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The Development and Testing of an Instrument to Measure Successful Aging

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Instrument Development

The Development and Testing of an Instrument to Measure

Successful Aging
Meredith Troutman, PhD, PMHCNS-BC; Mary A. Nies, PhD, RN, FAAN, FAAHB; Sara Small, MSN; and
Amanda Bates, MSN

Abstract
This article reports the development and testing of the Successful Aging Inventory (SAI). Two hundred
participants completed two versions of the SAI, a Likert format and dichotomous format. To test the valid-
ity of the SAI, participants also completed the Life Satisfaction Inventory-A, Purpose in Life Test, Mastery
Scale, and the Center for Epidemiologic Studies Depression Scale. Both versions of the SAI had accept-
able psychometric properties. Principal components analysis resulted in five factors for the Likert version,
accounting for 62.19% of the variance. The SAI shows promise as a measure of successful aging and also
has the potential to be a useful method of tracking older adults’ overall progress and improvements in
response to health promotion strategies. The next step is to evaluate its sensitivity and appropriateness
for use with ethnic and racial minority older adults, and those with more varied health status.

Over the past 15 years, successful aging has been de-
fined in research in a variety of ways: as having an accept-
able level of health and adaptation to the aging process
(Bryant, Corbett, & Kutner, 2001); maintaining low risk
of disease and disease-related disability, high mental and
physical function, and active engagement with life (Rowe
& Kahn, 1998); having greater life satisfaction and purpose
in life (Fisher, 1995; Palmore, 1995; Tornstam, 1994); and
experiencing a spiritual and existential quest and personal
growth in wisdom and spirituality (Wong, 2000). Research-
ers have also measured the phenomenon with different in-
struments. While there is overlap, distinctions across many
of the conceptual definitions are often based on where the
emphasis lies (e.g., health versus sustained independence).
The purpose of this article is to present an initial attempt to
develop a tool, the Successful Aging Inventory (SAI), that
measures successful aging based on a theoretical defini-
tion, that includes multiple dimensions of successful aging,
and does not exclude individuals from being considered
successful agers based on physical limitations alone.

Dr. Troutman is Assistant Professor and Gerontology Faculty Affiliate, School of Nursing, Dr. Nies is Carol Grotnes Belk Endowed Chair in Nurs-
ing & Professor and Adjunct Professor, Department of Public Health Sciences, College of Health and Human Services, University of North Carolina
(UNC) at Charlotte, and Ms. Small and Ms. Bates are in private practice, Charlotte, North Carolina.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this
activity. This project was made possible through funding from a UNC Charlotte Junior Faculty Research Grant.
Address correspondence to Meredith Troutman, PhD, PMHCNS-BC, Assistant Professor and Gerontology Faculty Affiliate, CHHS 444B, School
of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223;
e-mail: MeredithTroutman@uncc.edu.
Received: January 14, 2010; Accepted: July 1, 2010; Posted: January 21, 2011
doi:10.3928/19404921-20110106-02

Research in Gerontological Nursing • Vol. 4, No. 3, 2011 221

Troutman et al.

Table 1

Variation and Similarity in Conceptual Definitions for Successful Aging

Study Definitions
Fisher (1995) a
Being involved in addressing current problems of identity and development, and doing so in light of
anticipated future situations, as implicated on the basis of past experience. Successful agers continue
to grow and learn as they use past experiences to cope with the present and set goals for future
development.
Rowe and Kahn (1998) Lower risk of disease/disability, greater mental and physical function, active engagement with life.
Guse and Masesar (1999) a
Being friendly, having a sense of humor, being interested in/willing to help others, adapting to
changes, never giving up or letting things get one down, and enjoying oneself as much as one pos-
sibly can.
Ford et al. (2000) Sustained independence during the 2-year period of observation.
Knight and Riccardelli Health, activity, personal growth, happiness/contentment, independence, relationships, apprecia-
(2003)a tion/value of life, and longevity.
Tate, Lah, and Cuddy Health, satisfying lifestyle, keeping active, having a positive attitude, family, independence, keeping
(2003)a active mentally and spirituality, accepting aging, moderation, diet, keeping active socially, having
goals, financial security, having interests, being useful, contentment, and humor.
Uotinen, Suutma, and “Loosely based” (p. 173) on Rowe and Kahn’s criteria: no illness or injury presenting problems in daily
Ruoppila (2003)a life, no health problems imposing limitations on hobbies, self-rated cognitive functioning better
than satisfactory, good age-comparative functional capacity, and no signs of depression.
Wagnild (2003) Enjoyment of health and vigor of the mind, body, and spirit into middle age and beyond.
Hsu (2005) Absence of disease and physical problems, normal cognition, and good social support.
Litwin (2005) The ability to remain integrated within social life, if it is adult’s wish to do so, while maintaining the
maximum functional capacity possible.
Li et al. (2006) Cognitive function, activities of daily living, mood status, and no disability.
Matsubayashi, Ishine, White participants identified physical health/functioning, mental health, and social health as key
Wada, and Okumiya (2006) attributes of successful aging. Japanese participants reported physical health/functioning, mental
health, social health, and learning new things as key features.
Ko, Berg, Butner, Uchino, Rowe and Kahn’s criteria for successful aging.
and Smith (2007)
Brown, McGuire, and Health, engagement in serious leisure activities, activity involvement, personal growth, close per-
Voelkl (2008)a sonal relationships.
McLaughlin, Connell, Having no major disability, no activity of daily living disability, no more than one difficulty with
Heeringa, Li, and Roberts seven measures of physical functioning, obtaining a median or higher score on tests of cognitive
(2010) functioning, and being “actively engaged.”

a
Study used participants’ self-assessment of successful aging.

Background
There is variation in conceptual definitions of success-
ful aging, although many overlap (Table 1). A clear link
is not always evident between the instruments that have
been used to measure successful aging and theoretical con-
structs. No singular tool multidimensionally assesses suc-
cessful aging with consideration of the older adult’s per-
ception, although an abundance of literature substantiates
the complexity of successful aging (e.g., Bowling & Dieppe,
2005; Boyle, Barnes, Buchman, & Bennett, 2009; Duay &
Bryan, 2006; Ford et al., 2000; Hsu, 2005; Inui, 2003; Mat-
subayashi, Ishine, Wada, & Okumiya, 2006; Phelan, An-
derson, LaCroix, & Larson, 2004; Ryff, 1982; Varshney,
2007). Depp and Jeste (2009) noted the clear evidence of
the indistinctness surrounding the meaning of successful
aging; their literature search of studies that included an
operationalized definition of successful aging identified 28
studies with 29 different definitions.
Various studies have looked at different factors in suc-
cessful aging, including socioeconomic class, health and

222 Copyright © SLACK Incorporated


well-being, lifestyle, spirituality, and interpersonal relation-
ships. However, administering multiple instruments to as-
sess each such variable is problematic because older adults
fatigue easily and may have sensory impairments that pose
challenges to completing lengthy paperwork. Further, as-
sessing successful aging via a battery of instruments may
only be feasible for the healthiest of older adults and not
those most in need of assessment and intervention—peo-
ple who are not aging well. Instruments frequently used
to measure successful aging are lengthy, require a literacy
level above that of some older adults, and have confusing
formats. In addition, few instruments have been designed
specifically to measure responses from older adults them-
selves (Burnside, Preski, & Hertz, 1998).
The literature on successful aging suggests that assessing
older adults’ perspectives on their aging (Glass, 2003; Phel-
an & Larson, 2002) and taking into consideration multiple
health domains is important to understand the phenom-
enon (Table 1). Thus, there is a need for instruments specifi-
cally designed for older adults. In response to these issues,
the first author (M.T.) developed an instrument intended to
capture successful aging from the perspective of older adults
(only two of the 28 studies reviewed by Depp and Jeste, 2009,
assessed self-rated successful aging), while considering vari-
ous dimensions shown to be vital to successful aging: func-
tional performance (Depp & Jeste, 2009), personality (Depp
& Jeste, 2009), spirituality (Sadler & Biggs, 2006; Wong,
2000), gerotranscendence (Tornstam, 1994, 1997), and life
satisfaction and purpose in life (Depp & Jeste, 2009; Wong,
2000). The instrument was derived within the context of a
mid-range theory of successful aging.
Conceptual Framework
The conceptual definition of successful aging resulted
from a concept analysis (Flood, 2002) that used Walker
and Avant’s (1995) framework. Nursing and non-nursing
literature (e.g., medicine, psychology, sociology) was ex-
tensively reviewed to construct the conceptual definition
and identify key attributes and empirical referents. Suc-
cessful aging is defined as an individual’s perception of
favorable adaptation to the cumulative physiological and
functional alterations associated with the passage of time,
while experiencing spiritual connectedness and a sense of
meaning and purpose in life (Flood, 2002).
Subsequently, the first author (formerly Flood, 2006)
developed a mid-range theory of successful aging. The
theory was derived directly from an extensive and ongoing
review of nursing, medical, gerontological, psychological,
and sociological research and theoretical literature that
Research in Gerontological Nursing • Vol. 4, No. 3, 2011
Measuring Successful Aging
occurred over a 5-year period and included classic works
(e.g., Rowe & Kahn, 1998) from further back. Major find-
ings from the literature were synthesized and organized ac-
cording to their key characteristics. Five areas of focus in
the literature that were linked with “successful” or “healthy”
aging or “well-being” of older adults were identified: physi-
cal status and mobility, mental/personality characteristics,
spirituality, gerotranscendence, and purposefulness/life
satisfaction. These areas were named accordingly and com-
prised major dimensions of the theory.
The major dimensions of the theory of successful aging,
derived from the literature, are thus named functional per-
formance mechanisms, intrapsychic factors, spirituality,
gerotranscendence, and purposefulness/life satisfaction.
The central assumption is that adaptation is essential for
successful aging, and effective use of coping mechanisms
allows one to age successfully. Coping mechanisms that fa-
cilitate successful aging are control processes in one of four
dimensions (Flood, 2002):
l Functional performance mechanisms (use of conscious
awareness and choice as an adaptive response to cumu-
lative physiological and physical losses due to aging).
l Intrapsychic factors (enduring character features that
enhance the ability to adapt to change and problem
solve).
l Spirituality (personal views and behaviors expressing re-
latedness to something greater than oneself).
l Gerotranscendence (a shift in metaperspective, from a
materialistic and rationalistic perspective to a more ma-
ture and existential one) (Tornstam, 1994).
Effective use of these coping mechanisms, which are
interrelated, increases the likelihood of aging successfully.
This theory is similar to Baltes and Baltes’ (1990) selection,
optimization, and compensation model, which focuses
on understanding the personal cognitive strategies older
people themselves use to age successfully (Sadler & Biggs,
2006). Research has demonstrated support for the concep-
tualization of successful aging in the theory of successful
aging (Cozort, 2008; Flood, 2006; Flood & Scharer, 2006;
McCarthy, 2009).
The first author compiled a list of instruments that had
been used to measure successful aging (or healthy aging
or well-being) in the previous studies and identified areas
that had not been addressed (e.g., “A relationship with God
or some higher power is important to me.”) but had been
described in the literature as relevant to successful aging.
These instruments were carefully reviewed by the authors.
Questions that appeared repeatedly and for which there
was recurring literature support in relation to successful
223
Troutman et al.

Table 2

SAI Item Content and Theoretical Dimensions Represented

Item Theoretical Dimension
1. I manage to do the things that I need to do to take care of my home and Functional performance mechanisms
to take care of myself (eating, bathing, and dressing).
2. I have been able to cope with the changes that have occurred to my Functional performance mechanisms, Intrapsychic
body as I have aged. factors
3. I look forward to the future. Intrapsychic factors
4. I feel able to deal with my own aging. Intrapsychic factors
5. I feel able to cope with life events. Intrapsychic factors
6. I can come up with solutions to problems. Intrapsychic factors
7. I am good at thinking of new ways to solve problems. Intrapsychic factors
8. I enjoy doing creative new things or making things. Intrapsychic factors
9. I am in a positive, pleasant mood. Intrapsychic factors
10. I think of my loved ones who have passed away and feel close to them. Gerotranscendence
11. I spend time in prayer or doing some kind of religious activity. Spirituality
12. As I have aged, the way I think of the world has changed. Gerotranscendence
13. I would rather have a few close friends than many casual ones. Gerotranscendence
14. Sometimes there can be two right answers to a problem or situation. Gerotranscendence
15. A relationship with God or some higher power is important to me. Spirituality
16. I feel interest in/concern for the next generation. Gerotranscendence
17. My life is meaningful. Gerotranscendence, Purposefulness/life satisfaction
18. I am overall satisfied with my life right now. Gerotranscendence, Purposefulness/life satisfaction
19. I feel that I serve a purpose in this world. Gerotranscendence, Purposefulness/life satisfaction
20. Being the age that I am now is as good or better than I thought it Gerotranscendence
would be.

©2010, M. Troutman. Used with permission.

Note. Dichotomous-format responses for each item are yes/no; Likert-format responses are hardly ever/strongly disagree, sometimes/somewhat disagree, about half the time/neither
agree nor disagree, most of the time/somewhat agree, and almost always/strongly agree.
SAI = Successful Aging Inventory.

aging were noted. For example, “I am overall satisfied with
my life right now” is indicative of life satisfaction, which
has been frequently linked with successful aging (Baltes &
Mayer, 1999; Barrett & Murk, 2009; Fisher, 1995; Meeks
& Murrell, 2001; Neugarten, Havighurst, & Tobin, 1961;
Palmore, 1995; Vaillant & Mukamal, 2001). “I often think
of my loved ones who have passed away and feel close to
them” demonstrates gerotranscendence, which is hypoth-
esized as a precursor to successful aging (Tornstam, 2005)
and is associated with life satisfaction (Ahmadi Lewin,
2000; Cozort, 2008; Tornstam, 2005).
The first author developed a set of questions that cap-
tured the five major areas of focus. The process of con-
structing SAI items involved several iterations; statements
were written, revised, and some were deleted. Twenty final
items were derived from the theory and literature on which
it was based and then formatted as brief statements (Table
2). SAI item derivation was also influenced by the first au-
thor’s previous research experiences, in which older adult
participants often offered their opinions on “what should
be on this test” as they completed instruments such as the
Life Satisfaction Inventory-A (LSI-A). Several senior nurse
researchers reviewed the items for content validity, and, to
assess face validity, participants in this study were asked
to provide any comments or suggestions about whether or
not the SAI seemed to capture what they understood suc-
cessful aging to be. Both groups indicated that either type
of validity appeared to be present.
The SAI items attempted to capture each of the dimen-
sions of the successful aging theory. Some items contain

224 Copyright © SLACK Incorporated


overlapping concepts from the dimensions. For example,
“I have been able to cope with the changes that have oc-
curred to my body as I have aged” is indicative of coping
(intrapsychic factors) and age-related physical changes
(functional performance mechanisms).
Both a dichotomous (yes/no) and Likert-format (hard-
ly ever/strongly disagree, sometimes/somewhat disagree,
about half the time/neither agree nor disagree, most of the
time/somewhat agree, almost always/strongly agree) ver-
sions were constructed. Both versions were formatted to
be reader friendly for older adults: A large font was used,
content was placed in a table with clearly defined borders,
and item boxes were shaded to help differentiate the vari-
ous items. Reading levels were evaluated for both versions;
the dichotomous version had a 5.8 grade reading level, and
the Likert version had a 5.9 grade reading level.
Description and Scoring of Instrument
Both versions of the SAI were composed of 20 brief,
positively worded statements expressing single ideas or be-
haviors suggestive of successful aging. Respondents were
asked to indicate the extent to which they agreed with a
statement or that the statement applied to them. Dichoto-
mous items were scored 0 and 1, with higher scores repre-
senting affirmative responses. The range of possible scores
was 0 to 20. Items from the Likert version were scored 0
to 4, with higher scores corresponding to more frequent/
stronger positive responses. Thus, total scores could range
from 0 to 80.
Method
Sample
Two hundred community-dwelling older adults partici-
pated in a study designed to determine the psychometric
properties of the SAI. Institutional Review Board approval
was obtained prior to beginning the study. Informed con-
sent was obtained prior to participation. Participants were
recruited from local senior centers, health fairs, neighbor-
hoods, and assisted living facilities. They were required to
be 65 and older, able to speak English, and free of cognitive
impairment.
The animal fluency test (Benton, Hamsher, & Sivan,
1994) was administered to check cognitive status before
the older adults completed any questionnaires. In this test,
individuals are asked to identify all of the animals they can
in 60 seconds. Fewer than 12 animals is highly suggestive
of cognitive impairment, and 12 to 15 animals may be in-
dicative of mild cognitive impairment. The animal fluency
test discriminates individuals with dementia from those
Research in Gerontological Nursing • Vol. 4, No. 3, 2011
Measuring Successful Aging
without dementia with similar degrees of sensitivity and
specificity as the Mini-Mental State Examination (Kilada
et al., 2005). This kind of naming task is associated with
executive, linguistic, and semantic components (Lezak,
Howieson, & Loring, 2004). The intent was to screen for
participants who would be able to understand the battery
of instruments, while being as inclusive as possible. After
screening, no participants were excluded on the basis of
cognitive impairment.
Procedure
Demographic information was collected, and then the
SAI, LSI-A, Purpose in Life (PIL) test, Mastery Scale (MS),
and Center for Epidemiologic Studies Depression Scale
(CES-D) were administered. Members of the research
team read the forms to anyone requiring reading assis-
tance. Each participant was provided a $5 food coupon
or $5 cash as a token of appreciation for completing the
questionnaires.
Reliability
Cronbach’s alpha coefficient is an important measure
of the internal consistency reliability of a psychometric in-
strument and is considered an unbiased estimator. McCar-
thy (2009) observed a Cronbach’s alpha coefficient of 0.82
when she administered the SAI in a sample of 112 residents
of a continuing care retirement community. Cozort (2008)
reported a Cronbach’s alpha coefficient of 0.91 when the
SAI was administered to 123 residents of an independent
living facility.
Validity
The researchers provided participants the opportunity
to write in any comments about whether the SAI seemed to
adequately capture the essence of successful aging. Partici-
pants were also encouraged to offer any verbal comments.
Participants generally believed the instrument assessed
what made sense to them as successful aging. None identi-
fied any SAI items that did not make sense or seemed out
of place. Therefore, face validity was deemed adequate.
Life satisfaction has been identified as an indicator of
successful aging (Barrett & Murk, 2006; Fisher, 1995; Havi-
ghurst, 1961). Satisfaction with one’s life has been the most
commonly proposed definition of successful aging and is
also the most commonly investigated (Bowling & Dieppe,
2005). Purpose in life has also been recognized as a main
constituent of successful aging (Bowling & Dieppe, 2005;
Boyle et al., 2009; Fisher, 1995; Reichstadt, Depp, Palinkas,
Folsom, & Jeste, 2007). Therefore, measures of these con-
225
Troutman et al.
structs were selected for the purpose of assessing validity.
Although a number of other constructs are relevant to suc-
cessful aging (e.g., functional ability, social support), these
two were chosen because they are subjective assessments
and not reliant on physical abilities or social/material re-
sources. The intent was to produce a more inclusive measure
of successful aging and avoid the notion of some bench-
mark being necessary to age successfully. Therefore, the
LSI-A (Neugarten et al., 1961) and PIL test (Crumbaugh &
Maholick, 1969) were used to assess convergent validity.
The range of possible scores on the LSI-A is 0 to 20;
higher scores reflect greater life satisfaction. Sample items
are “As I look back on my life, I am fairly well satisfied,” and
“I’ve gotten pretty much what I expected out of life.” LSI-
A content validity is supported by items based on repeated
interviews with people ages 50 to 90 about life patterns, at-
titudes, daily activities, values, social interactions, and other
concerns (American Thoracic Society, 1999). The LSI-A has
interrater reliability of 0.78 (Neugarten et al., 1961). Studies
using the LSI-A with older adults have produced statistical-
ly sound and theoretically meaningful results (Chokkana-
than & Lee, 2006; Xavier et al., 2002). Construct validity is
evidenced by correlations with the Life Satisfaction Rating
Scale (American Thoracic Society, 1999).
The PIL is a 20-item, 7-point Likert scale that measures
the degree to which a person experiences a sense of mean-
ing and purpose in life (Crumbaugh, 1968). Items include
“In life I have very clear goals and aims” and “My personal
existence is very purposeful and meaningful.” The range of
possible scores is 0 to 120, and higher scores indicate great-
er purposefulness. The PIL has been used with older adults
(Ebersole & DePaola, 1987, 1989; Gerwood, LeBlanc, &
Piazza, 1998). Crumbaugh (1968) reported a Pearson’s r of
0.995 between two forms of the PIL test when adminis-
tered to the same sample and found support for construct
validity.
The MS (Pearlin & Schooler, 1978 ) is a 7-item Likert
format scale that measures personal control. This instru-
ment was administered to assess for correlations with SAI
scores based on one proposition of the theory of successful
aging (Flood, 2006)—that high levels of personal control
contribute to successful aging. Items include “I have little
control over the things that happen to me” and “I can do
just about anything I really set my mind to do.” MS items
are answered on a 4-point scale (strongly agree, agree, dis-
agree, strongly disagree). The range of possible scores is 7 to
28. The scale has been shown to exhibit reasonable inter-
nal reliability (Seeman, 1991) and good construct validity
(Pearlin, Lieberman, Menaghan, & Mullan, 1981).
226
The CES-D (Radloff, 1977) was used to assess discrimi-
nant validity. On the basis of the theory of successful aging,
one would not be expected to have depressive symptoms if
one is effectively using intrapsychic factors (e.g., creativity,
low levels of negative affectivity, personal control) as cop-
ing mechanisms. Therefore, a negative correlation would
be expected between the CES-D and SAI. The CES-D is
a 20-item Likert scale composed of statements such as “I
was bothered by things that don’t usually bother me” and
“I did not feel like eating, my appetite was poor.” Partici-
pants respond according to how often they have felt this
way during the past week, from rarely or none of the time to
most or all of the time. Internal reliability is demonstrated
by Cronbach’s alpha coefficients of 0.87 to 0.89 (Radloff,
1977). Correlations with the Hamilton Rating Scale for
Depression and the Raskin Depression Rating Scale were
good after 4 weeks of treatment (r = 0.69 and r = 0.75; Ra-
dloff, 1977). The CES-D has been used with older adult
samples (Pennix, Deeg, van Eijk, Beekman, & Guralnik,
2000; Pennix et al., 1998).
Results
Sample
The study sample was composed primarily of White
women (Table 3). Ages ranged from 52 to 100 (one par-
ticipant wrote in her age as 52 after being screened), with
a mean age of 75.01 (SD = 8.24 years). Educational attain-
ment ranged from second grade to 5 years of post-second-
ary education, with a mean educational level of 12.87 years
(SD = 2.82). (In keeping with the idea of inclusiveness,
participants were not screened for educational level prior
to giving informed consent. Therefore, some people who
did not have the SAI reading level participated.) Nineteen
percent of participants (n = 38) had less than a high school
education, while 29% (n = 58) had completed high school,
and 48% (n = 96) had 1 or more years of college education.
Just under half of the participants (n = 91, 45.5%) were
married, 34.5% (n = 69) were widowed, 13% (n = 26) were
divorced, 5% (n = 10) were single, 1.5% (n = 3) did not re-
port, and 0.5% (n = 1) had a significant other/companion.
Most participants (n = 133, 66.5%) reported an income
that allowed them to live comfortably, although 20.5% (n =
41) believed they could barely get by; 9.5% (n = 19) lived in
some luxury, and 3.5% (n = 7) provided no response.
Participants were asked whether they had various
chronic conditions common in older adults; Table 4 re-
flects the frequencies of these conditions. Thirty-four par-
ticipants (17%) were free of any chronic health condition.
The modal number of health conditions was 1, occurring
Copyright © SLACK Incorporated
 Measuring Successful Aging

in 39% (n = 78) of participants. One quarter (n = 51) of the

sample had two concurrent medical conditions, 7.5% (n = Table 3
15) had three, and 6% (n = 12) reported four concurrent Characteristics of the Sample
medical conditions, while the remainder (n = 10, 5%) had (N = 200)
five or more. Variable n (%)
Most participants (n = 116, 58%) rated their health as
Race
good. Twelve percent (n = 24) said their health was excel-
White 179 (89.5)
lent, and the remainder rated their health as either fair (n =
Black 15 (7.5)
48, 24%) or poor (n = 9, 4.5%). The majority of the sample
Hispanic 3 (1.5)
(n = 127, 63.5%) reported exercising regularly.
Other 2 (1)

Scale Description Missing 1 (0.5)

Descriptive statistics were calculated for both versions Gender
of the SAI, and each version was examined for variability. Women 133 (66.5)
Survey packets were mixed so that participants randomly Men 67 (33.5)
received either the Likert or dichotomous version of the
SAI. No statistically significant differences were found in
SAI scores for participants with less than a sixth-grade
education and those with educational levels of sixth grade Table 4
or higher. One hundred six participants completed the Lik-
Health Conditions of the Sample
ert-format SAI (one participant did not fully complete it).
(N = 200)
Their scores ranged from 23 to 80, with a mean of 65.26
(SD = 10.49), a median of 67, and a mode of 74. The SAI Health Condition n (%)
scores were negatively skewed. Ninety-three participants Arthritis/orthopedic condition 73 (36.5)
completed the dichotomous-format SAI. These scores Cardiovascular disease 67 (33.5)
ranged from 14 to 20, with a mean score of 18.33 (SD = Diabetes 42 (21)
1.68) and both a median and mode of 19. Scores for the Cancer 22 (11)
dichotomous version were also negatively skewed. Respiratory condition 22 (11)
Depression 21 (10.5)
Scale Reliability Anxiety 18 (9)
For the Likert-format SAI, the Cronbach’s alpha coef- Stroke 10 (5)
ficient was 0.86. For the dichotomous version, the Kud-
er-Richardson coefficient was 0.67. Thus, participant re-
sponses on the Likert SAI demonstrated more internal to determine the appropriate number of components to
consistency. Many of the participants were individuals who retain: eigenvalue, variance, and scree plot. These criteria
sporadically attended the senior center or participated in indicated that five components should be retained. The five
the monthly senior lunch meetings. For this reason, the components accounted for 62.19% of the variance.
research team could not be assured of their ability to col- Some researchers use factor matrix loading cut-off
lect follow-up data on all (or a majority of) participants at points as low as 0.35, while others use cut-off points as high
a 2- or 4-week time point. Thus, test-retest reliability was as 0.55 (Munro & Page, 1993). In this case, scale items were
not assessed. determined as belonging to one of the five components on
the basis of a factor loading cut-off point of 0.4. The per-
Scale Dimensionality centages of variance explained by each component were as
Factor analysis was conducted to determine what struc- follows:
ture existed for the Likert-format SAI items, since this ver- l Intrapsychic and functional performance coping mech-

sion of the instrument had more desirable reliability and anisms (Items 1 through 9): 32.29%.
validity. Principal components analysis for the Likert ver- l Existential being (Items 16 through 20): 10.52%.

sion was conducted using a varimax rotation. Three crite- l Introspective gerotranscendence (Items 12 through 14):

ria suggested by Mertler and Vannatta (2005) were used 7.04%.

Research in Gerontological Nursing • Vol. 4, No. 3, 2011 227

Troutman et al.

Table 5

Correlation Matrix for SAI and Study Variables

Measure SAI Score LSI-A Score PIL Score MS Score CES-D Score
SAI score
Pearson correlation 1 0.112 0.512** 0.395** –0.338**
p Value 0.253 0.000 0.000 0.001
n 106 106 95 95 87
LSI-A score
Pearson correlation 0.112 1 0.437** 0.228** –0.404**
p Value 0.253 0.000 0.002 0.000
n 106 197 185 184 148
PIL score
Pearson correlation 0.512** 0.437** 1 0.470** –0.338**
p Value 0.000 0.000 0.000 0.000
n 95 185 188 187 150
MS score
Pearson correlation 0.395** 0.228** 0.470** 1 –0.346**
p Value 0.000 0.002 0.000 0.000
n 95 184 187 187 150
CES-D score
Pearson correlation –0.338** –0.404** –0.338** –0.346** 1
p Value 0.001 0.000 0.000 0.000
n 87 148 150 150 150

Note. SAI = Successful Aging Inventory; LSI-A = Life Satisfaction Inventory-A; PIL = Purpose in Life test; MS = Mastery Scale; CES-D = Center for Epidemiologic Studies Depres-
sion Scale.
**
Correlation is significant at the 0.01 level (two-tailed).

l Spirituality (Items 11 and 15): 6.35%.
l Retrospective gerotranscendence (Item 10): 5.99%.
The items intended to represent the constructs in the
theory of successful aging did not load cleanly onto factors
according to theory constructs (functional performance
mechanisms, intrapsychic factors, spirituality, gerotrans-
cendence, purpose in life/life satisfaction), as was antici-
pated (See Table 2 for listing of dimensions from which
each item was derived).
Scale Validity
To assess convergent and discriminant validity, Pearson
correlations were calculated to examine the relationships be-
tween scores on the two SAI versions and the LSI-A, PIL, MS,
and CES-D. Mean scores on these instruments were as fol-
lows: LSI-A, 13.72 (SD = 4.73); PIL, 84.32 (SD = 14.64); MS,
19.22 (SD = 2.67); and CES-D, 10.02 (SD = 7.81). Positive cor-
relations between the SAI and the LSI-A, the SAI and the PIL,
and the SAI and the MS were expected. For the Likert-format
SAI, no significant correlation was found with the LSI-A (Ta-
ble 5). However, significant correlations were found with the
PIL, MS, and the CES-D. Interestingly, for the dichotomous
SAI, a significant, albeit slight correlation was found with the
LSI-A (p < 0.012, r = 0.263), and a significant correlation also
existed with the PIL (p < 0.000, r = 0.361).
Convergent validity inferences for the Likert SAI can
be made from the moderate correlations with the PIL and
MS; discriminant validity was demonstrated by significant
negative correlations with the CES-D. Convergent validity
for the dichotomous SAI can be inferred from correlations
with the LSI-A and PIL, although these were less strong
than those of the Likert-format version.
Discussion
The sample was composed primarily of White women
whose education was comparable to other older Ameri-

228 Copyright © SLACK Incorporated


cans, 76% of whom have at least a high school diploma
(Federal Interagency Forum on Aging-Related Statistics,
2008). The sample’s self-reported health was also compa-
rable to that of White older Americans, 76% of whom re-
port good to excellent health (Federal Interagency Forum
on Aging-Related Statistics, 2008). The sample reported a
slightly lower frequency of cardiovascular disease than na-
tional means for older adults—52% and 54% for men and
women, respectively—and lower frequencies of arthritis
than national standards for this age group (43% and 54%
for men and women) (Federal Interagency Forum on Ag-
ing-Related Statistics, 2008). Likewise, fewer had cancer,
stroke, and depression (Federal Interagency Forum on Ag-
ing-Related Statistics, 2008). However, the sample had a
higher frequency of diabetes than older adults nationwide
(19% and 17% for men and women) (Federal Interagen-
cy Forum on Aging-Related Statistics, 2008). Thus, the
sample was in somewhat better health than older adults
nationwide; however, they were both community dwell-
ing and ambulatory, so these findings might be expected.
Marital status findings suggest the sample may have had
less social support than the average older adult; nationally,
60% to 78% of older adults in the 65-74, 75-84, and 85 and
older age ranges are married (Federal Interagency Forum
on Aging-Related Statistics, 2008), while only 45% of par-
ticipants in this study were married.
The sample tended to score above the scale norms for
the LSI-A, 12.5 (Neugarten et al., 1961); less than those for
the PIL, 106.3 to 113.16 (Crumbaugh & Maholick, 1969;
Krawczynski & Olszewski, 2000); and higher than some
reported for the MS, 12.0 to 12.6 (Graff et al., 2007), 12.8 to
14.3 (Bohlmeijer, Valenkamp, Westerhof, Smit, & Cuijpers,
2005), but less than others, 21.8 (Jang, Haley, Small, &
Mortimer, 2002). The sample generally had little depressive
symptomology, with a mean CES-D score of 10.02 (scores
ranging from 0 to 15 indicate absence of depression; Radl-
off, 1977). They tended to score on the upper end for either
version of the SAI. This finding is interesting, since, on av-
erage, they did not score on the upper end of the possible
range of LSI-A and PIL scores.
The SAI, and in particular the Likert version, shows
promise as a single instrument measuring successful ag-
ing. There were few instances of omitted or double-marked
responses in this study. No participants reported or dem-
onstrated difficulty completing either version of the SAI,
and several commented that they found the scale easy to
understand and complete.
The SAI captures vital constructs of successful aging
that the LSI-A and PIL do not, although it does contain
Research in Gerontological Nursing • Vol. 4, No. 3, 2011
Measuring Successful Aging
three items that address meaning, purpose, and life sat-
isfaction. Like many of the samples that have been used
in research on successful aging, this sample was primarily
White, educated, and financially stable. Their mean scores
on life satisfaction, purpose in life, mastery, and depres-
sive symptoms were within expected ranges, based on the
norms for these scales.
Limitations
We recognize that the process used for item genera-
tion—a comprehensive review of the successful aging lit-
erature and synthesis of key themes, from which a some-
what narrowly delineated set of items was derived and then
subject to approval by content experts and senior research-
ers for face and content validity—is a deviation from the
traditional method of generating a large pool of items that
exceeds the desired amount. Initially, the number of items
written should be two to four times the desired amount
(Marsh & Yeung, 1997). However, another statistical rule
of thumb says that in the beginning stages of test construc-
tion, one needs 5 research participants per item on the test
(Schutz, as cited by Giacobbi, n.d.); we did adhere to this
tenet.
Our intent was to develop an instrument derived from
the theory of successful aging (Flood, 2006), as a means of
measuring successful aging, according to this conceptual-
ization of it. We constructed a reasonable number of items
that could feasibly be administered to older adults, along
with a selection of other instruments comprising the test
battery. We sought to develop a psychometrically sound
instrument that could be tested without burdening partici-
pants. Nonetheless, the authors acknowledge the nonstan-
dard method of item selection as a potential limitation.
Therefore, one implication is the need for research to
refine the SAI and make revisions, as indicated. Indeed, the
first author’s research currently underway involves collec-
tion of focus group data from older adults describing their
understanding of successful aging. These findings will be
used to further inform the theory of successful aging and
identify the need to include or eliminate additional items
from the SAI.
Although the questionnaire format is an accepted ap-
proach for gathering information, it cannot fully capture
the wide range of individuals’ thoughts, feelings, and ideas.
It is possible the SAI does not include some aspects of suc-
cessful aging considered important by older adults. Simi-
larly, it is possible that some elements of successful aging
were “missed”; despite the intention to construct items that
convey a single idea, some SAI items (e.g., “I think of my
229
Troutman et al.
loved ones who have passed away and feel close to them”)
might need to be reworded, as participants could think of
deceased loved ones but not feel close to them. Rewrit-
ing this item to more clearly communicate the intended
idea (e.g., “When I think of loved ones who have passed
away, I feel close to them”), might evoke more affirmative
responses.
Conclusion and Implications
On the basis of initial testing, the Likert-format SAI ap-
pears suitable for measuring successful aging; it captures
intrapsychic and functional performance, existential, spiri-
tual, and gerotranscendental elements of the phenomenon.
This study was a beginning step in the development of an
instrument to measure a theoretically derived definition of
successful aging, which accounts for multiple dimensions
of the aging process from the older adult’s perspective.
While the SAI seems promising as a measure of successful
aging, further work remains.
Additional research to assess validity and reliability of
the SAI will allow researchers greater confidence in using
it. Focus groups could help obtain a deeper understand-
ing of older adults’ perceptions of what successful aging is
and to assess for face validity of the SAI. Future research
will include administering the SAI to more diverse sam-
ples. In light of the increasing diversity in the United States
(Bomar & Glenn, 2004; Wilmoth & Longino, 2006), it is
essential that the instrument’s utility be evaluated in varied
ethnic and racial groups. For example, a study of the SAI’s
psychometric properties with Black older adults has been
conducted (Troutman, Nies, & Mavellia, 2011).
Similarly, it would be beneficial to assess use of the in-
strument with older adults who have depression, to more
fully assess discriminant validity. It will be particularly
important to be able to evaluate successful aging in those
who are likely to have barriers to well-being in old age and
who may be less likely to age successfully. Thus, adminis-
tering the SAI to older adults with greater levels of func-
tional and physical limitations (e.g., those who require
skilled nursing care in nursing homes), fewer economic
resources, and less educational attainment would be valu-
able, as variation would be expected in these subpopula-
tions. Validity of the SAI could also be better understood
if the SAI were measured concurrently with instruments
that measure functional status and social support, vari-
ables that have been associated with successful aging
(Gow, Pattie, Whiteman, Whalley, & Dreary, 2007; Nus-
selder & Peeters, 2006; Rowe & Kahn, 1998; Willcox, Will-
cox, Shimajiri, Kurechi, & Suzuki, 2007).
230
Administration of the SAI in a different setting, such as
a senior center where older adults regularly attend, would
afford the opportunity to determine test-retest reliability.
It is vital to gain insight into this form of reliability, as the
long-term goal of this research is to implement interven-
tions aimed at promoting successful aging in vulnerable
older adults.
Identification of those who are not aging successfully can
provide a foundation for developing strategies to help such
individuals more effectively adapt to age-related physiologi-
cal, cognitive, emotional, and functional changes, as well as
experience spiritual connectedness and a sense of meaning
and purpose in life during older adulthood. Intervention
studies could ultimately strengthen nurses’ ability to facili-
tate successful aging through health promotion strategies.
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