Microsoft Office image (2013)

Microsoft Office image (2013)

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 ( 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?


  1. 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.
  2. 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:

Guest Blogger: Rafael Samper-Ternent, M.D., Fellow Sealy Center on Agingbouncing

For the past century medicine has mostly relied on the biomedical model to deal with diseases and develop ways to prevent or manage them. Recent advances in genetics have added to the notion that molecular changes are the key focus of disease. Research has shown that the biomedical model that focuses mainly on disease falls short of comprehensively understanding aging. A more comprehensive approach that includes not only physical aspects of aging, but also mental and social aspects has been shown to better capture the essence of the aging process.

In recent years, the term resilience has gained attention in the field of aging. Resilience is broadly defined as the ability to bounce back from adversity. All older adults experience adverse events, however, only a portion of older adults have disability, require special assistance or must change their lifestyle significantly after an adverse event. Unfortunately most aging research to date focuses on these negative aspects of aging. Fewer studies have analyzed the positive aspects of aging, including the ability that many older adults have of recovering from adverse events and leading independent, healthy and productive lives.

The MacArthur Studies on Successful Aging where among the first studies to show that absence of disease and disability, good cognitive function and social engagement were key elements associated with aging well. More recently, studies have shown that additional factors such as a positive outlook on life, good social support and healthier lifestyles help older adults recover from adverse events. We are just now understanding that a positive approach to aging where things like recovery, a meaningful aging experience and spirituality, among many others, are as important or maybe more important than traditional outcome measures used in aging research like disability and mortality.

As the population continues to grow older we should consider whether our approach to aging has a positive or negative tone. The more we change our mindset and perceive aging as a another stage in our lives that can be as rewarding, exciting and interesting as any of the other stages, the easier and better our aging process will be and the better we will be able to care for the older adults in our lives. More research is needed to define and operationalize resilience, however, keeping in mind that all adults have the ability to recover can certainly make a difference in how we approach aging.


(Bowling & Dieppe, 2005; Bowling, 2007; Engel, 1980; Rowe & Kahn, 1987; Rowe & Kahn, 1998; Rowe & Kahn, 1999b; Rowe & Kahn, 1999a; Windle, Markland, & Woods, 2008; Windle, 2011)

Reference List

  1. Bowling, A. (2007). Aspirations for older age in the 21st century: what is successful aging? International Journal of Aging and Human Development, 64, 263-297.
  2. Bowling, A. & Dieppe, P. (2005). What is successful aging and who should define it? BMJ, 331, 1548-1551.
  3. Engel, G. L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535-544
  4. Rowe, J. W. & Kahn, R. L. (1987). Human Aging – Usual and Successful. Science, 237, 143-149
  5. Rowe, J. W. & Kahn, R. L. (1998). Successful aging. Aging Clinical and Experimental Research, 10, 142-144
  6. Rowe, J. W. & Kahn, R. L. (1999a). Successful Aging. New York: Dell Publishing
  7.  Rowe, J. W. & Kahn, R. L. (1999b). The future of aging. Contemp. Longterm Care, 22, 36-4
  8. Windle, G. (2011). What is Resilience? A review and concept analysis. Reviews in Clinical Gerontology, 21, 152-169.
  9. Windle, G., Markland, D. A., & Woods, R. T. (2008). Examination of a theoretical model of psychological resilience in older age. Aging Ment. Health, 12, 285-292.

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