Hindawi Publishing Co po a ion
Jou nal o Aging Resea ch
Volume 2012, A icle ID 868797, 9pages
doi:10.1155/2012/868797
Resea ch A icle
Is The e Success ul Aging o Nonagena ians?
The Vi ali y 90+ S udy
Lily Nos a y,1Ty i Sa keala,2An i He onen,1and Ma ja Jylh¨
a1
1Ge on ology Resea ch Cen e and School o Heal h Sciences, 33014 Uni e si y o Tampe e, Tampe e, Finland
2Finnish Cance Regis y, Ins i u e o S a ical and Epidemiological Cance Resea ch, Pieni Roobe inka u 9, 00130 Helsinki, Finland
Co espondence should be add essed o Lily Nos a y, lily.nos a [email p o ec ed]
Recei ed 23 Ma ch 2012; Re ised 12 Sep embe 2012; Accep ed 12 Sep embe 2012
Academic Edi o : Lo e a DiPie o
Copy igh © 2012 Lily Nos a y e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License,
which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
Objec i es. This s udy was designed (1) o es ima e he p e alence o success ul aging among nonagena ians based on six diffe en
models and (2) o in es iga e whe he success ul aging is associa ed wi h socio-demog aphic ac o s. Me hods.Amailedsu ey
was conduc ed wi h people aged 90+ in Tampe e in 2010. Responses we e ecei ed om 1283 people. The p e alence o success ul
aging was measu ed by six mul idimensional models including physical, social, and psychological componen s. Age, sex, ma i al
s a us, le el o educa ion, and place o li ing we e s udied as ac o s associa ed wi h success ul aging. Resul s.Thep e alenceo
success ul aging a ied om 1.6% o 18.3% depending on he model applied. Success ul aging was mo e p e alen in men, and also
mo e p e alen among communi y-li ing people. In mos models, success ul aging was also associa ed wi h younge age, being
ma ied, and a highe le el o educa ion. Discussion. Models which emphasize he absence o disease and ac i i y as c i e ia o
success ul aging may no be he mos ele an and applicable in oldes old. Ins ead, p e e ence should be gi en o models ha ocus
mo e on au onomy, adap a ion and sense o pu pose. Age-sensi i e app oaches would help us be e unde s and he po en ial o
success ul aging among indi iduals who al eady ha e success in longe i y.
1. In oduc ion
Inc easing longe i y is one o he g ea achie emen s o ou
ci iliza ion, bu i has also gi en ise o discussion abou
good and success ul aging. The concep o success ul aging
has a ac ed much deba e, bu he e is s ill no uni e sally
accep ed de ini ion o s anda d measu emen ool o i . The
Encyclopedia o Aging de ines success ul aging as su i al
(longe i y), heal h (lack o disabili ies), and li e sa is ac ion
(happiness) [1]. I appea s ha he main sou ces o difficul y
lay in he ambigui y o he meaning o “success,” in he
complexi y o he aging p ocess, he apid changes aking
place in socie y, and he changing cha ac e is ics o he olde
popula ion.
Discussions on success ul aging ha e aken wo main
pe spec i es: one de ines success ul aging as a s a e o being,
while he o he unde s ands i as a p ocess o adap a ion,
desc ibed as doing he bes wi h wha one has [2]. S udies
aking he adap a ion app oach ha e o en ound ha
olde people hemsel es eel hey a e aging success ully,
e en hough adi ional quan i a i e models say o he wise
[3,4]. Success ul aging as a s a e o being, hen, is an
objec i e measu able condi ion a a ce ain poin in ime,
demons a ing he posi i e ex eme o no mal aging. The
mos in luen ial model o success ul aging as a s a e o being
was in oduced by Rowe and Kahn [5–8], who cha ac e ize
“success” as absence o disease and disabili y, main ained
physical and men al unc ioning, and ac i e engagemen
wi h li e. Many s udies and de ini ions ake he iew ha
success ul aging is possible only among indi iduals wi hou
disease and impai men . Ob iously such ca ego iza ions a e
likely o exclude mos olde people, ypically he oldes -old,
om he possibili y o success ul aging [9].
Success ul aging is o cou se impossible in he absence
o aging. S ill, acco ding o Bowling [3], longe i y is only
a ely men ioned in lay o biomedical de ini ions. In s udies
using quan i a i e measu es, younge age is one o he mos
egula p edic o s o success ul aging [10,11], and he
a e o “success” d ops d ama ically in e y old age. This
may la gely be due o he usual ocus on physical de ici s.
2 Jou nal o Aging Resea ch
Indeed, se e al esea che s ha e emphasized he need o use
mul idimensional models and o adop diffe en concep ual
app oaches o s udying diffe en age g oups [3,12]. Recen ly,
Young e al. [13] sugges ed ha success ul aging may coexis
wi h diseases and unc ional limi a ions i compensa o y
psychological and social mechanisms a e used. Thei model
conside s h ee impo an p inciples: he he e ogenei y o
aging, mul iple pa hways o success ul aging, and indi idual
compensa ion mechanisms o adjus o age- ela ed changes.
The oldes -old g oup o nonagena ians mee s he key
biomedical c i e ion o success ul aging ha is longe i y.
They a e also a apidly g owing age g oup ha is he e oge-
neous in e ms o heal h and unc ioning: a la ge majo i y
ha e some heal h p oblems bu a e independen in basic
e e yday ac i i ies [14].
In his s udy, we in es iga e success ul aging in an
unselec ed popula ion o nonagena ians, applying se e al
diffe en models ha include physical, social, and psycho-
logical dimensions. The models diffe wi h espec o he
h eshold o “success” on he physical, social, and psycho-
logical dimensions. Ou aim is no o in oduce an ideal
o uni e sal model, bu a he o demons a e he a ia ion
in he p e alence o success ul aging by applying diffe en
c i e ia. The i s objec i e o his s udy was o cons uc
six diffe en models o success ul aging and o use hese
models o es ima e he p e alence o success ul aging among
nonagena ians. The second objec i e was o in es iga e
whe he success ul aging in nonagena ians, de ined in se e al
diffe en ways, is associa ed wi h sociodemog aphic ac o s.
2. Me hods
2.1. Da a. The Vi ali y 90+ s udy is a popula ion-based
mul idisciplina y esea ch p og am on nonagena ians in he
ci y o Tampe e, Finland. In he con ex o his p og am,
mailed su eys we e conduc ed wi h all communi y-dwelling
people in 1996 and 1998, and wi h bo h communi y-dwelling
and ins i u ionalized people ou imes since 2001. This
s udy used he da a om he mailed su ey in 2010. A
ques ionnai e was sen o all indi iduals aged 90 o o e in
Tampe e (N=1630). Responses we e ecei ed om 1283
people, gi ing a esponse a e o 79%. P oxy esponses we e
ob ained om 22% o he subjec s who we e hemsel es
unable o answe he ques ions. Fo addi ional 20%, he
esponden chose he answe s bu someone else helped in
eading he ques ions o w i ing down he answe s.
The esea ch p o ocol was app o ed by he Ci y o
Tampe e E hics Commi ee. In o med consen was ob ained
om all esponden s o hei legal ep esen a i es.
2.2. Independen Va iables. We explo ed he associa ions
o i e sociodemog aphic ac o s wi h success ul aging:
age, sex, ma i al s a us, le el o educa ion, and place o
li ing. Age was ca ego ized in o h ee g oups: 90-91, 92-
93, and 94–107. Ma i al s a us was classi ied as cu en ly
ma ied and cu en ly unma ied, including ne e ma ied,
di o ced, and widowed. Educa ion was ca ego ized in o ou
g oups as low (no mo e han elemen a y schooling), middle
(lowe seconda y school), high ( oca ional school, olk high
school, o uppe seconda y school), and highes (college and
academic educa ion). Place o li ing was dicho omized as
communi y (p i a e and se ice housing) and ins i u ion
( esiden ial ca e, se ice housing wi h 24-hou assis ance,
and hospi als).
2.3. Componen s o Success ul Aging. Ou dependen a iable
was success ul aging. I was desc ibed by six diffe en
models ha we e cons uc ed using psychical, social, and
psychological indica o s.
The physical componen included h ee elemen s: dis-
eases, unc ioning, and senses. The pa icipan s we e asked
whe he hey had been old by a doc o ha hey had (1) a
hea p oblem, (2) s oke, (3) ci cula o y p oblems in he
b ain, (4) diabe es, (5) a h i is, (6) Pa kinson’s diseases,
(7) hip ac u e, o (8) demen ia o memo y p oblems. Fo
he measu emen o unc ional abili y, he pa icipan s we e
asked whe he hey we e able o pe o m independen ly (a)
h ee mobili y ac i i ies: mo ing abou indoo s, walking 400
me e s, using s ai s and (b) wo ADL ac i i ies: ge ing in
and ou o bed and d essing and und essing. The esponse
op ions, (1) yes, wi hou difficul y; (2) yes, wi h difficul y; (3)
only wi h help; (4) no a all, we e ca ego ized as independen
(1 + 2) and dependen (3 + 4). The pa icipan s we e also
asked whe he hey we e able o ead he newspape , wi h
glasses i hey used glasses ( ision), and o hea wha ano he
pe son was saying when hey we e alone wi h hem, wi h
hea ing aid i hey used a hea ing aid (hea ing).
The psychological componen was desc ibed by h ee
a iables. The pa icipan s we e asked whe he hey suffe ed
om dep ession o had dep essi e eelings (yes, no). P esen
sel - a ed heal h was ca ego ized as a e age o good ( e y
good, ai ly good, and a e age) and poo ( ai ly poo and
poo ). Sel - a ed heal h was included in he psychological
componen s because i is a subjec i e measu e wi h no
p ede e mined c i e ia: i e lec s no only he mo e objec i e
componen s o heal h, bu also and impo an ly he age-
ela ed way in which he indi idual adjus s and adap s o
diffe en heal h p oblems [15]. The pa icipan s we e also
asked whe he hey hough i was good o people o li e
o be 100 yea s (yes, no).
The social componen was measu ed by wo ques ions:
he equency o mee ings wi h child en (six ca ego ies om
oday o yes e day o se e al yea s ago) and he equency
o alking on he phone wi h amily membe s o iends
(six ca ego ies om oday o yes e day o se e al yea s ago).
One- i h (20.1%) o he esponden s had no child en. I
hese pa icipan s had had elephone con ac s du ing he pas
wo weeks, hey we e ca ego ized as ha ing had con ac wi h
child en.
The pe cen age o missing da a a ied be ween he
diffe en a iables. The highes igu es we e eco ded o
wo psychological a iables. Pa o he eason o his was
ha hese ques ions we e no asked o p oxy esponden s.
Mos o hese pa icipan s li ed in ins i u ions and had
mul iple heal h p oblems. To a oid educing he numbe
o pa icipan s in he analyses, we ca ego ized bo h p oxy
esponses and o he missing alues in hese wo a iables
a he nega i e ex eme (poo sel - a ed heal h and hinking
Jou nal o Aging Resea ch 3
Success ul
aging
Physical
componen
Psychological
componen
Social
Diseases Physical
unc ioning Dep ession Li ing
will
Mee ing
child en
Telephone
use
Vision
and
componen
hea ing
Sel - a ed
heal h
Figu e 1: Th ee componen s o success ul aging.
ha i is no good o li e o be 100). This impu a ion was
done o a oid o e es ima ion o he p e alence o success ul
aging, which would happen i he ailes pa icipan s we e
los om he analyses.
2.4. Cons uc ing Six Models o Success ul Aging. Following
Rowe and Kahn [6] and Young e al. [13], we de ined suc-
cess ul aging as consis ing o h ee componen s as shown in
Figu e 1. Six diffe en models we e cons uc ed wi h diffe en
h esholds. The main diffe ences be ween he models a e in
he physical componen , whe e we de ined ou al e na i e
c i e ia o “success,” anging om mos o leas demanding
as ollows:
C i e ion 1: absence o disease + good ision and
hea ing + independence in all i e ac i i ies.
C i e ion 2: less han h ee diseases, no demen ia,
good ision and hea ing, and independence in ADL
and mo ing abou indoo s (independen in 3 easie
ac i i ies).
C i e ion 3: no demen ia, good ision and hea ing,
and independence in all i e ac i i ies.
C i e ion 4: good ision and hea ing, and indepen-
dence in all i e ac i i ies.
In he psychological componen , “success” was de ined as
absence o dep essi eness, a e age o good sel - a ed heal h,
and ag eemen wi h he iew ha i is good o li e o be 100.
In he social componen , “success” was de ined as ha ing me
one’s child en and ha ing alked on he phone wi h amily
membe s o iends du ing he pas wo weeks.
The six models o success ul aging we e cons uc ed as
ollows:
Model 1: Physical componen c i e ion 1 and psycho-
logical componen & social componen .
Model 2: Physical componen c i e ion 2 and psycho-
logical componen & social componen .
Model 3: Physical componen c i e ion 3 and psycho-
logical componen & social componen .
Model 4: Physical componen c i e ion 4 and psycho-
logical componen & social componen .
Model 5: Physical componen c i e ion 3 and psycho-
logical componen .
Model 6: Physical componen c i e ion 3 and social
componen .
2.5. Analysis. The p e alence o success ul aging in diffe en
sociodemog aphic ca ego ies was compa ed by c oss abu-
la ion using he Chi-squa e es . Logis ic eg ession models
we e used o assess he independen associa ions o diffe en
models o success ul aging wi h sociodemog aphic ac o s.
Odds a ios (ORs) and 95% con idence in e als (95% CI)
we e calcula ed. These analyses we e pe o med using he
SPSS Package 16.
3. Resul s
Mos o he pa icipan s (85.9%) we e unde 95 yea s o age,
and mo e han 80% we e women. These igu es well e lec
he dis ibu ions in he gene al popula ion. Only 12.1%
we e s ill ma ied and 37.5% li ed in an ins i u ion. The
majo i y had no mo e han elemen a y schooling (Table 1).
Hea p oblems, a h i is, and demen ia we e he mos
equen diseases, and only 14.7% o men and 10.2% o
women did no ha e any o he eigh condi ions lis ed in he
ques ionnai e. Fou in en esponden s we e independen in
all i e ac i i ies, and se en in en we e independen in ADL
and mo ing abou indoo s. Acco ding o diffe en c i e ia,
5.3 o 25.2% we e aging success ully i only he physical
4 Jou nal o Aging Resea ch
Table 1: Popula ion cha ac e is ics.
Cha ac e is ic F equency %
Age (N=1283)
90–91 44.5
92–93 25.5
94+ 30.0
Gende (N=1283)
Women 81.2
Men 18.8
Ma i al s a us (N=1267, missing 16)
Unma ied 87.9
Ma ied 12.1
Educa ion (N=1234, missing 49)
Low 56.4
Middle 9.9
High 22.7
Highe 11.0
Place o li ing (N=1278, missing 5)
Communi y 62.5
Ins i u ion 37.5
componen was conside ed. In he psychological componen ,
he p e alence o success ul aging was 20%, in he social
componen he igu e was ma kedly highe a 75%. Men had
be e sco es han women in bo h he physical componen
(mos c i e ia) and he psychological componen (Table 2).
The p e alence o success ul aging a ied be ween he
six models (Table 3). I was lowes (1.6%) o Model 1,
which equi ed absence o all diseases, independence in all
i e ac i i ies, and good ision and hea ing, in addi ion
o he psychological and social componen s, and highes
(18.3%) o Model 6, which diffe ed om Model 1 in
ha diseases o he han demen ia we e allowed, and he
psychological componen was no included. Success ul aging
was signi ican ly mo e p e alen in men han women and
among communi y-li ing han ins i u ionalized indi iduals,
ega dless o he model. Acco ding o mos models, success-
ul aging was mo e equen among hose aged 90–93 han
hose aged 94+, among ma ied people, and among hose
wi h a highe educa ion.
Finally, logis ic eg ession models we e calcula ed o
examine he independen associa ion o diffe en sociode-
mog aphic indica o s wi h he six models o success ul aging
(Table 4).
In ou models, highe age was independen ly associa ed
wi h less success ul aging. Gende was ano he p edic i e
a iable, and in all models excep model 6, men we e
signi ican ly mo e success ul in aging han women. Highe
educa ion was a signi ican p edic o in wo models, and in
Model 6 bo h hose wi h a high and he highes educa ional
le el diffe ed signi ican ly om hose wi h he lowes le el o
educa ion. Ma i al s a us did no play an independen ole,
bu place o li ing was a signi ican de e minan o success ul
aging in all bu Model 1.
4. Discussion
This pape examined one he mos p ominen concep s in
aging esea ch, success ul aging, by cons uc ing six diffe en
models o measu e i among nonagena ians. The models
we e based on wo k by Rowe and Kahn, Rowe, and Young
e al. [6–8,13,16], al hough no he exac same indica o s
we e used. Acco ding o Young e al. [13] and Rowe and Khan
[6], success ul aging is ypically unde s ood as comp ising
h ee main domains: physical (in Young e al.: physiological),
psychological, and social (in Young e al.: sociological).
The esul s showed ha he p e alence o success ul aging
a ies ma kedly om one model o ano he , s anding a
1.6% o Model 1 ha equi ed he absence o any disease,
independence in unc ioning, and he abili y o hea and
ead, as well as mee ing he psychological and social c i e ia,
and a 18.3% o Model 6, which equi ed he absence o
demen ia, independence in unc ioning, he abili y o hea
and ead, and mee ing he social c i e ia. Howe e , he main
socioeconomic p edic o s emained la gely he same ac oss
he models.
I is ob ious ha he absence o disease is he mos
demanding c i e ion o measu ing success ul aging. Dis-
ease and a leas some unc ional de e io a ion a e almos
ine i able in e y old age. Only 11% o he nonagena ians in
ou s udy had no majo disease, and only 5.3% we e bo h ee
o disease, able o hea and see, and independen in i e daily
ac i i ies (physical dimension c i e ion 1). Ve y ew ea lie
s udies ha e a emp ed o es ima e he p e alence o success-
ul aging in nonagena ians o in e y old age in gene al. on
Fabe e al. [2] classi ied only 10% o communi y-dwelling
and 1.9% o ins i u ionalized pa icipan s aged 85 o o e
as success ul age s. In he NonaSan eliu s udy by Fo miga
e al. [17], he igu e was 12% wi h communi y-dwelling
nonagena ians. These s udies emphasized he ole o heal h
and physical unc ioning, bu also included some social o
quali y-o -li e measu es. I is clea ha especially when he
ocus is on he physical dimension, success ul aging will be
e y a e among people expe iencing longe i y.
Rowe and Kahn [6] included p oduc i e ac i i ies in hei
model o success ul aging bu hese can ha dly be expec ed
om nonagena ians. Ho gas e al. [18] showed ha he
daily ac i i ies o indi iduals aged 90 o o e diffe ed om
o he age g oups, and in all ca ego ies his age g oup was
engaged in signi ican ly less ac i i y han o he s. This implies
ha he social dimension o success ul aging among he
oldes old should be measu ed using diffe en c i e ia and
agains diffe en ac i i ies han in he case o he younge old
and should be seen in ela ion o he si ua ion o he bes
pe o me s in he same age g oup.
In c oss-sec ional analysis, we limi ed ou examina ion o
socioeconomic p edic o s ha a leas po en ially ha e played
a ole in he li es o he indi iduals o a longe ime, and,
wi h he excep ion o place o li ing, a e no supposed o be
in luenced by ac o s ha we e hough o be componen s o
success ul aging. In mos s udies age has eme ged as one o
he s onges p edic o s o success ul aging [18]. In ou s udy,
pe sons aged 94 o o e we e less likely o mee he success ul
aging c i e ia han he younge age g oups. The diffe ence
Jou nal o Aging Resea ch 5
Table 2: F equency (%) o he a iables composing h ee componen s o success ul aging in men and women.
Va iables Men (N=226–238) % Women (N=1006–1038) % P alue All (N=1227–1283) %
Physical componen
No hea p oblem 42.4 47.1 0.192 46.2
No s oke 96.2 94.4 0.250 94.7
No ci cula o y p oblems in b ain 78.6 79.3 0.798 79.2
No diabe es 85.7 88.8 0.178 88.2
No a h i is 69.7 54.3 <0.001 57.2
No Pa kinson’s disease 99.6 98.3 0.148 98.6
No hip ac u e 89.2 81.3 0.003 82.8
No demen ia 66.4 59.2 0.033 60.6
No disease 14.7 10.2 0.045 11.0
2 o less diseases wi h no demen ia 39.5 29.8 0.004 31.6
Able o see 72.8 59.9 <0.001 62.3
Able o hea 68.1 71.5 0.299 70.9
Able o see and hea 53.2 48.2 0.170 49.2
Independen in i e ac i i ies 58.3 34.9 <0.001 39.2
Independen in 3 easie ac i i ies 83.0 72.5 <0.001 74.5
C i e ion 1∗7.7 4.8 <0.001 5.3
C i e ion 2∗28.3 26.1 0.500 26.5
C i e ion 3∗24.8 19.1 0.050 20.2
C i e ion 4∗33.9 23.2 <0.001 25.2
Psychological
No dep essi eness 87.8 79.6 0.004 81.2
Sel - a ed heal h a e age o good 72.3 61.4 0.002 63.4
Willing o li e up o 100 yea s 42.4 24.8 <0.001 28.1
Psychological componen 34.0 16.7 <0.001 20.0
Social engagemen
Me child en du ing pas 2 weeks 92.7 93.5 0.644 93.4
Phone con ac s 84.6 79.4 0.070 80.4
Social componen 78.8 74.4 0.166 75.2
∗C i e ions. C i e ion 1: No disease, and able o hea and ead, and independen in all i e ac i i ies. C i e ion 2: Less han 3 diseases, no demen ia, able o hea and ead, and independen in h ee easie ac i i ies.
C i e ion 3: No demen ia, able o hea and ead, and independen in 5 ac i i ies. C i e ion 4: Able o hea and ead, independen in 5 ac i i ies.

6 Jou nal o Aging Resea ch
Table 3: P e alence o success ul aging (%) acco ding o he six models in diffe en socioeconomic ca ego ies.
Models o success ul aging∗
123456
To al p e alence 1.6 6.3 5.7 6.8 6.3 18.3
Age
90–91 1.9 7.9 6.5 7.5 7.5 23.8
92–93 2.5 6.8 7.1 8.6 7.7 21.2
94+ 0.5 3.4 3.2 4.2 3.4 7.8
P alue 0.104 0.021 0.042 0.048 0.022 <0.001
Gende
Men 4.7 12.4 11.1 13.2 12.4 22.3
Women 1 5 4.5 5.5 5.1 17.5
P alue <0.001 <0.001 <0.001 <0.001 <0.001 0.095
Ma i al s a us
Ma ied 3.3 11.8 11.8 14.5 12.5 24.2
No ma ied 1.4 5.6 4.9 5.9 5.6 17.6
P alue 0.095 0.003 0.001 <0.001 0.001 0.03
Place o li ing
Communi y 2.3 8.4 7.6 9.1 8.2 25.9
Ins i u ion 0.6 2.9 2.5 3.1 2.5 6.1
P alue 0.026 <0.001 <0.001 <0.001 <0.001 <0.001
Educa ion
Low 1.3 4.7 4.6 6 5.8 14.4
Middle 1.6 7.4 4.9 4.9 5.7 20.5
High 2.1 7.5 7.1 8.2 7.2 22.6
Highe 3 12.5 9.6 11.9 9.6 29.1
P alue 0.51 0.005 0.093 0.058 0.377 <0.001
∗Models o success ul aging. Model 1. Heal h and unc ioning c i e ion 1 + psychological + social. Model 2. Heal h and unc ioning c i e ion 2 + psychological
+ social. Model 3. Heal h and unc ioning c i e ion 3 + psychological + social. Model 4. Heal h and unc ioning c i e ion 4 + psychological + social. Model 5.
Heal h and unc ioning c i e ion 3 + psychological. Model 6. Heal h and unc ioning c i e ion 3 + social.
be ween he age g oups was signi ican o all excep Model
1, and i was g ea es in Model 6 whe e he o e all p e alence
o success ul aging was highes . A e adjus ing o o he
sociodemog aphic a iables, a signi ican age diffe ence s ill
pe sis ed in ou models.
In ou s udy, he p e alence o success ul aging was
consis en ly highe o men, and in all excep he las model
he diffe ences we e also signi ican a e he adjus men s.
Ea lie s udies [10] show no consis en pa e ns o gende
diffe ences, bu he esul s seem o be dependen on he
model used. McLaughlin e al. [11] ound no gende
diffe ence in p e alence, bu highe odds o success ul
aging in women a e con olling o sociodemog aphic
a iables. Ou indings among nonagena ians a e only pa ly
explained by he high p e alence o disabili ies and disease in
women, as men had clea ly be e sco es in he psychological
componen as well. These dispa i ies a e likely o e lec
diffe en ial su i al, li elong diffe ences in biological, heal h,
and social condi ions.
Ma i al s a us was associa ed wi h success ul aging in
unadjus ed analysis bu no in he adjus ed models, whe e
he une en age and gende dis ibu ion o he a iable was
con olled o .
Educa ion is known o ha e an impac on heal h and li e
s yle, and i e lec s socioeconomic s a us; he e o e, i can
also be conside ed a po en ial p edic o o success ul aging.
Mos o he s udies e iewed by Depp and Jes e [10] ound
no diffe ences acco ding o educa ional le el, bu he analysis
by McLaughlin e al. [11] in he Heal h and Re i emen S udy
showed ha he p e alence o success ul aging was highe
in g oups wi h a highe educa ion and household income.
The s udy o P uchno e al. [19] e ealed ha a highe le el
o o mal educa ion is associa ed wi h success ul aging. Ou
indings wi h an olde g oup han in hese s udies showed
a g aded inc ease in he p e alence o success ul aging wi h
highe educa ion, al hough he diffe ence was no signi ican
o all models. The disc epancy be ween he indings may
a leas pa ly be due o sampling bias. In se e al s udies
ins i u ionalized people and hose o lowe social posi ion
we e less likely o pa icipa e [10], while ou s udy ep esen s
he whole age g oup in he egion.
Place o li ing is no usually conside ed a p edic o o
success ul aging and in many (bu no all, see e.g., on
Fabe e al. [2]) s udies samples only include communi y-
dwelling indi iduals. In ou s udy, we wan ed o ake accoun
o he possibili y o success ul aging e en in an ins i u ion.
Jou nal o Aging Resea ch 7
Table 4: Associa ions o success ul aging, acco ding o he six models, wi h socioeconomic cha ac e is ics. A mul i a ia e logis ic eg ession model, all he p edic o s included in he model
simul aneously. Odds a ios (OR) and 95% con idence in e als (CI).
Models o success ul aging
123456
Age
90–91 2.74 (0.59–12.76) 1.93 (0.99–3.78) 1.68 (0.83–3.4) 1.43 (0.76–2.66) 1.82 (0.93–3.57) 2.85 (1.81–4.49)
92–93 3.93 (0.82–18.89) 2.15 (1.02–4.53) 1.76 (0.91–3.42) 1.93 (1.0–3.73) 2.14 (1.05–4.40) 2.90 (1.79–4.73)
94+ 1 1 1 1 1 1
Gende
Men111111
Women 0.20 (0.07–0.54) 0.46 (0.26–0.82) 0.53 (0.29–0.96) 0.54 (0.31–0.94) 0.47 (0.27–0.83) 0.98 (0.06–1.50)
Ma i al s a us
Unma ied 1 1 1 1 1 1
Ma ied 0.85 (0.26–2.73) 1.17 (0.61–2.26) 1.60 (0.82–3.12) 1.71 (0.92– 3.16) 1.42 (0.74–2.7) 1.11 (0.69–1.81)
Educa ion
Low111111
Middle 1.64 (0.34–7.88) 1.77 (0.81–3.85) 1.16 (0.47–2.87) 0.89 (0.37–2.18) 1.10 (0.47–2.54) 1.57 (0.94–2.63)
High 1.14 (0.39–3.33) 1.28 (0.72–2.3) 1.23 (0.68–2.22) 1.10 (0.64–1.91) 0.95 (0.54–1.69) 1.45 (1.00–2.11)
Highe 1.35 (0.38–4.6) 2.03 (1.06–3.89) 1.48 (0.73–2.99) 1.45 (0.76–2.76) 1.14 (0.57–2.28) 2.00 (1.26–3.17)
Place o li ing
Communi y 3.11 (0.89–10.8) 2.48 (1.36–4.53) 2.66 (1.39–5.05) 2.64 (1.48–4.72) 3.18 (1.68–6.0) 4.30 (2.83–6.53)
Ins i u ion 1 1 1 1 1 1
8 Jou nal o Aging Resea ch
Howe e , he esul s showed ha he p e alence o success ul
aging was clea ly lowe o hose li ing in ins i u ions, and
his was also ue o he adjus ed models. Ou ea lie
analyses (no shown he e) indica ed ha disease, disabili y,
and p oblems wi h hea ing and seeing a e mo e p e alen in
ins i u ions, as is sel - a ed heal h, which pa ly explains his
inding.
4.1. S eng hs and Limi a ions. The majo s eng h o his
s udy is ha i co e s he whole popula ion aged 90 o o e
in he a ea conce ned, including ins i u ionalized people as
well as p oxy esponses. The esponse a e was high. Ou
ea lie and ongoing analyses sugges ha he in o ma ion on
heal h and unc ioning collec ed by mailed ques ionnai es
among nonagena ians is sufficien ly alid and eliable [20,
21]; pa icula ly as o a majo i y o hose suffe ing om
demen ia, he answe s we e gi en by a p oxy esponden .
In o de o gain a b oad and ho ough unde s anding o
success ul aging, we included bo h physical, psychological,
and social componen s in ou analyses. Unlike mos o he
s udies, we also included he abili y o see and hea as an
impo an con ibu ing ac o o independence and quali y
o li e. The main limi a ions o ou s udy ha e o do wi h
he measu es used o assess he social and psychological
componen s. Ou only in o ma ion abou mee ing wi h
o he people conce ned mee ings wi h child en; no da a
we e a ailable abou o he amily membe s o iends. One
i h o he esponden s had no child en, and we decided
o gi e hem a posi i e sco e o social con ac s i hey
had made o ecei ed any elephone calls du ing he pas
wo weeks. One- i h o ou esponses we e om p oxies,
who we e no asked abou sel - a ed heal h o li ing o be
100. The e o e, we had a high pe cen age o missing o
p oxy answe s o wo ques ions ega ding he psychological
dimension o success ul aging. In o de no o o e es ima e
he p e alence o success ul aging, we sco ed his missing
da a and p oxy answe s as nega i e. These kinds o p oblems
a e una oidable in unselec ed samples o e y old people,
bu hey none heless add some unce ain y o ou indings.
Ano he ob ious limi a ion o ou s udy is ha we had no
di ec ques ions designed o cap u e ou esponden s’ sel -
e alua ions o hei li e.
4.2. Implica ions. Ou s udy in a nonselec ed popula ion o
pe sons aged 90 o o e suppo s ea lie indings ha he
p e alence o success ul aging is highly dependen on he
model applied, bu in e e y case success ul aging is associa ed
wi h age, gende , and socioeconomic s a us. Howe e , i is
appa en ha wi h any model ha de ines success ul aging
as a s a e o being and ha uses c i e ia commonly used
o younge age g oups, success ul aging emains a a e
si ua ion among he oldes old. An inc eased likelihood o
heal h and unc ional p oblems, o en ollowed by educed
oppo uni ies o ac i e social engagemen , is no ma i e
consequences o biological aging and ypical o ex eme
longe i y. The e o e, in e y old age, a he han models
emphasizing he absence o disease and ac i i y, emphasis
should be gi en o app oaches ocusing on au onomy,
adap a ion, and sense o pu pose [3,22,23]. These age-
sensi i e app oaches would help us be e unde s and he
po en ial o success ul aging among hose indi iduals who
ha e al eady had success in longe i y.
Acknowledgmen s
Ge on ology Resea ch Cen e is a join effo be ween he
Uni e si ies o Jy ¨
askyl¨
a and Tampe e. This s udy was
suppo ed by G an s om he CIMO Fund o L. Nos a y
and om he Compe i i e Resea ch Funding o Tampe e
Uni e si y Hospi al (9M025) o M. Jylh¨
a. The au ho s wish
o hank Anna-Maija Koi is o, M.S. dg ee, o he s a is ical
help and ad ice.
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