"Successful Aging": Are we using a one size fits all prescription?

When we think about the word “success” or the concept that we are “successful”, thoughts around the attainment of goals come to mind. The definition involves the accomplishment of an aim or a person that has gained prosperity. These terms are all abstract and don’t really contain a concrete definition of what that means. And that’s okay. But it presents a challenge for researchers and clinicians who aim to classify “successful agers” versus “non-successful agers” because at its heart, success is unique to each individual. What is important to one person may mean absolutely nothing to their neighbor. So when we talk about aging successfully, are we getting caught using a one size fits all prescription?

When I talk to my clients or other healthcare professionals, the mindset around successful aging can focus solely around physical aspects the term. Things such as living independently, remaining active, eating well. All of those things are critically important and most can agree that your ability to accomplish all of your daily tasks is a key piece to a person’s identity and therefore an important component of healthy aging. But is it the only piece?

Do all of these things matter if a person is so encapsulated in depression or grief that they can’t motivate themselves to get out of bed in the morning; to do all of the things that they are physically capable of doing?

These are not easy questions and I am not claiming to have the answers. But I believe that they require discussion and not just discussion amongst healthcare professionals but amongst families, partners, neighbours and friends.

In regards to well-being, there are strong connections between our physical, mental, psychosocial and socioeconomic well-being. These concepts can’t be teased apart easily and definitely not addressed in isolation. I think physiotherapists and other rehabilitation professionals provide a disservice when they consider the “knee” they are treating without consideration for the person whose world is being impacted by that injury.

A sore knee can make moving around at home and doing day-to-day tasks more challenging. It can bring feelings of frustration and anger because the person is unable to do the activities that bring them joy – such as activities with a loved one. It can effect a person’s ability to work which can cause financial strain. This financial strain can effect the dynamics of the family unit if other persons need to compensate for that monetary loss. Being a financial provider can be closely tied to a person’s sense of identity and that can affect a person’s psychological well-being. So a “knee” that you are treating, comes within an often complicated context.
Relating this back to aging, we have a decreased capacity to adapt as we get older. Our social networks change, our bodies slow down. Some of this is a normal part of the aging process, others are choices that an individual makes. So the question becomes what defines success in this context of decreasing resources.

Can a person be a successful ager if they are physically capable but psychologically unwell? This begins to open up a discussion around realms of aging and if we are discussing the same or differing constructs. It taps into a common term in the research known as “quality of life” which tries to consider both physical and psychological well-being. This recognizes that these worlds are in no way mutually exclusive and one is strongly influenced by the status of the other.

Successful aging has a context

There is an incomplete picture if you consider the person without considering the environment in which they live. We are starting to see more older adults living in poverty or in a state of financial vulnerability. It is difficult to label a person as aging successfully when next month they may not have a secure home or enough food on the table.

Successful aging also has a cultural context. What is deemed successful aging in the Western culture is not universal. Some cultures believe that taking care of their elderly family members is a sign of respect for their contribution to their family. This means that encouraging them to continue doing things for themselves is not done and would create weakness and frailty in these individuals. Within this cultural context, would this physical weakness be considered successful aging?

This article raises more questions than it does answer. Successful aging is an abstract concept that has a context. It is difficult to define in general terms and is very unique to the individual that is describing it. As a clinician, my role is to understand what it means to be successful for the person that I am seeing in the context of our treatment plan and to them as a person going forward in their life. Writing a one size fits all prescription or assuming that your ideas of successful aging are going to be the same as everyone else you speak to, ignores key aspects of this term and potentially creates a misunderstanding from the very start.

So let’s start a conversation! An exploration of different ideas around aging successfully and the things that we can do NOW to ensure that it happens. Aging successfully doesn’t start when you turn 65, it is a foundation that gets built every day from when you’re 15 to when you’re 50 and beyond.

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Christina Prevett

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