What is successful ageing and who should define it?

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Ann Bowling, professor of health services research (a.bowling@ucl.ac.uk)1,
Paul Dieppe, director2

¹ Department of Primary Care and Population Sciences, University College London, London NW3 2PF
² Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: A Bowling

Accepted 9 October 2005

A definition of successful ageing needs to include elements that matter to elderly people

The substantial increases in life expectancy at birth achieved over the previous century, combined with medical advances, escalating health and social care costs, and higher expectations for older age, have led to international interest in how to promote a healthier old age and how to age “successfully.” Changing patterns of illness in old age, with morbidity being compressed into fewer years and effective interventions to reduce disability and health risks in later life, make the goal of ageing successfully more realistic. Debate continues about whether disability has been postponed,1 although the Berlin ageing study2 and the US MacArthur study of ageing3 showed that greater longevity has resulted in fewer, not more, years of disability.

A forward looking policy for older age would be a programme to promote successful ageing from middle age onwards, rather than simply aiming to support elderly people with chronic conditions. But what is successful ageing? And who should define it?

Methods

We discuss existing models of the constituents of successful ageing from the social, psychological, and medical sciences. We undertook a systematic literature review, searching PubMed, PsycINFO, and SocioFile (all years) for “successful ageing.” We included 170 papers presenting reviews or overviews of the topic, data from cross sectional and longitudinal surveys, and qualitative studies (full list available on request, but the main ones are listed here2^–22). We also included lay definitions elicited from our own recent survey of successful ageing.

What is successful ageing?

The main themes emerging from the theoretical literature reflected psychosocial or biomedical approaches, or combinations of these (see box). There was some overlap with lay views; although the latter were more comprehensive and multidimensional.