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Once upon a time, researchers focused on survival as the gold standard outcome for life. While mortality continues to be a critical measure, concepts related to quality of life are integral to many health care professions.
As a physical therapist, I work with patients to develop functional goals that are linked to participation in life. During a literature search (most likely for something unrelated), I became curious about the emergence of different life measurement terms in research. I searched for the oldest article titles in Pub Med (http://www.ncbi.nlm.nih.gov/pubmed) that included each term and found:
- Mortality (1841)
- Quality of life (1959)
- Successful aging (1967)
- Active life expectancy (1983)
From a measurement perspective, death is a concrete event; successful aging is abstract. Abstract concepts are inherently challenging to define and quantify. Terminology and operational definitions for successful aging are diverse. Measures of success may focus on physical ability/disability, cognitive function, emotional or social health, disease, or combinations of different health domains (Lowry, 2012).
What is wrong with different definitions? Basic epidemiologic measures such as prevalence prove problematic. The range for “mean proportion of successful agers” across 28 studies was “0.4% to 95%” (Lowry, 2012).
So is successful aging a public health issue? Do older adults view successful aging differently than health care providers? Reichstadt et al. (2010) conducted qualitative interviews on perceptions of “successful aging” with 22 community-dwelling older adults. Themes included balance between “self-acceptance/self-contentment” and “engagement with life/self-growth in later life.”
Discussion Questions
- Share your own definition of successful aging.
- What other terms are used for quality of aging in your community or health care setting? How is the outcome measure defined?
References
- Lowry KA, Vallejo AN, Studenski SA. Successful aging as a continuum of functional independence: lessons from physical disability models of aging. Aging Dis 2012;3:5-15.
- Reichstadt J, Sengupta G, Depp CA, Palinkas LA, Jeste DV. Older adults’ perspectives on successful aging: qualitative interviews. Am J Geriatr Psychiatry 2010;18:567-575.
Our Guest Blogger this week is Rebecca Galloway, PT, GCS, CEEAA, Assistant Professor, SHP Department of Physical Therapy.
Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
Rodger Marion 
April 25, 2013 at 7:14 am
Weekly Discussion on Aging Transcript – April 24, 2013[10:00]
Saphira Avindar: Hi Rodger
[10:00] Rodger Markova: How are you today?
[10:02] Rodger Markova: Hey Tony
[10:06] Drdtrain: GOOD. Hello Saphira.
[10:06] Saphira Avindar: Hi Tony, it’s Rebecca
[10:07] Drdtrain: OOO. Nice name.
[10:06] Rodger Markova: Next month, May 20 and 21 Kay, Ellen and I are doing a noon workshop on using Second Life in education.
[10:07] Saphira Avindar: I would like to attend the workshop.
[10:08] Rodger Markova: It will be over in the library, hands on and it’s the same thing twice at noon on May 20 and at 4 on May 21
[10:09] Drdtrain: Good. Think it is needed to get more people involved.
[10:11] Saphira Avindar: Is there still technical support for using SL in a course?
[10:11] Rodger Markova: Yes, sort of…. Ellen has been working with the tech support people to be more friendly about SL.
[10:13] Saphira Avindar: For my courses, I would most likely use an ICU room in the hospital.
[10:13] Rodger Markova: That would be great. There probably is one already in the hospital
[10:14] Saphira Avindar: I would really like to integrate SL into 2 courses, but would need help to adapt the existing ICU-ish rooms to PT applicable skills.
[10:14] Rodger Markova: You are free anytime to use what exists now. You don’t have to ask just use it
[10:15] Saphira Avindar: ok
[10:15] Saphira Avindar: Any thoughts on the successful aging concept?
[10:16] Drdtrain: I remember thinking it was a good concept. Although very hard to measure. We focus more on frailty it seems.
[10:16] Rodger Markova: Successful aging I’m finding is tricky. Not as an academic concept but as a lifestyle
[10:17] Drdtrain: And frailty doesn’t necessarily mean ‘unsuccessful’ aging. It means you just get old and frail.
[10:17] Saphira Avindar: Yes, there has been more emphasis in measuring “frailty” or disability components than other aspects of life
[10:17] Rodger Markova: True, we all get old and frail ultimately however when does vary.
[10:18] Drdtrain: Maybe looking at extent of activity – keeping active in your community, traveling, maybe more to do with having the financial means.
[10:18] Saphira Avindar: Part of the health promotion perspective is that frailty is associated with mortality, hospitalization, and institutionalization… thus, it is frowned upon.
[10:18] Rodger Markova: From a health care standpoint disability is the point of entry, unless we focus on prevention
[10:19] Saphira Avindar: There is a life space assessment tool that incorporates ability to move and socialize beyond your home
[10:19] Rodger Markova: and it’s hard to find reimbursement for prevention as that is a lifetime task and who wants to pay someone all of their lives?
[10:20] Drdtrain: Right, SA. And again, disability may not equate to ‘unsuccessful’ aging.
[10:20] Drdtrain: Good point. Let’s just prevent bad things from happening up to a certain point (age) and then they’re on their own.
[10:21] Saphira Avindar: I find it interesting that our system covers (to some extent) chronic illness in pediatrics (rehab over several years until adulthood); however, only short-term services are available for the geriatric folks with chronic illness.
[10:24] Saphira Avindar: I have encountered numerous cases where resources stop long before an older adult returns to baseline function.
[10:24] Drdtrain: And often it is pretty much broke with little chance for ‘fixing’ But I have seen many older folks get hip or knee replacements with great success.
[10:24] Rodger Markova: yes, I agree
[10:26] Drdtrain: It when things get more systemic and the intervention or chances of survival are small that things slip away and mortality becomes more the issue – palliative & end-of-life care.
[10:26] Rodger Markova: Hospice has added a great deal to end-of-life care
[10:27] Saphira Avindar: People can still have meaningful qualify of life goals in the last weeks of life.
[10:27] Rodger Markova: Yes true
[10:27] Rodger Markova: and a good death is that final step in successful aging
[10:28] Drdtrain: All in the process of life!
[10:28] Drdtrain: I’m going to catch the last half of the Geri lecture and get some lunch. Have a great rest of the week all. Later.
[10:28] Rodger Markova: See you later Tony
[10:28] Saphira Avindar: Bye Tony
[10:29] Rodger Markova: Rebecca, do you want to take a look at the hospital and see what’s there?
[10:30] Saphira Avindar: Yes, we can go. It has been a few months since I last visited there.