Perceptions of Successful Aging With a Late-Life Disability
Perceptions of Successful Aging With a Late-Life Disability
Purpose: Researchers often use the term "successful aging" to mean freedom from disability, yet the perspectives of elders living with late-life disability have not been well described. The purpose of this study was to explore the meaning of successful aging among a diverse sample of community-dwelling elders with late-life disability.
Design and Methods: Using qualitative grounded theory methodology, we interviewed 56 African American, White, Cantonese-speaking Chinese, and Spanish-speaking Latino disabled elders who participate in On Lok Lifeways, a Program of All-inclusive Care for the Elderly. Through semi-structured interviews with open-ended questions, we explored the elders' perceptions of what successful aging and being old meant to them.
Results: Despite experiencing late-life disability, most participants felt they had aged successfully. An overarching theme was that aging results in Living in a New Reality, with two subthemes: Acknowledging the New Reality and Rejecting the New Reality. Participants achieved successful aging by using adaptation and coping strategies to align their perception of successful aging with their experiences. Themes were common across race/ethnic groups but certain strategies were more prominent among different groups.
Implications: Across race and ethnic groups, most of these participants with late-life disability felt they had aged successfully. Thus, successful aging involves subjective criteria and has a cultural context that is not captured in objective measurements. Understanding elders' perception will help establish common ground for communication between clinicians and elders and identify the most appropriate interventions to help elders achieve and maintain the experience of successful aging.
The increasing social and economic affect of late-life disability has resulted in greater interest in helping elders avoid disability. One prominent way this has been framed in research is as successful aging. Of the many conceptualizations for successful aging, Rowe and Kahn's (1997) framework has been widely adopted in research and defines successful aging as the absence of disease and disability, maintenance of a high degree of physical and cognitive functioning, and meaningful engagement in life. Measuring this framework has been challenging, with operational definitions varying greatly; however, the greatest common elements have been preservation of physical functioning and freedom from disability (Depp & Jeste, 2006). In addition, the focus on avoiding disease and disability is seen in the objectives of Healthy People 2020 (2012) and the strategic goals of the National Institute on Aging (2007). These initiatives seek to improve elders' physical well-being and quality of life. Though successful aging is a research concept, the term has now worked its way into common usage. Successful aging "expos" have emerged that are marketed directly toward elders and represent the idea with images of the young-looking, disability-free elders (Successful Aging Expos, 2012).
The way in which successful aging has been defined by researchers can influence how practitioners and others approach or understand aging and disability and their expectations of what is possible. This is also true of aging individuals. Definitions from outside guide and define what aging individuals think is possible and what function needs to be maintained. This is problematic when aging inherently brings limitations—very few bypass this reality. What this does to those who don't meet the ideal is a concern. Understanding how individuals make sense of successful aging in the context of disability and age-related changes gives voice to those who have to deal with the changes they are experiencing. Our research is focused on understanding successful aging from the perspectives of those experiencing late-life disability.
Elders who do not meet objective criteria for successful aging often perceive themselves to be aging successfully anyway (Cernin, Lysack, & Lichtenberg, 2011; Montross et al., 2006; Pruchno, Wilson-Genderson, Rose, & Cartwright, 2010; Strawbridge, Wallhagen, & Cohen, 2002). When asked to define successful aging, elders identify domains of physical functioning and health, but they also emphasize subjective domains that counterbalance physical decline, such as acceptance, attitude, adaptation, and emotional well-being (Laditka et al., 2009; Lewis, 2011; Tate, Lah, & Cuddy, 2003; Troutman, Nies, & Mavellia, 2011; von Faber et al., 2001). Some studies compared participants who met and did not meet objective criteria for successful aging but did not explore the reasons for discordance between the different measures (Berkman et al., 1993; Cernin et al., 2011; Pruchno et al., 2010). Though chronic conditions and physical disability increase with age, few studies have focused specifically on elders with late-life disability. Thus, the unique views of disabled elders, particularly of those who feel they are aging successfully are not well described and need to be understood.
Self-perception is a key aspect of many theoretical conceptualizations of successful aging. Havighurst (1961), Ryff (1989), and Baltes and Baltes (1990) view successful aging as an adaptive process that results in elders maintaining the perception of well-being and successful aging. Havighurst (1961) and Ryff (1989) focused on adaptations that resulted in maintaining a sense of life satisfaction, leading to successful aging. Baltes and Baltes (1990) theorize a process, called selective optimization and compensation, whereby elders maintain a subjective feeling of satisfaction by making adaptations to optimize functional domains that are important to them. Understanding elders' self-perception of successful aging that is devoid of an imposed set of objective criteria can help in clinical exchanges by allowing the development of a patient-centered definition. From such an understanding, providers can identify the types of interventions that are most appropriate to improve the experience of successful aging and respect elders' values.
As our population ages, it is also becoming more diverse. However, the concept of successful aging has not been well studied in diverse populations. Across different race/ethnic groups, Laditka and colleagues (2009) found similarities and differences to other research. Compared with the other race/ethnic groups in this sample, Asians were more likely to emphasize the relationship between outlook and health, family, and having few health problems. Thematic differences were not found among Latinos; however, Markides and Ray (1988) found that, compared with Whites, Latinos were more likely to consider themselves as old and to report more declines in health as they age, which could affect both their subjective and objective measure of successful aging. Angel (2009) notes there are cultural and structural barriers to successful aging because disparities in health, health care access, and acculturation affect elderly Latinos' ability to age successfully, especially when physical criteria are used. Other studies examined successful aging among elders in Asia and noted that financial stability was an aspect (Chou & Chi, 2002; Hsu & Jones, 2012; Li et al., 2006). Troutman and colleagues (2011) and Cernin and colleagues (2011) examined successful aging among African Americans and found that faith was included as a component.
In light of the predominant research view of successful aging, we sought to explore the concept among groups of elders who are not well represented in research. Consequently, the purpose of this qualitative study was to explore the meaning of successful aging specifically from the perspective of culturally diverse elders living with late-life disability who would likely not meet objective criteria of successful aging.
Abstract and Introduction
Abstract
Purpose: Researchers often use the term "successful aging" to mean freedom from disability, yet the perspectives of elders living with late-life disability have not been well described. The purpose of this study was to explore the meaning of successful aging among a diverse sample of community-dwelling elders with late-life disability.
Design and Methods: Using qualitative grounded theory methodology, we interviewed 56 African American, White, Cantonese-speaking Chinese, and Spanish-speaking Latino disabled elders who participate in On Lok Lifeways, a Program of All-inclusive Care for the Elderly. Through semi-structured interviews with open-ended questions, we explored the elders' perceptions of what successful aging and being old meant to them.
Results: Despite experiencing late-life disability, most participants felt they had aged successfully. An overarching theme was that aging results in Living in a New Reality, with two subthemes: Acknowledging the New Reality and Rejecting the New Reality. Participants achieved successful aging by using adaptation and coping strategies to align their perception of successful aging with their experiences. Themes were common across race/ethnic groups but certain strategies were more prominent among different groups.
Implications: Across race and ethnic groups, most of these participants with late-life disability felt they had aged successfully. Thus, successful aging involves subjective criteria and has a cultural context that is not captured in objective measurements. Understanding elders' perception will help establish common ground for communication between clinicians and elders and identify the most appropriate interventions to help elders achieve and maintain the experience of successful aging.
Introduction
The increasing social and economic affect of late-life disability has resulted in greater interest in helping elders avoid disability. One prominent way this has been framed in research is as successful aging. Of the many conceptualizations for successful aging, Rowe and Kahn's (1997) framework has been widely adopted in research and defines successful aging as the absence of disease and disability, maintenance of a high degree of physical and cognitive functioning, and meaningful engagement in life. Measuring this framework has been challenging, with operational definitions varying greatly; however, the greatest common elements have been preservation of physical functioning and freedom from disability (Depp & Jeste, 2006). In addition, the focus on avoiding disease and disability is seen in the objectives of Healthy People 2020 (2012) and the strategic goals of the National Institute on Aging (2007). These initiatives seek to improve elders' physical well-being and quality of life. Though successful aging is a research concept, the term has now worked its way into common usage. Successful aging "expos" have emerged that are marketed directly toward elders and represent the idea with images of the young-looking, disability-free elders (Successful Aging Expos, 2012).
The way in which successful aging has been defined by researchers can influence how practitioners and others approach or understand aging and disability and their expectations of what is possible. This is also true of aging individuals. Definitions from outside guide and define what aging individuals think is possible and what function needs to be maintained. This is problematic when aging inherently brings limitations—very few bypass this reality. What this does to those who don't meet the ideal is a concern. Understanding how individuals make sense of successful aging in the context of disability and age-related changes gives voice to those who have to deal with the changes they are experiencing. Our research is focused on understanding successful aging from the perspectives of those experiencing late-life disability.
Elders who do not meet objective criteria for successful aging often perceive themselves to be aging successfully anyway (Cernin, Lysack, & Lichtenberg, 2011; Montross et al., 2006; Pruchno, Wilson-Genderson, Rose, & Cartwright, 2010; Strawbridge, Wallhagen, & Cohen, 2002). When asked to define successful aging, elders identify domains of physical functioning and health, but they also emphasize subjective domains that counterbalance physical decline, such as acceptance, attitude, adaptation, and emotional well-being (Laditka et al., 2009; Lewis, 2011; Tate, Lah, & Cuddy, 2003; Troutman, Nies, & Mavellia, 2011; von Faber et al., 2001). Some studies compared participants who met and did not meet objective criteria for successful aging but did not explore the reasons for discordance between the different measures (Berkman et al., 1993; Cernin et al., 2011; Pruchno et al., 2010). Though chronic conditions and physical disability increase with age, few studies have focused specifically on elders with late-life disability. Thus, the unique views of disabled elders, particularly of those who feel they are aging successfully are not well described and need to be understood.
Self-perception is a key aspect of many theoretical conceptualizations of successful aging. Havighurst (1961), Ryff (1989), and Baltes and Baltes (1990) view successful aging as an adaptive process that results in elders maintaining the perception of well-being and successful aging. Havighurst (1961) and Ryff (1989) focused on adaptations that resulted in maintaining a sense of life satisfaction, leading to successful aging. Baltes and Baltes (1990) theorize a process, called selective optimization and compensation, whereby elders maintain a subjective feeling of satisfaction by making adaptations to optimize functional domains that are important to them. Understanding elders' self-perception of successful aging that is devoid of an imposed set of objective criteria can help in clinical exchanges by allowing the development of a patient-centered definition. From such an understanding, providers can identify the types of interventions that are most appropriate to improve the experience of successful aging and respect elders' values.
As our population ages, it is also becoming more diverse. However, the concept of successful aging has not been well studied in diverse populations. Across different race/ethnic groups, Laditka and colleagues (2009) found similarities and differences to other research. Compared with the other race/ethnic groups in this sample, Asians were more likely to emphasize the relationship between outlook and health, family, and having few health problems. Thematic differences were not found among Latinos; however, Markides and Ray (1988) found that, compared with Whites, Latinos were more likely to consider themselves as old and to report more declines in health as they age, which could affect both their subjective and objective measure of successful aging. Angel (2009) notes there are cultural and structural barriers to successful aging because disparities in health, health care access, and acculturation affect elderly Latinos' ability to age successfully, especially when physical criteria are used. Other studies examined successful aging among elders in Asia and noted that financial stability was an aspect (Chou & Chi, 2002; Hsu & Jones, 2012; Li et al., 2006). Troutman and colleagues (2011) and Cernin and colleagues (2011) examined successful aging among African Americans and found that faith was included as a component.
In light of the predominant research view of successful aging, we sought to explore the concept among groups of elders who are not well represented in research. Consequently, the purpose of this qualitative study was to explore the meaning of successful aging specifically from the perspective of culturally diverse elders living with late-life disability who would likely not meet objective criteria of successful aging.
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