Skip to main content

Successful Aging Does Not Equal Aging without Disability



What does successful aging look like? In one of the more influential papers on the subject published in 1987, Rowe and Kahn describe successful aging as involving freedom from disease and disability.  This definition has been adapted over time but is still being used today.  Take a recent study published in CMAJ defining "successful aging" at 60 years of age or older as satisfying each of following criteria:
  • no history of cancer, coronary artery disease, stroke or diabetes; 
  • good cognitive, physical, respiratory and cardiovascular functioning
  • the absence of disability
  • and good mental health.
These definitions are subject to criticism from multiple aspects. First, by definition almost all older adults will at some point “fail” in aging successfully given the high incidence of cognitive and functional limitations affecting the elderly, as well as the high incidence of multimorbidity. Secondly, these definitions fail to include perceptions of older adults about what they believe defines success with aging.

Challenging the Definition

Rafael Romo, Alex Smith, and colleagues recently published a paper that further challenges the notion that “successful aging” is aging without disability.  The authors interviewed a diverse group of disabled elders who would have “failed” successful aging by traditional research standards.  They asked these individuals if they felt they have aged successfully, and asked what successful aging and being old meant to them.

The authors found that despite experiencing late-life disability (the group on average dependent on 2 ADLs and nearly all iADLS), most participants (71%) felt they had aged successfully.

The qualitative analysis is fascinating and well worth the read, but I'd like to highlight one implication of this study, which comes out of the discussion:
"From a policy perspective, the major implication is that more funding should be directed toward understanding and supporting those who live with late-life disability, as opposed to the current emphasis on prevention."
This also reminds me of a quote out of the movie "How to Live Forever" (if you haven't seen it below is the trailer):
I see the hunger for long life as a kind of craving, and any craving leaves us the poorer.   Whether it is a craving for food, or a craving for sex, or a craving for money, or in this case a craving for life.
Similarly, a craving to prevent disability leaves us all poorer, as we fail to address how best to support those living with the inevitable changes that define the human condition.



by: Eric Widera (@ewidera)

Comments

It could be of importance to also consider where pain fits into the definition of successful aging. Does it fall under 'disability' and, thereby, absence of pain is essential. Or, should pain be considered an inevitable consequence of aging with a focus on it being manageable and not debilitating?
As a physiatrist new to HPM, I would share that the process of adjustment and securing adequate support is key to surviving and even flourishing in a situation previously as an observer thought to be untenable and even perhaps "a fate worse than death." No one would choose tetraplegia from a spinal cord injury. It is truly a devastating change in function and health. Yet, after grieving their loses as well as learning and mastering new knowledge and skills many people living with tetraplegia can develop new perspectives attitudes and beliefs and thereby adjust to their new, unexpected and challenging lives. They absolutely need the help and support of a multidisciplinary team. Perhaps the same can be said of some stages and processes within the trajectory of life-limiting and life-threatening illnesses.
Al Power said…
Great post, and comments as well!

Now let's expand this a bit further and talk about "successful aging" while living with dementia. In a similar vein, it can be done.

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Does “compassionate deception” have a place in palliative care?

by: Olivia Gamboa (@Liv_g_g)

There is broad consensus in the medical community that lying to patients is unethical.  However, in the care of patients with dementia, the moral clarity of this approach blurs.  In her recent New Yorker article, “The Memory House,”  Larissa MacFarquhar provides an excellent portrait of the common devices of artifice, omission and outright deception that are frequently deployed in the care of patients with dementia.  She furthermore explores the historical and ethical underpinnings of the various approaches used in disclosing (or not) information to patients living with dementia.

Ms. MacFarquhar introduces the idea of “compassionate deception,” or the concept that withholding truths, or even promoting outright falsehoods, is a reasonable and even ethical choice for those caring for patients with dementia.  To the extent that it helps a person with dementia feel happier and calmer, allowing them to believe in a gentler reality (one in which, say, their spo…