Lay perceptions of successful ageing A. Bowling University College London, London, 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?

Criticisms of R&K model Narrowness – given high prevalence of morbidity in O/A most people are ‘unsuccessfully’ ageing SA realistic only for a few Lack of continuum Failure to address adaptation/disease management Neglect of life course dynamics Neglect of earlier soc-psych.lit.

Biomedical adaptations of R&K model Vaillant (2002): SA - longevity, healthy ageing, retirement, play, creativity, generativity, ‘to love, to work, to learn…to enjoy’. Kane (2003): SA - broader, includes but transcends health, + ‘generativity’ (building on Vaillant) + life course approach to include people who ‘age successfully’ despite illness and limitations.

Bowling’s (2007) systematic review of biomedical, social, psychological SA 170 included papers, included 75 empirical studies. Most were biomedical, using R&K’s model. 13/75 included social functioning as SA varying in detail (social engagement, roles, participation, activity, contacts, exchanges, positive relationships) [Disengagement, activity and continuity theories of ageing.] [Disengagement, activity and continuity theories of ageing.]

Bowling’s (2007) syst/review 13/75 included life satisfaction or well- being as component* of SA – zest, resolution, fortitude, gap between desired and achieved goals, self-concept, mood, incl. happiness. * Berlin Ageing Study used life satisfaction as outcome of SA (Baltes & Baltes 1990) (Baltes & Baltes 1990)

Bowling’s (2007) syst/review 8/75 were psychological models Ryff: Psychological development approach: ‘positive or ideal functioning’ over life course. 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

Bowling’s (2007) syst/ review Baltes & Baltes (1990) SOC model: Precursor of SA: ‘selective optimisation with compensation’ (SOC):- When selected activities can no longer be performed, strategies are needed to find new ones, and to maximize reserves When selected activities can no longer be performed, strategies are needed to find new ones, and to maximize reserves

Bowling’s (2007) system. review of biomedical, psychological, social concepts of SA Bowling’s (2007) system. review of biomedical, psychological, social concepts of SA Lay definitions: 15/ survey, qualitative studies: Lay definitions: 15/ survey, qualitative studies: mental, physical and social health, functioning and resources psychological outlook, sense of humour life satisfaction having a sense of purpose, productivity, contribution to life financial security learning new things, accomplishments, physical appearance spirituality

Successful ageing: Many investigators failed to define successful ageing Outcomes and constituents not distinguished Models discipline/culture specific Lay people rarely consulted about their perspectives Consequence = policy actions will have less relevance to the lives of older people themselves

Aim of study: To identify perceptions of successful ageing among people in middle and older age groups. To identify perceptions of successful ageing among people in middle and older age groups. Method: Method: British population survey of a random sample of 854 community dwelling men and women aged 50+ – Office for National Statistics Omnibus Module. British population survey of a random sample of 854 community dwelling men and women aged 50+ – Office for National Statistics Omnibus Module.

Response rates: Omnibus survey response rate: 62% 1703 achieved interviews overall Of these, 854 respondents were aged 50+ and were successfully were administered the successful ageing module

Respondents characteristics: Mean age: 64, range of (confidence intervals: ), median: 62. <50% males. 75% married/cohabiting. 75% lived with others, mainly spouses. 50% had no educational qualifications. 33% reported a limiting longstanding illness. >80% reported their health as ‘Excellent’, ‘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 associated with successful ageing?’ Main themes: Total (n=854) % (no.) Health and functioning 66 (565) Psychological factors 47 (397) Social roles and activities 35 (302) Financial circumstances 30 (258) Social relationships 26 (224) Neighbourhood 10 (83) Work 6 (51) 6 (51) Independence 4 (30) 4 (30)

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

Self-rated successful ageing: 76% of respondents rated themselves as ageing successfully (‘Very well’ or ‘Well’) using their own perceptions of SA. <20% were categorised as ‘successfully aged’ using 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) Psychological factors (having/not having life satisfaction, happy outlook) (45%, 383) Social roles, activities (having/not having enjoyable social life, activities) (20%, 169) Social relationships (having/not having family, friends) (17%, 148) Finances (having/not having enough money for basic needs) (12%, 104) Having/not having work enjoyed (8%, 72) Being independent/not (4%, 32) Living in a good/bad home, neighbourhood (3%, 29)

People who rated themselves as successfully ageing more likely to: People who rated themselves as successfully ageing more likely to: Rate their health positively (Spearmans rho: 0.498, p<0.01), Have no reported limiting, longstanding illness (Spearmans rho: 0.237, p<0.01), Rate their quality of life positively (Spearmans rho: 0.536, p<0.01).

How do you think getting older/ageing will affect you? (most common responses shown). Random sample of people aged 50+ in Britain

QoL survey of random sample of people aged 65+ in Britain. Which model of SA? Variables computed to represent: medical model (health status, diagnosed conditions, physical and mental functioning) broader medical model (including social activites) social model (social functioning – activities and contacts) psychological model (self-efficacy, sense of purpose/playing useful part, coping facing up to problems, overcoming difficulties, self esteem, self confidence, self worth) Lay model (the above plus income, perceived neighbourhood - facilities, services, safety, crime, traffic etc)

National survey of QoL people aged 65+ in Britain: Assuming QoL is the end-point of SA: which model of SA best predicted QoL? Lay model: strongest predictor of self-rated global quality of life: Respondents who were classified as SA with this model, compared with those not, had over 5 times the odds of rating their QoL as good, rather than not good.

Conclusion: Most older people consider themselves to have aged successfully where classifications based on traditional medical models do not traditional medical models do not Multidimensional lay models of SA have greatest predictive power of QoL (used as outcome of SA) A biomedical perspective of successful ageing needs balancing with a psycho-social perspective, and vice versa, and include lay views Constituent and outcome variables need clarifying in longitudinal research