful aging. Odds ratios with 95% CI were
calculated to quantify the effect of each significant
independent variable on each theme.
Results
During May 1996, the questionnaire was mailed
to the 2,043 study members known to be alive with
current addresses. A second mailing was sent 2
months later to the nonrespondents, and a third
mailing was sent 3 months after the second mailing.
In total, 1,821 (89%) questionnaires were completed
and returned. Completed questionnaires were received from 1,620 (79%) after the first mailing, 166
(8%) after the second mailing, and 35 (2%) after the
third mailing. Sixty-one (3%) were returned marked
‘‘deceased,’’ and no response was received from 161
(8%) men.
Description of Survey Respondents
The mean age of respondents was 78 years, with
21% under the age of 75 years, over half (53%) aged
75–79 years, and 464 (26%) respondents aged over
80 years. Over three quarters, 78%, reported living
The Gerontologist
with other adults. Thirty percent of respondents
rated their health compared to others of the same age
as excellent, and a further 54% rated their health as
good. Eleven percent rated their current satisfaction
with life as fair, poor, or bad. A large proportion,
81%, reported no limitations with basic ADLs,
whereas 53% reported no limitations with IADLs.
Overall, 83.8% of the 1,821 respondents replied
‘‘yes’’ to the following question: ‘‘Do you think you
have aged successfully?’’ All other responses, including ‘‘no,’’ ‘‘I don’t think so,’’ ‘‘I don’t know
yet,’’ and ‘‘yes, but,’’ are considered in the ‘‘not yes’’
category for this analysis. There was a difference
after 85 years of age in the proportion reporting
successful aging, with 84% of men under the age of
85 years and 76% of men aged 85 years and older
reporting having aged successfully. An interesting
observation can be made, which recognizes that the
respondents to the first mailing of the questionnaire
were significantly more likely to have self-reported
having aged successfully than were the 11% of
respondents to the second or third mailing. Likelihood of having aged successfully significantly decreased with increasing number of limitations in
daily living, both in basic and instrumental activities.
Similarly, likelihood of a self-report of successful
aging decreased markedly with declining self-rated
health and satisfaction with life.
Definitions of successful aging appropriate for
coding for this analysis were received from 1,771 of
the 1,821 respondents. The 50 questionnaires not
analyzed were in some instances returned by a study
member who filled out some pages but not others or
did not return all pages of the questionnaire, or the
returned questionnaire was received from a family
member who completed the entire questionnaire on
behalf of the member (in some instances on behalf of
a study member who had recently died).
Components and Themes in Definitions of
Successful Aging
Twenty component themes evolved from the
respondents’ definitions of successful aging. Generic
labels of five or six letters each were defined for easy
reference. The percentage of respondents providing
each theme, the labels, and descriptors are provided
in Table 1. The most frequent component found in
a definition of successful aging, provided by 30% of
respondents, related to health and disease
(HEALTH). Encompassed in the HEALTH definition were aspects of physical health, described in
a positive sense as good health or less pain, visits to
physicians, and having check-ups. Mention of being
or keeping active was frequently included in a definition. Specifications of physical activity (ACTPHY)
in 19.6%, keeping mentally active (ACTMEN) in
12.0%, and socially active (ACTSOC) in 7.5% were
coded as separate themes. Additionally, 20.5% of
Vol. 43, No. 5, 2003
739
Table 1. ‘‘What Is Your Definition of Successful Aging?’’:
Response Themes
Thematic Label
%
Theme Description
HEALTH
30.0
SATISF
28.4
ACTIVE
20.5
ACTPHY
POSATT
19.6
18.8
FAMILY
18.5
INDEPE
16.7
ACTMEN
ACCEPT
12.0
10.4
MODERA
8.6
DIET
8.2
ACTSOC
GOALS
SECURE
INTRST
7.5
7.6
7.3
6.0
USEFUL
5.8
MISCEL
4.3
CONTNT
HUMOUR
NONE
2.4
2.2
5.6
Good health, less pain, all
faculties, see doctor, checkups
Happiness, enjoy life, satisfying
lifestyle, don’t worry,
retirement (quit work)
Keeping active (unspecified), keep
busy, keep going, keep working
Keeping active—physically
Positive outlook, attitude,
interest in life
Have a loving spouse, family, &
friends
Independence, being able to carry
on, lead a normal life, make
own decisions, mobile, do
whatever you want, keep up
responsibilities
Keeping active—mentally
Spiritual, accepting, growing old
gracefully, peace of mind,
tranquility
Moderation, ‘‘one day at a time,’’
to decline gradually,
limitations, adjust capabilities
Diet, eating (includes all ingestible:
smoking, drinking, vitamins),
good appetite
Keeping active—socially
Having goals, challenges, travel
Financially secure
Hobbies, having various interests,
activities
Being useful, volunteering, helping
others, being productive
Miscellaneous (staying alive,
don’t know)
Content
Humor, laughing
None, not applicable, left blank,
used question mark
responses included a nonspecific mention of keeping
active in general (ACTIVE). A happy life or satisfying lifestyle (SATISF) was mentioned by 28.4%,
and ideas related to having a positive outlook on life
or having a positive attitude (POSATT) were mentioned by 18.8%. Having close and loving family and
friends (FAMILY) is viewed as a component of
successful aging by 18.5%. A spiritual component,
accepting growing old (ACCEPT), was included in
10.4% of definitions. Independence (INDEPE) encompassing both physical mobility and ability to
make one’s own decisions was mentioned by 16.7%.
Recognition of necessity for moderation (MODERA)
including adjustment of capabilities was included in
8.6%. A component encompassing mention of diet
or eating (DIET), including mention of ingestibles
such as vitamins or alcohol intake, was included by
8.2%. With lesser frequencies, having goals or
challenges (GOALS), being financially secure
(SECURE), having hobbies or interests (INTRST),
being useful (USEFUL), being content (CONTNT),
and having a sense of humor (HUMOUR) were also
part of definitions. A miscellaneous (MISCEL)
category was created to identify 4% of definitions
that included phrases such as ‘‘waking up everyday,’’
‘‘staying alive,’’ or ‘‘I don’t know yet, I’m only 85.’’
The association between pairs of themes in a
definition of successful aging is presented in Table 2.
Odds ratios with 99% CIs are useful to provide
insight into the direction and magnitude of associations. Physical, mental, and social activity components are highly related. Highly significant odds
ratios, greater than 4 for each pair of these three,
imply that individuals were very likely to mention
combinations of aspects of activity in their definition. Activity in one of its four forms was also more
likely to be found in a definition including interest,
having goals, family, or diet and less likely to be
mentioned with themes of independence or health.
The component of spirituality was significantly less
likely to be included in a definition with activity,
independence, or health. Interest in life and having
goals were significantly related, with one increasing
by more than twofold the likelihood of the other to
be a component of a definition.
The results of 20 backward stepwise fit logistic
regression models relating respondents’ characteristics to each theme in the definition of successful
aging are presented in Table 3. Men rating their
satisfaction with life as excellent were significantly
more likely to include themes of being active in all
domains of mental, physical, and social aspects than
were men rating satisfaction with life as fair, poor,
or bad. Further, the men with high life satisfaction
were significantly more likely to report themes of
positive outlooks (POSATT), having goals in life
(GOALS), being interested in life (INTRST), and
being useful or helpful (USEFUL). In addition, those
with high life satisfaction were significantly less
likely to report themes of HEALTH or financial
independence (INDEPE). Those free of activity
limitations were more likely to report themes of
keeping physically or mentally active (ACTPHY and
ACTMEN), maintaining a positive attitude toward
life (POSATT), and recognizing DIET as a component of successful aging. Marital status was related
only to the theme of keeping socially active
(ACTSOC), with married men being less likely to
report this theme than those not married. A selfrated health of excellent or good, compared with
a self-rating lower than good, identified men
significantly more likely to include the themes of
keeping active (in general; ACTIVE) or concepts
of diet and nutrition (DIET) in their definition of
successful aging. Moderation in life (MODERA) was
more likely to be mentioned in a definition of
successful aging if a man rated his health low. Some
740
men did not provide an explicit definition of
successful aging and wrote in ‘‘none’’ or put
a question mark, although other parts of their
questionnaire were completed. These responses were
labeled NONE and tended to be provided by men
with low life satisfaction and men experiencing
limitation with IADLs. Themes of spirituality and
acceptance (ACCEPT), financial security (SECURE),
being content (CONTENT), and having a sense of
humor (HUMOUR) could not be predicted by any of
the characteristics considered.
Discussion
The Manitoba Follow-up Study (MFUS) is now in
its 55th year of continuous operation. The study
began in 1948 as a prospective investigation of the
development of cardiovascular disease in a cohort of
healthy young men. Today, a cohort of approximately 1,500 survivors at a mean age of 83 years is
being followed. This study has the opportunity to
contribute to expanding areas of medical research
through contributions such as this. Continuing
investigation through linkage of these survey data
to the wealth of clinical data of this study is just
beginning. In addition to the ongoing collection of
clinical data, continued survey of this cohort with
the instrument described in this paper will provide
the opportunity to explore longitudinally whether
the definition of successful aging by the elderly
Canadian male is a static or dynamic process,
influenced by life course events. This and other
aspects of the aging process of elderly Canadian
males will be the subject of future communication
with the gerontologic research community.
There continues to be a paucity of research with
respect to the health and functioning of the elderly
male. Reasons for this ‘‘understudying of men’’ may
arise from many sources, including the fact that in
our society the number of elderly women continues
to exceed the number of elderly men and that the
number of widows continues to exceed the number
of widowers. Hence, the extent of needed social
support and social programs is deemed less for
elderly men than for elderly women (Thompson,
1994). Perhaps the priority for studying elderly male
populations is considered low because elderly male
populations have traditionally been viewed as
homogeneous (Thompson, 1994). We are learning
that the health, functioning, and perceptions of the
elderly population, both males and females, are not
homogeneous, and continued investigation including
that described in this paper is warranted. Exploring
and understanding these aspects of the lives of young
elderly, elderly, and very elderly people of today will
provide the needed insight into planning for the
‘‘baby boomers,’’ as the boomers bring with them
the largest increase in the elderly population soon to
be experienced in our society.
This paper reported on definitions of successful
The Gerontologist
*
14.86
4.32
0.66
1.44
9.7–22.8 2.6–7.3 0.4–1.1 0.7–2.9
*
4.90
1.06
1.94
3.0–7.9 0.7–1.6 1.1–3.4
*
1.25
3.42
0.7–2.2 1.7–6.7
*
2.20
1.3–3.8
*
1.36
0.9–2.1
1.30
0.9–1.9
1.75
1.0–3.0
1.44
1.0–2.1
1.52
0.8–2.8
*
1.88
1.0–3.4
2.87
1.8–4.7
2.88
1.5–5.5
1.13
0.6–2.0
2.14
1.0–4.6
1.60
0.9–2.7
*
0.94
0.5–1.8
0.80
0.5–1.4
1.19
0.6–2.4
0.55
0.3–1.0
0.59
0.2–1.6
1.14
0.7–1.9
0.60
0.2–1.5
*
0.70
0.4–1.2
0.58
0.4–0.9
0.88
0.5–1.7
0.45
0.3–0.8
0.88
0.4–1.8
0.34
0.2–0.6
1.36
0.8–2.4
0.41
0.2–0.8
*
1.73
0.9–3.4
1.49
0.8–2.7
3.08
1.5–6.2
1.65
0.9–2.9
2.21
0.9–5.1
1.68
0.9–3.0
2.03
0.9–4.4
1.50
0.7–3.2
1.22
0.6–2.4
*
0.96
0.5–2.0
0.78
0.4–1.5
1.04
0.4–2.5
0.88
0.5–1.6
0.75
0.3–2.3
0.55
0.3–1.1
2.13
1.1–4.3
0.40
0.1–1.2
0.74
0.4–1.5
1.24
0.5–3.1
*
0.98
0.5–1.9
1.39
0.8–2.3
0.75
0.3–1.9
0.78
0.4–1.4
0.62
0.2–1.9
0.92
0.5–1.6
0.39
0.1–1.3
1.08
0.5–2.2
0.98
0.5–1.8
0.64
0.2–1.9
0.24
0.1–1.1
*
1.07
0.7–1.7
1.85
1.3–2.7
1.87
1.1–3.2
0.98
0.7–1.5
1.73
0.9–3.1
0.99
0.7–1.5
2.92
1.8–4.8
0.77
0.4–1.3
0.72
0.5–1.1
2.00
1.1–3.6
5.74
3.5–9.3
0.53
0.3–1.1
*
0.75
0.5–1.2
0.63
0.4–0.9
0.63
0.4–1.1
0.74
0.5–1.0
0.71
0.4–1.3
0.63
0.4–0.9
0.96
0.6–1.6
0.40
0.2–0.7
1.11
0.8–1.6
0.54
0.3–1.1
5.59
3.4–9.3
0.47
0.3–0.8
1.43
1.0–2.0
*
0.52
0.3–0.8
0.76
0.5–1.1
0.97
0.6–1.6
0.69
0.5–0.9
0.81
0.5–1.5
0.93
0.7–1.3
1.21
0.7–2.0
0.79
0.5–1.3
0.67
0.5–0.9
1.32
0.8–2.3
1.61
0.9–2.6
0.92
0.6–1.5
2.31
1.7–3.2
1.13
0.8–1.5
*
ACTMEN ACTPHY ACTSOC ACTIVE INTRST POSATT GOALS ACCEPT INDEPE USEFUL SECURE MODERA FAMILY HEALTH SATISF
0.35
0.1–2.3
0.09
0.1–1.3
0.29
0.1–3.9
0.62
0.2–2.0
0.76
0.1–5.0
0.99
0.4–2.8
0
—
1.13
0.3–3.9
0.81
0.3–2.5
1.69
0.4–6.7
1.32
0.3–5.2
0.25
0.1–3.4
0.71
0.2–2.2
0.7
0.3–1.8
1.23
0.5–2.9
0.26
0.1–3.6
0
—
*
HUMOUR CONTNT
0.77
0.61
0.4–1.6 0.1–2.9
5.66
1.23
3.6–9.0 0.5–3.3
2.14
1.03
1.1–4.2 0.2–4.9
1.99
1.17
1.2–3.2 0.4–3.1
1.62
1.83
0.7–3.6 0.5–7.3
1.48
6.62
0.9–2.5 2.8–15.6
2.12
2.76
1.1–4.1 0.9–8.3
0.68
2.27
0.3–1.6 0.8–6.4
0.31
0.73
0.1–0.8 0.2–2.5
1.52
1.88
0.7–3.5 0.5–7.5
1.05
1.06
0.5–2.4 0.2–5.1
2.3
1.21
1.2–4.29 0.3–4.81
2.07
2.00
1.3–3.4 0.8–5.0
0.61
0.60
0.4–1.1 0.2–1.7
0.92
0.99
0.6–1.5 0.4–2.5
*
1.67
0.5–5.9
*
DIET
Notes: Odds ratios is bold font are statistically significant at p , .01. ACTMEN, ACTPHY, ACTSOC, and ACTIVE ¼ mentally, physically, socially, and generally active, respectively; INTRST ¼ having hobbies or interests; POSATT ¼ positive attitude; GOALS ¼ having goals; ACCEPT ¼ accept growing old; INDEPE ¼ independence; USEFUL,
SECURE, and CONTNT ¼ being useful, financially secure, and content, respectively; FAMILY, SATISF, and HUMOUR ¼ having loving family, satisfying lifestyle, and a sense of
humor, respectively; MODERA ¼ recognizing need for moderation; HEALTH ¼ health; DIET ¼ diet.
CONTNT
HUMOUR
DIET
SATISF
HEALTH
FAMILY
MODERA
SECURE
USEFUL
INDEPE
ACCEPT
GOALS
POSATT
INTRST
ACTIVE
ACTSOC
ACTPHY
ACTMEN
Theme
Table 2. Odds Ratios With 99% Confidence Intervals for Pairs of Themes Reported in Definitions of Successful Aging
Table 3. Age-Adjusted Relative Odds, With 95% Confidence Intervals, of Including Each Theme in a Successful Aging Definition
for Self-Rated Health, Life Satisfaction, and Functional Activities
Self-Rated Health
(vs. fair, poor, or bad)
Theme
Life Satisfaction
(vs. fair, poor, or bad)
Excellent
Good
Excellent
Good
HEALTH
—
—
SATISF
—
—
ACTIVE
2.40*
1.50–3.84
—
0.70
0.50–0.98
1.85*
1.22–2.80
—
ACTPHY
3.16*
1.90–5.24
—
POSATT
—
—
FAMILY
—
—
INDEPE
—
—
ACTMEN
—
—
MODERA
0.39*
0.22–0.69
3.78*
1.63–8.77
—
0.49*
0.30–0.80
2.30
1.02–5.21
—
0.56*
0.40–0.80
2.14*
1.40–3.27
1.55*
1.19–2.03
1.59*
1.24–2.03
1.49*
1.16–1.91
2.51*
1.50–4.19
0.73
0.56–0.97
1.46
1.08–1.98
4.15*
1.72–10.0
—
GOALS
—
—
INTRST
—
—
USEFUL
—
—
NONE
—
—
DIET
ACTSOC
—
—
1.76
1.06–2.93
—
—
3.08*
1.34–7.09
—
1.62*
1.13–2.31
1.94*
1.35–2.78
1.63
1.09–2.42
4.75*
1.46–15.4
0.21*
0.10–0.42
IADL
(,2 vs. 2)
ADL
(0 vs. 1)
Married
vs. Not
—
—
—
—
—
—
—
—
—
1.60*
1.17–2.20
1.78*
1.31–2.42
—
1.48
1.09–1.99
—
—
—
—
—
—
—
—
1.43
1.01–2.05
—
—
—
1.55
1.04–2.33
—
—
—
—
1.64
1.01–2.68
—
—
—
—
—
0.62
0.40–0.95
—
—
—
—
—
3.26
1.01–10.6
0.40*
0.24–0.68
—
—
—
0.42*
0.26–0.68
—
—
Notes: ADL ¼ activities of daily living; IADL ¼ instrumental ADL; MISCEL ¼ miscellaneous; ACTMEN, ACTPHY, ACTSOC,
and ACTIVE ¼ mentally, physically, socially, and generally active, respectively; INTRST ¼ having hobbies or interests; POSATT ¼
positive attitude; GOALS ¼ having goals; ACCEPT ¼ accept growing old; INDEPE ¼ independence; USEFUL, SECURE, and
CONTNT ¼ being useful, financially secure, and content, respectively; FAMILY, SATISF, and HUMOUR ¼ having loving family,
satisfying lifestyle, and a sense of humor, respectively; MODERA ¼ recognizing need for moderation; HEALTH ¼ health; DIET ¼
diet. None of these variables were significantly associated with components of ACCEPT, SECURE, MISCEL, CONTNT, or HUMOUR.
*Statistically significant at p , .01.
aging obtained directly and unprompted from 1,771
men, all members of an established cohort of elderly
Canadian males. Twenty themes were derived from
their definitions. There was large variation in the
frequency of themes reported, ranging from 2% to
30% of responses. Further, there was a degree of
clustering found among themes, suggesting that
some themes were more likely to be provided along
with other themes in an individual’s definition of
successful aging.
The concept of successful aging has evolved and
has been debated, with some overlap, from two main
perspectives in the gerontological literature. One
perspective, dominant in the work of Rowe and
Kahn (1998), is based on clinical standards, that is,
an individual’s ability to manage, function, and
actively engage in a physical world. The other
perspective stems from psychosocial theory of
742
successful aging as a lifelong adaptive process. A
dominant model in the psychosocial literature was
proposed by P. B. Baltes and Baltes (1990). Their
model explores the process of aging as a SOC,
wherein successful aging is viewed as a dynamic
process, that is, a series of choices and adaptations
made by individuals.
Many of the themes of successful aging provided
by MFUS members are consistent with these two
perspectives. Rowe and Kahn’s concept of successful
aging is embodied in three areas: health and
disability, a high cognitive and physical functioning
capacity, and an active engagement with life
(Rowe & Kahn, 1987). MFUS members’ definitions
providing themes of ‘‘good health, low levels of
pain’’ and ‘‘independence,’’ ‘‘mobility,’’ and ‘‘carry
on’’ describe aspects of Rowe and Kahn’s first area.
High cognitive and physical functioning capacity is
The Gerontologist
described by MFUS members’ themes stated as
‘‘keeping active physically’’ and ‘‘keeping active
mentally.’’ Further ‘‘ability to make one’s own
decisions’’ is embodied within a high cognitive
functioning. MFUS members’ definitions including
‘‘being useful, volunteering, helping others, being
productive,’’ ‘‘having a positive outlook and interest
in life,’’ ‘‘having hobbies, various interests and
activities,’’ and ‘‘keeping busy or active (in general),’’
along with the theme of ‘‘keeping busy—socially,’’
all describe an active engagement with life. Other
definitions of successful aging provided by MFUS
members are more consistent with the psychosocial
literature. The components of the SOC model (P. B.
Baltes & Baltes, 1990) are reflected through adaptation in the themes involving an individual’s attitude
toward life and the aging process in general. MFUS
members’ themes described as ‘‘moderation, gradual
decline, growing old gracefully or adjusting to
capabilities’’ reflect the concept of adaptation.
‘‘Keeping active socially’’ provides an indication of
the importance of social networking throughout the
aging process. The MFUS members’ theme of having
‘‘loving spouse, family and friends’’ is consistent
with recent literature of Rowe and Kahn (1998) in
which their initial concept of successful aging was
expanded to include supportive family relationships.
Others, including Seeman, Singer, Ryff, Dienberg
Love, and Levy-Storms (2002), have also reported the
relationship between positive social interaction and
successful aging.
Some definitions provided by MFUS members
provided no surprises. It should be anticipated from
early literature that aspects of good health or
freedom from disease, keeping busy, being active
and useful, and maintaining one’s independence
would all be found in definitions of successful aging.
More recent literature suggests that themes of family
and friends, a component of peace with one’s self,
moderation in activity, adapting, and knowing one’s
limitations are being recognized. In support of the
latter is the recent report by von Faber describing
‘‘successful aging of the oldest old’’ in The Netherlands (von Faber et al., 2001). They concluded that
successful aging is more an adaptation than a state of
health or well-being. Crowther, Parker, Achenbaum,
Larimore, and Koenig (2002) recently have reported
‘‘positive spirituality’’ to be ‘‘a forgotten factor’’ in
models of successful aging. Their work is supported
by the 10% of MFUS members who included ‘‘peace
of mind,’’ ‘‘tranquility,’’ and aspects of positive
spirituality, either from a community focus of
religion or a more individualistic view of spirituality
(Crowther et al., 2002), in their definitions of
successful aging.
Highly prevalent in our survey, but not often
discussed in the gerontological literature, the second
most frequent component of definitions, after
‘‘health,’’ was ‘‘happiness, enjoying life, having
a satisfying lifestyle, no worries, be happy.’’ Perhaps
Vol. 43, No. 5, 2003
743
this component should lead us to speculate that
success was in the eye of the beholder, that
attainment of success in aging is a personal judgment. Somewhat more tangible, and perhaps also
less well described in the literature, are MFUS
members’ themes of ‘‘financial security,’’ ‘‘having
goals in life including challenges and ability to travel
(both physically and financially),’’ ‘‘diet,’’ ‘‘having
a sense of humor,’’ and, simply put, ‘‘contentment.’’
Each of these themes was mentioned with a frequency
of less than 10%, but nonetheless was considered
part of the definition of successful aging by MFUS
members.
Our research provided insight into how some
characteristics of individuals (e.g., age, self-rated
health, life satisfaction, activity limitations, and
marital status) might be related to different concepts
of successful aging. Men highly satisfied with life
were more than twice as likely to have mentioned
having family and friends, being useful, or recognizing limitations in their definitions of successful
aging. It was interesting that marital status was
only related to one theme (ACTSOC), suggesting
that most all of the themes were equally likely to be
provided by married and not married study members. A component of spirituality, encompassing
peace of mind, acceptance, and growing old
gracefully (ACCEPT) was unrelated to self-rated
health or life satisfaction, and its chance of being
included in a definition of successful aging was not
influenced by limitations. Although identified by 1 in
10 men as an important part of successful aging, this
theme does not appear to be influenced by these
independent variables.
An inherent problem with defining successful
aging is that success is a subjective judgment.
Success comes with different standards for different
people and hence, as we have shown, success can
mean many different things. What might be success
to one may be failure to another. Successful aging is
restrictively contingent upon ‘‘the value system of
the enquirer—or, their social construction of reality’’ (Bowling, 1993, p. 449). A society’s value
system predetermines the way in which successful
aging is conceptualized. It is a socially and culturally
determined construction (Torres, 1999). Cultural
and social norms define the roles that elderly people
fill in their community and influence attitudes
toward aging (Holmes & Holmes, 1995). Different
cultures view aging differently, and this affects the
relational world of the elderly population (Nussbaum et al., 2000).
If we can infer that an elderly man’s answer to the
question ‘‘What is your definition of successful
aging?’’ reflects his personal perspectives and priorities at his advanced age, our results defining and
understanding successful aging should be viewed as
a valuable resource to health care professionals. As
appropriate services for the elderly population are
planned to promote successful aging in order to
enhance the quality of lives, it is important that
successful aging be viewed as a broader concept than
currently thought by the research community.
As the health care profession adapts to the
changing demographic composition of society, more
heed must be paid to the voice of the elderly
population. The goal of this paper is to provide
investigators of the aging process, including general
practitioners, internists, and all specialists, the
opportunity to look at the meaning of successful
aging from the perspective of the elderly male. It is
hoped that consideration of these definitions, including some familiar concepts and some less
common components in the definition of successful
aging, may stimulate further research in this aspect
of gerontology.
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Received September 4, 2002
Accepted February 14, 2003
Decision Editor: Linda S. Noelker, PhD
The Gerontologist