J Cross Cult Gerontol (2011) 26:261–278

DOI 10.1007/s10823-011-9147-9

ORIGINAL ARTICLE

A New Multidimensional Model of Successful

Aging: Perceptions of Japanese American Older Adults

Gayle Y. Iwamasa & Michiko Iwasaki

Published online: 31 May 2011

# Springer Science+Business Media, LLC (outside the USA) 2011

Abstract This study examined the concept of successful aging using an ethnographic
grounded-theory approach. Seventy-seven Japanese American older adults participated
in focus groups. Participants perceived successful aging as optimal functioning in the
following areas: Physical health, psychological health, cognitive functioning, socializa-
tion, spirituality, and financial security. The content of each dimension represents both
culture-specific and culturally-universal elements. This new multidimensional model of
successful aging was compared to Rowe and Kahn’s (The Gerontologist 37:433–440,
1997) and Phelan et al.’s frameworks (Journal of the American Geriatric Society 52:211–
216, 2004) of successful aging. The model of successful aging generated from this study
appears to be more comprehensive than existing models and incorporates sociocultural
experiences.

Keywords Japanese Americans . Older adults . Successful aging . Focus groups . Qualitative
method . Grounded theory

This study was funded by a grant from the National Institute of Mental Health awarded to the first author. We
thank all of the research participants and staff member research collaborators at Seinan Center and Keiro
Retirement Home for their continual support. We also wish to thank Satomi Wakabayashi for her valuable
research assistance.
G. Y. Iwamasa (*)
Department of Veterans Affairs, Veterans Health Administration, Office of Mental Health Operations,
9152 Kent Avenue, Building 401, Indianapolis, IN 46216, USA
e-mail: gayle.iwamasa@va.gov

M. Iwasaki
Department of Counseling, Rehabilitation Counseling & Counseling Psychology,
West Virginia University, Morgantown, WV, USA

G. Y. Iwamasa
Department of Psychology, DePaul University, Chicago, IL, USA

M. Iwasaki
Department of Counseling & Guidance Services, Ball State University, Muncie, IN, USA
262 J Cross Cult Gerontol (2011) 26:261–278

Successful aging research has a long history in the gerontology literature, with the central
issue being the definition of successful aging. Havighurst (1961) frequently receives credit
for the first conceptual definition of successful aging as a condition in which an older
person experiences maximum life satisfaction without a severe cost to society. Since then,
researchers in various disciplines have challenged and refined the definition of successful
aging. So, is there really a good definition of “successful aging?” It appears that the answer
remains undefined because the meaning of success is ambiguous, the complexity of the
human aging process, and because of ongoing changes in our society and in the
characteristics of the older adult population.

Overview of Successful Aging Studies

In the 1960’s, gerontologists attempted to conceptualize successful aging with major social-
gerontological theories. The Kansas City Studies of Adult Life (Cumming and Henry
1961), the first longitudinal study of adult personality, contributed to the development of
such major theories. In this study, 279 mostly White, middle old-age individuals were
studied over a 6-year period in order to understand age-related changes in personality and
coping. Derived from this study, disengagement theory suggested that successful adaptation
involved mutual withdrawal between older adults and society (Cumming and Henry 1961).
Then, from the same study, activity theory (Havighurst 1963; Neugarten et al. 1968) and
continuity theory (Atchley 1972) were developed; activity theory indicates that successfully
aged individuals continue being engaged in activities within society, whereas continuity
theory postulates that the consistency of one’s patterns of thinking, behavior, and social
relationships throughout the lifespan predicts successful aging. As these theories reflect,
researchers seemed to define successful aging unidimensionally (i.e., successful aging may
be achieved by following a single idea such as keeping active). Hooyman and Kiyak (2002)
pointed out that these theories were not sufficient to explain successful aging because the
concept seems more complex and also failed to consider the socio-cultural context in which
aging occurs. Additionally, the main criticism of original theories of successful aging
seemed to be the fact that they were based on one longitudinal study in which all the
variables were pre-determined by the researchers.
The second wave of the successful aging conceptualization began with the MacArthur
Foundation Research Network on Successful Aging in 1984. This interdisciplinary research
team recruited 4,030 older adults aged 70–79 years from three East Coast cities. A series of
physical (e.g., balance, gait) and cognitive (e.g., memory, visuospatial ability) measure-
ments were taken, accompanied by socio-demographic questions and a health history (e.g.,
presence of diabetes, stroke). Based on their performance on physical and cognitive
functioning, the top one-third of participants was identified (N=1,313) as high functioning
during a baseline period (1988–1989; see Berkman et al. 1993). Among these selected
individuals, 1,189 (952 European Americans, 223 African Americans, and 14 other ethnic/
racial minorities) participated in a follow-up study 7 years later (Berkman et al. 1993).
By reviewing the MacArthur Studies, Rowe and Kahn (1997) generated a model of
successful aging. They defined successful aging as the combination of (a) low probability
of disease and disability, (b) high cognitive and physical functioning, and (c) active
engagement with life. The model includes physical, cognitive, psychological, and social
aspects of human life and has become a prototype for the successful aging concept. It is
important to note that the MacArthur Studies focused exclusively on physical and cognitive
functional outcomes to define success. Further, generalizability of the findings of the
J Cross Cult Gerontol (2011) 26:261–278 263

MacArthur studies for culturally diverse older adults is questionable, as Asian Americans
and Latinos were largely absent from the research. Holstein and Minkler (2003) provide an
excellent critique of this model of successful aging, including potential assumptions and
harmful consequences for those older adults who are already at risk of being marginalized,
such as the poor and people of color.
Recently, Phelan et al. (2004) conducted a large-scale survey on successful aging that
included Asian Americans. The concept of successful aging was examined by studying how
Whites and Japanese Americans perceived the major attributes of successful aging found in
the gerontological literature. Twenty three-category format questions (i.e., important—
neutral—not important) were generated to reflect previously published concepts of
successful aging and related areas. Based on two large geriatric longitudinal studies in
Washington State, 970 Japanese Americans and 1,602 Whites were contacted by mail. The
response rate was 61.2% (N=1,173). Thirteen statements were identified as important by
both groups. These items reflected physical health (two items), psychological/mental health
(eight items), social health (two items), and functioning (one item). Although no statistical
comparison was made, based on descriptive statistics, researchers stated that more Whites
(78.6%) identified “continue to learn new things” as an additional important attribute for
successful aging as compared to the Japanese American group (62.1%). Based on these
findings, the researchers concluded that the concept of successful aging is multidimen-
sional, “Specifically, older adults’ perceptions of successful aging are multidimensional,
involving beliefs about physical, functional, social, and psychological health” (p. 215).
The use of qualitative methods has become more apparent in the recent international
literature on successful aging. For example, older Indians in Singapore (Nagalingam 2007),
the Canadian Inuit community (Collings 2001), and Leiden residents in the Netherlands
(von Faber et al. 2001) have been studied. In the U.S., qualitative methodology was used in
an investigation of the successful aging concept with community dwelling seniors in San
Diego, California. In this study, four themes emerged: attitudes/adaptation, security/
stability, health/wellness, and engagement/stimulation (Reichstadt et al. 2007). Unfortu-
nately, the ethnic and racial background of the 72 participants of this study were not
provided.

Statement of Existing Problems

Although a review of the literature in successful aging suggested a movement toward a

multidimensional framework as seen in Rowe and Kahn’s (1997) and Phelan et al.’s (2004)
models, both studies applied “Western” templates to study successful aging even though
two decades earlier, Thomas and Chambers (1989) had criticized the bias of the original
framework. Even Phelan et al.’s study that included a large group of Japanese Americans,
nonetheless utilized a pre-determined research template based on attributes found in past
research that did not include many ethnic minorities. As discussed by Iwamasa and Sorocco
(2002, 2007), methodological biases occur when researchers use the etic approach that
assumes that universal concepts apply to diverse populations rather than using an emic
approach, which purposefully incorporates culturally-based concepts into the research
methodology. For example, quantitative research methods are closely associated with etic
perspectives because such inquiries are designed to test theories which are often generated
based on middle-class Caucasian individuals. On the other hand, qualitative methods are
often used to explore culture-specific ideas without using predetermined operational
definitions of variables, and are thus consistent with emic research methods.
264 J Cross Cult Gerontol (2011) 26:261–278

Significance of the Present Study

The current study contributes to the existing literature by applying an emic approach
to study successful aging among Japanese American older adults (JAOAs). Japanese
Americans are known for a remarkable longevity compared to other ethnic groups
(McCormick et al. 2002; Curb et al. 1990) despite experiencing many hardships
associated with immigration and World War II-related racism and internment (Fugita and
Fernandez 2004; Nagata and Takeshita 2002). Unlike many western countries where old
age is often viewed negatively (Butler 2009; Myers 2007; Nelson 2002), Japanese
culture embraces and celebrates old age throughout older adulthood with each decade of
aging having special significance: kanreki (60th birthday), koki (70th), kiju (77th), Sanju
(80th), beiju (88th), sotsuju (90th), and hakuju (99th). Older Asian Americans as a group
are growing rapidly and projected to grow 302% between 2000 and 2030 compared to
77% for Whites (Administration on Aging 2004). Therefore, studying JAOAs’
perceptions of successful aging has much potential merit for conceptualization of the
phenomenon.
The major aim of the present study was to generate an emic model rather than verifying
an existing etic model of successful aging with JAOAs. The conceptual schema obtained
from the participants was then compared to the etic-based Rowe and Kahn (1997) and
Phelan et al. (2004) models of successful aging.

Methods

Participants

A total of 77 Japanese American older adults were recruited from two senior facilities in
Los Angeles, CA: Keiro Retirement Home (45 participants) and Seinan Senior Center (32
participants) to participate in focus groups on successful aging. As a part of community-
based participatory research, staff members of both facilities served as research
collaborators and promoted the study on site. Staff provided sign-up sheets with days and
times they selected as being convenient to as many participants as possible. Those
interested in participating signed themselves up for time slots at their convenience. In
addition, many participants were recruited using a “snowball” sampling method, where
participants who enjoyed participating in the study recruited additional participants from
among their acquaintances at the facilities through word of mouth.

Measures

Demographic questionnaire A brief demographic questionnaire asking about age, gender,

generational status, marital status, family income, education, and internment status during
World War II was developed for this study.

Acculturation scale Suinn-Lew Asian Self-Identity Acculturation Scale-ITC version (SL-

ASIA-ITC; Leong and Chou 1988) was administered in order to obtain a brief measure of
participant acculturation level. The SL-ASIA-ITC, a short version of the revised SL-ASIA
(SL-ASIA-R; Suinn 1998) consists of five multiple choice (from 1 = Asian-oriented to 5 =
Caucasian-oriented) items regarding respondents’ language use and preference, reading
ability, ethnicity of friends, and self-reported acculturation level. A total score is obtained
J Cross Cult Gerontol (2011) 26:261–278 265

by summing the responses and dividing it by five. The closer the acculturation score is to
five, the higher the level of acculturation.

Geriatric depression scale The Geriatric Depression Scale-Short Form (GDS-S; Sheik and
Yesavage 1986), a shortened version of the GDS (GDS; Yesavage et al. 1983), contains 15
“yes–no” items, has been shown to be an effective screening measure with five or lower
cut-off points, and has been shown to be highly correlated with the original measure (Sheik
& Yesavage). The GDS-S was reported to be a reliable and valid screening tool for major
depression with community dwelling older adults with different age, gender ethnicity, and
chronic illness status (Nyunt et al. 2009).

Procedure

Prior to completion of this study, the first author, a third generation Japanese American,
had developed collaborative relationships with staff and members at both study sites
over a number of years. She spent considerable time at each facility several times a
year, not only talking with staff and members, but also participating in classes and
activities offered at both, and providing presentations on topics of interest to members
(e.g., Alzheimer’s Disease, holiday blues, etc.). Prior to the implementation of this
study, several studies based upon data collected at the study sites had been published
and shared with both agencies, typically through presentations with handouts.
Additionally, pilot testing of the current study’s methodology was conducted in the
year prior to the current data collection in order to confirm and refine processes and
procedures used in this study.
Upon arrival at the study sites, participants received packets containing the following
materials: (a) general information about the study (i.e., purpose, format, length, informed
consent, and honorarium); (b) the demographic questionnaire; (c) the SL-ASIA-ITC; and
(d) the GDS-S. The GDS-S was use as a screening measure for depression. Four
participants who scored five or higher were identified. After consulting the staff members at
Keiro Retirement Home and Seinan Senior Center involved with the study and speaking
with potential participants, the first author determined they were not depressed, and allowed
them to participate. The SL ASIA-ITC and demographic questionnaires were administered
for descriptive purposes. A consent form was signed after receiving adequate information to
make a decision about study participation.
A focus group methodology was then employed throughout the research (Morgan and
Krueger 1993; National Pacific/Asian Resource Center on Aging 1989). This qualitative
methodology was selected because of our primary aim to explore the concept of successful
aging without imposing predetermined ideas and also to assess the extent that Japanese
culture would affect the conceptualization. The focus group method allows generation of
participant-based thoughts and ideas and facilitates verbal interaction among participants in
order to expand and clarify the concepts being shared. Because of the possibility of
participants adhering to traditional Japanese sex-roles, gender-specific groups were formed
in order to avoid hesitancy and reluctance to share one’s opinion in front of the other
gender. A total of ten groups were formed; three groups for men and seven groups for
women. Each group consisted of 5–9 participants.
Following a consistent protocol developed through pilot testing of the current study, the
first author, a younger Japanese American researcher, led all ten focus groups, asking the
older and more experienced Japanese American seniors to share their opinions and
266 J Cross Cult Gerontol (2011) 26:261–278

experiences on aging and successful aging. Two male groups and one female group were
conducted mainly in Japanese due to the majority of the language preferences participants
indicated in SL-ASIA. All participants were encouraged to speak the language in which
they felt most comfortable, and switching back and forth between English and Japanese
also was encouraged, as some participants felt certain phrases and expressions were best
conveyed in a certain language. For all groups, the same bilingual research assistant served
as an interpreter to minimize any communication barriers. This methodology enriched the
interaction between participants, allowing the facilitator to remain “a participant observer”
to a large degree, throughout the focus groups.
Groups began with a word association task: “What comes to mind when you hear the
phrase, successful aging?” After the sharing of initial responses, the facilitator asked, “What
are the characteristics of a Japanese American older adult who is aging successfully?”
Participants were encouraged to share personal stories, build on others’ responses, and
generate further ideas. At times, participants were prompted to share specific examples.
Groups lasted from 60–110 min. At each group, refreshments were provided and
participants often remained to socialize after the group concluded. All participants received
$25 for their participation, many of whom donated their honoraria to the sites, an example
of the Japanese American value of giving back to the community. In addition, honoraria of
$3,000 were provided to each site.
All focus group discussions were tape-recorded and transcribed for data analysis. Two
bilingual research assistants served as translators and transcribers. Translated transcriptions
were double-checked by both research assistants to ensure accuracy.

Data analysis

Descriptive statistics were conducted on various demographic variables and on the acculturation
and depression measure. For each analysis, missing cases were excluded. Data from the focus
groups were analyzed using the grounded theory approach (Glaser and Strauss 1967; Strauss and
Corbin 1990). The grounded theory approach is often used for model development which
involves the open coding of transcriptions, categorizing of the codes, and then examining the
relationships among the categories. Using the longest focus group transcription, the first author
and two bilingual research assistants began the process of open coding with each individual
response coded according to the question of “what is this about?” After the initial coding was
completed, the remaining transcriptions were coded separately, one by one. During the coding
process, constant comparative analyses among the three coders were conducted, and
differences in coding were discussed until consensus was reached. This process leads to
continued categorization and sometimes the collapsing of categories, until all the transcripts
were coded. Then the relationships between categories were examined and common themes
generated. The obtained conceptual schema was then compared to the Rowe and Kahn’s
(1997) and Phelan et al.’s (2004) frameworks of successful aging.

Results

Descriptive information

The mean age of participants was 78.3 years (SD=8.5) with a range of 55–96 years. Two
participants did not specify their age (2.6%). Mean age across the two sites were similar.
Fifty-three participants were women and the percentage of men and women across both
J Cross Cult Gerontol (2011) 26:261–278 267

sites was roughly similar. Educational level included 48% high school graduates, and an
additional 38% whose educational level was a college degree or higher. The majority of the
participants were Nisei (2nd generation, 69%). The remainder of the participants were Issei
(1st generation, 25%); Sansei (3rd generation, 5%); and Unspecified (1%). Almost half of
participants (46%) were interned during WWII. Table 1 presents a summary of the
demographic characteristics.
Fairly high internal consistency coefficients were obtained for the SL-ASIA-ITC: α=.87
and the mean was 2.9 (SD=.97), indicating that most participants were moderately
acculturated, which is consistent with the range of generational status of the participants.
The mean score of GDS-S was 1.6 (SD=1.79). Four participants scored higher than the
recommended cut-off score (score of >5). The elevated GDS-S score of the four individuals
was likely due to translation of the GDS-S as evidenced by somewhat weak internal
consistency (KR-20=.63) of our Japanese-translation version of the GDS-S, and each
participants’ verbal denial that they were depressed. All participants showed interest in
participating in a group discussion, and no participants appeared to be depressed as
observed by the facilitator, research assistant and on-site staff.

Perceptions of successful aging

A major theme that emerged from the present study with Japanese American Older Adults
(JAOAs) was that successful aging involves optimal functioning in multiple areas with
different degrees of emphasis. Participants described successful aging in terms of physical,
psychological, cognitive and social functioning, spirituality, and financial security. Across

Table 1 Summary of descriptive statistics

% Mean SD Median Mode

Age (n=75) (55–96 years old) 78.3 8.5 79.0 80.0

Gender (n=77) Men = 24 31.2
Women = 53 68.8
Marital Status (n=77) Single = 3 3.9
Married = 29 37.7
Separated/Divorced = 9 11.7
Widowed = 36 46.8
Education (n=77) <High School = 11 14.3
High School = 37 48.1
>High School = 29 37.7
Generation (n=77) Issei = 19 24.7
Nisei = 53 68.8
Sansei = 4 5.2
NA = 1 1.3
Internment (n=76) Yes = 35 45.5
No = 41 53.2
SL-ASIA-ITC (n=76) 2.9 .97 3.0 3.0
GDS-S (n=74) 1.7 1.9 1.0 0.0

SL-ASIA-ITC Suinn-Lew Asian Self-Identity Acculturation Scale-ITC version, GDS-S Geriatric Depression
Scale Short Version
268 J Cross Cult Gerontol (2011) 26:261–278

these dimensions, participants shared both culturally-universal themes (i.e., ideas which
were commonly known to the general American population) and culture-specific themes (i.e.,
ideas specific to Japanese culture). Figure 1 represents a visual model generated from the
present study. Table 2 provides examples of each dimension and comparisons to the
dimensions from Rowe and Kahn (1997) and Phelan et al. (2004).

Dimensions of successful aging

Physical functioning Physical functioning was the most predominant dimension (or theme)
of successful aging. Most initial responses from the word association task for successful
aging were related to physical functioning that captured a number of subcategories such as
health, diet, exercise, activities, and physical appearance. Specific examples of this
dimension included “keeping good health,” “not having difficulties in…like medical
difficulties,” “exercising,” “living every day with regular routines,” and “eat healthy.”
During the group discussion, many culturally unique ideas regarding physical functioning
were reported. Regardless of acculturation level, many JAOAs spoke of the traditional Japanese
diet that is known to be low fat, emphasizes non-animal protein, and is rich in fiber as being
important to successful aging. Examples include “every one of us eats rice,” “eat a lot of fish
instead of meat,” “Misoshiru (a soybean-based soup), tofu, tea…,” “umeboshi (dried plum),”
and “…all vegetable…okra.” The link between a Japanese diet and health was highlighted
during group discussion particularly from the women’s (53%) groups.
Participant A: “I think that we have to give Asian women a lot of credit…they are not
obese as Caucasians. We have less obesity…I think because we watch our diet and
we don’t overeat.”
Participant B: “[Be] active.”
Participant A: “That’s it.”
Participant C: “It’s the nature, that’s what I think. I stayed in Japan for a long time,
and I never seen chubby Japanese women until I came [to the] United States.
Japanese women come over here, all gain weight.”
Participant B: “You know in the news, they did say that especially in Japan, there are
very healthy people because of what they are eating.”
Participant C: “A lot of fish, vegetables, soy…”

Successful Aging

Japanese American
Cultural Influence

Fig. 1 multidimensional model of successful aging

J Cross Cult Gerontol (2011) 26:261–278 269

Table 2 Multidimensional model of successful aging and comparison to Rowe and Khan’s (1997) and
Phelan et al.’s (2004) models

Dimension Subcategories and examples from current study Rowe and Khan Phelan et al.
(1997) (2004)

Physical Health: “keeping good health”; “not having difficulties Avoiding disease Health
in…like medical difficulties”; “sleep well”; “the
family genes it counts, too”; etc.
Exercise: “exercise”; “physically fit”; “gate ball”; etc. Maintaining high
physical
function
Activities: “living every day with regular routines”;
“being active”; etc.
Physical appearance: “dressing up without thinking
[about] our age”; “other nationalities, they don’t know
how old we are”; etc.
Diet: “eat healthy”; “eat three times a day…”; “eat a lot
of fish instead of meat”; “every one of us eat rice”;
etc.
Psychological Positive affect and attitudes: “being happy”; “You got Avoiding disease Positive Affect
to smile all the time and laugh”; “being optimistic”;
“not to complain all the time”; etc.
Maintenance of independence: “start realizing that as Independence/
you grow older, you must take care of your butt”; “do Autonomy
not cause trouble [for] others”; etc.
Willingness to change: “Ability to change”; “you must Adjustment
change your way of life”; etc.
Openness to new experience:” interested in the outside
world”; “try to do something new everyday”; etc.
Intrapersonal coping: “consider other people’s feeling Coping
more”; “gaman (endurance, perseverance)”; “nintai
(patience, endurance)”; shikata ga nai (there is
nothing we can do about it); “gambare (hang in
there)”; etc.
Social Social support/social network: “having friends around Engagement Social Support/
you”; “find [finding] the right crowd, be around with life Social
people”; “mingle with the younger groups”; “coming Network
to the Seinan Center [a JA day program]”; etc.
Recreation and entertainment: “singing”; “dancing”
“going to movies” “karaoke”; “shigin (Japanese
poem)”; “hanafuda (Japanese card game)”; etc.
Social learning: “you can emulate somebody…you see
someone that you admire…; “listening to the elders”;
“enryo (diffidence, modesty)”; etc.
Social roles: “doing things for family”; “I baby sit my
19 month-old grandson”; “being a good father, good
husband”; “maybe a good wife”; etc.
Cognitive Using one’s mind: “brain is so active and working all Avoiding disease New Learning
the time; “be alert”; “to exercise your brains, not you
exercise your legs”; etc.
Education: “good education”; “you’ve got to read a Maintaining high
lot”; “the person wants to learn more”; “attend cognitive
workshops”; etc. function
Spirituality Religion: “go to church”; “pray to God”; “listen [and] Not addressed Internal Peace
return to God”; Shinto beliefs and practices, etc.
270 J Cross Cult Gerontol (2011) 26:261–278

Table 2 (continued)

Dimension Subcategories and examples from current study Rowe and Khan Phelan et al.
(1997) (2004)

Internal peace: “being serene”; “live in repose”; “heals

mind”; etc.
Faith: “faith”; “be more faithful”; “faith is very
important”; etc.
Altruistic behavior: “give a lot of love to people”;
“care [for] other people with love”; “volunteering”;
“volunteer at Keiro [a JA nursing home]; etc.
Appreciation: “appreciate for so many things”; “grow
old gracefully”; etc.
Financial Monetary value: “have a lot of money”; “money is Not addressed Not addressed
important”; “if you have money, you’d be happy”;
“money does not always make you successful if you
are not happy”; “money is not everything”; etc.
Financial security: “some one with some money”;
“financially stable”; “financial steadiness”; “money…
budget”; etc.

Bold = Sub-category; Italics = culture specific

JAOA women also commented on physical appearance as an important factor for aging
successfully. They made statements including, “dressing up without thinking [about] our
age,” or “…dress and act younger.” However, even in a men’s focus group, a participant
talked about his 80-year old mother who refused to wear a shirt given to her because she
thought only old ladies wore such a shirt.
The importance of physical health was highlighted repeatedly in all groups regardless of
gender, as seen in the following comments made by a Japanese-speaking male participant:
“The most ideal thing is to keep healthy. Health. This is the most important thing. If
you are healthy, you don’t have any worries. If we are physically weak, we tend to
worry about the future such as having to go to a nursing home. Then, we start
worrying about leaving our friends behind. We start worrying about one after
another.”

Psychological functioning Psychological functioning was another major dimension of

successful aging as evidenced by the frequency of comments and discussion throughout
various phases of the study. This dimension consists of subcategories reflecting positive
affect and attitudes, maintenance of independence, willingness to change, and openness to
new experiences. Phrases such as “Being happy,” “Being optimistic,” “Not to complain all
the time,” and “You got to smile all the time and laugh” are specific participant examples of
positive affect and attitudes. The following story from a male participant represents the
importance of maintaining independence, willingness to change, and openness to new
experiences:

“My wife passed away about 8 years ago. My son lives in New York. So, I live by
myself. I try to do everything all [I] can. I’m living at home, my own home. I have to
write all the checks, I do all of cooking…and I do the housework. If you name it, I do
it all.”
J Cross Cult Gerontol (2011) 26:261–278 271

In addition, culture-specific psychological concepts were discussed. In many groups,

participants spoke of what their parents used to teach them about Japanese values such as,
“Don’t bring shame (haji) to the family,” “We were always told to endure, gaman
(endurance, perseverance),” and “nintai (patience).” Other concepts such as sensitivity to
others’ needs (e.g., “Consider other people’s feeling more”), shikata ga nai (there is nothing
we can do about it), no monku (no complaints), and gambare (hang in there) also were
frequently mentioned in the discussion of JAOAs who have aged successfully. The
following is an example of Japanese American-specific psychological values from one of
the men’s groups. Participants were discussing the unconstitutional incarceration of
Japanese Americans in concentration camps during WWII and the resulting loss of
property, valuables and belongings:
Participant A: “Well, a lot of people didn’t have homes. They had to sell [that] to
another party, you know, I know my father had to…”
Participant B (nodding): “They had to accept it.”
Participant C: “Everything was gaman (endurance, perseverance).”
Participant B: “You got to accept it [because] you can do nothing about it [shikata ga
nai].”
Participant C: “We just took it. No monku (complaints).”
These Japanese culture-specific values have been discussed elsewhere. For example,
Homma-True (1997) discussed how gaman is often passed on within families to the next
generation to teach coping skills during difficult circumstances. Thus, many JAOAs
maintain and implement traditional Japanese values and coping mechanisms throughout
their lives.

Social functioning Social functioning also was identified as instrumental in successful aging
by our JAOA participants. The following are examples recorded during the word-association
phase in our study: “Having friends around you,” “[finding] the right crowd,” “be around
people,” and “mingle with the younger groups.” Subcategories of recreation and entertainment
were important methods of optimizing social functioning, as our JAOA participants perceived
peers who regularly engaged in recreational activities as aging successfully. They spoke of
general entertainment activities U.S. (e.g., singing, dancing, going to movies) as well as
traditional Japanese activities such as karaoke, shigin (poems), and hanafuda (card game). In
several men’s groups, whether they agreed or disagreed, the topic of finding a girlfriend
during one’s senior years also periodically arose during discussion.
Our participants also emphasized social learning factors in the context of how to age
successfully. Several participants said they could emulate a person who is aging
successfully. They also indicated that they could learn a lot from listening to their own
elders. Success in performing social roles and culturally expected behaviors also was
addressed. “Being a good father,” “a good husband,” “a good wife,” “living with
children,” and “baby-sitting the grandchildren,” were specific examples raised in many
groups.

Cognitive functioning Cognitive functioning was discussed in almost all our focus groups.
Participants spoke of using one’s mind (e.g., “The brain is so active and working all the
time;” “Be alert”) or intellectual functioning (e.g.,” Good education;” “The person wants to
learn more”) as significant factors of successful aging. Our JAOA participants perceived
ongoing efforts to maintain high cognitive functioning in a creative way as seen in the
following comment:
272 J Cross Cult Gerontol (2011) 26:261–278

“I am a retired auto-mechanic. So, I still fix my own car. But, thing is [that], when I
do the job, I like putting all the nuts and bolts in one can. So, when I finish the job,
you know, nuts and bolts should and must be all empty from the can. If some in there,
that means [that] I forgot some…” (laughter from the group ensues).

Many participants also believed gaining new knowledge is an important component of

successful aging. In one of the women’s groups, a participant suggested gaining up-to-date
medical knowledge as an example: “You know like bone density, how do we know what we
are doing for osteoporosis, if you don’t have a test.?” Many participants suggested both
individual (e.g., “You’ve got to read a lot”) and group (e.g., “Attend a workshop”) mental
activities to gain new knowledge.

Spirituality A spirituality dimension of successful aging also emerged in our focus group
discussions. This dimension, and the financial dimension discussed next, were less
emphasized in the groups than the previous dimensions, yet were still considered important
components in successful aging by our participants. We found several subcategories related
to spirituality: Religion, internal peace, faith, appreciation, and altruistic behavior. In terms
of religion-specific elements, “Go to church,” or “Pray to God” were mentioned by our
participants. A female participant said, “I find [that] going to church helps [me] a lot…You
go in there and you feel really serene.” A few lower-acculturated male participants also
mentioned his traditional Japanese religious practice: “Well for me, in the morning and at
night, 100% I pray for my ancestor… I say that thank you so much for everything.”
Another male participant spoke of his daily visits to the cemetery (hakamairi) to speak to
his deceased wife.
Our participants also emphasized that internal peace and faith can bring happiness: “I
know a lot of people who are living in solitude, and people who are in a convent, living like
a hermit, very, very happy and wonderfully aging.” Given various hardships from their past
(e.g., a sickness, internment), several participants stated that they appreciate the fact that
they are alive. One Japanese-speaking woman said, “It is important to live with faith and
appreciate that we are protected each day.” Having a sense of appreciation (e.g., “Grow old
gracefully”) for living and the importance of altruistic behavior and helping a community
though fund raising and volunteer work also were discussed in several focus groups.

Financial security As with spirituality, in the present study finances also emerged as
important, although to a lesser degree than physical, psychological, or cognitive factors of
successful aging. Our JAOAs presented a variety of views regarding the importance of
finances in successful aging. One extreme side was characterized by responses such as
“Have a lot of money” or “Money is important.” The opposite idea also was observed
through comments such as “Money does not always make you successful if you are not
happy” or “Money is not everything.” Participants however, appeared to be have consensus
about the idea of financial security (e.g., “Someone with some money;” “Financially
stable;” or “Money…budget”).
In a discussion of WWII and their internment, many participants talked about the
experience of losing everything and starting their lives over again. The following comments
highlighted financial hardships. One participant said, “We were notified to move to the
camp in a week. We were only allowed to take two suitcases.” Loss of belongings occurred
even more suddenly for other people as found in statements such as “Those who lived in
Terminal Island had everything taken away…they were told to leave right away.” A
participant explained the post-war lives of Japanese Americans as follows; “…came back to
J Cross Cult Gerontol (2011) 26:261–278 273

L.A. or wherever they went to, we start all over again. Just like our parents and Nisei, they
work very hard to establish to get born again, to help next generation, send to college…”

Discussion

The present study investigated the concept of successful aging using an emic-based
inductive research methodology with Japanese American older adults. This culturally
sensitive methodology allowed participants to fully express their perceptions of successful
aging, as opposed to conventional quantitative methods that limit the parameters to be
studied. Study participants perceived that successful aging involves multiple aspects of
one’s life comprised of both universal and culture-specific elements: physical, psycholog-
ical, social, and cognitive functioning, spirituality, and financial security. The model
derived from the present study confirms several components described by previous
multidimensional models (viz., Rowe and Kahn 1997; Phelan et al. 2004)—the physical,
cognitive, psychological and social aspects of successful aging. In addition, the present
model includes two additional dimensions –spirituality and financial security that were
rarely addressed in quantitative investigations of the concept of successful aging.
Among the six dimensions (or themes) derived from our quantitative data, the dimension
of physical functioning appeared to be the most important component as evidenced by
participants’ frequent comments on health related issues such as exercise, diet, and
activities. Rowe and Kahn’s (1997) model addresses physical aspects in two dimensions:
avoiding disease and maintaining high cognitive/physical function, and emphasized the
important roles of environment and behavior in determining risk for disease in later life. In
Phelan et al.’s (2004) study, physical health was addressed in two items: “good health” and
“absence of chronic disease.” Our participants expressed not only basic knowledge for
maintaining good health and avoiding chronic illnesses and conditions (e.g., daily exercise),
but also of their culturally-based behaviors (e.g., eating a traditional Japanese diet) and how
these factors relate to their health status.
Although not directly addressed by Rowe and Kahn’s (1997) model, the role of
psychological functioning in successful aging also was emphasized by our participants. In
Rowe and Kahn’s model, the “avoidance of disease” dimension may have included
psychological illnesses such as depression, anxiety, and addiction, however the extent to
which psychological factors were included in that factor is unclear. Although they
recognized the predictive power of perceived control (self-efficacy) in the component of
“maintaining cognitive function,” Rowe and Kahn’s (1997) model still does not reflect a
significant role for psychological factors such as perceived control or self-efficacy.
In contrast, Phelan and colleagues (2004) found that certain affective items were highly
valued by their respondents. These items, endorsed as important by both Japanese
Americans and Caucasians in their research, related to satisfaction, feeling good, and
absence of loneliness and isolation. Phelan et al.’s study (2004) also indicated that
psychologically-related concepts also were important including the ability to make
informed choices, cope with challenges, and adjust to changes.
While both the present focus group and Phelan et al.’s studies (2004) stress the
importance of psychological factors, differences were found for the subcategories of
autonomy and independence between their dimension and ours. Phelan, et al.’s study
represented autonomy as “Being able to meet all of my needs and some of my wants” and
“Being able to act according to my own inner standards and values.” In their study, Whites
274 J Cross Cult Gerontol (2011) 26:261–278

endorsed more of these values than did Japanese Americans. In our study, participants
emphasized the collectivistic Japanese cultural value of adjusting one’s needs to maintain
group harmony rather than the individualistic emphasis on expressing one’s needs. In the
present study, the importance of independence was presented by focusing on others (e.g.,
“Do not cause trouble [for] others”) rather than on oneself. Thus, the operational definitions
of independence and autonomy as determined by Phelan et al. (2004) appear to be
culturally-based and may not apply to all older adults, particularly those who maintain a
collectivistic worldview, such as Asian Americans, Latinos and American Indians.
Additional culture-specific psychological concepts such as gaman (endurance, persever-
ance), nintai (patience, endurance), and no monku (no complaints) frequently arose during
our discussions of successful aging when participants shared their experiences of being
interned during WWII, and the targets of discrimination such as racism and ageism, and
exclusion.
The dimension of social functioning that emerged from our focus group discussion
relates to Rowe and Kahn’s (1997) “engagement with life” component and two items from
Phelan et al.’s (2004) framework: “Having friends and family who are there for me” and
“Staying involved with the world and people around me.” JAOAs participating in our focus
groups also indicated similar ideas: “Having friends around you” and “[finding] the right
crowd.” As existing literature suggests, having strong social support and a social network
appear to be major coping factors when people experience challenges and difficulties in
their lives, especially in later life when they face many losses (e.g., Cohen et al. 2001;
Helgeson 2003). In the 1995 follow-up assessment of the MacArthur Studies, among those
identified as “high functioning older adults,” strong social ties were associated with less
decline in functioning (Unger et al. 1999).
Although most of our participants were fairly acculturated, a few responses related to
socialization and social relations appeared to be related to acculturation level. For example,
depending on their acculturation level, participants talked about western or Japanese
recreational/entertainment activities. These results were similar to the findings of Young et
al. (2002) study of Japanese Americans in Seattle, where they preferred recreational
activities that blended with their cultural values and traditions. In addition, participants who
were less acculturated suggested that the Japanese traditional style of interrelationships such
as engaging in culturally expected social roles, promoting other’s goals, and belonging to
society (similarly described by Markus and Kitayama 1991) were essential elements of
successful aging. On the other hand, those who were more acculturated often found a great
deal of stress associated with engaging in such social interactions; they suggested that “not
mingling only with Japanese [people]” as important in aging successfully.
Although “maintaining high cognitive/physical functioning” was identified as one of the
three components of successful aging by Rowe and Kahn (1997), less emphasis on
cognitive functioning was found in both Phelan et al.’s study (2004) and in our focus
groups. Quantitative analyses of the data from the MacArthur Studies indicated that
education was found to be the best predictor of continuously high cognitive performance
among participants (Albert et al. 1995). Education is highly valued among Japanese
Americans. The Issei often made sacrifices to provide for higher education to their Nisei
children, who were deeply committed to being successful in education and their professions
as means of being accepted by American society and to make their parents proud (Tomine
1991). Our sample reflects this emphasis, with almost 70% of Nisei participants who have
higher educational backgrounds. In Phelan et al.’s study (2004) the cognitive factor was
addressed in one item: continuing to learn new things, which was endorsed as important
more by Whites (78.6%) than Japanese Americans (62.1%).
J Cross Cult Gerontol (2011) 26:261–278 275

Although comments related to spirituality were subtle, this dimension appeared to be

important in the present study and parallels the existing literature in spirituality. Pargament
(1999) defined spirituality as a “search for the sacred” and “the heart and soul of religion,”
encompassing both religious and non-religious elements. In a discussion of aging
successfully, participants suggested some religiously-related ideas such as “Go to church”
and “Listen [and] return to God” that can be associated with both Christian and Shinto
practices. The importance of non-religious aspects of spirituality such as experiential,
phenomenological, nature-oriented, moral and humanistic values on physical health have
been discussed (Bussing et al. 2005). In the present study, similar values were represented:
inner peace (e.g., “Being serene”); faith (e.g., “Be more faithful); altruistic behavior (e.g.,
“Care [for] other people with love”); and appreciation (e.g., “Grow old gracefully”).
Spirituality is not included in Rowe and Kahn’s (1997) model of successful aging, while
Phelan et al. (2004) included one spiritually-related item: “Having a sense of peace when
thinking about the fact that I will not live forever.” This item was rated by as important by
both Whites (74.6%) and Japanese Americans (72%).
As found in the present study, spiritual beliefs and practices play an important role in
maintaining one’s well-being and the ability to cope with stress. Neglect of spirituality in these
previous models of successful aging may reflect the traditional tendency toward conventional
scientific research in the U.S., which de-emphasizes the importance of spirituality in human
life. Although specific spiritual beliefs and practices were raised during many of the focus
groups, we did not specifically ask for religious or spiritual affiliation in our demographic
questionnaire. This would be an interesting addition in future research.
Similar to the dimension of spirituality, discussion of financial issues arose after JAOA
participants spoke of physical, psychological, social and cognitive functioning. They spoke
of how having a lot of money or little money may affect the other areas of one’s
functioning, particularly psychological functioning (e.g., “does it make people happy or
worry?” A financial factor was not included in either Rowe and Kahn’s (1997) or Phelan et
al.’s (2004) models of successful aging, which is interesting given that income in the
MacArthur studies was found to be strongly associated with physical performance and was
a significant predictor of physical decline (Seeman et al. 1994).
Whereas financial concern merits much attention given the current U.S. economy,
JAOAs seem to have culturally-specific reactions to financial matters such as money,
budgeting, and material belongings. Their perceptions about the importance of financial
security may relate to their experiences as a group target by racism in the U.S. JAOAs and
their immigrant parents worked hard to establish their roots in America and to restore their
lost possessions after WWII. Even children of the internees were often affected by the
history of WWII via what Nagata (1991) termed “transgenerational impact of trauma.”
Thus, in addition to the growing financial concerns among the general senior population in
the U.S, JAOAs may also understand the importance of financial security when defining
successful aging because of their own economic upheaval and instability due to having
experienced racism and discrimination throughout their lives. Today, many American
seniors, especially racial and ethnic minorities, face financial concerns that will affect their
retirement and influence their management of medical and long-term care. Thus, the area of
financial security appeared to be essential in the concept of successful aging for our
participants.
We acknowledge that this study has several limitations. First, this study focused on
Japanese American older adults who were relatively healthy and high functioning
individuals. They were recruited from two senior facilities where JAOAs are typically
engaged in regular activities and interact with others. Thus, the model that emerged from
276 J Cross Cult Gerontol (2011) 26:261–278

the present study may not be applicable to JAOAs who are isolated, withdrawn, or who
choose not to participate in research. Further, we did not specifically assess how level of
acculturation may affect well-bring, which would be an interesting area of research for
future study of ethnic minority older adults.
We recognize similarities between our model of successful aging and Hettler’s wellness
model (National Wellness Institute 2009), that includes the following six interdependent
dimensions: Physical, emotional, intellectual, social, spiritual, and occupational. As seen in
Fig. 1, there some overlap between the two models, with the exception of Hettler’s
occupational dimension, as it appears to focus on issues such as career choice, work
satisfaction, job performance. Thus, investigating the relationship between successful aging
and wellness is another area for future research.
The model generated from our study included six dimensions. Although the content of
all six dimensions represented both Japanese culture-specific and non-culturally specific
elements, findings suggest the need for further investigation of the conceptualization of
successful aging. Future research should address the applicability of this model with Whites
and other ethnic and racial minorities, especially given the growing numbers of Hispanic/
Latino seniors. Findings from such studies will assist researchers in understanding the
cultural variations that occur in the conceptualization of successful aging, which can inform
professionals who provide services to older adults.

References

Administration on Aging (2004). A Profile of Older Americans: 2003. Retrieved October 15, 2005 from
http://www.aoa.gov/prof/Statistics/profile/2003/4.asp
Albert, M. S., Jones, K., Savage, C. R., Berkman, L., Seeman, T., Blazer, D., et al. (1995). Predictors of
cognitive changes in older persons: the MacArthur Successful Aging Studies. Psychology and Aging, 10,
578–589.
Atchley, R. C. (1972). The social forces in later life. Belmont: Wadsworth.
Berkman, L. F., Seeman, T. E., Albert, M., Blazer, D., Kahn, R., Mohs, R., et al. (1993). High, usual and
impaired functioning in community-dwelling older men and women: findings from the MacArthur
Foundation Research Network on Successful Aging. Journal of Clinical Epidemiology, 46, 1129–1140.
Bussing, A., Ostermann, T., & Matthiessen, P. F. (2005). Role of religion and spirituality in medical patients:
confirmatory results with the SpREUK questionnaire. Health and Quality of Life Outcomes, 3:53.
Retrieved October 15, 2005, from http://www.hqlo.com/content/pdf/1477-7525-3-10.pdf
Butler, R. N. (2009). Combating ageism. International Psychogeriatrics, 21, 211.
Cohen, S., Gottlieb, B. H., & Underwood, L. G. (2001). Social relationships and health: challenges for
measurement and intervention. Advances in Mind-Body Medicine, 17, 129–141.
Collings, P. (2001). “If you got everything, it’s good enough”: perspectives on successful aging in a
Canadian Inuit community. Journal of Cross-Cultural Gerontology, 16, 127–155.
Cumming, E., & Henry, W. E. (1961). Growing old. New York: Basic Books.
Curb, J. D., Reed, D. M., Miller, F. D., & Yano, K. (1990). Health status and life style in elderly Japanese
men with a long life expectancy. Journal of Gerontology, 45, S206–211.
Fugita, S. S., & Fernandez, M. (2004). Altered lives, enduring community: Japanese Americans remembering
their World War II incarceration. Seattle: University of Washington Press.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research.
Chicago: Aldine.
Havighurst, R. J. (1961). Successful aging. The Gerontologist, 1, 8–13.
Havighurst, R. J. (1963). Successful aging. In R. Williams, C. Tibbits, & W. Donahue (Eds.), Process of
aging (Vol. 1, pp. 299–320). New York: Atherton.
Helgeson, V. S. (2003). Social support and quality of life. Quality of Life Research, 12, 25–31.
Holstein, M. B., & Minkler, M. (2003). Self, society, and the “New Gerontology. The Gerontologist, 43,
787–796.
J Cross Cult Gerontol (2011) 26:261–278 277

Homma-True, R. (1997). Japanese American families. In E. Lee (Ed.), Working with Asian Americans: A
guide for clinicians (pp. 114–124). New York: The Guilford Press.
Hooyman, N. R., & Kiyak, H. A. (2002). Social Gerontology: A multidisciplinary perspectives (6th ed.).
Boston: Allyn & Bacon.
Iwamasa, G. Y., & Sorocco, K. H. (2002). Aging and Asian Americans: Developing culturally appropriate
research methodology. In G. C. Nagayama Hall & S. Okazaki (Eds.), Asian American psychology: The
science of lives in context (pp. 105–130). Washington, DC: American Psychological Association.
Iwamasa, G. Y., & Sorocco, K. H. (2007). The psychology of Asian American older adults. In F. Leong, A.
G. Inman, A. Ebreo, L. Yang, L. M. Kinoshita, & M. Fu (Eds.), Handbook of Asian American
psychology (2nd ed., pp. 213–226). Thousand Oaks: Sage.
Leong, F. T. L., & Chou, E. L. (1988). Developing brief versions of the Suinn-Lew Asian Self-Identity
Acculturation (SL-ASIA) Scale for counseling research. Asian and Pacific Islander Journal of Health, 6,
American 13–24.
Markus, H. R., & Kitayama, S. (1991). Culture and the self: implications for cognition, emotion, and
motivation. Psychological Review, 98, 224–253.
McCormick, W. C., Obata, C. Y., Uomoto, J., Young, H., Graves, A. B., Kukull, W., et al. (2002).
Similarities and differences in attitudes toward long-term care between Japanese American and
Caucasian Americans. Journal of the American Geriatrics Society, 50, 1149–1155.
Morgan, D. L., & Krueger, R. A. (1993). When to use focus groups and why. In D. L. Morgan (Ed.),
Successful focus groups: Advancing the state of the art (pp. 3–19). Newbury Park: Sage.
Myers, J. E. (2007). Combating ageism: Advocacy for older persons. In C. Lee (Ed.), Counseling for social
justice (2nd ed., pp. 51–74). Alexandria: American Counseling Association.
Nagalingam, J. (2007). Understanding successful aging: a study of older Indian adults in Singapore. Care
Management Journals, 8, 18–25.
Nagata, D. K. (1991). Transgenerational impact of the Japanese-American internment: Clinical issues in
working with children of former internees. Psychotherapy, 28, 121–128.
Nagata, D. K., & Takeshita, Y. J. (2002). Psychological reactions to redress: diversity among Japanese
Americans interned during World War II. Cultural Diversity & Ethnic Minority Psychology, 8, 41–59.
National Pacific/Asian Resource Center on Aging. (1989). Focus groups implementation guidelines. Seattle:
Author.
National Wellness Institute (2009). Six dimensional model of wellness. Retrieved March 3, 2010 from http://
www.nationalwellness.org/index.php?id_tier=2&id_c=25
Nelson, T. D. (2002). Ageism: Stereotyping and prejudice against older persons. Cambridge: MIT.
Neugarten, B., Havighurst, R. J., & Tobin, S. S. (1968). Personality and patterns of aging. In B. L. Neugarten
(Ed.), Middle age and aging (pp. 1761–172). Chicago: University of Chicago Press.
Nyunt, M. S., Fones, C., Niti, M., & Ng, T. P. (2009). Criterion-based validity and reliability of the Geriatric
Depression Screening Scale (GDS-15) in a large validation sample of community-living Asian older
adults. Aging & Mental Health, 13, 376–382.
Pargament, K. I. (1999). The psychology of religion and spirituality? Yes and no. The International Journal
for the Psychology of Religion, 9, 3–16.
Phelan, E. A., Anderson, L. A., LaCroix, A. Z., & Larson, E. B. (2004). Older adults’ views of “successful
aging”: how do they compare with researcher’s Definitions? Journal of the American Geriatric Society,
52, 211–216.
Reichstadt, J., Depp, C. A., Palinkas, L. A., Folsom, D. P., & Jeste, D. V. (2007). Building blocks of
successful aging: a focus group study of older adults’ perceived contributors to successful aging. The
American Journal of Geriatric Psychiatry, 15, 194–201.
Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The Gerontologist, 37, 433–440.
Seeman, T. E., Charpentier, P. A., Berkman, L. F., Tinetti, M. E., Guralnik, J. M., & Albert, M. (1994).
Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur Studies of
Successful Aging. Journal of Gerontology, 49, M97–M108.
Sheik, J. J., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development
of a shorter version. Clinical Gerontologist, 5, 165–273.
Strauss, A., & Corbin, J. (1990). Basics of qualitative research: grounded theory procedures and techniques.
London: Sage.
Suinn, R. M. (1998). Measurement of acculturation in Asian Americans. Asian American and Pacific
Islander Journal of Health, 6, 7–12.
Thomas, L. E., & Chambers, K. O. (1989). ‘Successful aging’ among elderly men in England and India: A
phenomenological comparison. In T. L. Eugene (Ed.), Research on adulthood and aging: The human
science approach (pp. 183–203). Albany: State University of New York Press.
278 J Cross Cult Gerontol (2011) 26:261–278

Tomine, S. I. (1991). Counseling Japanese Americans: From internment to preparation. In C. C. Lee & B. L.
Richardson (Eds.), Multicultural issues in counseling: New approaches to diversity (pp. 91–105).
Alexandria: American Association for Counseling and Development.
Unger, J. B., McAvay, G., Bruce, M. L., Berkman, L., & Seeman, T. (1999). Variation in the impact of social
network characteristics on physical functioning in the elderly persons: Macarthur Studies of Successful
Aging. Journal of Gerontology, 54, S245–S251.
Von Faber, M., Bootsma-van der Wiel, A., van Exel, E., Gussekloo, J., Laggay, A. M., van Dongen, E., et al.
(2001). Successful aging in the oldest old: who can be characterized as successfully aged? Archival of
Internal Medicine, 161, 2964–2700.
Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., et al. (1983). Development and
validation of geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research,
17, 37–49.
Young, H. M., McCormick, W. C., & Vitaliano, P. (2002). Evolving values in community-based long-term
care services for Japanese Americans. Advances in Nursing Sciences, 25, 40–56.