Successful Aging: How We See Ourselves
It is often said that perception is reality.
How we see ourselves plays a key role in maintaining personal well-being and self-esteem; it’s how we define who we are, and our place in the world. A positive self-image is always important, but it becomes especially so as we grow older and our personal attributes and abilities begin to show their age. Gerontology researchers, who use the term “successful aging” to describe growing old free of disability, have not devoted resources to studying how elders living with late-life disability perceive themselves and their lives — until now.
Recently, On Lok Lifeways, joined with medical researchers from the University of California and the San Francisco Veterans Administration Medical Center to explore what “successful aging” meant to a diverse sample of elders with late-life disability. Fifty-Six people from the On Lok Lifeways program (the original Program of All-inclusive Care for the Elderly, or PACE, known in Denver as Innovage), participated in half-hour interviews for the study, entitled “Perceptions of Successful Aging among Diverse Elders with Late-Life Disability” and saw it published in November 2012.
The participants lived in the community but met the criteria for nursing home eligibility, thus representing a sample possessing the types of late-life disabilities the study sought to understand. Criteria included being age 55 or older, having at least two impairments affecting activities of daily living (ADL) and/or instrumental activities of daily living being (IADL). The participants included African Americans, Chinese Americans, Latino Americans and Caucasian Americans who speak English, Cantonese and Spanish. All had a Mini-Mental Status Examination (MMSE) score of 18 or higher. In the MMSE, any score greater than or equal to 25 points (out of 30) indicates a normal cognition. Below this, scores can indicate severe (
The overarching theme that emerged from this study is that aging results in Living in a New Reality. Two subordinate themes, Acknowledging the New Reality and Rejecting the New Reality also were revealed. Opening a window for all of us on how we perceive ourselves, the ethnically diverse interviewees shed light on how they saw themselves as aging individuals, and the importance of those perceptions on our quality of life, or lack thereof. The participants identified a life without illness, health and physical function as critical to their perception of aging well, so the reality of physical disability clearly plays a lead role in how elders perceive successful aging.
Faith, financial security, relationships and friendships, and a sense of meaning and satisfaction in their lives also were factors, but the research shows that effective coping strategies to address disability are the keys to aging successfully. The interviewees emphasized coping strategies such as acceptance, attitude, adaptation, and general emotional well-being that help them offset their physical decline. The subordinate themes, acknowledging the new reality and rejecting the new reality, embrace these and other coping strategies.
At least one member in each ethnic group endorsed the study’s sub-themes and their associated coping strategies. Certain strategies were more prominent for different people. African Americans and Caucasians emphasized the importance of independence. African Americans demonstrated strong faith-based perspectives. Latinos placed great value on walking. Chinese-American participants expressed concerns about becoming a burden for their families.
Most of the participants believed they had aged successfully despite their late-life disability. Until this research, a widely accepted definition of successful aging came from a 1997 study that decreed successful aging is “the absence of disease and disability, maintenance of a high degree of physical and cognitive functioning, and meaningful engagement in life.” Successful aging by this definition is not only difficult to measure, it is also difficult to achieve.
So what implications does this have for the data-driven decision-making process many elders are subjected to? Should not cultural criteria as well as the elders’ own subjective perceptions be considered too, just like objective measurements like blood pressure, heart rate and weight? The answers to these questions are highly relevant for gerontologists and our aging population at large because there is something going on with health care reform. It’s called “patient-centered” care and you will be hearing more — much more — about it in the coming years. Patient-centered care is not just about educating patients with a new diagnosis about standard available treatments; it also means considering patients’ cultural traditions, personal preferences and values, family situations, social circumstances and lifestyles.
This is a dramatic change in how healthcare providers have traditionally approached their jobs. Patient-centered healthcare improves the communication between patient and healthcare provider, and helps identify the most appropriate interventions so that as many of us as possible may experience “successful aging.” Watch for “Patient-Centered Medical Homes,” a physician practice model that emphasizes care coordination, increased access and enhanced doctor-patient communication, all with an emphasis on improving measurable outcomes.
In his new book “Aging into Bliss,” local author Christopher Foster adds another dimension to the discussion of successful aging. Mr. Foster serves up a convincing ode to the beauty, strength and love inherent in our true self. He asserts that our twilight years are the perfect time to discover our true self. “Radical self-reliance” — the ability to avoid buying into cultural labels for the aged like feeble and irrelevant — and aspects of our character that youth typically doesn’t achieve like patience, perspective, humility, relationship, community, acceptance, and forgiveness all present themselves for recognition and appreciation. It’s a great read.
My perception is that successful aging is all of the above. Successful aging and quality of life are closely tied to adaptation by effectively using coping mechanisms, a positive attitude, love of life and love of self.
Robin Avery is a Gerontologist, a Consultant to, and Developer and Operator of assisted living communities, with a Masters Degree from The Naropa University. He can be reached at ravy2003@msn dot com.