Successful AgingWhere Next?

The idea of successful aging has been the subject of research for a broad range of academic disciplines for more
than 3 decades. Early mention of successful aging can
be found in the work of social scientists in the United
States during the 1960s and 1970s.16 During the 1980s
and 1990s, psychologists and behavioral scientists addressed
successful aging.711 Over the last 2 decades, physicians and
health services researchers have contributed to theories of
successful aging.1219
In recent years, this concept has gained increased attention, likely because of a combination of demographic trends
and social forces. Baby boomersthose born between 1946
and 1965face the prospect of surviving to very old age,
and those who have already reached the age of 65 have a
life expectancy of an additional 16 to 20 years.20 Furthermore, analyses using longitudinal data suggest that, in addition to living longer, people are healthier and more active
than before and that rates of disability and institutionalization will continue to fall in the future.2124 Finally, older
adults are more highly educated than previous generations
and are interested in health-related matters.25 Because of
this combination of circumstances, healthcare providers
may find their patients seeking information about how to
age successfully. Some patients may want to apply scientific
findings to their own situations to maximize their personal
likelihood of aging successfully.
We therefore conducted a review of published literature that has attempted to define successful aging and the
factors that might predict success. Articles were identified
from the following sources: (1) MEDLINE search (using
the key terms successful aging, normal aging, theories of aging, centenarians); (2) psycINFO search (using the same key terms as in (1)); (3) on-line card catalog
search (using the key term aging) of the University of
Washington libraries, which contain over 1.9 million book
titles; (4) recommendations from local reviewers of the
manuscript; and (5) reference lists of all articles and books
found by the procedures just described. No exclusions
were made for year of publication. Studies were excluded
if they used a definition of successful aging that had already been identified, if they focused on a related concept
(e.g., healthy aging, effective aging, elite aging) but made
no mention of the term successful aging, or if they were
not published in English. We were not seeking to provide a
comprehensive literature review on lifestyle factors that
promote healthy aging. Neither did we intend to propose a
definition of successful aging or argue for the validity of
the concept of successful agingas a stand-alone construct or in comparison with other related, but nonetheless
distinct, concepts such as healthy aging. Rather, our intent
was simply to identify and present in a highly summarized
JAGS 50:13061308, 2002
2002 by the American Geriatrics Society

format the many and varying definitions of successful aging that have been put forth in the literature over the past
30 to 40 years. We intend this summary to be a succinct
reference for clinicians who care for aging adults and researchers engaged in the study of aging. In addition, we offer a rationale for exploring the publics definition(s) of
successful aging; we also suggest questions and design considerations for those seeking to pursue further work related to this concept.
DEFINITIONS OF SUCCESSFUL AGING
Four decades of literature yield a variety of definitions of
successful aging. Table 1 outlines the key elements of the
various definitions. We made two observations in comparing
the various ways in which successful aging has been operationalized in past research. First, although several definitions emphasize maintenance of functional capacity as an
essential element of success, no single, uniform, operational definition of success has been adopted. Studies of
predictors of successful aging, wherein high-level functioning
constitutes part of the definition of success, identify physical activity, social engagement, and freedom from chronic
illness as predictors with some regularity (Table 2), whereas
these same elements constitute how other researchers define success. Second, we observed that very little work has
been done to ascertain the views of aging individuals. 2629
The relevance to aging individuals of the various definitions of successful aging thus remains uncertain.
IMPLICATIONS FOR CLINICAL PRACTICE
AND RESEARCH
Why would the absence of a common definition of successful aging among behavioral and clinical scientists be
relevant to clinicians and researchers? Simply being aware
that there is no consensus on a definition of successful aging has relevance for clinicians. It points to the importance
of discussing directly with patients their values and ideals
related to the aging process, including their personal conception of successful aging, to ensure that there is mutual
understanding of their health goals and priorities for the
latter years of life. Additionally, clinicians could consider
periodically reassessing their patients ideas of what it
means to age successfully. We know that one feature of individuals who achieve personal satisfaction as they age is
the ability to modify their goals in accordance with changing personal circumstances.30 This would be of interest
particularly if studies with aging individuals determined
that beliefs change with age.
For their part, researchers should recognize that, thus
far, investigative work has used a composite outcome variable based on a given investigators own definition of success

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Table 1. Definitions of Successful Aging According to Researchers

Major Element(s) Included in Definition of Successful Aging

Researcher
Havighurst5
Palmore2
Williams3
Ryff7,8
Butt/Beiser9
Rowe/Kahn13
Baltes/Baltes11
Perls/Silver14
Schulz/Heckhausen10
Strawbridge18
Roos/Havens19

Freedom
Mastery/ Active Engagement High/Independent Positive
Life Satisfaction Longevity From Disability Growth
With Life
Functioning*
Adaptation
X
X

X
X

X
X
X
X
X

X
X

X
X

X
X
X
X

*High/independent functioning has been variously defined as high physical (Rowe/Kahn, Strawbridge, Roos/Havens), cognitive (Rowe/Kahn, Roos/Havens), and social
(Rowe/Kahn) functioning or as a lack of dependency or need of assistance (Williams, Strawbridge).

and that empirical validation of that definition has not

been documented. Researchers need to be aware that predictors of successful aging will depend on the way the outcomesuccessful agingis defined. Future research in the
area of successful aging should attempt to compare the
definitions of successful aging of aging individuals themselves with those developed by the research community. An
intriguing issue will be how to validate definitions if there
are substantial discrepancies, but, overall, the perceptions
of those undergoing the aging process will be critical in determining the relevance of researchers definitions and most
importantly, the practical value of research using this term.
INVESTIGATIONS WITH PATIENTS
Inquiries into older individuals perspectives on the meaning of successful aging are important next steps. It is
possible, for instance, that successful aging may be a fluid
concept for individuals as they age and that individuals
definitions may vary substantially by birth cohort, gender,
ethnic subgroup, and the presence or absence of various
chronic diseases. Exploratory research could be conducted
to examine the relevance and meaning of success among
different subgroups of aging individuals at different phases
of the life span (i.e., middle, young-old, old, and old-old

age). Cohorts of aging individuals could be reinterviewed

periodically to assess whether within-individual variation
in the definition of success occurs with the passage of time.
Cross-cultural comparisons may be informative, particularly if comparisons were made between cultures that
honor their older people (such as Asian cultures) and the
American culture, which in general seeks to defy or deny
aging. An important question, in light of the centrality of
maintenance of function in the definitions of many researchers, would be whether individuals who experience
functional loss believe they can still age successfully. Additional questions that should be addressed include the following. What role do the setting of new goals during ones
later years, the history of a career filled with achievements,
full- or part-time work during retirement, self-perceived
health, economic hardship, and mandatory retirement
play in older peoples definition of success? Do definitions
of successful aging have any predictable relationship to
mortality? Do definitions influence healthcare-seeking behavior? How do aging individuals react to the term successful aging? An important first question would be, Do aging individuals find the term successful aging relevant and
meaningful, or completely unacceptable? If the latter,
what alternative term might they propose?

Table 2. Predictors of Successful Aging

Predictor

Researcher
Palmore2
Rowe/Kahn17
Strawbridge18
Roos/Havens19

High Educational
Level

Regular Physical
Activity

High
Self-Efficacy

X
X
X

Note: Predictors based on the researchers definition of the outcome variable.

Social
Contacts/Supports

Freedom from
Chronic Illness

X
X
X
X

X
X

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EDITORIALS

CONCLUSIONS
Although researchers have operationalized the term in a
variety of different ways, successful aging remains a value
judgment for many. Beliefs of aging individuals about the
meaning and relevance of successful aging have not been
systematically documented. The face validity of the term,
and an empirical understanding of its utility and relevance,
could be enhanced if beliefs of the lay public were elicited
and compared with and incorporated into researchers definitions. Asking aging individuals about the meaning and
relevance of successful aging should enrich the theoretical
definitions that have predominated on this concept that
has potentially high relevance to persons of all ages, allowing a more patient-centered definition of successful aging
to emerge. A clearer understanding of patients beliefs about
what constitutes successful aging should enhance providers
ability to choose from an array of healthcare recommendations those that are most relevant to their individual patients. A patient-centered definition will also be essential
for future research in the field of successful aging, for it
will allow determination of predictors truly relevant to
persons who are aging. An enriched definition should increase our appreciation of a perspective that has not been
elicited in work thus far. Such an understanding is critical
to effective provider-patient communication and the provision of health care to an increasingly informed older
population.
Elizabeth A. Phelan, MD, MS
Department of Medicine, Division of Gerontology and
Geriatric Medicine
Eric B. Larson, MD, MPH
Department of Medicine, Division of General Medicine
Department of Health Services
School of Public Health and Community Medicine
University of Washington
Seattle, Washington
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