Factors associated with successful aging in persons aged 65 to 75 years

European Geriatric Medicine xxx (2014) xxx–xxx

G Model

EURGER-545; No. of Pages 6

Research paper

Factors associated with successful aging in persons aged 65 to 75 years

M.-M. Dahany a, M. Drame a,b,*, R. Mahmoudi a,c, J.-L. Novella a,c, D. Ciocan c,L. Kanagaratnam b, I. Morrone a,c, F. Blanchard a,c, P. Nazeyrollas a,d, C. Barbe a,b, D. Jolly a,b

a University of Reims Champagne-Ardenne, Faculty of Medicine, EA 3797, 51092 Reims, Franceb Reims Teaching Hospitals, Robert-Debre Hospital, Department of Research and Innovation, 51092 Reims, Francec Reims Teaching Hospitals, Maison Blanche Hospital, Department of Geriatrics and Internal Medicine, 51092 Reims, Franced Reims Teaching Hospitals, Robert-Debre Hospital, Department of Cardiology, 51092 Reims, France

A R T I C L E I N F O

Article history:

Received 29 July 2014

Accepted 4 September 2014

Available online xxx

Keywords:

Elderly

Quality of life

Successful aging

A B S T R A C T

Background: We aimed to identify, among persons aged 65 to 75 years, those presenting successful aging

defined with health-related quality of life, and to identify factors associated with successful aging.

Methods: The study design was a cross-sectional study based on healthcare data from 2005, from a

representative sample of the French population. Our study population was comprised of subjects aged

65 to75 who completed the Duke Health Profile (DHP). The outcome was successful ageing as defined by

a score on the general health dimension of the DHP above the 75th percentile according to sex. Logistic

regression was used to investigate the association between successful aging and socio-demographic,

psychosocial, physical and behavioural factors.

Results: In total, 2160 were included in this analysis, average age was 70.1 � 3.0 years. Overall, 645 (29.9%)

presented good quality of life as assessed by the general health dimension, and thereby qualified as

successful aging. By multivariable analysis, lower weight (OR = 2.75), regular physical activity (OR = 1.44),

and the fact of having religious beliefs (OR = 1.36) were positively associated with successful aging.

Conversely, psychological distress, comorbidities, and obesity negatively influenced aging. Social support,

smoking status and marital status were not.

Conclusion: This study, from a representative sample of the French population, found similar variables

related to successful aging as in other studies. Physical and psychological well-being, regular exercise

and nutritional status are major determinants of successful aging. It is thus vitally important that

healthcare policies and programmes emphasise these elements in order to promote healthy and

successful aging.

� 2014 Published by Elsevier Masson SAS.

Available online at

ScienceDirectwww.sciencedirect.com

1. Introduction

On January 1, 2011, the French population was estimated at65 million inhabitants, of which 11 million (16.8%) were aged 65 orolder. Life expectancy at birth was 78 years for men and 84 forwomen [1]. Regardless of all the hypotheses formulated aboutaging in France, the fact is that the population of metropolitanFrance will continue to expand until at least 2050. Accordingly, inthe principal scenario at the basis of estimations in the Omphalestudy, persons aged 65 years and older will represent 23% of thepopulation in 2025, and 29% in 2050 [2].

* Corresponding author. Tel.: +33 3 26 78 44 12; fax: +33 3 26 83 25 89. Reims

Teaching Hospitals, Robert-Debre Hospital, Department of Research and Innova-

tion, Rue du General Koenig, 51092 Reims, France.

E-mail address: [email protected] (M. Drame).

Please cite this article in press as: Dahany M-M, et al. Factors associateMed (2014), http://dx.doi.org/10.1016/j.eurger.2014.09.005

http://dx.doi.org/10.1016/j.eurger.2014.09.005

1878-7649/� 2014 Published by Elsevier Masson SAS.

These figures almost certainly reflect an improvement in Health-Related Quality of Life (HRQoL) in our society. However, the questionarises of the HRQoL of these extra years gained in terms of lifeexpectancy. From this viewpoint, the individual and group objectivesare one and the same, namely to age as successfully as possible, and todelay as long as possible the onset of frailty. This had led to renewedinterest in recent years in the phenomenon of successful aging, aconcept that chooses to take a positive approach to aging.

Historically, the concept of successful aging has been the objectof several distinct approaches, albeit without achieving aconsensus as to the actual definition of the concept per se. ForHavighurst [3], successful aging was a question of subjectivequality of life (QoL), whereas for Rowe and Kahn [4], in successfulaging, extrinsic factors play a neutral or positive role, distinguish-ing it from usual or normal aging.

Since 1960, several more or less complementary definitionshave been proposed for successful aging, ranging from the most

d with successful aging in persons aged 65 to 75 years. Eur Geriatr


mailto:[email protected]


http://www.sciencedirect.com/science/journal/18787649


M.-M. Dahany et al. / European Geriatric Medicine xxx (2014) xxx–xxx2

G Model


restrictive (little or no loss in age-related physiological functions[4]), to those that even allow for the presence of chronic diseases[5]. According to Baltes and Baltes, there is no unique criterion todefine successful aging [6]. As with the concept QoL, successfulaging is a multidimensional concept that covers physical,biological and mental health, but also cognitive function, socialengagement, productivity, personal control and satisfaction withlife. However, none of these aspects individually is sufficient todefine successful aging. Baltes and Baltes suggest that by usingsubjective and objective criteria, taking into account individualand cultural variation, a global definition of successful aging can bereached. These conceptual differences are not without conse-quence. Indeed, Strawbridge et al. reported, from a sample ofsubjects aged over 65 years, a difference of more than 30% in therate of successful aging, depending on whether subjectivesatisfaction criteria (of the Havighurst type) were used, orobjective performance criteria as defined by Rowe and Kahn [7].

This could explain why findings are highly heterogeneous andhotly debated, and why many reports underline the necessity ofusing subjective criteria to evaluate successful aging. Indeed, manyolder persons consider themselves to be aging successfully, eventhough they do not qualify as such according to Rowe and Kahn’sphysical criteria [8].

It appears possible to use HRQoL to evaluate successful agingwith all its component factors. Indeed, the main dimensions ofHRQoL cover physical, psychological and social health, and areestablished as subjective measures in that the most appropriateperson to assess the completeness and preferences relating todifferent areas of their life is the individual himself. This hypothesishas already been applied in an English study among subjects aged65 and over, which showed that using traditional cut-offs fordefining successful aging were less sensitive than the use of HRQoL[8]. Other authors have chosen to evaluate successful aging basedon HRQoL definitions, such as the WHOQOL-100 or the FlanaganQoL scale [9].

In this context, it appears both interesting and important toassess successful aging based on a subjective conceptual modelrepresented by HRQoL. The information thus yielded could help tobetter apprehend the target population of older people, with a viewto introducing effective strategies of health promotion.

This study aimed to identify, among a sample from the Frenchpopulation aged 65 to 75 years, those who presented ‘‘successfulaging’’, and factors associated with successful aging.

2. Methods

This study design was a cross-sectional study based on datafrom the ‘‘Barometre Sante 2005’’ performed in a sample of Frenchpopulation. The ‘‘Barometre Sante’’ (health barometer) enquiry is anational telephone survey on health performed in randomlyselected individuals aged 12 to 75 years. These surveys have beenperformed at regular intervals in selected populations since1992 by the French health authorities. The population for ourstudy was comprised of all individuals aged 65 to 75 whoparticipated in the 2005 edition of the ‘‘Barometre Sante’’ and inwhom the Duke Health Profile was administered.

3. Study variables

The following variables were recorded. Demographic charac-teristics included age, sex, religion, and marital status. Socialsupporters or network concerned children, if any, whether thesubject lived alone or not, existence of conflicts with friends orother members of their close circle. Data pertaining to health statusincluded falls or accidents within the previous 12 months,


comorbidities and (body mass index [BMI]); lower weight wasdefined as BMI < 18, and higher weight as BMI > 25. Psychologicalhealth status was existence, in the 12 months prior to theinterview, of psychological suffering, difficult situations (difficul-ties or negative results), depression, stress or anxiety. Health-related behaviours concerned at-risk behaviours, e.g. smoking, useof illicit substances, violence, suicide attempts, and health-promoting behaviours such as regular physical exercise.

The outcome was successful aging, defined based on self-reported HRQoL on a generic questionnaire, namely the DukeHealth Profile (DHP).

The DHP is a generic HRQoL instrument comprising of 17 items(each graded 0 to 2) regrouped in 10 dimensions, to give a scoreranging from 0 (worst possible HRQoL) to 100 (best possibleHRQoL) [10]. For the purposes of this study, only the ‘‘generalhealth’’ dimension was taken into account to define successfulaging. This dimension is obtained by the average of the three healthscales, namely physical health, mental health, and social health.Successful aging was analysed as a dichotomous variable.Successful aging was defined as a general health score abovethe 75th percentile according to sex.

This threshold chosen for our study is also in line with that usedby Strawbridge et al., who considered as successful agers allsubjects with a score above the 80th percentile on a scalemeasuring both physical and functional capacities [11].

4. Statistical analysis

As we had no influence over the calculation of the number ofsubjects for the study, since the database was already completed,we calculated the minimum risk that we would be able to showwith the available data. Thus, at an alpha risk of 5%, a beta risk of20%, and the proportion of successful agers set at 29.9% (645/2160subjects), the study data would have sufficient power to detect anodds ratio (OR) of at least 1.35.

For descriptive analysis, quantitative variables are expressed asmean � standard deviation (SD) and qualitative variables as numberand percentage. Bivariable analysis by logistic regression wasperformed to investigate the association between each explanatoryvariable and the outcome. Results are expressed as OR and associated95% confidence intervals (95%CI). Multivariable logistic regressionwas performed including all variables related to the outcome bybivariable analysis using stepwise selection, with the threshold forentry and exit from the model set at 0.20 and 0.10, respectively. Sincethe successful aging was defined for each sex, we were unable to takesex into account in our analysis. Overall goodness-of-fit was assessedusing the Hosmer and Lemeshow test. A P-value of 0.05 wasconsidered statistically significant. All analyses were performed usingSAS version 9.2 (SAS Institute Inc, Cary, NC, USA).

The program was set up in observance of the Declaration ofHelsinki and French law relating to biomedical research involvinghuman subjects.

5. Results

Among the 30,514 subjects who participated in the national‘‘Barometre Sante’’ survey in 2005, 2277 subjects aged 65 to75 years completed the Duke Health Profile. Among these 2277, weincluded in this analysis the 2160 subjects for whom the score onthe general health dimension of the DHP was available. Fig. 1presents a flowchart of the study population, and the baselinecharacteristics are shown in Table 1. Average age was70.1 � 3.0 years with a majority of females (61.9%). In total, 645(29.9%) had successful aging according to our definition. Theevolution of HRQoL according to age is shown in Fig. 2.



30,514 participants in the “Baromètre

santé 2005” health survey

17,733 participants completed the Duke

Health Pro fil e

2,277 participants aged 65 to 75 years

with co mpleted Duke Health Pro fil e

15,456 aged < 65 years

12,781 were not questioned about

their quality of li fe

Fig. 1. Flowchart of the study population.

M.-M. Dahany et al. / European Geriatric Medicine xxx (2014) xxx–xxx 3

G Model


By bivariable analysis (Table 2), the following demographiccharacteristics were significantly linked to successful aging:younger age, and the fact of having a religion. The only socialvariable related to successful aging was the absence of conflictduring the 12 months preceding the survey. Health-relatedvariables found to be related to successful aging included self-reported low body weight, absence of chronic disease, and nothaving fallen within the previous 12 months. In terms ofpsychological variables, the ability to deal with difficulties, theabsence of stress or difficult situations, and the ability to deal with

Table 1Baseline characteristics of the study population.

Variable n/N %

Socio-demographic characteristics

Female sex 1336/2160 61.8

Not in a couple 933/2151 43.3

Practices a religion 1072/2142 50.0

Social support

Living alone 808/2156 37.4

No children 235/2155 10.9

Experienced situations of conflict over the

previous 12 months

122/2154 5.6

Physical health

Body mass index

Underweight 1007/2126 47.37

Normal range 33/2126 1.55

Overweight 1086/2126 51.08

Presence of at least one chronic disease 981/2152 45.4

At least one fall in the previous 12 months 529/2149 24.6

Had an accident within the previous 12 months 146/2153 6.7

Psychological health

Felt anxious or stressed during the

previous 12 months

1139/2150 47.0

Unable to cope with difficulties 610/2147 28.3

Experienced difficult situations during the

previous 12 months

369/2109 17.5

Lacked energy or motivation during the

previous 12 months

876/2147 40.8

Tends not to communicate with people

when stressed

1071/2103 50.9

Isolates oneself when stressed 699/2079 33.6

Tends to eat more when stressed 622/2081 29.8

Tends to take medication when stressed 506/2048 24.7

Health behaviours

Active smokers 207/2156 9.6

Exposed to passive smoking 379/2155 17.5

Has been a victim of violence 20/2150 0.9

Has previously consumed cannabis 26/2118 1.2

Has previously attempted suicide 86/2153 3.9

Practices a regular physical activity 590/2160 27.3

N: number of persons for whom information was available.


life events such as a lack of energy or motivation over the previous12 months, were shown to be related to successful aging. Nohistory of suicide attempts and the practice of regular physicalexercise also positively influenced aging on bivariable analysis.

All the variables identified by bivariable analysis (younger agewas borderline significant) were also independently associatedwith successful aging by multivariable analysis. These factors withthe associated ORs are presented in Table 3.

6. Discussion

Our study found that demographic characteristics (such asyounger age and the fact of practising a religion), regular exercise,combined with psychological and physical factors were allassociated significantly with successful aging. These findingsconfirm previous reports from other populations, and using otherapproaches [12,13]. Regular physical activity has previously beenreported to contribute to successful aging [14]. The beneficialeffects of regular exercise have been widely documented in severalcontexts, including cardiovascular disease, diabetes, cognitivedecline, and mood disorders [15,16]. It is therefore not unexpectedto observe a relation between regular exercise and perceivedhealth as reported by older persons.

One finding of our study that has rarely been reported in theliterature is that the fact of having a religion seems to have abeneficial effect on the life of older subjects. This is coherent withtwo other studies that investigated this variable in African-American [17] and Chinese [14] populations. While spirituality andreligious beliefs may be historically engrained in these cultures,religion and spirituality in general are particularly important forolder subjects of all cultures, and are frequently associated withimproved psychological and mental well-being [18].

In our study, a younger age was found to be associated withsuccessful aging, albeit at a borderline significance level. This resultis coherent with findings of other authors [14,19,20], althoughanother group has reported contradictory results [9]. Physical QoLtends to decline with advancing age in older persons, who findthemselves faced with an increasing burden of diseases linked toaging, which can limit (to varying degrees) their ability to performthe activities of daily living.

Conversely, our study found several factors that were nega-tively associated with successful aging. Among these, psycholo-gical difficulties appear to be the most important. Similar findingshave previously been reported elsewhere [14,21]. By psychologicalfactors, we mean all domains covering anxiety, stress andpsychological distress. The impact of the psychological componenton HRQoL, particularly in older subjects, has previously beendocumented in several studies [14,17,21,22]. Regardless ofwhether we consider depression, anxiety or stress, all theseconditions considerably influence the feeling of having a lowHRQoL in affected patients [23]. Severe depression is associatedwith poor HRQoL, and thus, with unsuccessful aging. This is all themore valid in older subjects, and could likely explain the higherrate of suicide observed in this population.

Taken together, these considerations underline the importanceof the ability of older persons to cope, as this can help to alleviate ortolerate the emotional turmoil induced by situations of stress oranxiety.

In terms of physical health, we found that the presence ofchronic disease had a negative impact on successful aging, as itconstitutes a source of incapacity [14,21,24]. In a review of theliterature, Depp et al. showed that among 28 studies using29 definitions, 26 of the definitions included physical functioning[23]. They also reported that comorbidities (e.g. diabetes, arthritis)and various types of incapacity (hard of hearing) had a deleterious



Fig. 2. Evolution of general health score on the Duke Health Profile, according to age (median, quartiles and extremes).


G Model


effect on aging. Other studies of successful aging in various ethnicpopulations have all shown the capital importance of physicalhealth in older persons’ perception of aging [11,17,21]. Althoughthis observation is hardly surprising, it does underline that healthis a major determinant of successful aging and therefore, efforts topromote successful aging must encompass adequate managementof disease.

Table 2Bivariable analysis of factors associated with successful aging.

Variable OR 95%CI P

Socio-demographic characteristics

Agea 0.97 0.94–0.99 0.04

Not in a couple 0.96 0.80–1.16 0.71

Practices a religion 1.26 1.05–1.53 0.01

Social support

Living alone 0.97 0.80–1.18 0.81

No children 0.76 0.56–1.04 0.09

Experienced situations of conflict over the

previous 12 months

0.24 0.13–0.44 < 0.0001

Physical health

Body mass index

Underweight 2.35 1.17–4.72 0.02

Overweight 0.68 0.57–0.83 < 0.0001

Presence of at least one chronic disease 0.45 0.37–0.55 < 0.0001

At least one fall in the previous 12 months 0.76 0.61–0.96 0.01

Had an accident within the previous

12 months

0.81 0.55–1.20 0.28

Psychological health

Felt anxious or stressed during the

previous 12 months

0.27 0.22–0.33 < 0.0001

Unable to cope with difficulties 0.25 0.20–0.33 < 0.0001


previous 12 months

0.27 0.19–0.37 <0.0001


previous 12 months

0.31 0.25–0.39 <0.0001

Tends not to communicate with people

when stressed

1.07 0.88–1.29 0.51

Isolates oneself when stressed 0.45 0.36–0.56 < 0.0001

Tends to eat more when stressed 0.75 0.60–0.93 0.009

Tends to take medication when stressed 0.34 0.26–0.44 < 0.0001

Health behaviours

Active smokers 0.81 0.58–1.13 0.21

Exposed to passive smoking 0.95 0.74–1.21 0.68

Has been a victim of violence 0.58 0.19–1.75 0.33

Has previously consumed cannabis 1.06 0.45–2.43 0.90

Has previously attempted suicide 0.36 0.19–0.68 0.002

Practices a regular physical activity 1.69 1.36–2.04 < 0.0001

a Increase in risk per additional year.


We also observed higher weight to negatively affect successfulaging, as also reported elsewhere [14,23]. Indeed, higher weightand obesity likely influence comorbidities, which are often moresevere in obese patients. Secondly, excess weight may lead aperson to have low self-esteem in today’s society, which in turncould adversely influence successful aging as one of the manypsychological factors involved [25].

Despite the numerous factors that we observed to be related tosuccessful aging, some other determinants have been reported inthe literature that were not found to be significantly linked tosuccessful aging in our study.

For example, the fact of living alone was not independentlyrelated to successful aging in our data, a finding that replicatesresults reported in Chinese subjects [14]. Social support has beenwidely reported to contribute to successful aging, although we didnot replicate this finding [14,21,23]. Social contact affectsmorbidity, mortality and physical functioning [26], and familyor social relationships are a strong motivating factor for elderlypersons [27]. Nonetheless, the place of social support remainsdebated in the literature. In many populations of Africa and Asia,family and social relationships are extremely important, as thefamily occupies a central role in these cultures. Conversely, inmany western countries, the importance of the family is lessmarked. Furthermore, in our study, the lack of social links may besimply due to the fact that the variables used to evaluate the sociallife of our subjects were not the most appropriate, and were not

Table 3Factors independently related to successful aging by multivariable analysis.

Variable OR 95%CI P

Agea 0.96 0.93–1.00 0.06

Practices a religion 1.36 1.09–1.72 0.006


previous 12 months

0.60 0.47–0.78 < 0.0001


previous 12 months

0.46 0.32–0.67 < 0.0001

Body mass index

Underweight 2.75 1.15–6.54 0.02

Overweight 0.74 0.59–0.93 0.010

Presence of at least one chronic disease 0.56 0.44–0.70 < 0.0001

Unable to cope with difficulties 0.35 0.26–0.48 < 0.0001

Isolates oneself when stressed 0.54 0.42–0.70 < 0.0001

Tends to take medication when stressed 0.62 0.46–0.86 0.003

Felt anxious or stressed during the previous

12 months

0.40 0.31–0.51 < 0.0001

Practices a regular physical activity 1.44 1.16–1.85 0.003

a Increase in risk per additional year.



M.-M. Dahany et al. / European Geriatric Medicine xxx (2014) xxx–xxx 5

G Model


representative of the whole range of activities in the social lives ofthe older persons. Indeed, the fact of living alone is not sufficient toevaluate the degree of social support. Other variables, such as thepresence of friends, or participation in group activities would havehelped to explore the full spectrum of this dimension in greaterdepth. Unfortunately, no further data on this point were availablein the ‘‘Barometre Sante 2005’’. In addition, the only variableexploring relational difficulties that was significant on bivariableanalysis was actually quite vaguely formulated, and may have ledto confusion. The question asked was whether the subject had hadany serious disputes with friends or any major financial problemsduring the previous 12 months. A positive answer, therefore, couldhave been construed as indicating conflict with friends, whereas inactual fact, it may have referred to the financial problems. Clearly,the data available did not provide the adequate criteria to assessfully the importance of the social dimension in the lives of the oldersubjects in our study.

Lastly, in line with some previous reports [9,11,23], we did notfind marital status to be related to successful aging. Conversely,other studies have reported that older subjects whose spouseshave died are less satisfied with their aging [14,28–30].

No relation was observed in our study between active or passivesmoking and successful aging. Although other authors havereported similar results [11,14], a literature review found that in70% of the 28 studies included in their review, smoking had adeleterious effect on aging [23]. The lack of relation in our studymay be explained by the cross-sectional study design. No doubt, alongitudinal study might have yielded different results in thisregard.

Our study included a large sample size, using robustmethodology, designed to be representative of the Frenchpopulation as a whole, and this confers on our results adequatestatistical power, and makes it possible to envisage the general-ization of these results to the entire population of 65 to 75 years oldin France. The main difficulty in our study was the choice of thethreshold on which to base our definition of successful aging. Datafrom the literature report that, despite varying definitions ofsuccessful aging, around 30% of elderly subjects considerthemselves to be aging successful [23]. Therefore, if we consideras successful agers all subjects whose general health score on theDHP is situated above the 75th percentile according to sex, thepercentage of subjects thus obtained (29.9%) would be in line withthat reported in the literature [14,23].

Our study also suffers from some limitations. Firstly, there mayexist differences between the population who completed the DHPand those who did not. However, when we compared demographiccharacteristics between these two groups (namely age, sex,department of resident in France, number of persons in thehousehold, average income in the household, and marital status),we did not observe any significant differences. A second limitationof our study is its design. This was a cross-sectional study, whereasthe concept of successful aging is evidently a longitudinal process.Naturally, the aging process does not begin at exactly 65 years ofage. The whole sum of a person’s life experience contributes to howthat person will age, and thus, all the results observed should bequalified simply as factors that could be related to successfulaging, and not as predictors of successful aging. Nonetheless,cross-sectional study designs have previously been used to studyaging [14,17,20,28], and their results were largely similar to thosefound by longitudinal analysis [14]. The cross-sectional designimplies another limitation related to people who died before theage 65. Their absence in the analysis could have affectednegatively the results. Thus, our study would be improved ifcomplemented by a longitudinal study, taking into account thefactors identified here, to identify those that may potentiallyinfluence successful aging.


7. Conclusion

Our study based on data from the ‘‘Barometre Sante 2005’’,shows that psychological and physical well-being, as well asregular physical activities were major determinants of successfulaging. In light of these results, it appears necessary to promotepreventive strategies to enhance aging, based on physical activityand a balanced diet, both factors that have been largely advocatedalready. In addition, strategies for improving the ability to copealso seem to have an essential role to play.

Disclosure of interest

The authors declare that they have no conflicts of interestconcerning this article.

Acknowledgements

To the French National Institute for Prevention and HealthEducation, which implemented this national-wide survey.

To Dr. France Hui Sze Kwong, President of Regional HealthObservatory of Champagne-Ardenne, for making available thedata.

To Fiona Ecarnot for translation and editorial assistance.

References

[1] Pla A, Beaumel C. [French population reaches 65 million inhabitants]. INSEEPremiere; 2012. p. 1332.

[2] Brutel C. [Projections of the population at the horizon of 2050: inevitableaging]. INSEE Premiere; 2012. p. 762.

[3] Havighurst RJ. The sociologic meaning of aging. Geriatrics 1958;13(1):43–50.[4] Rowe JW, Kahn RL. Human aging: usual and successful. Science 1987;237(4811):

143–9.[5] Baltes M, Carstensen L. The process of successful ageing. Ageing Soc

1996;16:397–422.[6] Baltes PB, Baltes MM. Psychological perspectives on successful aging: the

model of selective optimisation with compensation. In: Baltes. PB, Baltes MM,editors. Successful aging: perspectives from the behavioural sciences. Victoria:Cambridge University Press; 1990. p. 1–34.

[7] Strawbridge WJ, Wallhagen MI, Cohen RD. Successful aging and well-being:self-rated compared with Rowe and Kahn. Gerontologist 2002;42(6):727–33.

[8] Bowling A, Iliffe S. Psychological approach to successful ageing predicts futurequality of life in older adults. Health Qual Life Outcomes 2011;9:13.

[9] de Moraes JF, de Azevedo e Souza VB. Factors associated with the successfulaging of the socially-active elderly in the metropolitan region of Porto Alegre.Rev Bras Psiquiatr 2005;27(4):302–8.

[10] Guillemin F, Paul-Dauphin A, Virion JM, Bouchet C, Briancon S. [The DukeHealth Profile: a generic instrument to measure the quality of life tied tohealth]. Sante Publique 1997;9(1):35–44.

[11] Strawbridge WJ, Cohen RD, Shema SJ, Kaplan GA. Successful aging: predictorsand associated activities. Am J Epidemiol 1996;144(2):135–41.

[12] Phelan EA, Anderson LA, LaCroix AZ, Larson EB. Older adults’ views of ‘‘suc-cessful aging’’ – how do they compare with researchers’ definitions? J AmGeriatr Soc 2004;52(2):211–6.

[13] Rowe JW, Kahn RL. Successful aging. Gerontologist 1997;37(4):433–40.[14] Ng TP, Broekman BF, Niti M, Gwee X, Kua EH. Determinants of successful aging

using a multidimensional definition among Chinese elderly in Singapore. Am JGeriatr Psychiatry 2009;17(5):407–16.

[15] Menec VH. The relation between everyday activities and successful aging: a 6-year longitudinal study. J Gerontol B Psychol Sci Soc Sci 2003;58(2):S74–82.

[16] Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al.European Guidelines on cardiovascular disease prevention in clinical practice(version 2012): The Fifth Joint Task Force of the European Society of Cardiologyand Other Societies on Cardiovascular Disease Prevention in Clinical Practice(constituted by representatives of nine societies and by invited experts) *Developed with the special contribution of the European Association forCardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012;33(13):1635–701.

[17] Troutman M, Nies MA, Mavellia H. Perceptions of successful aging in blackolder adults. J Psychosoc Nurs Ment Health Serv 2011;49(1):28–34.

[18] Dezutter J, Soenens B, Luyckx K, Bruyneel S, Vansteenkiste M, Duriez B, et al.The role of religion in death attitudes: distinguishing between religious beliefand style of processing religious contents. Death Stud 2009;33(1):73–92.

[19] Hamid TA, Momtaz YA, Ibrahim R. Predictors and prevalence of successfulaging among older Malaysians. Gerontology 2012;58:366–70.

[20] Pruchno RA, Wilson-Genderson M, Cartwright F. A two-factor model ofsuccessful aging. J Gerontol B Psychol Sci Soc Sci 2010;65(6):671–9.


http://refhub.elsevier.com/S1878-7649(14)00197-1/sbref0015


















































G Model


[21] Reichstadt J, Depp CA, Palinkas LA, Folsom DP, Jeste DV. Building blocks ofsuccessful aging: a focus group study of older adults’ perceived contributors tosuccessful aging. Am J Geriatr Psychiatry 2007;15(3):194–201.

[22] Chan SW, Shoumei JI, Thompson DR, Yan HU, Chiu HF, Chien WT, et al. A cross-sectional study on the health-related quality of life of depressed Chinese olderpeople in Shanghai. Int J Geriatr Psychiatry 2006;21(9):883–9.

[23] Depp CA, Jeste DV. Definitions and predictors of successful aging: a compre-hensive review of larger quantitative studies. Am J Geriatr Psychiatry2006;14(1):6–20.

[24] Brown CA, McGuire FA, Voelkl J. The link between successful aging and seriousleisure. Int J Aging Hum Dev 2008;66(1):73–95.

[25] Laforest L, Van Ganse E, Ritleng C, Desamericq G, Letrilliart L, Moreau A, et al.Correlates of quality of life of pre-obese and obese patients: a pharmacy-basedcross-sectional survey. BMC Public Health 2009;9:337.


[26] Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol1979;109(2):186–204.

[27] Steinbach U. Social networks, institutionalisation, and mortality among el-derly people in the United States. J Gerontol 1992;47(4):S183–90.

[28] Li C, Wu W, Jin H, Zhang X, Xue H, He Y, et al. Successful aging in Shanghai,China: definition, distribution and related factors. Int Psychogeriatr 2006;18(3):551–63.

[29] Pruchno RA, Wilson-Genderson M, Rose M, Cartwright F. Successful aging:early influences and contemporary characteristics. Gerontologist 2010;50(6):821–33.

[30] Roos NP, Havens B. Predictors of successful aging: a twelve-year study ofManitoba elderly. Am J Public Health 1991;81(1):63–8.






























Documents

Factors associated with successful aging in persons aged 65 to 75 years