Recent growth in the number of adults surviving to advanced ages raises questions about the quality of life associated with increased longevity. Psychosocial factors have received relatively little attention in research on quality of life among the oldest-old. This study uses nationally representative data on older US adults to examine how social relationships, feelings of loneliness, and satisfaction with life and the aging experience differ between the oldest-old, those who have survived to age 90 or older, and older adults in their 70s. We find that the oldest-old are able to maintain social relationships with family and friends and receive more social support than younger elderly adults. Yet, the oldest-old are more likely to feel lonely due to their greater rates of widowhood. Satisfaction with life was higher among the oldest-old, but the oldest-old had more negative perceptions of the aging experience. Psychosocial dimensions of longevity should be considered in research on quality of life among the oldest-old. 1. Introduction As a result of recent demographic changes, such as declining mortality rates among older adults, reaching advanced old age has become an increasingly common experience in the US and around the world [1–3]. The rapid growth in the number of very old people raises questions about the quality of additional years of life lived by those achieving exceptional longevity. The World Health Organization has declared that “increased longevity without quality of life is an empty prize” [4]. Although much of the research thus far on longevity and quality of life has emphasized health and functioning, we argue that a more comprehensive understanding of quality of life at advanced old ages could be achieved by additionally considering psychosocial well-being. Traditional approaches to studying quality of life among those who reach advanced old age are rooted in a biomedical paradigm that emphasizes the avoidance of disease and cognitive and physical declines [5]. There is concern, for instance, that those who survive to very old age spend their remaining years in a state of poor health and functioning and, therefore, have a poor quality of life [6, 7]. Prior research on long-lived individuals indeed confirms that among individuals who survive to exceptional old age there is a high prevalence of disease and disability as well as impaired cognitive performance [8–12]. However, aging is a multidimensional concept, and psychosocial factors that assess psychological and social well-being should be included in conceptual frameworks used to
References
[1]
F. C. Bell and M. L. Miller, Life Tables for the United States Social Security Area, 1900–2100, Social Security Administration, Office of the Chief Actuary, 2002.
[2]
J. Oeppen and J. W. Vaupel, “Broken limits to life expectancy,” Science, vol. 296, no. 5570, pp. 1029–1031, 2002.
[3]
J. W. Vaupel, J. R. Carey, K. Christensen et al., “Biodemographic trajectories of longevity,” Science, vol. 280, no. 5365, pp. 855–860, 1998.
[4]
World Health Organization, The World Health Report: Report of the Director-General, World Health Organization, Geneva, Switzerland, 1997, http://www.who.int/whr/1997/en/whr97_djmessage_en.pdf/.
[5]
J. W. Rowe and R. L. Kahn, “Human aging: usual and successful,” Science, vol. 237, no. 4811, pp. 143–149, 1987.
[6]
E. M. Crimmins and H. Beltran-Sanchez, “Mortality and morbidity trends: is there compression of morbidity?” The Journals of Gerontology Series B, vol. 66B, no. 1, pp. 75–86, 2010.
[7]
E. M. Crimmins, M. D. Hayward, A. Hagedorn, Y. Saito, and N. Brouard, “Change in disability-free life expectancy for americans 70 years old and older,” Demography, vol. 46, no. 3, pp. 627–646, 2009.
[8]
K. Andersen-Ranberg, M. Schroll, and B. Jeune, “Healthy centenarians do not exist, but autonomous centenarians do: a population-based study of morbidity among Danish centenarians,” Journal of the American Geriatrics Society, vol. 49, no. 7, pp. 900–908, 2001.
[9]
J. Evert, E. Lawler, H. Bogan, and T. Perls, “Morbidity profiles of centenarians: survivors, delayers, and escapers,” The Journals of Gerontology, vol. 58, no. 3, pp. 232–237, 2003.
[10]
B. Hagberg, B. Bauer Alfredson, L. W. Poon, and A. Homma, “Cognitive functioning in centenarians: a coordinated analysis of results from three countries,” The Journals of Gerontology Series B, vol. 56, no. 3, pp. 141–151, 2001.
[11]
J. S. Kim, M. H. Bramlett, L. K. Wright, and L. W. Poon, “Racial differences in health status and health behaviors of older adults,” Nursing Research, vol. 47, no. 4, pp. 243–250, 1998.
[12]
D. F. Terry, P. Sebastiani, S. L. Andersen, and T. T. Perls, “Disentangling the roles of disability and morbidity in survival to exceptional old age,” Archives of Internal Medicine, vol. 168, no. 3, pp. 277–283, 2008.
[13]
C. M. Aldwin and D. F. Gilmer, Health, Illness, and Optimal Aging: Biological and Psychosocial Perspectives, Sage, Thousand Oaks, Calif, USA, 2004.
[14]
M. P. Lawton, “Environment and other determinants of well-being in older people,” The Gerontologist, vol. 23, no. 4, pp. 349–357, 1983.
[15]
B. L. Neugarten, R. J. Havighurst, and S. S. Tobin, “The measurement of life satisfaction,” Journal of Gerontology, vol. 16, no. 2, pp. 134–143, 1961.
[16]
J. S. House, K. R. Landis, and D. Umberson, “Social relationships and health,” Science, vol. 241, no. 4865, pp. 540–545, 1988.
[17]
H. Koivumaa-Honkanen, R. Honkanen, H. Viinam？ki, K. Heikkil？, J. Kaprio, and M. Koskenvuo, “Self-reported life satisfaction and 20-year mortality in healthy finnish adults,” American Journal of Epidemiology, vol. 152, no. 10, pp. 983–991, 2000.
[18]
A. C. Patterson and G. Veenstra, “Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California,” Social Science and Medicine, vol. 71, no. 1, pp. 181–186, 2010.
[19]
C. F. Mendes de Leon, D. T. Gold, T. A. Glass, L. Kaplan, and L. K. George, “Disability as a function of social networks and support in elderly African Americans and Whites: the Duke EPESE 1986–1992,” The Journals of Gerontology B, vol. 56, no. 3, pp. S179–S190, 2001.
[20]
G. McAvay and J. Rodin, “Determinants of change in perceived health in a longitudinal study of older adults,” The Journals of Gerontology, vol. 47, no. 6, pp. P373–P384, 1992.
[21]
J. T. Cacioppo, L. C. Hawkley, L. E. Crawford et al., “Loneliness and health: potential mechanisms,” Psychosomatic Medicine, vol. 64, no. 3, pp. 407–417, 2002.
[22]
G. K. Randall, P. Martin, M. McDonald, and L. W. Poon, “Social resources and longevity: findings from the Georgia centenarian study,” Gerontology, vol. 56, no. 1, pp. 106–111, 2010.
[23]
B. S. Fees, P. Martin, and L. W. Poon, “A model of loneliness in older adults,” The Journals of Gerontology B, vol. 54, no. 4, pp. P231–P239, 1999.
[24]
M. D. Buono, O. Urciuoli, and D. De Leo, “Quality of life and longevity: a study of centenarians,” Age and Ageing, vol. 27, no. 2, pp. 207–216, 1998.
[25]
M. E. Hughes, L. J. Waite, L. C. Hawkley, and J. T. Cacioppo, “A short scale for measuring loneliness in large surveys,” Research on Aging, vol. 26, no. 6, pp. 655–672, 2004.
[26]
E. Diener, R. A. Emmons, R. J. Larsen, and S. Griffin, “The satisfaction with life scale,” Journal of Personality Assessment, vol. 49, no. 1, pp. 71–75, 1985.
[27]
W. Pavot, E. Diener, C. R. Colvin, and E. Sandvik, “Further validation of the satisfaction with life scale: evidence for the cross-method convergence of well-being measures,” Journal of Personality Assessment, vol. 57, no. 1, pp. 149–161, 1991.
[28]
M. P. Lawton, “The Philadelphia geriatric center morale scale: a revision,” The Journals of Gerontology, vol. 30, no. 1, pp. 85–89, 1975.
[29]
StataCorp, Stata Statistical Software: Release 11.0., Stata Press, College Station, Tex, USA, 2007.
[30]
M. Bury and A. Holme, “Quality of life and social support in the very old,” Journal of Aging Studies, vol. 4, no. 4, pp. 345–357, 1990.
[31]
M. G. Kovar and R. I. Stone, “The social environment of the very old,” in The Oldest Old, R. M. Suzman, D. P. Willis, and K. G. Manton, Eds., 1992.
[32]
P. Martin, B. Hagberg, and L. W. Poon, “Predictors of loneliness in centenarians: a parallel study,” Journal of Cross-Cultural Gerontology, vol. 12, no. 3, pp. 203–224, 1997.
[33]
C .L. Johnson and B. M. Barer, Life Beyond 85 Years, Prometheus Books, Amherst, NY, USA, 2003.
[34]
A. J. Bishop, P. Martin, and L. Poon, “Happiness and congruence in older adulthood: a structural model of life satisfaction,” Aging and Mental Health, vol. 10, no. 5, pp. 445–453, 2006.
[35]
L. W. Poon, P. Martin, A. Bishop et al., “Understanding centenarians' psychosocial dynamics and their contributions to health and quality of life,” Current Gerontology and Geriatrics Research, vol. 2010, Article ID 680657, 13 pages, 2010.
