Paper 1: Defining Successful Aging: A Tangible or Elusive Concept?

Peter Martin1, Norene Kelly1, Eva Kahana2, Boaz Kahana2, Leonard W. Poon3

1Iowa State University
2Case Western University
3University of Georgia

Introduction

This is the first of five papers to review and define the notion of “successful aging” — a term that is commonly used in the gerontological literature as both a process and an outcome with significant amount of research in the last fifty years on its meanings, models, measurement, interpretations, and implications for applications.  If one ages successful, it implies that one has successfully “added years to life and life to years”  — a goal all of us would want to achieve.  Policy makers would want to instill programs that would lead its citizens to achieve some measurable benchmarks of successful aging.  Yet, after 50 years of research and discussion, there is still significant amount of ambiguity on the definition and application of the mechanisms of successful aging.

The goal of this project is to define what we know about successful aging in order to better grasp the contributing mechanisms and more importantly interventions and applications at both the individual and group levels.  The first paper review the history of attempting to define successful aging quantitatively and qualitatively, and the second paper provides a bibliographic follow-up.  The third paper defines the impact and importance of “contexts” or “environments” associated with successful aging.  The fourth paper outlines the measurement issues.  Finally, the last paper outlines intervention and application issues that unfortunately had been implied in all successful aging research but fell short of realizing their practical goals.

Defining Successful Aging: A Tangible or Elusive Concept?

The term “successful aging” has been used in the gerontological literature to cover processes of aging throughout the life span (Wykle, Whitehouse, & Morris, 2005) and implies positive aging processes for some (Rowe & Kahn, 1998) while provoking criticisms of failing to either be not comprehensive enough or too over-arching for others (Holstein & Minkler, 2003). Sometimes successful aging is called “vital aging” or “active aging” with the implication that later life can be a tie of sustained health and vitality (Moody, 2005).  As Moody pointed out, the term “successful aging” suggests “key ideas such as life satisfaction, longevity, freedom from disability, mastery and growth, active engagement with life, and independence” (p. 59).  The emphasis for many  may be on maintaining positive functioning as long as possible (Phelan & Larson, 2002) but others have suggested that successful aging can also be discussed under more adverse health conditions (Poon, Gueldner, & Sprouse, 2003). This paper will highlight those who have popularized the topic of successful aging, present some of these definitions and outline their commonalities and differences.

Early Definitions

One of the earliest definitions of successful aging found in the gerontology literature is the one introduced by Robert Havighurst (1961). He suggested that in order for the science of gerontology to provide good advice, it must have a theory of successful aging.  Such a theory should be

…a statement of the conditions of individual and social life under which the individual person gets a maximum of satisfaction and happiness and society maintains an appropriate balance among satisfactions for the various groups which make it up–old, middle aged, and young, men and women, etc. (p. 8)

For Havighurst, the study of successful aging was a central theme for gerontology as a discipline. It is well known that at the time of Havighurst’s proposition, there existed two contrasting theories of successful aging:  activity theory and disengagement theory (Cumming & Henry, 1961; Havighurst, Neugarten & Tobin, 1963). Activity theory stated that aging successfully meant maintaining middle-aged activities and attitudes into later adulthood; gerontologists generally preferred this theory since it was assumed to capture the desire of aging individuals.  Disengagement theory, on the other hand, meant that a person aging successfully would want, over time, to disengage from an active life.  Havighurst (1961) suggested that it should be possible to select which of these two theories should prevail by creating an “…operational definition of successful aging and a method of measuring the degree to which people fit this definition” (p. 9).

Havighurst, however, admitted to the difficulty of this approach.  Measurements that had been attempted, and criticized, included operationalizing successful aging as:  1) a way of life that is socially desirable for this age group; 2) maintenance of middle-age activity; 3) a feeling of satisfaction with one’s present status and activities; and 4) a feeling of happiness and satisfaction with one’s life.  He and his colleagues consequently analyzed persons’ life satisfaction with present and prior life and developed the Life Satisfaction Index based on five components: 1) zest vs. apathy; 2) resolution and fortitude; 3) goodness of fit between desired and achieved goals; 4) positive self-concept; and 5) mood tone.  Havighurst (1961) thought that values and personality must be taken into account, and that it would be helpful to use different measures of successful aging.

A decade later, Neugarten (1972) concluded that the pivotal factor in predicting which individuals will age successfully is personality. Coping style, prior ability to adapt, and expectations of life, as well as income, health, social interactions, freedoms, and constraints were all seen as part of the coalescence of personality and thus played into the enormous complexity of successful aging.

The MacArthur Network of Successful Aging

As the mid-1980s approached, the progress of gerontology began to stall perhaps due to a preoccupation with disease, disability, and chronological age (Rowe & Kahn, 1998).  It was in this environment that the MacArthur Network on Successful Aging was launched in 1984, led by Jack Rowe, a physician, and Robert Kahn, a psychologist, along with a group of 16 scientists from a wide range of backgrounds sought to clarify the factors that promote “positive” aging.  As has by now been published widely, the MacArthur study operationalized three criteria of successful aging: freedom from disease and disability, high cognitive and physical functioning, as well as social and productive engagement. The MacArthur study followed a sample of 1000 older adults who met the criteria over a period of seven years (Jeste, Depp, & Vahia, 2010).

Rowe and Kahn (1987) argued that the emphasis on normality (as for example outlined by the Duke Studies on “normal aging,” Palmore, Nowlin, Busse, Siegler, & Maddox, 1985) created a number of limitations.  For example, Rowe and Kahn stated that most gerontological research focused on average tendencies within different age groups and neglected the substantial heterogeneity within such groups — a disparateness that appears to increase with age.  Thus, age itself could not serve as a sufficient explanatory variable, and habits shaped by psychosocial influences were also seen as very important.

Consequently, Rowe and Kahn (1987) proposed the development of a conceptual distinction within the “normal” category, which would serve to contrast usual aging with successful aging.  Rowe and Kahn’s emphasis at that time was on maintaining physical health and avoiding disease:

In many data sets that show substantial average decline with age, one can find older persons with minimal physiologic loss, or none at all, when compared to the average of their younger counterparts. These people might be viewed as having aged successfully with regard to the particular variable under study, and people who demonstrate little or no loss in a constellation of physiologic functions would be regarded as more broadly successful in physiologic terms. (pp. 143-144)

The approach Rowe and Kahn took was well-received and subsequent publications helped underline the approach Rowe and Kahn took to popularize the term successful aging. In 1997, Rowe and Kahn further refined their conception and offered a now well-known graphic representation that included three important components.

We define successful aging as including three main components:  low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life. All three terms are relative and the relationship among them… is to some extent hierarchical… Successful aging is more than absence of disease, important though that is, and more than the maintenance of functional capacities, important as it is. Both are important components of successful aging, but it is their combination with active engagement with life that represents the concept of successful aging most fully. (p. 433)

Rowe and Kahn (1998) summarized the MacArthur Network research further highlighting the planning, determination, and work that successful aging requires. They stated that it “…is dependent upon individual choices and behaviors. It can be attained through individual choice and effort” (Rowe & Kahn, 1998, p. 37).

Rowe and Kahn (1998) summarized their approach to successful aging with a model of overlapping components (i.e., avoiding disease, maintaining high cognitive and physical function, and engagement with life). Where all three components overlap (i.e., the combination of all three), successful aging is fully represented. The model is testable by assessing to what extent older adults are able to fulfill one, two or all three components. The consequence, however, is that very few older people are able to maintain high levels of functioning to be labeled “successful.”

Among others, Masoro (2001) criticized the successful aging model primarily because it downplayed the importance of genetics and species-determined deterioration of late life. Furthermore, the emphasis on “success” would endorse a “fortunate elite” and neglect or even blame those less fortunate.  In a rebuttal, Kahn (2003) cited heritability evidence from the MacArthur studies and noted that publications on successful aging were intended to “encourage health promotive behavior on the part of older men and women, and to advocate policies that facilitate and reward such behavior” (p. 61).

Selective Optimization with Compensation

During the time of MacArthur studies, Baltes and Baltes (1990) served as editors of the book, Successful aging: perspectives from the behavioral sciences, which tended to offer a more qualitative and psychosocial approach. Their approach acknowledged aging-related losses in the physical and psychosocial domains and focused on individual’s actualization of the remaining strengths and resources.  In their chapter on the model of selective optimization with compensation, they indicated that an encompassing definition of successful aging

…requires a value-based, systemic, and ecological perspective.  Both subjective and objective indicators need to be considered within a given cultural context with its particular contents and ecological demands.  However, both the objective aspects of medical, psychological and social functioning and the subjective aspects of life quality and life meaning seem to form a Gordian knot that no one is prepared to untie at the present time.  Our suggested solution is to use multiple subjective and objective criteria and to explicitly recognize individual and cultural variations. (p. 7) 

Baltes and Baltes’ premise was that successful, individual development (including aging) is a process including three components:  selection, optimization, and compensation.  In terms of a definition, Baltes and Baltes admitted to a greater interest in its power to identify and organize questions and research directions rather than whether it would, in the long run, remain a scientifically viable topic.

In the Baltes and Baltes (1990) volume, numerous other authors contributed definitions.  Fries, taking a medical or public health viewpoint, focused on compression of morbidity.  Successful aging, he wrote, “…consists of optimizing life expectancy while at the same time minimizing physical, psychological, and social morbidity, overwhelmingly concentrated in the final years of life” (Fries, 1990, p. 35).  Featherman, Smith, and Peterson (1990) approached successful aging from the perspective of the social sciences:

Thus, as a first approximate definition, successful aging is a social psychological, processual construct that reflects the always-emerging, socially esteemed ways of adapting to and reshaping the prevailing, culturally recognized conditions of mind, body, and community for the elderly of a society. (p. 52) 

Pederson and Harris, in the same volume, noted that many definitions of successful aging emphasized plasticity and variation, and were thus compatible with a developmental behavioral genetic perspective, which offers insights into the etiology of individual differences.

Baltes and colleagues (Baltes, 1997; Baltes & Baltes, 1990; Baltes, Staudinger, & Lindenberger, 1999) introduced an explicit lifespan model of selective optimization with compensation. The model contains antecedent conditions (e.g., selective adaptation and transformation, internal and external resources), orchestrating processes (selection, optimization, and compensation) and outcomes (maximizing gains and minimization losses, growth, maintenance of function, and regulation of loss). The outcomes contribute to new antecedent conditions. The model is a testable structural model if each component is adequately operationalized.  Baltes (1997) pointed out that the benefits of evolutionary selection decreases with age, whereas the need for culture increases pointing to the “incomplete architecture of human ontogeny.”

One specific application of the successful aging model includes Carstensen’s socioemotional selectivity theory (Carstensen, Fung, & Charles, 2003). This approach suggests that older adults prioritize emotional goals and adjust emotional regulation and social interactions to maximize positive experiences (Carstensen & Löckenhoff, 2003).  This theoretical approach is consistent with the selective optimization with compensation model as older adults are thought of becoming more selective choosing close relationships to optimize positive emotional experiences.

Preventive and Corrective Proactivity

In an effort to be more inclusive of older adults who face physical, social and environmental challenges in late life, as potentially aging successfully, Kahana and Kahana (1996) introduced their stress theory-based conceptual model of preventive and corrective proactivity. They acknowledged that older adults are likely to face normative stressors of chronic illness, social losses and lack of person-environment fit. However, according to this framework, maintenance of good quality of life may still be possible to the extent that elders can call upon internal coping resources and external social resources. Such resources can translate into proactive behavioral adaptations that include health promotion, helping others, and planning ahead (preventive adaptations), along with marshaling support, role substitution and environmental modifications (corrective adaptations). Such proactive adaptations can help ameliorate the adverse effects of stressors on quality of life outcomes, such as psychological well being, goals and meaning in life, and maintenance of valued activities and relationships. The model was further refined to consider more macro contextual dimensions of the temporal and environmental influences on successful aging (Kahana & Kahana, 2003; Kahana, Kahana & Kercher, 2003).

The proactivity model has been applied to highly vulnerable groups of older adults, such as those living with HIV/Aids (Emlett, Tozay & Raveis, 2011; Kahana & Kahana, 2001). Empirical support for this approach has recently been reported (Kahana, Kelley-Moore & Kahana, in press). Proactivity-based approaches to successful aging have also been advocated by Aspinwall (1997, 2011) and Ouwehand and colleagues (2007). Such approaches focus on prevention, thereby having some common elements with Rowe and Kahn’s (1987) model. Yet, they also incorporated a focus on corrective adaptation, which is consistent with Baltes and Baltes’s (1990) orientation of selective optimization with compensation. Additionally, successful aging is recognized both as an outcome and as a process.

Subjective Views of Successful Aging

In the last decade, a number of researchers took to the task of reviewing, comparing, and evaluating successful aging as a concept. In particular, the notion that the definition could or should consist of a subjective dimension emerged as a significant theme. Phelan and Larson (2002) conducted a literature review with regard to definitions as well as the factors that might predict success. They identified seven major elements:  life satisfaction, longevity, freedom from disability, mastery/growth, active engagement with life, high/independent functioning, and positive adaptation. Accordingly, they made two observations regarding the way successful aging has been operationalized: “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… Second, we observed that very little work has been done to ascertain the views of aging individuals” (Phelan & Larson, 2002, p. 1306).  Their recommendation for future research, then, was to consider the definitions of aging from the individuals’ perspectives.

Strawbridge, Wallhagen, and Cohen (2002) similarly suggested that understanding older persons’ own criteria “…should enhance the conceptualization and measurement of this elusive concept” (Strawbridge, Wallhagen, & Cohen, 2002, p. 727).   They called the choice of the term “successful” problematic as it implies that there are winners and losers.  Their study found that while a little more than half the participants reported themselves to be aging successfully, only 18.8 percent could be classified as such according to Rowe and Kahn’s criteria. As indicated above, Kahn (2003) responded to this criticism by noting that their studies included representative and not only an elite group.

Continuing with this theme of a self-report or a subjective definition, Tate and Cuddy (2003) analyzed a 1996 survey of elderly Canadian men. Twenty themes emerged from the open-ended question, “What is your definition of successful aging?’”  The top three answers, each appearing in over 20% of the responses, were good health, satisfaction/happiness, and keeping active. Of the question, “Would you say you have aged successfully?” more than 83 percent responded “yes” without qualification.

Although health was the most popular definition in the above survey, Glass (2003) warned against the belief that successful aging is impossible if disease and disability occur:  “To the extent that we conceptualize successful aging as not aging, as only disease-free aging, our concept (and our policies) will be impoverished” (Glass, 2003, p. 382).  Calling the concept “vaporous,” he too emphasized self-perception, saying that “…we need to know considerably more about what older people value and how they define successful aging; we know next to nothing about these two subjects” (Glass, 2003, p. 382). Previously, he had described the history of successful aging “…as the parallel development of two distinct schools: the psychosocial school, which primarily defines successful aging as mental states (e.g., acceptance of death, life satisfaction), and a biomedical school, which defines it as the avoidance of disease and disability” (Glass, 2003, p. 382).  He did perceive several areas of agreement with regard to the definition; it is:  1) “the good life,” beyond health and longevity; 2) what older adults value in the quality of their life and their death; and 3) better than “usual aging.”

Phelan, Larson, Anderson and Lacroix (2004) again revisited the usefulness of incorporating aging persons’ perceptions into a definition.  They found that although older adults’ definition is multidimensional (encompassing physical, functional, psychological, and social health); none of the literature describing elements of successful aging included all these dimensions. In fact, they found that most constructs encompassed only one of these four dimensions, while a few were multidimensional.

Longevity and Successful Aging

A number of research teams have focused on longevity research, or more specifically, centenarian research, to define successful aging. The terms “healthy longevity” (Yi, Poston, Vlosky, and Gu, 2009) or “exceptional longevity” (Christensen, McGue, Petersen, Jeune, & Vaupel, 2008; Gondo, 2006; Willcox, Willcox, & Suzuki, 2006) are often used to emphasize the importance of having lived a very long and healthy life. Along the same line, Poon et al. (1992) defined “master survivors” as “successful agers in their eighties” and “expert survivors” “for those in their 100s” (p. 4).  Poon et al. clarified that their study on centenarians attempted to capture the underlying factors allowing centenarians to adapt successfully to very old age.

Several centenarian researchers defined successful aging more specifically. The definitions often center on physical, cognitive, or functional status.  Hitt, Xu, Silver, and Perls (1999), for example, reported that centenarians in the New England Centenarian Study were healthy and independent for most of their lives. However, the health status of centenarians has not always been reported to be so positive. Andersen-Ranberg, Schroll, and Jeune (2001), for example, claimed that “healthy centenarians do not exist but autonomous centenarians do.”  Their findings suggest that longevity may come at a price. Baltes and Smith (2003), for example, noted that reaching the limits of human life may be a risk factor for human dignity.

Although some centenarians may have been viewed as not having aged successfully, at least until the end of a very long life, some researchers noted that there are clear individual differences.  Franke (1987), for example, indicated that about 25% of all centenarians were classified as functioning well. Lehr (1991) reported results from a cluster analysis indicating that 18 percent of centenarians in a German centenarian study showed very little physical impairment and remained very active. Gondo and Hirose (2006)  indicated that about 20 percent of the Tokyo Centenarian Study participants “aged successfully,” defined as not being physically dependent, and having no major sensory impairment. Overall, this study included only 2 percent “exceptional centenarians” (i.e., with high functional status), 18 percent “normal” centenarians (i.e., with maintenance of physical and cognitive function), 55 percent frail (i.e., with impairment of either cognitive or physical function) and 25 percent “fragile” (i.e., with impairment of both cognitive and physical function; Gondo et al., 2006). Arnold et al. (2010) reported that centenarians in the Georgia Centenarian study included 17 percent who had escaped major disease and 43 percent who did not experience cognitive impairment. A recent study by Cho (Cho, 2011; Cho, Martin & Poon, 2011) indicated that about half of all centenarians in the Georgia Centenarian Study could be classified as “successful” if definitions of subjective health, perceived happiness and better perceived economic status were used as definitions of successful aging. Interestingly enough, none of the centenarians would be classified as “successful” when Rowe and Kahn’s criteria were used.

Alternative Formulations Beyond Successful Aging

As an alternative to “successful aging,” Tornstam (2005) put forth a developmental theory of positive aging, which he termed “gerotranscendence.”  Successful aging, he suggested, was an erroneous projection of midlife values, activity patterns, and expectations onto old age. A theory of gerotranscendence, on the other hand, would allow old age to possess its own meaning and character.

Observing the lack of agreement about an optimal definition of successful aging or its measurement, and citing the need for it – to promote public healthy-aging agendas – Depp and Jeste (2006) conducted a comprehensive review of larger quantitative studies.  Various terms had emerged in the literature, such as healthy aging, successful aging, productive aging, and aging well.  As to the components, researchers over the years had debated about which were overly restrictive or even ageist, as well as the extent to which subjective versus objective criteria should be used. Depp and Jeste categorized the components of existing definitions into 10 domains. There was an average of 2.6 components per definition.  The most frequently appearing component was disability and/or physical functioning, followed by cognitive functioning.

Depp and Jeste (2006) found a wide range in the reported proportion of successful agers in the studies analyzed: 0.4% to 95%.  Several methodological issues contributed to this variability, they found. “One source is the definitions… Another source of variability was the sampling and measurement of successful aging. A final cause of variability may be a bias toward studying negative outcomes” (Depp & Jeste, 2006, pp. 16-17).  Depp and Jeste consequently suggested that the primarily biomedical definitions should be enlarged to encompass “biopsychosocial” definitions, to better connect the disparateness of the operational definitions, lifespan developmental theories, and older adults’ definitions.  “The ideal definition of successful aging should be acceptable to clinicians, researchers, and older adults alike yet is likely dependent on the research question” (Depp & Jeste, 2006, p. 18).

The results of a 2010 study of the early influences and contemporary characteristics of successful aging helped to “…define successful aging as a multidimensional con­struct having both objective and subjective dimensions” (Pruchno, Wilson-Genderson, Rose, & Cartwritght, 2010, p. 821).  The authors proposed a definition consisting of objective and subjective success – two independent but related dimensions – and demonstrated the utility of a two-factor model.

Jeste, Depp and Vahia (2010) again examined successful aging, this time focusing on the cognitive and emotional aspects.  They noted that when an objective definition based on physical health is used in the literature, only a small minority of older adults can be defined as aging successfully; however, a great majority believes they are aging successfully, and indeed generally meet psychosocial criteria.  The authors concluded that “…there is a gulf between researcher and lay definitions — the former describes freedom from disease and disability, and the latter focuses on adaptation, meaningfulness, and connection. It should be possible to better integrate these perspectives, incorporating both subjective and objective elements into definitions…” (p. 82).

Summary and Conclusion

The definition of successful aging has evolved over the last 50 years from addressing early theories of activity and disengagement to theoretical approaches that focus directly on successful aging. The major definitions are summarized in Table 1. Some approaches focus more on physical, other approaches more on psychosocial components of successful aging. More recently, successful aging approaches attempt to integrate both into a biopsychosocial approach.

Paper 1 Table 1 Successful Aging Definitions

Additional directions are found in nursing and geriatric education (Wykle & Gueldner, 2010) and by incorporating distal experiences which also define a person’s level of “success” (Martin & Martin, 2002).  The developmental outcome of these life-long experiences could well be overall life satisfaction or personality. Appropriately, the focus on experience with a temporal component would bring researchers back to the original definitions first introduced by Havighurst and Neugarten.

Rowe and Kahn (1998) chose “successful” as the counterpart to “usual,” rather than a term that better serves as an antonym of usual, such as extraordinary or exceptional. Using extraordinary or exceptional would perhaps be more accurate and less of a value judgment. Missing from Rowe and Kahn’s definition is a subjective component. Also, they did not take into account preexisting limitations on “individual choice and effort,” such as lifelong disability, poverty, etc. These latter dimensions are addressed in proactivity-based models such as those proposed by Kahana and Kahana (1996, 2003).

Given the brief history, some of the questions for the next generations of gerontologists interested in providing more parsimonious understanding of successful aging are: 1) What are the minimal definitions needed to describe successful aging?  2) How do we reconcile the various models of successful aging in our research?  3) How important are individual perception in the measurement of successful aging?  4) What are some of the primary interactions (e.g., gene and environment, environment and personality, etc.) that should also be emphasized?

Definitions of successful aging have stimulated research on physical and psychosocial aging over the past 50 years. This is an important accomplishment. The focus on this and similar terms has also provided a background for studying positive aging. Hopefully, the next decades of research on successful aging will further refine definitions of this very important gerontological concept.


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9 responses to “Paper 1: Defining Successful Aging: A Tangible or Elusive Concept?

  1. I’d like to see Paper 1 integrate my concept of successful aging which includes both objective and subjective components. Could easily insert after section labeled “Subjective Views of Successful Aging”. My model is described in: Pruchno, R.A. Wilson-Genderson, M. & Cartwright, F. (2010). A two-factor model of successful aging. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 65B (6), 671-679 doi: 10.1093/geronb/gbq051.

  2. Paper 1 already integrated the pruchno ’s two factor model and explained about two factor model in page 7, but referred to pruchno ’s other paper in the 2010.
    What about the
    The recent definition of Young, Y., Frick, K. D., & Phelan, E. A. (2009). Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging. Journal of the American Medical Directors Association, 10(2), 87-92. doi:DOI: 10.1016/j.jamda.2008.11.003
    Also Bowling, A. (2007). Aspirations for older age in the 21st century: What is successful aging? International Journal of Aging & Human Development, 64(3), 263-297., and Bowling A.(2006) “lay perceptions of successful ageing: finding from a national survey of middle aged and other adults in Britain”, Eur J Ageing,3:123-136

    • Thank you. These are useful suggestions. What specific aspects do these articles address that you think would be helpful to consider? Are lay perceptions different from professional perspectives?

      Peter Martin

  3. Of course yes, Bowling other paper: Bowling A. and Iliffe S. compared 5 models of successful ageing (biomedical, broader biomedical, social, psychological and lay model) on elderly 65+.
    The lay based model was more multi-dimensional. It predicted perceived QoL more powerfully than other models. People define themselves successful even if they are categorized as not successful by many models of successful ageing.
    Even Kaufman et al. (2004) mentioned that professional’s view make individuals define normal ageing process more negatively than they mgt have without the influence of successful ageing discourse.

    Bowling A. and Iliffe S. (2006) Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing, Age and Ageing;35:607-614

    • I think the first paper tends to see things from a more theoretical viewpoint than medicine. For many reasons, medicine is not grounded in theory. Although, one could go back to the work of Maimonides who wrote the first text on Medicine. I tend to look at what we talked about more broadly and perhaps more from a capitalistic model than a socialistic model. I believe Medicine can contribute a lot to this area and I really liked Peter whitehouse’s idea and a idea of mine on developing an instrument on predictors of succession in successful aging, perhaps because it is linguistically correct.

  4. Thanks for your response. We will consider including these items into the next draft of the paper. I particularly like the idea of biomedical, broader biomedical, social, psychological and lay models. Perhaps we should think about a broader definition that includes all and/or we might consider starting with a general definition that leads into more specific disciplinary definitions. Thanks again for your suggestions. Let us know if other things come to mind.

    Peter Martin.

  5. Peter,
    I did not get through all the papers but I plan on doing some of these this weekend.
    In the meantime, a colleague of mine and I have begun to address some of these predictors of succession to successful aging and I would be open to your thoughts on it once we complete the first draft. I am also going to ask Peter Whitehouse to take a look at it.

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