Lecture 6: Successful Aging PDF

Lecture 6 Chapter 9: Successful Aging VIGNASH THARMARATNAM Why Does Aging Matter?  Reasons that aging matters: 1. May then gain some sense of how to prepare now for a successful future Knowing how to accomplish successful aging can help us delay short-term rew...

Lecture 6 Chapter 9: Successful Aging VIGNASH THARMARATNAM Why Does Aging Matter?  Reasons that aging matters: 1. May then gain some sense of how to prepare now for a successful future Knowing how to accomplish successful aging can help us delay short-term rewards, and prioritize larger long-term ones instead Why Does Aging Matter?  2. People are living longer and the world is getting older  According to the World Health Organization (2016), the average life expectancy increased by 5 years between 2000 and 2015  Largest such increase since the 1960s  Alongside declining birth rates, leads to large demographic shifts  Causes less frequent vacancies for jobs  Imbalances in payments and withdrawals for social safety nets  More opportunities for intergenerational relationships/interactions Why Does Aging Matter?  3. Negative stereotypes about aging can get in the way of having positive interactions with older adults and best preparing for our own futures  College students tended to agree with the statement “Most old people get set in their ways and are unable to change” (Smith et al., 2017)  However, were less likely to agree with this and related statements the more they had regular contact with older adults What Is Successful Aging?  Twomain goals surrounding successful aging: 1. Success defined by simply living into old age Researchers in the US and UK tend to use retirement ages as standards and define old age as 65 years old and anyone over age 85 as the “oldest old” What Is Successful Aging?  2. Success defined by the quality with one ages  Robert Havighurst used the term successful aging to denote “adding life to years” vs. adding years to one’s life  Successful aging involves both maximizing satisfaction and happiness for an individual in older age and balancing the wants and needs of all age groups in a society  Focused heavily on the psychological aspects of successful aging  E.g. satisfaction with life, engagement with activities, and acceptance of age-related changes What Is Successful Aging?  Roweand Kahn (1997) suggested that successful aging features both psychological and physiological outcome, distinguished between three groups:  Older adults with pathology or disease states  Normal older adults  Successful agers - those with lower risk for future problems and current high functioning What Is Successful Aging?  Normal aging is associated with modest declines in cognitive and physical functioning  Although declines are not pathological, they put older adults at greater risk of problematic outcomes including physical, psychological, economic, and interpersonal difficulties  By studying successful agers, we might be able to intervene with normal agers and improve their aging What Is Successful Aging?  Rowe and Kahn define successful aging in terms of three components:  1.Low probability of disease and little or no current disease-related disability  2,High cognitive and physical functional capacity  3. Active engagement with life Particularly in interpersonal relationships and productive activities (i.e. activities with societal value) What Is Successful Aging? Ryff’s (1989) general model of well-being focuses more on psychological outcomes Integrates cultural and historical influences on the conceptualization of successful aging What Is Successful Aging?  Argues that successful aging has 6 components:  1. Self-acceptance: a positive sense of self  2. Positive relationships with others: meaningful connections to others that entail reciprocity, intimacy, and affection  3. Autonomy: one’s ability to control one’s own behaviors and maintain independence, even in the face of disagreement with others or social pressures to change What Is Successful Aging?  4. Environmental mastery: To have control over one’s environment and activities, including decisions about day-to-day activities  5. Purpose in life: To believe that life is meaningful and that they can continue to engage with important goals  6. Personal growth: When a person remains open to new experiences and demonstrates self-improvement over time What Is Successful Aging?  Strawbridge et al. (2002) asked 867 older adults from the Alameda County Study how strongly they agreed or disagreed with the statement “I am aging successfully (or aging well)”  Left the definition of “aging successfully” up to the individual  Foundthat half the participants rated themselves as successfully aging  However, when using criteria proposed by Rowe and Kahn, dropped to ~19% What Is Successful Aging?  Biggest difference between the two classification schemes was in the presence of chronic health conditions  Using the Rowe and Kahn definition, no respondents with chronic health conditions were classified as successfully aging,  While using the self-determined model, ~ 43% of those with at least one chronic health condition reported that they were aging successfully  Being classified as a successful ager in both models was associated with better overall well-being  Including measures of happiness, depression, relationships, energy, optimism, and perceived control Study 1: The MacArthur Study  The Rowe and Kahn (1997) criteria for successful aging also are known as the MacArthur model of successful aging  In 1984, the John D. and Catherine T. MacArthur Foundation assembled a group of 16 scientists from different disciplines to form one of the first conceptualization of gerontology  Focused on the genetic, physical, psychological, and social factors that allow some people to maintain or improve functioning as they age.  Collected data via longitudinal, dyadic (i.e., two-person), laboratory, and imaging studies  >1000 older adults who were considered to be aging well were followed for 8 years Study 1: The MacArthur Study  Importance of the MacArthur Study  Helped define the concept of successful aging to researchers in gerontology and geriatrics  Key funding agencies, including the National Institutes of Health, began to support research on successful aging after it was implemented  2. Work done was collaborative and interdisciplinary, allowing for a wide variety of scientific and healthcare perspectives to be adequately represented  3. The data were collected in several different ways (e.g. self-report, interview, and imaging), allowing for greater confidence in the findings Study 2: The Harvard Study  The Harvard Study of Adult Development has been following two cohorts of White men for 75 years to understand healthy (or successful) aging  A) In the Grant Study, 268 men drawn who graduated from Harvard University between 1939-1944  B)In the Glueck Study, 456 men drawn from the inner-city neighborhoods of Boston, Massachusetts Study 2: The Harvard Study  Study generated a rich multimodal data set  Includes questionnaires (completed every 2 years), participant and physician-rated physical health information (collected every 5 years), and interviews (completed every 5–10 years)  Participants were recruited from various levels of socioeconomic status  Participants recruited when they were adolescents/young adults and followed into old age  Samples were big enough to follow over time, even allowing for some attrition  One limitation was the study’s ↓ generalizability given that only White men were recruited Study 3: The Alameda County Study  Also known as the Health and Ways of Living Study  Data collection began in 1965 with a sample of 6,928 respondents from Alameda County, California, and continued to be collected for the next 35 years  Participants in this data set were more demographically diverse than those in the Harvard Study of Adult Development  Better able to examine demographic factors (e.g. sex, race)  Participants were followed longer than those in the MacArthur Study  Allowing for the impact of health behaviours to be seen over longer durations Study 3: The Alameda County Study  The study show 7 health behaviors (“the Alameda 7”) that predict longevity:  Sleeping 7–8 hours per night  Eating breakfast  Eating regular meals and not eating between meals  Maintaining a healthy weight  Exercising regularly  Limiting alcohol consumption  Not smoking  Not all of these variables has proven to be reliably related to successful aging, provided the foundation for future research Predictors of Successful Aging  Many studies use the Alameda 7 as a starting point for identifying predictors of longevity  However, longer longitudinal tests with more participants were needed for better evidence regarding these health behaviors  E.g. Li and colleagues (2018) analyzed data from two large studies in which participants were followed for up to 34 years  Never smoking, moderate alcohol consumption, healthy body weight (i.e., BMI 18.5–24.9), 30 minutes or more of moderate to vigorous exercise each day, and a high-quality diet predicted a longer life-span  If engaged in all 5, then +12 years extra for men, +14 years extra for women Predictors of Successful Aging  Data from the Harvard Study of Adult Development (Vaillant & Mukamal, 2001) suggest many factors assessed prior to age 50 predict successful aging (being both happy and healthy) in one’s mid-70s  Categorized people into four groups:  Both healthy and happy (i.e., happy-well)  Both unhealthy and unhappy (i.e., sad-sick)  Either happy or healthy (i.e., intermediate)  No longer living (i.e., prematurely dead) Predictors of Successful Aging  Same proportion of people of each category for the Harvard men at age 75 and city neighborhood men at age 65  I.e. Harvard graduates reached every stage of death and disability (i.e., prematurely dead, sad-sick, intermediate) about 10 years later  The two groups also differed in terms of parental social class, current income, job status, and intelligence test scores  However, one group of men in the city neighborhood sample had also completed college (not at Harvard)  The aging trajectories of those men were more similar to Harvard graduates than non-college educated inner-city neighborhood men  Suggests education may play a role in successful aging Predictors of Successful Aging  Examined a number of predictors measured before age 50 and outcomes measured at age 65 or later  Predictors:smoking, alcohol abuse, BMI, Education (for neighourbood men), exercise level (for Harvard men), marriage stability, maturity of psych. Defenses, depression level, parental social class etc.  Outcomes: objective physical health, subjective physical health, years of active life (e.g. before disability, objective mental health, subjective life satisfaction, objective social supports (Harvard men only) Predictors of Successful Aging A 5-minute treadmill test completed (proxy of perseverance) was related to successful aging for the Harvard graduates  Absence of both alcohol and cigarette abuse predicted successful aging in all outcome domains except for subjective life-satisfaction A warm marriage, absence of a depressive disorder, and good physical health before age 50 each predicted successful aging in both groups Predictors of Successful Aging  Depp and Jeste (2006) conducted a review of 28 studies published between 1987 and 2006 that focused on successful aging  Lesssmoking over one’s life and not having arthritis and hearing problems were each consistently strongly associated with successfully aging  Less strongly (but significantly) associated with successful aging were ↑ physical activity, better self-rated health, absence of depression, few physical health conditions, and lower systolic blood pressure  Higherlevels of education, being married, higher income, and being White tended were unrelated to successful aging status across studies in this review Predictors of Successful Aging Across multiple studies, abstaining from smoking and engaging in physical activity, the absence of depression, better physical functioning at a younger age, and good relationships were related to successful aging The SOC Model  The selection–optimization–compensation model (SOC; Baltes & Baltes, 1990) was developed from the Berlin Aging Study  Adults between the ages of 70 and 100 were enrolled and followed  Focused on ways that older adults successfully balance developmental losses with developmental gains  Developmental losses: ↓ cognitive-processing speed, ↓ neural efficiency, ↓ muscle mass, and ↓ sensory acuity The SOC Model  Developmental gains include:  Gaining a position of familial respect by becoming the matriarch/patriarch ↑ social status such as becoming an elder in one’s religious community ↑ material wealth and possessions compared to one’s younger years, ↑ knowledge and wisdom  Elevated professional rank such as supervisory, managerial, and leadership positions The SOC Model  SOC model emphasizes three processes relevant to successful aging  1. Selection: process of narrowing your activities to include only those that are particularly important or valuable to you  Selections can be either elective (i.e. via choice) or loss-based  E.g.electively letting go of sports in middle age to spend time on job/family  E.g. being forced to let go of sports due to a chronic mobility issues in middle age The SOC Model  2. Optimization: strengthening skills and capabilities in order to accomplish goals or continue to engage in selected activities  E.g.learning how to use technology (e.g. Zoom) to better strengthen ability to interact with others that are far away  3. Compensation: using aids in order to maintain engagement with a selected activity or goal when previous strategies are no longer sufficient to maintain performance  E.g.using reading glasses to read if eyesight gets worse with age The SOC Model  Freund and Baltes (1998) found that ↑ use of self- reported SOC strategies in 200 adults aged 72- 103 was associated with: ↑ positive emotions ↑ satisfaction with age ↓ loneliness  Chou and Chi (2002) found the relationship between financial hardship and life satisfaction is ↓ at ↑ levels of SOC, particularly when considering optimization strategies The SOC Model  Although people engage in SOC strategies at all ages, research suggests that such strategies may be particularly beneficial for older adults  Younger people likely face fewer developmental challenges that require adaptation  Middle-aged and older adults are happier on days when they use more SOC strategies, but this is not true of younger adults (Teshale & Lachman, 2013)  Use of SOC strategies were related to maintenance of occupational competency for workers older than (but not under) age 49 (Abraham & Hansson, 1995) Socioemotional Selectivity Theory  As we age, our developmental goals change  20s: focus on knowledge acquisition goals (building resources and mastery)  E.g. finishing school, preparing for career, find romantic partner  40s: focus on goals toward advancement and nurturance  E.g. getting ahead in a job, raising children, and preparing financially  60s: focus on goals centering on maintenance and stability  E.g. maintaining social networks, having more positive than negative emotional experiences (emotion regulation goals), and savoring the present moment Socioemotional Selectivity Theory  Socioemotionalselectivity theory: people choose developmentally appropriate goals based on how much time we have left to live  Many ways in which SST occurs: 1.Older adults tend to engage in the positivity effect: enhanced processing of positive (vs. negative) emotional stimuli Socioemotional Selectivity Theory  Charles and colleagues (2003) had younger (ages 18–29), middle-aged (ages 41–53), and older (ages 65–85) adults viewed positive, negative, or neutral images and were later asked to recognize and recall what they had seen  Older adults tended to have the worst memory performance overall, but remembered proportionately more positive than negative information Socioemotional Selectivity Theory  Mather and colleagues (2004) found that older adults had more amygdala activation in response to positive images than negative images  Pattern that was not observed for younger or middle-aged adults  Amygdala play a role in emotion processing, emotional memory, and reward salience (Amunts et al., 2005) Socioemotional Selectivity Theory  2. Older adults invest time and attention more towards their most important relationships and prune away less fulfilling relationships  Older people may have ↓ social networks due to losses through death, distance, and limitations to engage with others  Older (vs. younger) adults (European Americans, African Americans, Germans, and Hong Kong Chinese) report having fewer members of their social networks but similar levels of satisfaction (Fung et al., 2001)  Relationships that do exist more are more important and meaningful Socioemotional Selectivity Theory  3. Older adults have an increased perception of their limited time Fung and colleagues (1999) asked younger and older adults to choose between a familiar and a novel social partner Eithertold they had many years of good health left or their time was limited Socioemotional Selectivity Theory  A) Older adults made choices like younger adults when imagining that they had many years of good health in front of them  Equally likely to choose novel and familiar interaction partners  B) Younger adults made choices much like their older adults when imagining that their time was limited  More likely to choose to spend time with a familiar and emotionally close partner  C) When both groups imagined they had limited time, both had better memory for positive images compared to negative images The Proactivity Model of Successful Aging  The proactivity model of successful aging assumes that as we age, we accumulate a number of physical and social stressors which impair one’s physical and emotional well-being  Argues that successful aging is associated with planning ahead to reduce the impact of age-related risks to by:  1. Engaging in preventive behaviors  2. Proactively coping with corrective behaviours The Proactivity Model of Successful Aging  E.g. if one develops diabetes and it will get worse with time:  Can plan ahead by mobilizing financial resources, personal resources (e.g. optimism, self-esteem, having a future orientation), and social resources (e.g. social network, family relations)  Prevent things from getting worse by watching one’s diet, exercising, and putting aside money to afford medical care  Make things better in the current moment through corrective adaptations  E.g. learning as much as one can about one’s condition and drawing on other relationships to support themselves The Proactivity Model of Successful Aging  Evidence supporting the Proactivity Model of Successful Aging  Kahana and colleagues (2002) found that 72-98 years old adults that engaged in more preventive behaviors over 8 years (e.g. exercise and giving up smoking) reported a better quality of life  50 -70 year old adults that engaged in proactive coping was associated with good physical health (Ouwehand, 2005)  25–75 year old adults endorsing planning strategies that were future oriented had greater life satisfaction (Prenda & Lachman, 2001) Age and Well-Being  Paradox where older adults tend to be less physically healthy yet also happier than younger adults  Rates of depression in older adults are lower than in younger adults (Hasin et al., 2005; NIMH, 2017)  Older adults tend to experience less negative affect than younger adults and similar levels of positive affect (Lohani et al., 2014)  Negative affect ↓ with age while positive affect tends to remain stable over the years (at least until the oldest of old age; Charles & Carstensen, 2010) Age and Well-Being  Across 160 countries, Steptoe et al. (2005) found a U-shaped relationship between emotional well-being and age  Particularly for people from high-income, English- speaking countries  Levelsof self-reported well-being ↓ during one’s mid-20s through 40s, reaching lowest levels between ages 45-54 and then ↑ in later adulthood in these countries  However, for countries in former Soviet Union, Eastern Europe, and Latin America, well-being ↓ with age  In sub-Saharan Africa age was unrelated to well-being Age and Well-Being  Reasons for U-shaped well-being in high- income, English-speaking countries  1. Experience ↓ stress and emotional upheaval in our day-to-day lives with ↑ age  An inverted U-shaped relationship between stress and age  Stone and colleagues (2017) found adults age 50 reported the most stress, with reported levels steeply declining with age into one’s their 70s (lowest point) Age and Well-Being  May also be less likely to consider things stressful in our advanced age  E.g. small disagreement with friend/romantic partner not as stressful or threating to relationship in old age vs. when younger  Stone and colleagues (2017) found that inverted U-shaped relationship of stress and age maintained even after factoring health status, marital status, having children  Might not just be that older people have less things to stress about Age and Well-Being  2. Emotional maturity hypothesis: we become better at regulating our emotions in older age SST theory argues that emotion regulation is considered an important developmental goal associated with older age (Carstensen et al., 1999) Age and Well-Being  Older (vs. younger) adults reported that they were better able to use cognitive reappraisal to decrease negative emotions in response to film clips (Shiota & Levenson, 2009)  Older adults benefited more from positive reappraisal: trying to find something positive in the film clip  Youngeradults benefited more from detached reappraisal: trying to remain detached from the film clip Age and Well-Being An indicator of optimal emotion regulation is the maintaining high positive affect and low negative affect over time Tends to be associated with ↑ age (Carstensen et al., 2000) Wisdom  Often associate wisdom with age  Baltes and Staudinger (1993) define wisdom as “good judgment and advice in important but uncertain matters of life”  Wisdom suggests that one has an expert knowledge system in the fundamental pragmatics of life  Allows them to have excellent insight and judgment, especially when the future is uncertain or situations are perplexing Wisdom  Baltes and Staudinger (1993) outlined 5 skill areas that characterize wisdom:  1. Factual Knowledge  E.g. Knowing the who, what and when of a situation, knowing examples of possible situations  2. Procedural Knowledge  E.g. Strategies of information search, decision making and advice given Wisdom  3. Lifespan Contextualism  E.g. Understanding situations in the context of one’s age, culture or unique circumstances (e.g. having a terminal illness)  4. Relativism  E.g. Understanding religious and personal preferences, current and future values, historical period, cultural relativism  5. Uncertainty  E.g. Understanding there is no perfect solution, optimizing gains vs. losses, understanding future is not fully predictable, and having backup solutions Wisdom  Tomeasure wisdom, researchers present people with vignettes that represent difficult life dilemmas and ask them to think aloud about the issues Thethink-aloud answers are then coded on the five dimensions Wisdom  Ardelt (2004) describes “personal wisdom” as an advanced stage of personality development combining various personality characteristics  Cognitive level: involves a commitment to the truth, an awareness of the positive and negative aspects of human nature, and an acknowledgment of the ambiguity and uncertainty of life  Affective level: defined by compassion for others  Reflective level: associated with the ability to adopt multiple perspectives and consider issues without casting blame Wisdom  Using self-reports to assess wisdom, Ardelt and Edwards (2016) found wisdom was most strongly related to subjective well- being in older adults  Even after factoring in physical health, socioeconomic status, current financial status, social involvement, age, gender, race, and marital status  Relationship was strongest for those in nursing homes and hospice care (i.e. elderly), compared to community-dwelling older adults Blue Zones  Blue Zones: areas in the world where people were more likely to live to be 100 years old  Made up of five areas: Sardinia (Italy), Okinawa (Japan), the Nicoya peninsula (Costa Rica), Ikaria (Greece), and Loma Linda, California (United States)  Dan Buettner and his team (2005) found that in addition to living longer than might be expected, the older adults were happy and engaged in their communities Blue Zones 9 behaviors associated with extreme longevity in Blue Zones  1. Engage in physical activity naturally as part of your day-to-day activities Found that many centenarians engaged in regular, low-intensity exercise as part of their daily experiences  E.g. gardening, walked to the local market, looking after livestock Blue Zones  2. Cut caloric intake by about 20%  Older adults in Blue Zones reported that they stopped eating before they were full  E.g. in Okinawa, elders use the phrase “hara hachi bu” as a reminder to “eat until you are eight parts full”  3. Eat a higher proportion of plants and plant- based foods in their diets and relatively less meat and processed foods  Meat, particularly pork, was common in the diets of older adults in four of the five Blue Zones, but only consumed a few times each month Blue Zones  4. Drinking in moderation, no more than a glass or two daily  Regularly consuming some alcohol with meals slows the rate of eating, increases contact with friends, and may have antioxidant and other health benefits  However, the risks generally outweigh the benefits when not in moderation Blue Zones 5.Have a strong sense of purpose that provides the scaffolding for one’s life activities The older adults of Okinawa call this “ikigai” (reason to live), and those from Nicoya call it “plan de vida” (life plan) Blue Zones  6. Slowing down and appreciating life as it is happening  E.g.the older adults in Nicoya take a break every afternoon and socialize with friends  The Seventh Day Adventists in Loma Linda, California, observe the Saturday Sabbath  Spend time focusing on their religion, their families, and their friends rather than working Blue Zones  7.High rate of participation in a spiritual community  Those in Loma Linda, CA, tend to be Seventh Day Adventists  Communities in Sardinia and Nicoya are historically largely Catholic  People of Ikaria are affiliated with the Greek Orthodox Church  Okinawans tend to have a spiritual reverence centered on honouring ancestors Blue Zones  8. Focus on one’s family  Older adults who lived to be 100 years or older tended to have married, had children, and structured their lives around supporting their families  Inthe Okinawa group, even the elders begin each day by honoring their ancestors  In4 out of 5 Blue Zones, members of older generations tend to live with members of the younger generations  E.g. parents in their 70s and 80s live with their children, who are now in their 40s–60s Blue Zones  9. Maintain social connections, particularly with others who also engage in healthy behaviors Longevity and successful aging are associated with rich social connections If the people in your social network engage in healthy behaviors, you are more likely to do so The Hispanic Paradox  TheHispanic Paradox: Latino Americans (especially those born outside the US) have equal or superior health outcomes than White Americans, even though they also tend to have worse socioeconomic indicators, (e.g. average income and education levels) The Hispanic Paradox  Some evidence suggest the paradox might extend to psychological markers of successful aging, including well-being and satisfaction with life  Calvo et al. (2017) found that older Hispanic immigrants reported higher life satisfaction than non-Hispanic Whites  Influenced by whether people lived with children  Children ↓ life satisfaction for non-Hispanic White, ↑ life satisfaction for Hispanic (both US born and immigrants) The Hispanic Paradox  Paradox could also be due to demographic confounds:  E.g.Borrell and Lancet (2012) found that foreign-born Puerto Rican and US-born Mexican American women over the age of 65 years were found to have a lower death rate than their non-Hispanic White peers, but no advantage to other groups (including male participants) The Hispanic Paradox  Paradox could also be due to biased sample selections  E.g. undocumented immigrants, particularly adult males, may be less likely to be seen in treatment facilities and thus underrepresented in research on health outcomes (e.g., Sullivan & Rehm, 2005)  Individualswho successfully immigrate to the United States may tend to be particularly healthy, reducing generalizability of findings to larger populations