Positive Aging: Physical and Mental Health in Later Life

Introduction to Positive Aging

Positive aging can be defined as experiencing old age in a positive light. Other terms used to describe this process include aging well and successful aging. These terms are intended to imply both physical and psychological health sufficient to sustain a meaningful and rewarding quality of life (reviewed by Rohr and Lang, 2009). The possibility of experiencing positive aging has increased as life expectancies doubled over the past 100 years, with most of this increase affecting persons over the age of 60. In practical terms, elderly individuals who are able to continue working in their profession or are otherwise active are considered to have aged successfully. This essay samples the research literature to better understand the physical and mental health issues that can have a positive or negative impact on positive aging, viewed through the lens of developmental theory.

Social Context and Aging

Social role theory suggests there are cultural norms, and thus expectations, concerning what role the aged should play in society (reviewed by Newman and Newman, 2007). Examples of such expectations include establishing a legal retirement age of 65, becoming an elder in a tribal community, or developing physical and mental infirmities that increase an aged individual's medical and financial dependency on the state.

Rohr and Lang (2009) discussed evidence supporting their theory that social connectedness can determine how well a person ages, such that an aged person in need of social contact will strive to meet expectations, even to the point of self-harm. This is consistent with the findings of Baltes (as discussed by Newman and Newman, 2007, p. 191), who found that dependency expectations held by nursing home staff inadvertently encouraged dependency behavior among residents. After the staff were trained to reward independent behaviors, residents began to behave independently. This result revealed how residents' need for social interaction moderated their fear of the isolating effect of behaving independently.

The impact of social expectations and roles is not limited to changes in behavior, but extends to physical and mental health as well. Jackson (2004) found that women of European descent living in the United States experienced better mental health when they lived life according to a sequence of work, marriage, and parenting. This finding is consistent with Baltes's developmental theory of life span psychology, which proposes that social and cultural expectations define what roles individuals inhabit as they transition through life (Newman and Newman, 2007, p. 189). If retirement is one such role, then Jackson's findings would suggest that retirees could experience better mental health when they retire at the expected age. Using the nursing home example above, this further suggests that a resident experiences better mental health when conforming to staff expectations, regardless of whether that conformity results in dependent or independent behaviors.

Psychosocial Contexts of Aging

The developmental theories of social roles and life span psychology emphasize the influence of environmental factors on human behavior, treating contributions from biology and cognitive processes largely as passive. In contrast, psychosocial theory brings together environmental, biological, and psychological factors in an effort to explain how a human being progresses from infancy to old age (reviewed by Newman and Newman, 2007). At its core, this theory holds that a person transitions through one social context after another throughout life, adapting psychologically to changing expectations; however, the capacity to adapt depends in part on biological maturity. Successful adaptation produces an expanding repertoire of social and cognitive abilities, while failure leads to cognitive rigidity and social isolation.

One aspect of growing old in many western societies is the expectation of retirement and the subsequent enjoyment of leisure activities. As life expectancies continue to increase, some aged individuals may resist expectations to limit their activities in order to conform to social norms (reviewed by Newman and Newman, 2007, p. 191). This suggests that the internal lives of individuals matter independent of social context.

Kleiber and colleagues (2008) argued that resisting the expectation of retirement may be akin to "throwing the baby out with the bathwater." They suggest that many involuntary retirees fail to realize that their lives could be substantially rewarding if they were to step back and analyze their options. For example, working 40 to 60 hours per week may have conferred a sense of value and contribution for the past 30 to 40 years, and its loss is understandably viewed as a negative in a retiree's life. However, long-held dreams of increased family involvement, volunteer activities, or philanthropic engagement become more attainable with an increase in free time. Quality of life can therefore increase substantially if the transition to retirement is based on a deliberate and reflective process. This suggests the internal experience of aged individuals is just as important for positive aging as social context.

When Kunzmann (2008) examined data from the Berlin Aging Study for a possible interaction between affect and functional health, the findings showed that aged individuals with a positive view of aging tended to be more socially involved, had higher intelligence test scores, and were functionally healthier. In contrast, aged individuals with a negative attitude toward getting old tended to be less socially involved. However, the manner by which individuals arrived at a positive or negative affect differed: social involvement correlated strongly with positive but not negative affect. Another way of viewing this is that a positive attitude toward aging is dependent on an outward-based self-evaluation, while a negative attitude is based on an internal process self-evaluation. A positive affect is therefore more fragile than a negative affect because social contexts change over time.

One downside of a negative affect is an increased risk of suicidal ideation and suicide. When Lapierre and colleagues (2007) examined the efficacy of an intervention program that included cognitive-behavioral counseling and assistance with planning and pursuing a meaningful retirement, suicidal ideation dropped significantly compared to a control group. At the six-month follow-up interview, close to 80% of treated individuals were free of suicidal ideation during the previous week, whereas only 36% of the control group could make the same claim. The core theory behind this 11-week workshop intervention was the belief that setting and pursuing goals post-retirement could improve the mental health of retirees — a belief this study confirmed. The treated group also reported more hope, less depression, and a more positive retirement experience.

Heisel and colleagues (2009) took a similar investigative approach when they assessed the efficacy of talk therapy for older adults reporting suicidal ideation. The therapy was based on the assumption that an inability to satisfy personal needs leads to depression, and that the resulting depression leads to impaired social functioning and further difficulty satisfying personal needs. Suicidal ideation can therefore be viewed as both severe depression and a form of interpersonal communication. After 16 weeks of weekly one-hour therapy sessions, study participants reported significant declines in depressive symptoms and suicidal ideation. Therapists also reported a significant shift from clinical to sub-clinical levels of depression among participants.

In a study examining neurophysiological responses to positive, neutral, and negative images, elderly individuals tended to interpret neutral images as slightly more positive than their younger counterparts (van Reekum, Schaefer, Lapate, Norris, and Greishchar, 2011). The motivation for this inquiry was prior research showing that aged individuals tend to exhibit a positive bias when interpreting events in their lives. What van Reekum and colleagues added to this body of research is the finding that the positive bias was not due to an increased positive interpretation of positive or negative events, but rather to a positive interpretation of neutral events — negative events were still viewed as negative. This finding is consistent with psychological adaptation as a person approaches the end of life, a process that would tend to enhance the ability to retain social connections.

These studies reveal an important interaction between the social and internal lives of aged individuals, and the significant impact this interaction can have on quality of life. Such an interaction is consistent with psychosocial theory, which holds that social, biological, and cognitive processes work together to determine the developmental trajectory of an individual.

References

Heisel, Marnin J., Duberstein, Paul R., Talbot, Nancy L., King, Deborah A., and Tu, Xin M. (2009). Adapting interpersonal psychotherapy for older adults at risk for suicide: Preliminary findings. Professional Psychology: Research and Practice, 40(2), 156–164.

Jackson, Pamela. (2004). Role sequencing: Does order matter for mental health? Journal of Health and Social Behavior, 45(2), 132–154.

Kleiber, Douglas, McGuire, Francis A., Aybar-Damali, Begum, and Norman, William. (2008). Having more by doing less: The paradox of leisure constraints in later life. Journal of Leisure Research, 40(3), 343–359.

Kunzmann, Ute. (2008). Differential age trajectories of positive and negative affect: Further evidence from the Berlin Aging Study. Journal of Gerontology, 63B(5), P261–P270.

Lapierre, S., Dube, M., Bouffard, L., and Alain, M. (2007). Addressing suicidal ideations with the realization of meaningful personal goals. Crisis, 28, 16–25.

Martin-Garcia, Salome, Rodriquez-Blazquez, Carmen, Martinez-Lopez, Iluminada, Martinez-Martin, Pablo, and Forjaz, Maria Joao. (2013). Comorbidity, health status, and quality of life in institutionalized older people with and without dementia. International Psychogeriatrics, April 11, published ahead of print online. Retrieved April 16, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/23575107.

Mroczek, Daniel K., and Spiro, Avron III. (2005). Change in life satisfaction during adulthood: Findings from the Veterans Affairs Normative Aging Study. Journal of Personality and Social Psychology, 88(1), 189–202.

Newman, Barbara M. and Newman, Philip R. (2007). Theories of Human Development. Mahwah, NJ: Lawrence Erlbaum Associates.

Rohr, Margund K. and Lang, Frieder R. (2009). Aging well together — A mini-review. Gerontology, 55, 333–343.

van Reekum, Carien M., Schaefer, Stacey M., Lapate, Regina C., Norris, Catherine J., Greishchar, Lawrence L., and Davidson, Richard J. (2011). Aging is associated with positive responding to neutral information but reduced recovery from negative information. SCAN, 6, 177–185.