Lay perceptions of Lay perceptions of successful ageingsuccessful ageing

A. Bowling A. Bowling University College London, University College London,

London, UKLondon, UK

Most popular biomedical model: Most popular biomedical model:

Absence of risk of disease and disease-related Absence of risk of disease and disease-related disability, high mental and physical functioning, and disability, high mental and physical functioning, and active engagement with life, including maintenance active engagement with life, including maintenance of autonomy & social support. of autonomy & social support. ((Rowe and Kahn, 1987, 1998)Rowe and Kahn, 1987, 1998)

Some biomedical models also include longevity as Some biomedical models also include longevity as an indicator of SA rather than as an outcome.an indicator of SA rather than as an outcome.

(Bowling 2007)(Bowling 2007)

How to age successfully?How to age successfully?

Criticisms of R&K modelCriticisms of R&K modelNarrowness – given high prevalence of morbidity in O/A Narrowness – given high prevalence of morbidity in O/A most people are ‘unsuccessfully’ ageingmost people are ‘unsuccessfully’ ageing

SA realistic only for a fewSA realistic only for a few

Lack of continuum Lack of continuum

Failure to address adaptation/disease managementFailure to address adaptation/disease management

Neglect of life course dynamicsNeglect of life course dynamics

Neglect of earlier soc-psych.lit.Neglect of earlier soc-psych.lit.

Biomedical adaptations of R&K modelBiomedical adaptations of R&K model

Vaillant (2002): SA - longevity, healthy Vaillant (2002): SA - longevity, healthy ageing, retirement, play, creativity, ageing, retirement, play, creativity, generativity,generativity, ‘to love, to work, to learn…to ‘to love, to work, to learn…to enjoy’.enjoy’.

Kane (2003): SA - broader, includes but Kane (2003): SA - broader, includes but transcends health, + ‘transcends health, + ‘generativity’generativity’ (building on Vaillant)(building on Vaillant) + + life course approach to include people who life course approach to include people who ‘age successfully’ despite illness and ‘age successfully’ despite illness and limitations.limitations.

Bowling’s (2007) systematic review of Bowling’s (2007) systematic review of biomedical, social, psychological SAbiomedical, social, psychological SA

170 included papers, included 75 empirical studies. 170 included papers, included 75 empirical studies.

Most were biomedical, using R&K’s model.Most were biomedical, using R&K’s model.

13/75 included social functioning as SA varying in detail 13/75 included social functioning as SA varying in detail (social engagement, roles, participation, activity, (social engagement, roles, participation, activity, contacts, exchanges, positive relationships)contacts, exchanges, positive relationships)

[Disengagement, activity and continuity theories of [Disengagement, activity and continuity theories of ageing.]ageing.]

Bowling’s (2007) syst/review Bowling’s (2007) syst/review

13/75 included life satisfaction or well-13/75 included life satisfaction or well-being as being as component* component* of SA – zest, of SA – zest, resolution, fortitude, gap between desired resolution, fortitude, gap between desired and achieved goals, self-concept, mood, and achieved goals, self-concept, mood, incl. happiness. incl. happiness.

* Berlin Ageing Study used life satisfaction * Berlin Ageing Study used life satisfaction as as outcomeoutcome of SA of SA

(Baltes & Baltes 1990)(Baltes & Baltes 1990)

Bowling’s (2007) syst/reviewBowling’s (2007) syst/review

8/75 were psychological models8/75 were psychological models

Ryff: Psychological development approach: ‘positive or ideal Ryff: Psychological development approach: ‘positive or ideal functioning’ over life course.functioning’ over life course.

Essential to this: Essential to this: positive interactions, purpose, autonomy, self-acceptance,positive interactions, purpose, autonomy, self-acceptance, personal growth, environmental fit.personal growth, environmental fit.

? But emphasis on autonomy marginalised dependent people? But emphasis on autonomy marginalised dependent people

Bowling’s (2007) syst/ reviewBowling’s (2007) syst/ review

Baltes & Baltes (1990) SOC model: Baltes & Baltes (1990) SOC model:

Precursor of SA: ‘selective optimisation with Precursor of SA: ‘selective optimisation with compensation’ (SOC):-compensation’ (SOC):-

When selected activities can no longer be When selected activities can no longer be performed, strategies are needed to find new performed, strategies are needed to find new ones, and to maximize reservesones, and to maximize reserves

Bowling’s (2007) system. review of biomedical, Bowling’s (2007) system. review of biomedical, psychological, social concepts of SApsychological, social concepts of SA

Lay definitions: Lay definitions: 15/ survey, qualitative studies:15/ survey, qualitative studies:

mental, physical and social health, functioning and resources mental, physical and social health, functioning and resources

psychological outlook, sense of humour psychological outlook, sense of humour

life satisfactionlife satisfaction

having a sense of purpose, productivity, contribution to lifehaving a sense of purpose, productivity, contribution to life

financial securityfinancial security

learning new things, accomplishments,learning new things, accomplishments,

physical appearancephysical appearance

spiritualityspirituality

Successful ageing:Successful ageing:

Many investigators failed to define successful ageingMany investigators failed to define successful ageing

Outcomes and constituents not distinguishedOutcomes and constituents not distinguished

Models discipline/culture specificModels discipline/culture specific

Lay people rarely consulted about their perspectives Lay people rarely consulted about their perspectives

Consequence = policy actions will have less relevance to Consequence = policy actions will have less relevance to the lives of older people themselvesthe lives of older people themselves

Aim of study:Aim of study:

To identify perceptions of successful ageing To identify perceptions of successful ageing among people in middle and older age groups. among people in middle and older age groups.

Method:Method:

British population survey of a random sample of British population survey of a random sample of 854 community dwelling men and women aged 854 community dwelling men and women aged 50+ – Office for National Statistics Omnibus 50+ – Office for National Statistics Omnibus Module. Module.

Response rates:Response rates:

Omnibus survey response rate: 62%Omnibus survey response rate: 62%

1703 achieved interviews overall1703 achieved interviews overall

Of these, 854 respondents were Of these, 854 respondents were aged 50+aged 50+ and and were successfully were administered the were successfully were administered the successful ageing module successful ageing module

Respondents characteristics:Respondents characteristics:

Mean age: 64, range of 50-94 (confidence intervals: 63.53 - 64.89), Mean age: 64, range of 50-94 (confidence intervals: 63.53 - 64.89), median: 62. median: 62.

<50% males.<50% males.

75% married/cohabiting. 75% married/cohabiting.

75% lived with others, mainly spouses. 75% lived with others, mainly spouses.

50% had no educational qualifications. 50% had no educational qualifications.

33% reported a limiting longstanding illness. 33% reported a limiting longstanding illness.

>80% reported their health as ‘Excellent’, ‘Very good, ‘Good’.>80% reported their health as ‘Excellent’, ‘Very good, ‘Good’. >80% also rated their quality of life as ‘So good…’/‘Very good’/ ‘Good’. >80% also rated their quality of life as ‘So good…’/‘Very good’/ ‘Good’.

Table 2. Summary of Q1: ‘What do you think are the things Table 2. Summary of Q1: ‘What do you think are the things associated with successful ageing?’ associated with successful ageing?’

Main themes:Main themes: Total (n=854) Total (n=854) % (no.)% (no.)

Health and Health and functioning functioning 66 (565)66 (565)

Psychological factors Psychological factors 47 (397)47 (397)

Social roles and Social roles and activitiesactivities 35 (302) 35 (302)

Financial Financial circumstances circumstances 30 (258) 30 (258)

Social relationships Social relationships 26 (224)26 (224)

NeighbourhoodNeighbourhood 1010 (83)(83)

WorkWork 6 (51) 6 (51)

Independence Independence 4 (30)4 (30)

Are you ageing successfully so far? Random Are you ageing successfully so far? Random sample of people aged 50+ in Britainsample of people aged 50+ in Britain

Are you ageing successfully so far?

Yes, very well

Yes, well

Yes, alright

No not well

No, not very well

Self-rated successful ageing:Self-rated successful ageing:

76% of respondents rated themselves as 76% of respondents rated themselves as ageing successfully (‘Very well’ or ‘Well’) using ageing successfully (‘Very well’ or ‘Well’) using their own perceptions of SA.their own perceptions of SA.

<20% were categorised as ‘successfully aged’ <20% were categorised as ‘successfully aged’ using a biomedical model of successful ageingusing a biomedical model of successful ageing

Why they rated themselves successfully aged/not (open-end Q):Why they rated themselves successfully aged/not (open-end Q):

Having/not having good health, functioning (physical, mental) (50%, 427)Having/not having good health, functioning (physical, mental) (50%, 427)

Psychological factors (having/not having life satisfaction, happy outlook) Psychological factors (having/not having life satisfaction, happy outlook) (45%, 383)(45%, 383)

Social roles, activities (having/not having enjoyable social life, activities) Social roles, activities (having/not having enjoyable social life, activities) (20%, 169)(20%, 169)

Social relationships (having/not having family, friends) (17%, 148)Social relationships (having/not having family, friends) (17%, 148)

Finances (having/not having enough money for basic needs) (12%, 104) Finances (having/not having enough money for basic needs) (12%, 104)

Having/not having work enjoyed (8%, 72)Having/not having work enjoyed (8%, 72)

Being independent/not (4%, 32)Being independent/not (4%, 32)

Living in a good/bad home, neighbourhood (3%, 29)Living in a good/bad home, neighbourhood (3%, 29)

People who rated themselves as People who rated themselves as successfully ageing more likely to:successfully ageing more likely to:

Rate their health positivelyRate their health positively (Spearmans rho: 0.498, (Spearmans rho: 0.498,

p<0.01),p<0.01),

Have no reported limiting, longstanding Have no reported limiting, longstanding illness illness (Spearmans rho: 0.237, p<0.01), (Spearmans rho: 0.237, p<0.01),

Rate their quality of life positively Rate their quality of life positively (Spearmans (Spearmans rho: 0.536, p<0.01).rho: 0.536, p<0.01).

How do you think getting older/ageing will affect you? How do you think getting older/ageing will affect you? (most common responses shown). Random sample of (most common responses shown). Random sample of

people aged 50+ in Britainpeople aged 50+ in Britain

worse health/functioning

defiant limitations on life worse mental health dependency

0.0

10.0

20.0

30.0

40.0

50.0

Perc

en

t

QoL survey of random sample of people QoL survey of random sample of people aged 65+ in Britain. aged 65+ in Britain.

Which model of SA? Which model of SA? Variables computed to represent:Variables computed to represent:

medical model (health status, diagnosed conditions, physical and medical model (health status, diagnosed conditions, physical and mental functioning) mental functioning)

broader medical model (including social activites) broader medical model (including social activites)

social model (social functioning – activities and contacts)social model (social functioning – activities and contacts)

psychological model (self-efficacy, sense of purpose/playing useful psychological model (self-efficacy, sense of purpose/playing useful part, coping facing up to problems, overcoming difficulties, self part, coping facing up to problems, overcoming difficulties, self esteem, self confidence, self worth)esteem, self confidence, self worth)

Lay model (the above plus income, perceived neighbourhood - Lay model (the above plus income, perceived neighbourhood - facilities, services, safety, crime, traffic etc)facilities, services, safety, crime, traffic etc)

National survey of QoL people aged 65+ in National survey of QoL people aged 65+ in Britain: Britain:

Assuming QoL is the end-point of SA: which Assuming QoL is the end-point of SA: which model of SA best predicted QoL?model of SA best predicted QoL?

Lay model: strongest predictor of self-rated Lay model: strongest predictor of self-rated global quality of life:global quality of life:

Respondents who were classified as SA with Respondents who were classified as SA with this model, compared with those not, this model, compared with those not, had had over 5 times the oddsover 5 times the odds of rating their QoL of rating their QoLas good, rather than not good. as good, rather than not good.

Conclusion:Conclusion:

Most older people consider themselves to have aged Most older people consider themselves to have aged successfully where classifications based on successfully where classifications based on

traditional medical models do nottraditional medical models do not

Multidimensional lay models of SA have greatest Multidimensional lay models of SA have greatest predictive power of QoL (used as outcome of SA)predictive power of QoL (used as outcome of SA)

A biomedical perspective of successful ageing needs A biomedical perspective of successful ageing needs balancing with a psycho-social perspective, and vice balancing with a psycho-social perspective, and vice versa, and include lay viewsversa, and include lay views

Constituent and outcome variables need clarifying in Constituent and outcome variables need clarifying in longitudinal researchlongitudinal research