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Running head: UNDERSTANDING THE RELATIONSHIP BETWEEN QUALITY OF

LIFE & SUCCESSFUL AGING

Bhumika

University Roll No: 20024501058

Department of Psychology, University of Delhi

(CBCS) B.A.(PROG)

DSC-PSY-1Aa: LIFESPAN DEVELOPMENT

Professor Ms. Indrani Regon

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Abstract

The World Health Organisation defines Quality of Life as an individual's perception of

their position in life in the context of the culture and value systems in which they live and in

relation to their goals, expectations, standards and concerns. According to the classic concepts

of Rowe and Kahn, successful aging is defined as high physical, psychological, and social

functioning in old age without major diseases. The present study aims to find the relationship

between quality of life and successful aging in older adults using the Quality of Life Inventory

QOLD) by Michael B. Erish, and the Successful Ageing Scale(SAS) by Gary T. Reker. The

QOLI has a total of 32 items and 16 areas while the SAS has 14 items and 3 domains. The two

participants (one male and one female) for the study are sampled using purposive sampling

which is a sampling method focusing on very specific characteristics of the units or individuals

that have been chosen, here the specific characteristic for being chosen were being in the age

group of 60+ years and at least year of retirement. Factors that are linked with successful aging

include an active lifestyle, positive coping skills, good social relationships and support, and the

absence of disease. The participant scores for QOLI were average for the male participant and

Low for the female participant.

Keywords: Successful Aging, Quality of Life, Late Adulthood, Life Satisfaction

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The relationship between quality of life and successful aging in older adults

Late Adulthood

Late adulthood is usually considered to be the closing period of life span. It is the later

part of life; the period of life after youth and middle age is usually associated with deterioration.

The concept of late adulthood is one of attention from time immemorial. Plato, the ancient Greek

philosopher, has divided life span into six stages of which the last two constitute late adults viz.

old age (62-79) and the advanced age (80 till death). Some developmentalists distinguish

between the young-old (65 to 74 years of age) and the old-old , or old age (75 years and older)

(Charness & Bosman, 1992). Yet others distinguish the oldest-old (85 years and older) from

younger older adults (65 to 84 years old) (Dunkle, 2009).

Erik Erikson suggests that this is the time it is important to find meaning and satisfaction

in life. Age sixty-five is considered a milestone and the beginning of late adulthood. By this age,

it generally brings about retirement from work, eligibility for Social Security and Medicare

benefits, income tax advantages, reduced fares and admission prices to leisure events, and special

purchase or discount privileges.Senior citizen is a common euphemism for an elderly person and

it implies that the person is retired. Late adulthood is a time of reflection, enjoying friends,

family and grandchildren and maintaining health in preparation for the final years of the lifespan.

During this stage, older adults remain socially active and independent rather than subjecting

themselves to isolation and withdrawal (Berger, 2008). The more aging adults live healthily, the

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more socially active and maintaining family roles there are. It is important to refrain from

stereotypical thought and the negative ageism that can contribute to their premature decline.

The UN suggests that 60+ years may be usually denoted as old age, which is the first

attempt at an international definition of old age. However the WHO has recognized that the

developing world defines old age, not by years, but by new roles, loss of previous roles or

inability to make an active contribution to society. Most of the developed countries set the age of

60 to 65 for retirement and old-age social programs eligibility. However, various countries and

societies reckon the onset of old age as anywhere from the mid-40s to the 70s.

According to the National Institute on Aging (NIA, 2015b), there are 524 million people

over 65 worldwide. This number is expected to increase from 8% to 16% of the global

population by 2050. Between 2010 and 2050, the number of older people in less developed

countries is projected to increase more than 250%, compared with only a 71% increase in

developed countries. Declines in fertility and improvements in longevity account for the

percentage increase for those 65 years and older. In more developed countries, fertility fell below

the replacement rate of two live births per woman by the 1970s, down from nearly three children

per woman around 1950. Fertility rates also fell in many less developed countries from an

average of six children in 1950 to an average of two or three children in 2005. In 2006, fertility

was at or below the two-child replacement level in 44 less developed countries (NIA, 2015d).

An increased interest in successful aging is producing a portrayal of the oldest-old that is

more optimistic than past stereotypes (Dunkle, 2009; Vasunilashorn & Crimmins, 2009).

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Interventions such as cataract surgery and a variety of rehabilitation strategies are improving the

functioning of the oldest-old. And there is cause for optimism in the development of new

regimens of prevention and intervention, such as engaging in regular exercise (Erickson &

others, 2009).

In general, women tend to live longer than men by an average of five years. The

oldest-old today are mostly female, and the majority of these women are widowed and live

alone, if not institutionalized. The majority also are hospitalized at some time in the last years of

life, and the majority die alone in a hospital or institution. Their needs, capacities, and resources

are often different from those of older adults in their sixties and seventies (Scheibe, Freund, &

Baltes, 2007). Despite the negative portrait of the oldest old by Baltes and his colleagues, they

are a heterogeneous, diversified group. In the New England Centenarian Study, 15 percent of the

individuals 100 years and older were living independently at home, 35 percent with a family or

in assisted living, and 50 percent in nursing homes (Perls, 2007).

During late adulthood the skin continues to lose elasticity, reaction time slows further,

and muscle strength diminishes. Hearing and vision so sharp in our twenties decline

significantly; cataracts, or cloudy areas of the eyes that result in vision loss, are frequent. The

other senses, such as taste, touch, and smell. are also less sensitive than they were in earlier

years. The immune system is weakened, and many older people are more susceptible to illness,

cancer, diabetes, and other ailments. Cardiovascular and respiratory problems become more

common in old age. Seniors also experience a decrease in physical mobility and a loss of

balance, which can result in falls and injuries. More than one third of older adults 80 and over

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who live in the community report that their health is excellent or good; 40 percent say that they

have no activity limitation (Suzman & others, 1992). Less than 50 percent of U.S. 85 to 89 year

olds have a disability (Siegler, Bosworth, & Poon, 2003); a substantial subgroup of the oldest old

are robust and active. The oldest old who have aged successfully have often been unnoticed and

unstudied.

Factors Affecting Longevity

Life expectancy is a statistical measure of the average time an organism is expected to

live, based on the year of birth, current age, and other demographic factors including gender. The

most commonly used measure of life expectancy is at birth (LEB). There are great variations in

life expectancy in different parts of the world, mostly due to differences in public health, medical

care, and diet, but also affected by education, economic circumstances, violence, mental health,

and sex.

Life span is the upper boundary of life, the maximum number of years an individual can

live. The maximum life span of human beings is about 120 to 125 years of age. Life expectancy

is the number of years that will probably be lived by the average person born in a particular year.

Differences in life expectancies across countries are due to such factors as health conditions and

medical care throughout the lifespan. Numerous extreme long-livers have been reported in

various mountainous regions, including Georgia, Kashmir, and Vilcabamba. In most Western

countries, including the Scandinavian countries, exceptional lifespans have also been reported.

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Healthy aging and longevity in humans are modulated by a lucky combination of genetic and

non-genetic factors. Family studies demonstrated that about 25 % of the variation in human

longevity is due to genetic factors. The search for the genetic and molecular basis of aging has

led to the identification of genes correlated with the maintenance of the cell and of its basic

metabolism as the main genetic factors affecting the individual variation of the aging phenotype.

In addition, studies on calorie restriction and on the variability of genes associated with

nutrient-sensing signaling, have shown that hypocaloric diet and/or a genetically efficient

metabolism of nutrients, can modulate lifespan by promoting an efficient maintenance of the cell

and of the organism. Recently, epigenetic studies have shown that epigenetic modifications,

modulated by both genetic background and lifestyle, are very sensitive to the aging process and

can either be a biomarker of the quality of aging or influence the rate and the quality of aging.

Today the oldest reported well documented maximum lifespan for females is 121 years

and for males 113 years. Both these persons are still alive. Analyses of reliable cases of

long-livers show that longevity records have been repeatedly broken over past decades. This

suggests that even longer human lifespans may occur in the future. There has been surprisingly

little success in identifying factors associated with extreme longevity. A variety of centenarian

studies have been conducted during the last half century. As reviewed by Segerberg, most of the

earlier studies were based on highly selected samples of individuals, without rigorous validation

of the ages of reputed centenarians.

A Few Specific genetic factors have been found to be associated with extreme longevity.

Takata et al. found a significantly lower frequency of HLA-DRw9 amongst centenarians than in

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an adult control group in Japan, as well as a significantly higher frequency of HLA-DR1. The

HLA-antigens amongst the Japanese centenarians are negatively associated with the presence of

autoimmune diseases in the Japanese population, which suggests that the association with these

genetic markers is mediated through a lower incidence of diseases. More recently, both a French

study and a Finnish study found a low prevalence of the e4 allele of apolipoprotein E amongst

centenarians. The e4 allele has consistently been shown to be a risk factor both for coronary

heart disease and for Alzheimer's dementia. In the French study, it was also found that

centenarians had an increased prevalence of the DDgenotype of angiotensin-converting enzyme

(ACE) compared with adult controls. (Bostock, Soiza, & Whalley, 2009)

The sex difference in longevity also is influenced by biological factors (Guillot, 2009;

Oksuzyan & others, 2008). In virtually all species, females outlive males. Women have more

resistance to infections and degenerative diseases (Candore & others, 2006). For example, the

female’s estrogen production helps to protect her from arteriosclerosis (hardening of the arteries).

And the additional X chromosome that women carry in comparison to men may be associated

with the production of more antibodies to fight off disease. An increasing number of individuals

live to be 100 or older. The search for longevity genes has recently intensified (Concannon &

others, 2009; Hinks & others, 2009). But there are also other factors at work such as family

history, health (weight, diet, smoking, and exercise), education, personality, and lifestyle

(Barbieri & others, 2009).

Physical development in Late Adulthood

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During late adulthood the skin continues to lose elasticity, reaction time slows further,

and muscle strength diminishes. Hearing and vision—so sharp in our twenties—decline

significantly; cataracts, or cloudy areas of the eyes that result in vision loss, are frequent. The

other senses, such as taste, touch, and smell, are also less sensitive than they were in earlier

years. The immune system is weakened, and many older people are more susceptible to illness,

cancer, diabetes, and other ailments. Cardiovascular and respiratory problems become more

common in old age. Seniors also experience a decrease in physical mobility and a loss of

balance, which can result in falls and injuries.

The aging process generally results in changes and lower functioning in the brain, leading

to problems like memory loss and decreased intellectual function. Age is a major risk factor for

most common neurodegenerative diseases, including mild cognitive impairment, Alzheimer's

disease, cerebrovascular disease, Parkinson's disease, and Lou Gehrig's disease.

The Brain: While a great deal of research has focused on diseases of aging, there are only

a few informative studies on the molecular biology of the aging brain. Many molecular changes

are due in part to a reduction in the size of the brain, as well as loss of brain plasticity. Computed

tomography (CT) studies have found that the cerebral ventricles expand as a function of age in a

process known as ventriculomegaly. More recent MRI studies have reported age-related regional

decreases in cerebral volume. The brain begins to lose neurons in later adult years; the loss of

neurons within the cerebral cortex occurs at different rates, with some areas losing neurons more

quickly than others. The frontal lobe (which is responsible for the integration of information,

judgment, and reflective thought) and corpus callosum tend to lose neurons faster than other

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areas, such as the temporal and occipital lobes. The cerebellum, which is responsible for balance

and coordination, eventually loses about 25 percent of its neurons as well.

The Immune System: Decline in immune system functioning with aging is well

documented. Exercise can improve immune system functioning.

Physical Appearance and Movement: Develop wrinkled skin and age spots on the skin.

Get shorter as they age, and their weight often decreases after age 60 because of loss of muscle.

The movement of older adults slows across a wide range of movement tasks.

The Circulatory System and Lungs: Cardiovascular disorders increase in late adulthood.

Consistent high blood pressure should be treated to reduce the risk of stroke, heart attack, and

kidney disease. Lung capacity does drop with age, but older adults can improve lung functioning

with diaphragm. strengthening exercises.

Sexuality: Aging in late adulthood does include some changes in sexual performance,

more for males than females. Nonetheless, there are no known age limits to sexual activity.

Cognitive Development in Late Adulthood

The Sensory Register: Aging may create small decrements in the sensitivity of the

sensory register. And, to the extent that a person has a more difficult time hearing or seeing, that

information will not be stored in memory. This is an important point, because many older people

assume that if they cannot remember something, it is because their memory is poor. In fact, it

may be that the information was never seen or heard.

The Working Memory: Older people have more difficulty using memory strategies to

recall details (Berk, 2007). As we age, the working memory loses some of its capacity. This

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makes it more difficult to concentrate on more than one thing at a time or to remember details of

an event. However, people compensate for this by writing down information and avoiding

situations where there is too much going on at once to focus on a particular cognitive task.

The Long-Term Memory: This type of memory involves the storage of information for

long periods of time. Retrieving such information depends on how well it was learned in the first

place rather than how long it has been stored. If information is stored effectively, an older person

may remember facts, events, names and other types of information stored in long-term memory

throughout life. The memory of adults of all ages seems to be similar when they are asked to

recall names of teachers or classmates. And older adults remember more about their early

adulthood and adolescence than about middle adulthood (Berk, 2007). Older adults retain

semantic memory or the ability to remember vocabulary.

Younger adults rely more on mental rehearsal strategies to store and retrieve information.

Older adults rely more on external cues such as familiarity and context to recall information

(Berk, 2007).

A positive attitude about being able to learn and remember plays an important role in

memory. When people are under stress (perhaps feeling stressed about memory loss), they have a

more difficult time taking in information because they are preoccupied with anxieties. Many of

the laboratory memory tests compare the performance of older and younger adults on timed

memory tests in which older adults do not perform as well. However, few real life situations

require speedy responses to memory tasks. Older adults rely on more meaningful cues to

remember facts and events without any impairment to everyday living.

Education, Work, and Health: Education is positively correlated with scores on

intelligence tests. Older adults may return to education for a number of reasons. Successive

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generations have had work experiences that include a stronger emphasis on cognitively oriented

labor. The increased emphasis on information processing in jobs likely enhances an individual’s

intellectual abilities. Poor health is related to decreased performance on intelligence tests in older

adults. Exercise is linked to higher cognitive functioning in older adults.

Wisdom is the ability to use common sense and good judgment in making decisions. A

wise person is insightful and has knowledge that can be used to overcome obstacles in living.

Does aging bring wisdom? While living longer brings experience, it does not always bring

wisdom. Those who have had experience helping others resolve problems in living and those

who have served in leadership positions seem to have more wisdom. So it is age combined with a

certain type of experience that brings wisdom. However, older adults do have greater emotional

wisdom or the ability to empathize with and understand others.

Problem solving: Tasks that require processing non-meaningful information quickly (a

kind of task that might be part of a laboratory experiment on mental processes) declines with

age. However, real life challenges facing older adults do not rely on speed of processing or

making choices on one’s own. Older adults are able to resolve everyday problems by relying on

input from others such as family and friends. And they are less likely than younger adults to

delay making decisions on important matters such as medical care (Strough et al., 2003; Meegan

& Berg, 2002).

Dementia: Refers to severely impaired judgment, memory or problem-solving ability. It

can occur before old age and is not an inevitable development even among the very old.

Dementia can be caused by numerous diseases and circumstances, all of which result in similar

general symptoms of impaired judgment, etc. Alzheimer’s disease is the most common form of

dementia and is incurable. But there are also non organic causes of dementia that can be

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prevented. Malnutrition, alcoholism, depression, and mixing medications can result in symptoms

of dementia. If these causes are properly identified, they can be treated. Cerebral vascular disease

can also reduce cognitive functioning.

Delirium: A sudden experience of confusion experienced by some older adults. Read the

article and listen to the story, Treating Delirium: An Often Missed Diagnosis, for more

information on treating delirium and the possible links between delirium and Alzheimer’s

Disease.

Use It or Lose It : Researchers are finding that older adults who engage in cognitive

activities, especially challenging ones, have higher cognitive functioning than those who don’t

use their cognitive skills.

Training Cognitive Skills : Two main conclusions can be derived from research on

training cognitive skills in older adults: (1) Training can improve the cognitive skills of many

older adults, and (2) there is some loss in plasticity in late adulthood.

Cognitive Neuroscience and Aging: There has been considerable recent interest in the

cognitive neuroscience of aging that focuses on links among aging, the brain, and cognitive

functioning. This field especially relies on fMRI and PET scans to assess brain functioning while

individuals are engaging in cognitive tasks. One of the most consistent findings in this field is a

decline in the functioning of specific regions in the prefrontal cortex in older adults and links

between this decline and poorer performance on complex reasoning, working memory, and

episodic memory tasks.

Successful Aging

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According to the classic concept of Rowe and Kahn, successful aging is defined as high

physical, psychological, and social functioning in old age without major diseases. Kim and Park

conducted a metaanalysis of the correlates of successful aging and they identified that four

domains describing successful aging were; avoiding disease and disability, having high

cognitive, mental and physical function, being actively engaged in life, and being

psychologically well adapted in later life.

Similarly, in the model of “Aging well” by Fernandez Ballesteros et al. successful aging

is defined by the domains of health and activities of daily living (ADL), physical and cognitive

functioning, social participation and engagement, and also positive affect and control, when the

definition by Baltes et colleagues is also considered. Kok et al. found in their study that many

older adults were aging relatively successfully, but there was a variation between indicators of

characteristics of successful aging, and the combinations of successful indicators varied also

between individuals.

Most definitions of successful aging also include outcomes which can be described as the

operational definitions of the concept. Kleinedam and colleagues have suggested that well

constructed operationalisation of successful aging includes measurements of physiological

health, wellbeing and social engagement, with subjective and objective aspects.

Physical Factors

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Unsurprisingly, a person’s physical health before the age of 50 may be the greatest

determinant to age well. One study determined that the most predictive factor of aging well was

the absence of cigarette and alcohol abuse. Other studies have also identified a lack of substance

abuse as the greatest predictive factor of aging well. A healthy Body Mass Index (between 21

and 29) at the age of 50 is also a predictive factor of successful aging. Moderate support has

been found for exercise as a predictive factor for aging well, along with better self-rated health,

and fewer chronic medical conditions (i.e. arthritis, diabetes, hypertension, etc.) While becoming

sick with certain physical illnesses may be outside of our control, we do have considerable

control over our weight, our level of exercise, and our abuse of cigarettes, alcohol, and

recreational drugs.

Psychological Factors

Recently, there has been an increased interest in the connection between good

psychological health and successful aging. Researchers have begun to focus on the role that

mental health plays in predicting how well people age. Multiple studies have identified

psychological factors as nearly as predictive of successful aging as physical health factors. Low

rates of depression and high rates of resilience are now consistently identified as being as

important as physical health in determining who will age successfully.

People that report lower rates of depression and higher rates of resilience are more likely

to age well. Psychological resiliency is often defined as an individual’s ability to properly adapt

to stress and adversity. Resiliency is demonstrated within individuals who can effectively and

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relatively easily navigate their way around crises and utilize effective methods of coping. Thus, a

person with a high level of resiliency is more likely to have a positive outlook on life and see his

or her life situation and health in a positive light.

In addition to resiliency, other psychological factors contribute to aging successfully.

Research has also found that feeling that one has a purpose in life is an indicator for healthy

aging for several reasons, including its potential for reducing mortality risk. People that have

mature (adaptive) defenses from the age of 20-50 (e.g.. humor, suppression, and anticipation) are

also more likely to age well than those that utilize more immature defenses, like projection and

dissociation. Overall, current research has found that those individuals who are psychologically

healthy and resilient are more likely to age successfully than their peers. While genetic factors

play a role in psychological health, there are therapeutic interventions that have been shown to be

effective in managing depression. Psychotherapy and medication management can help build

resiliency and decrease depressive symptoms.

Social Factors

While physical and psychological factors may be more indicative of aging well than

social factors, there are several social variables that are often cited as helpful in contributing to

aging successfully. The most cited social factor as a predictor of successful aging is a happy

marriage. This social factor has consistently been identified as a predictor of successful aging.

Those with greater social support and more social contacts are also more likely to age well.

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Another social factor that has been identified as a predictor of aging well is higher education.

Those with higher levels of education, particularly college degrees, are more likely to age

successfully. Education is often cited as a protective factor against psychological decline, but it

could also be that people with higher education are more likely to have held well-paying jobs,

thus allowing them greater access to resources like healthcare than their peers. Midlife is a good

time for people to assess the quality of their relationships. Putting the time and effort into

developing a social support network may not only increase psychological health but long-term

physical health.

Psychologists and sociologists have long wondered how people manage to age

successfully, and many theories have been developed that highlight the keys to successful aging.

We examine five: (1) Activity theory; (2) Continuity theory; (3) Socioemotional selectivity

theory; (4) Selective optimization with compensation; and (5) Developmental self-regulation

theory.

Developed by Havighurst and Albrecht in 1953, activity theory addresses the issue of

how persons can best adjust to the changing circumstances of old age–e.g., retirement, illness,

loss of friends and loved ones through death, and so on. In addressing this issue, they

recommend that older adults involve themselves in voluntary and leisure organizations, child

care and other forms of social interaction. Activity theory thus strongly supports the avoidance of

a sedentary lifestyle and considers it essential to health and happiness that the older person

remains active physically and socially. In other words, the more active older adults are, the more

stable and positive their self-concept will be, which will then lead to greater life satisfaction and

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higher morale (Havighurst & Albrecht, 1953). Activity theory suggests that many people are

barred from meaningful experiences as they age, but older adults who continue to find ways to

remain active can work toward replacing lost opportunities with new ones (Nilsson et al., 2015).

Continuity theory suggests as people age, they continue to view the self in much the same

way as they did when they were younger. An older person’s approach to problems, goals, and

situations is much the same as it was when they were younger. They are the same individuals,

but simply in older bodies. Consequently, older adults continue to maintain their identity even as

they give up previous roles. People do not give up who they are as they age. Hopefully, they are

able to share these aspects of their identity with others throughout life. Focusing on what a

person is still able to do and pursuing those interests and activities is one way to optimize and

maintain self-identity.

The Socioemotional Selectivity Theory focuses on changes in motivation for actively

seeking social contact with others (Carstensen, 1993; Carstensen, Isaacowitz & Charles, 1999).

This theory proposes that with increasing age, our motivational goals change based on how much

time we have left to live. Rather than focusing on acquiring information from many diverse

social relationships, as adolescents and young adults tend to do, older adults focus on the

emotional aspects of relationships. To optimize the experience of positive affect, older adults

actively restrict their social life to prioritize time spent with emotionally close significant others.

Research showing that older adults have smaller networks compared to young adults, and tend to

avoid negative interactions, also supports this theory.

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Selective Optimization with Compensation is a strategy for improving health and well

being in older adults and a model for successful aging. It is recommended that seniors select and

optimize their best abilities and most intact functions while compensating for declines and losses.

Perhaps nurses and other allied health professionals working with this population will begin to

focus more on helping patients remain independent by optimizing their best functions and

abilities rather than simply treating illnesses. Promoting health and independence are essential

for successful aging.

Developmental Self-regulation Theory is a dual-process model that could have been

based on St. Augustine’s serenity prayer. On the one hand, is primary control, or the strength and

courage to take action to change the things that can be changed. This includes a sense of

self-efficacy to take action needed to make lifestyle changes or undergo treatments that optimize

functioning, such as a healthy diet, exercise, medical treatments (like taking one’s insulin or

cataract surgery), or adopting outside aids like a cane or walker. The second process is called

accommodation, and it involves the grace to accept the things that cannot be changed. This

attitude of willing acceptance includes understanding, gratitude for times past, and a focus on the

positive things that still remain. Such accommodation can be contrasted with furious resentment

or depressed resignation to the losses of aging. In fact, some researchers argue that depression in

old age is often due, not to the losses of control aging inevitably entails, but from an inability to

accommodate, that is, to relinquish activities and goals that are no longer feasible.

Quality of Life

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In specific terms, quality of life refers to the degree of excellence in life (or living)

relative to some expressed or implied standard of comparison, such as most people in a particular

society (Oxford University Press 1989).

The World Health Organization defines Quality of Life as an individual's perception of

their position in life in the context of the culture and value systems in which they live in relation

to their goals, expectations, standards and concerns.

Meanwhile APA defines quality of life as well in the extent to which a person obtains

satisfaction from life. The following are important for a good quality of life: emotional, material,

and physical being; engagement in interpersonal relations; opportunities for personal (e.g., skill)

development; exercising rights and making self-determined lifestyle choices; and participation in

society. Enhancing quality of life is a particular concern for those with chronic disease or

developmental and other disabilities, for those undergoing medical or psychological treatment,

and for the aged.

Usually, quality of life is explicitly or implicitly contrasted with the quantity of life (e.g..

years), which may or may not be excellent, satisfying, or enjoyable. The Stoic philosopher

Seneca (c. 4 B.C.-A.D. 65) clearly valued quality over quantity: "... it matters with life as with

play; what matters is not how long it is, but how good it is" (Hadas 1958). In this vein, popular

definitions center on excellence or goodness in aspects of life beyond mere subsistence, survival,

and longevity; these definitions focus on "domains’’or areas of life that make life particularly

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enjoyable, happy, and worthwhile, such as meaningful work, self-realization (as in the full

development of talents and capabilities, and a good standard of living.

Models of Life Satisfaction and Subjective Well Being

Traditionally, there have been two theoretical approaches to the concept of life

satisfaction, which differ in the causal assumptions: the ‘bottom-up’ and ‘top-down’ perspectives

( Lance et al. 1989). The ‘bottom-up’ perspective assumes that a person’s overall life satisfaction

depends on his or her satisfaction in many concrete areas of life, which can be classified into

broad life domains such as family, friendship, work, leisure, and the like (Pavot and Diener

2008).

Multiple discrepancy theory (Michalos 1985), need hierarchy theory (Maslow 1970), and

the self-concordance model (Sheldon and Elliot 1999) are all good examples of ‘bottom-up’

theories that conceive domain satisfactions as needed. According to these theories the more

needs are satisfied, the greater the satisfaction with life as a whole. From the ‘bottom-up’

perspective, domain satisfactions mediate the effects of situational factors on life satisfaction.

The ‘top-down’ perspective is a dispositional explanation, which contends that

differences in personality and other stable traits of the person predispose people to be

differentially satisfied with their lives (Steel et al. 2008). Defendants of the ‘top-down’

perspective rather than denying the influence of situational factors, claim that both dispositional

and situational factors interact in relation to life satisfaction (Heller et al. 2004).

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‘Top-down’ and ‘bottom-up’ perspectives have often been presented as competing

theories; however, both approaches are not incongruent when dispositional factors are viewed as

more distal predictors of life satisfaction than domain satisfactions (Erdogan et al. 2012). The

dispositions of each person influence his or her perceptions of environmental conditions,

resulting in more or less satisfaction with life domains.

In a recent study, "Accounting for changes in social support among married older adults"

by Gurung, R. A. R., Taylor, S. E., & Seeman, T. E. (2003). By using longitudinal,

community-based data from the MacArthur Studies of Successful Aging, the researchers

examined determinants of changes in social support receipt among 439 married older adults. In

general, social support increased over time, especially for those with many preexisting social

ties, but those experiencing more psychological distress and cognitive dysfunction reported more

negative encounters with others. Gender affected social support receipt: Men received emotional

support primarily from their spouses, whereas women drew more heavily on their friends and

relatives and children for emotional support. The results center on the importance of social

support provision to those with the greatest needs.

In another study on "Developmental changes in personal goal orientation from young to

late adulthood" done by Ebner, N. C., Freund, A. M., & Baltes, P. B. (2006). Using a

multimethod approach, the authors conducted 4 studies to test life span hypotheses about goal

orientations across adulthood. Confirming expectations, in Studies 1 and 2 younger adults

reported a primary growth orientation in their goals, whereas older adults reported a stronger

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orientation toward maintenance and loss prevention. Orientation toward prevention of loss

correlated negatively with well-being in younger adults. In older adults, orientation toward

maintenance was positively associated with well-being. Studies 3 and 4 extend findings of a

self-reported shift in goal orientation to the level of behavioral choice involving cognitive and

physical fitness goals. Studies 3 and 4 also examine the role of expected resource demands. The

shift in goal orientation is discussed as an adaptive mechanism to manage changing opportunities

and constraints across adulthood.

A recent study which was focused on the objective components of quality of life (QOL)

of people with profound multiple disabilities (PMD). Mainly aimed at evaluating different

dimensions of QOL of people with PMD and investigating the association between their QOL

and several personal (age, gender, intellectual capabilities, motor limitations, sensory limitations,

physical and mental health status) as well as setting characteristics (location of the setting, type

of setting, size of the setting, group size, group composition, staffing level and staff turnover). As

a measure of the QOL of people with PMD we used the QOL-PMD, a questionnaire that we

specifically developed for this purpose. To measure the personal and setting characteristics, a

self-developed questionnaire was presented, 49 people with PMD were selected. For each of

these people three informants were chosen who each filled out the QOL-PMD. To account for

the clustered nature of the data, data were analyzed by means of mixed models. Characteristics

regarding the medical condition of the person with PMD turned out to be most strongly

associated with the QOL-PMD scores. Other personal characteristics such as age, gender, motor

limitations and sensory limitations did not have a significant effect on the QOL-PMD scores.

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With regard to the setting characteristics, location of the setting and staffing level turned out to

have a significant effect on the QOL-PMD scores. (Petry et al. 2009).

In a study done on "Physical activity and successful aging in Canadian older adults" by

(Baker, Meisner, Logan, Kungl, Weir et al. 2009). As Rowe and Kahn (1987) proposed that

successful aging is the balance of three components: absence of disease and disease-related

disability, high functional capacity, and active engagement with life. This study also examined

the relationship between physical activity involvement and successful aging in Canadian older

adults using data from the Canadian Community Health Survey, cycle 2.1 ( N = 12,042). Eleven

percent of Canadian older adults were aging successfully, 77.6% were moderately successful,

and 11.4% were unsuccessful according to Rowe and Kahn’s criteria. Results indicate that

physically active respondents were more than twice as likely to be rated as aging successfully,

even after removing variance associated with demographic covariates. These findings provide

valuable information for researchers and practitioners interested in age-specific interventions to

improve older individuals’ likelihood of aging successfully.

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Aim: To Find The Relationship Between Quality Of Life And Successful Aging In Older Adults

Using The Quality Of Life Inventory QOLD) By Michael B. Erish, And The Successful Ageing

Scale(SAS) By Gary T Reker.

Method

Participant

The male participant was 69 years old who had been a factory manager for the entirety

of his working life with a graduation degree, whereas the female participant was a housewife of

66 years with just 5-6 of work experience in her entire life with a high school graduate degree.

Measures

- Successful Aging Scale (SAS) by Gary T. Reker

Over the past 2 decades, a number of conceptual definitions and models of successful

aging have appeared in the literature. Of the numerous models, four stand out as having made a

significant contribution to understanding the complex construct of successful aging. These are

the psychological well being model of Ryff (1989), the SOC model of Baltes and Baltes (1990),

the primary/secondary control model of Schulz and Heckhausen (1996), and the

disease/cognitive functioning/engagement model of Rowe and Kahn (1997). While each of these

models has made a significant contribution, none has been able to capture all of the key

components. The same can be said about the measurement of successful aging. Measurement

consists of items that reflect the unique characteristics of each model, as it should. Given that

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each model has made a unique contribution to our understanding of successful aging, we need a

more comprehensive measuring instrument that combines all relevant components into a single

scale. The SAS was developed in an attempt to achieve that goal.

Reliability

Alpha coefficients were calculated for each of the three factors and the scale overall. The

internal consistency reliabilities are as follows: Healthy Lifestyle (4 items) .72; Adaptive Coping

(4 items) .73; Engagement with Life (5 items) .75; SAS (13 items) .84.

Validity

Construct Validity: Research has shown that successful agers are very resilient (Resnick,

et al., 2009; Schulz & Heckhausen, 1996; Wagnild, 2003), high in emotional intelligence (ability

to recognize, control, and communicate emotions and to recognize the emotions in other people),

and enjoy good physical and mental health (Palmore, 1979; Strawbridge et al. 1996). Thus, a

valid measure of successful aging is predicted to correlate significantly with measures of

resilience, emotional intelligence, and self rated physical health. In addition, it is expected that

the SAS and its subscales will be free of socially desirable responding, and thus will not correlate

significantly with a measure of social desirability.

Concurrent Validity: Successful agers are individuals who have been found to be very

optimistic (Reker & Wong, 1985), who have found meaning and purpose in their lives (Meddin,

1998; Reker, 2002), who are open minded and aware of the bigger picture (Reker, 2009), and

who embrace spirituality (Fry, 2000). Thus, a valid measure of successful aging is predicted to

correlate significantly with measures of optimism, meaningfulness, mindfulness, and spirituality.

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Quality of Life Inventory (QOLI) by Michael B. Erisch

Quality of Life Inventory (QOLI) is a psychological assessment of well being and

satisfaction with life. The QOLI assesses positive mental health and happiness, and yields an

overall score based on the “Sweet 16” areas that make up the quality of life, including love, work

and play. The QOLI test is a measure of positive psychology and positive mental health. Assess

the positive health, well being and quality of life of your clients. Help increase the happiness,

meaning, and fulfillment of your clients by giving them overall feedback on their quality of life

and feedback on the 16 areas of life that make up human happiness and fulfillment in cultures

around the world.

Reliability

Stability: The temporal stability of QOLI T scores was examined with test retest

reliability coefficients from a subsample of 55 participants. The retest coefficient of 0 .73 was

significant at p <.001 over an interval of about two weeks (mean interval in days = 14.4, SD =

3.9).

Internal consistency: Internal consistency reliability (coefficient alpha) computed for the

sum of the weighted satisfaction ratings was 0.79. The use of the sum of the weighted

satisfaction ratings for computing coefficient alpha was believed to provide a good substitute for

the use of the QOLI raw score (Frisch et al., 1992). The correlation between the sum of the

weighted satisfaction ratings and the QOLI raw score was 0.99, indicating that the two scores are

highly similar.

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Validity

Convergent and discriminant validity: Data from two other measures of life satisfaction

were collected in order to assess the convergent validity of the QOLI. The QOLl was

significantly and positively correlated with both measures (r= 56, p <.001 with SWLS; r.75, p <

001 with the Quality of Life Index). The correlation of .25 is statistically significant at p <.001,

but its small size suggests that the impact of the social desirability response set is minimal,

accounting for only about 6% of the variance in QOLI scores.

Procedure

The subjects were selected using a purposive sampling technique. Before beginning with

the study, a rapport with the participants was built, wherein the researcher greeted the

participants with warmth and friendliness. To make the participants comfortable small talk was

made about the weather, what made them interested in the study and so on. After both the

participants seemed comfortable, their right to privacy and confidentiality was discussed. Then

the informed consents were signed. They were also asked if they wanted to know about the

results of the study, to which they replied affirmatively. Then they were given the required

instructions regarding the questionnaires. There are no right or wrong answers. After the

completion of the questionnaires, the participants were asked to kindly write an introspective

report. Later on the results of the questionnaires were interpreted using the respective manuals

for SAS and QOLI.

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Behavioral Report

Both the participants paid close attention to the instructions. They had little difficulty

with understanding the questionnaires at first as the questionnaires were in English, and they

were not native english speakers. They seemed to be struggling a bit with the questionnaire due

to the language barrier. They both took their time to completely understand the items presented

in both the questionnaires; nevertheless they answered all the questions.

Introspective Report

Attached in Appendix

Results

Table 1

Raw Scores and T scores obtained by participants in the QOLI

Quality of Life Profile

Gender Raw Score T Score Percentile

Male 1.7 43 23

Female 1.5 42 19

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Table 2

Weighted Satisfaction in Different Areas of Life

Areas of Life Male Female

Health 4 -2

Self Esteem 6 2

Goals and Values 1 2

Money -4 -1

Work -1 2

Play 4 1

Learning 2 2

Creativity -1 2

Helping 6 4

Love -6 -6

Friends 4 1

Children 2 4

Relatives 0 4

Home 4 6

Neighborhood 1 2

Community 4 1

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Table 3

Raw Scores Obtained by participants in SAS

Successful Aging Scale

Gender Raw Score

Male 77

Female 58

Table 4

Scores obtained in the domains categorized under the Successful Aging Scale

Domains Male Female

Raw Score Interpretation Raw Score Interpretation

Healthy Lifestyle 24 High 17 Average

Adaptive Coping 25 High 17 Average

Engagement with Life 28 Average 24 Average

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Discussion

Our objective was to assess the relationship between successful aging and quality of life

using the Successful Aging Scale (SAS) by Gary T. Reker and Quality of Life Inventory (QOLI)

by Michael B. Frisch. In Table 1, by using the Quality of Life Inventory (QOLI), the male

participant obtained a raw score of 1.7, T score 43 and Percentile of 23, falling in the average

range on the QOLI. Whereas, the female participant obtained a raw score of 1.5, T score 42 and

Percentile of 19, falling in the very low range of QOLI.

Our male participant who falls in average classification in QOLI shows that he is typical

of well functioning in his ability to achieve satisfaction in valued areas of life. Average scorers

are basically content, happy, and fulfilled. They are generally successful in getting what they

want out of life, and they are able to get their basic needs met and achieve their goals in most,

though not all, important areas of life. Average scorers possess one or more of the important

psychosocial resources available to high scorers. Therefore, average scorers also tend to have

rewarding life circumstances and relationships. Average scorers possess some of the

psychological resources that are attributed to high scorers. They may have problem solving

abilities and they may be able to assert themselves in order to achieve their goals. Average

scorers generally set modest, attainable, but challenging goals for themselves in valued areas of

life. They are able to see the world in a fairly accurate light without distorting their

circumstances in a negative way by catastrophizing or blowing things out of proportion when

problems arise. They are generally able to set priorities. They emphasize the importance of the

rewarding and controllable areas of life and deemphasize the unfulfilling and uncontrollable

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areas. Average scorers may be expected to live fairly balanced lives in which they gain

satisfaction from many areas of life instead of focusing on one or two areas that could make

them vulnerable to dissatisfaction should problems occur. People scoring in the Average range

are generally not extremely distressed (e.g., depressed, anxious, or angry), and they seem to be

generally fulfilled rather than frustrated with their lives. Average scorers may feel too good or

too satisfied with life to get involved in or adhere to any medical or psychological treatment

regimen that may be prescribed.

Our female participant who falls in low classification QOLI shows that she is generally

unhappy and unfulfilled, she feels that she was somewhat unsuccessful in getting what she

wanted out of life, and was unable to get her basic needs met and achieve her goals in several

important areas of life. However, she was able to achieve some satisfaction in some areas of life,

a fact that can be used in treatment to encourage efforts at change.

While low scorers may not show obvious signs of distress or psychological disturbance,

they may, in fact, suffer from a medical or psychological disturbance, especially clinical

depression. In fact, most clients seeking mental health treatment score at or below the 20th

percentile T score of 42 and raw score of 1.5) on the QOLI, which is the top of the Low range.

Even if low scorers are not currently disturbed, they are at risk for developing a medical or

psychological disturbance.

Low scorers should be assessed and treated for medical and psychological disturbances,

including major depression, anxiety disorders, alcohol and drug abuse, psychophysiological and

somatoform disorders, relationship problems, and respiratory infections that may be caused by or

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contribute to their low quality of life. Low scorers' work performance and job satisfaction are

likely to suffer because of their level of unhappiness (Rain, lane, & Steiner, 1991).

Low scorers may benefit from treatment of significant "problems in living or life

satisfaction problems, areas of dissatisfaction revealed by their Weighted Satisfaction Profile.

Focusing treatment on areas of life dissatisfaction can help to alleviate any medical and

psychological problems, increase overall quality of life, and help prevent health problems. Low

scorers are usually cooperative with treatment because they see it as a way to reduce their

distress and unhappiness.

In this study we used the Successful Aging Scale (SAS) by Gary T. Reker on two

participants, one male and one female. As shown in Table 3, the male participant obtained a raw

score of 77 whereas the female participant obtained a raw score of 58. Successful Aging Scale

(SAS) contains three domains namel- healthy lifestyle, adaptive coping and engagement with

life. As shown in Table 4, the male participant scored 24 in the healthy falls under high range, 24

in the adaptive lifestyle domain which comes under a high range, and 28 in engagement with life

domain that falls under the average range. Similarly, for our female participant, as shown in

Table 4, she obtained 17 in the healthy lifestyle domain which falls under the average range, 17

in adaptive coping domain that also comes under the average range, and 24 in engagement with

life domain that falls under the average range again.

In a recent study done on the “Factors influencing the successful aging of older Korean

adults” (Hyun Cha, Eun Ju Seo & Sohyune et al., 2011) following a cross-sectional design. The

participants were 305 Korean older people aged 60 years or over, who met eligibility criteria.

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Using a general characteristics form, the self-liking/self-competence scale-revised version

(SLCS-R) form, the self-efficacy scale, the interpersonal relationship scale, the self-achievement

instrument, and the successful aging scale. The findings of the study conducted showed that the

prediction model for successful aging among older Korean adults was significant. The factor that

was found to have the most influence on successful aging among older Korean adults was

self-esteem, followed by self-achievement, interpersonal relationships, and self-efficacy. This

study also provides preliminary evidence that self-esteem is a major and primary predictor of

successful aging among older Korean adults. In the nursing practice, health professionals can use

the results of this study in order to help older Korean adults obtain a positive outlook, promote a

sense of self-worth, and achieve a higher degree of adaptability towards aging despite the health

problems and personal issues associated with older age by providing intervention programs that

advocate successful aging.

As we have taken from the study discussed above, it is important to take a holistic view

of what contributes to aging successfully. Those that are most likely to age well have good

physical and psychological health as well as a social support network. Successful aging is not

only the absence of chronic illness, but the perceived life satisfaction of the elderly person.

Focusing on successful aging in the light of adopting healthy lifestyle behaviors can help prevent

and reduce age related problems, and consequently decrease the cost of disease burden in this

period. Definitely, it should not be forgotten that elderly people need information, support, and

encouragement to be empowered for successful aging. It is duly observed through several

researchers that people with high levels of resilience, low rates of depression, few years of

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substance abuse, and a good social network are most likely to age successfully and, perhaps most

importantly, report high levels of life satisfaction into their golden years.

The findings of this study can lead to new research, including qualitative, quantitative,

integrated, and interventional research on successful aging and quality of life since our objective

was to assess the relationship between the two. Also, considering that most of the elderly who

constitute the sample live in the city center, it is recommended to consider the characteristics of

the people when applying to the elderly living in rural areas. The limitations of the study was that

the sample size was too small and the criteria for sampling was also restricting according to

which the subject should have at least 1 year of retirement gap, should be 65 years or older and

most restricting of all was the language barrier since subjects of this study were not native

english speakers and the study required them to know english well as its selection criteria.

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Appendix

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