Module 2 - Successful Aging

UN sustainable development goal

a set of 17 global goals adopted by all UN member countries in 2015 to guide action towards a more sustainable, equitable, and health world by 2030

healthy aging

defined by the WHO as the process of developing and maintaining the functional ability that enables well-being in older age

functional ability

all health-related attributes that enable people to be and do what they have reason to value

• “Enable people to be and do” → not just survival or absence of disease, but the actual ability to participate in life, like working, socializing, exercising, or hobbies.

• “What they have reason to value” → recognizes that different people value different activities and life roles, so functional ability is person-centered.

WHO workng group

a WHO working group led by Ivan Bautmans introduced the concept of intrinsic capacity and vitality capacity for older adults

intrinsic capacity

the composite of the physical and mental capacities that an individual can draw on at any point in time

vitality capacity

physiological state resulting from the interaction between multiple physiological systems, reflected in energy and metabolism, neuromuscular function, and immune and stress response functions of the body

• can be measured, generally things hat support intrinsic capacity

physiological reserve

extra capacity the body has to respond to stress, illness, or injury beyond what is needed for normal daily function

• e.g. a healthy heart can inc cardiac output during exercise or illnesss

frailty

medical condition of increased vulnerability, reduced physiological reserve, and decreased physical and functional capacity that leads to a higher risk of poor health outcomes, such as hospitalization, disability, and death

frailty criteria

created by Fried et al 1998; 3 or more phenotypic criterion met indicates frailty

1. unintentional weight loss (>4.5 kg / 10 lbs in past year)

2. exhaustion (self-reported fatigue or low energy)

3. low PA (compared to expected for age and sex)

4. slow gait speed

5. muscle weakness

societal respect for older adults

society often carries stereotypes and a certain amount of respect for people of old age; this situation was compounded by COVID

• older adults seen as a more vulnerable age group

• more concern surrounding older adults going out (both for their own and others safety)

• more isolation of older adults

• long-term care facilities had staffing issues as people did not want / were not able to work there for fear of seniors’ susceptibility to COVID

successful aging

two competing theories when it comes to successful aging (Havighurst, 1967)

• activity theory

• disengagement theory

activity theory

aging is successful when people maintain roles and activities similar to earlier life

• aging is successful when people maintain roles and activities similar to earlier life

• encourages participation in social, physical, and productive activities

advocates for more engaging programs, volunteering, exercise, lifelong learning

disengagement theory

successful aging occurs when older adults gradually reduce social involvement, preparing for the end of life

• aging involves natural withdrawal from social roles and activities

• suggests some withdrawal is normal and can be psychologically healthy

advocates for adapting to reduced social demands and encourages reflection

notions of successful aging

pre-conceived notions of successful aging can be harmful and exclusionary

• ties certain health behaviours to successful aging w/o considering societal structures, inequities, health disparities

• e.g. saying being able to go for a 30 min walk as a definitive sign of successful aging

Reich et al 2020

Reich et al 2020 conducted a systemic review of 23 studies in 13 countries

• sought different perspectives of what successful aging meant to older adults

successful aging differing perspectives

there were 6 categories of responses for successful aging

1. social engagement

2. positive attitude

3. independence

4. physical health

5. cognitive health

6. spirituality

social engagement

staying connected with family, friends, and community

• avoids isolation, encourages participation in community

positive attitude

maintaining optimum, resilience, and acceptance of aging instead of only focusing on losses

• helps one move forward

independence

being able to take care of oneself

• avoiding over-reliance on others for daily needs

physical health

preserving mobility, strength, and freedom as much as possible

• enables daily activities to still be done

cognitive health

keeping memory, problem-solving, and mental sharpness intact

• enables one to fully engage w/ life

spirituality

drawing meaning, comfort, strength, or guidance from faith, meditation or other practices

• helps one find a purpose in life

successful aging and social engagement

among the key categories of responses, social engagement appeared the most

• implies that it is one of the most important aspects of successful aging

positive self-perception of aging

the way an individual views and feels about their own aging process in a favourable light

• views of growth, gaining wisdom, adapting to change

PSPA study methodology

used data from Ohio Longitudinal Study of Aging and Retirement survey and National Death Index data

• subjects cognitively interact, 50+ years of age

• SPA determined w/ Attitudes Toward Own Aging sub scale

• outcome variable as survival

PSPA and longevity

positive self-perceptions of aging is correlated with increased longevity (Levy et al 2002)

• found that those w/ more PSPA at baseline lived an average 7.5 yrs. longer than those w/ NSPA

NSPA development

stereotypes learned early → people take in cultural messages about aging throughout life

internalization → as people actually reach older age, these stereotypes become part of how they see themselves

negative effects → if the stereotype is negative it can reduce confidence and limit engagement

exercise and physical function study

a study by Valenzuela et al 2023

• showed small effect sizes for balance, endurance, strength, multicomponent interventions

• error bars show variation, indicating substantial benefits for certain participants

systematic review

a type of research study that summarizes all the available evidence on a specific question using a structured, transparent, and reproducible method

• often includes a meta-analysis

meta analysis

a quantitative statistical technique used to combine the results of multiple studies on the same question to get a single, overall estimate of the effect

• allows a researcher to derive a more precise, overall estimate of an effect than any individual study could achieve on its own

Indigenous seniors in Canada

Indigenous elders highly valued in their communities

• valued for their experience and knowledge

• most closely in touch with the philosophical teachings and ways of life

Ulukhaktok community

study by Collings 2001 looked at how Ulukhaktok elders viewed aging

• Elders considered >50 yrs

• highly valued in society

  • providers of hunted food

  • exemplars of an idealized, traditional lifestyle

  • nexus of social relations

Ulukhaktok community themes

4 themes arose from the Collings 2001 study

• Natural

• Domestic

• Economic

• Attitudinal

natural

refers to the natural environment (parks, gardens, fresh air, sunlight)

• access to nature affects well-being and quality of life

• affects health, physical activity, independence

domestic

relates to the home environment and daily living spaces

• family and household relations

economic

concerns financial resources and security

• adequacy of pension, children’s finances, financial needs met

attitudinal

includes mental health, emotional well-being, perceptions, beliefs, and social attitudes

• transmission of knowledge, respect from community

highest mentioned item among young and older ages

Ulukhaktok responses

similar responses when categorized by age

different responses emerged between women and men (categorized by gender)

attidues during late life

in Ulukhaktok, an individual’s attitudes (particularly their willingness to act as a mentor/transmitter of knowledge and wisdom) during late life is a major determinant of successful aging

• health issues also perceived as important but declining health is natural and inevitable; as such how one deals with this (attitude) is important

how to think about successful aging

recognize diversity in older adults

recognize diversity in perceptions of successful/healthy aging among older adults

listen to older adults with whom you are working and consider environmental, sociocultural, and individual contexts