Blog Posts

‘Successful’ Aging?

In the 1991 book Successful Aging, by John W. Rowe, MD, and Robert L. Kahn, PhD, “successful” seems to mean healthy aging. The authors have three criteria: 1) freedom from disease and disability; 2) a high level of cognitive and physical functioning; and 3) social engagement. Perhaps “healthy aging” sounded too bland for the title of a book on aging. It would have been more accurate, though. The phrase “successful aging” illustrates conventional thought about growing older. It conflates good health in old age with a good old age. Though it sounds all right at first, the phrase has downsides.

It is misleading because of its implied opposite—unsuccessful aging. Isn’t it arrogant to label old people who are sick or disabled, or somewhat confused, or whose friends have all died, as unsuccessful at aging? Some people in these categories give much to their communities and their families, after all.

“Successful aging” conveys an implied stigma, or at least an undervaluing of people over 70 or 75 who struggle with chronic disease or limited mobility. Elders afflicted with poor health should not be blamed for their condition. They are often poor people whose control over their life circumstances has been limited by factors such as inadequate schools, housing and health care. Smoking and drinking, banes of middle-class healthy aging, may have been their coping habits. This fact does not absolve smokers and drinkers from personal responsibility, but it does provide a context for understanding the unfairness of the label “successful aging,” because they are only partly responsible for their fate.

In other words, “successful aging” wrongly suggests that attaining good health in later life is entirely our own responsibility. This misconception is hardly surprising in our highly individualistic society. 

If I am relatively intact in my mid-70s, the reasons are class privilege, white privilege, a stimulating job I loved, access to excellent health care, friends who value me, reasonably good habits and choices, and good luck. I did not do it all myself, but the phrase “successful aging” invites me to take all of the credit. It wrongly focuses entirely on me as an individual. It detaches me from all of the social, economic and political factors that determine healthy aging. 

Another reason to resist the term is that it conveys a spirit of competition. Those who have multiple illnesses and disabilities in later life are not competing with their more fortunate neighbors. Success works as a norm in business and sports because it can be measured exactly. Successful businesses make money; successful athletes win their races or their games. We have no such yardstick or coordinate for aging. “Successful aging” falsely implies that we do.

The phrase also glides past the fact that if the United States had gained national health care several decades ago, the number of really healthy people over 80 would be greater than it is today.

Finally, let’s not forget the role of luck. If our dearest friends die, the social support that is extremely beneficial in late life may not be available to us. A bad car accident may cause premature aging. The vagaries of the stock market may wipe out options like travel, alternative health care, a senior college course. An abusive spouse or child may undermine our health.

“Healthy aging” is a worthy goal and an honest phrase. “Successful aging” masks class bias, exaggerates our control over our lives and overlooks the fact that late-life health results partly from heredity and partly from the physical and psychological environment of our developing years and our adulthood. Let us decide for ourselves if our lives—at all ages—are successful.