What is Optimal Aging?
 Models
of Optimal Aging
 Wisdom
and Optimal Aging
 Religiosity,
Spirituality, and Optimal
 Ars
Moriendi ----- The Art of Dying
Optimal Aging
Optimal aging is a relatively new concept.
It is more than just good health; it must
include notions of adult development as
 The term optimal aging allows for the
recognition that there may be different
ways of aging well, that people start with
different configurations of vulnerabilities
and resources that affect how they age.
Models of Optimal Aging
 Rowe
and Kahn’s Model of
Successful Aging
 Vaillant’s
Model of Aging Well
Rowe and Kahn’s Model of
Successful Aging
Rowe and Kahn’s Model has three
1. Avoidance of disease (no genetic
2. Maintenance of high cognitive and
physical function
3. An active engagement with life
Rowe and Kahn’s Model
1. Avoiding disease and decelerating the
aging process
 Three critical elements in the prevention
of chronic illnesses in late life:
1) Avoidance of toxins (smoking, excessive
alcohol consumption, substance abuse
and UV radiation)
2) Good nutrition (carbohydrates, fat and
protein, vitamins, caloric restriction?)
3) Exercise (moderate and different
Rowe and Kahn’s Model (cont)
2. Maintenance of high cognitive and
physical function
 Good diet, exercise and avoiding toxins
 Good exercise programs can improve
cardiopulmonary and musculoskeletal
function even in old-old and very frail
 Exercises should not only include
physical activity but cognitive activity as
well (playing cards, crossword puzzles)
Card number game:
Using +, -, x, and ÷ to get 24 with these four cards.
Card number game:
Using +, -, x, and ÷ to get 24 with these four cards.
Rowe and Kahn’s Model (cont)
3. An active engagement with life – as a
high level of social support and
productive work (Rowe and Kahn, 1998)
 Social support and good mental and
physical health.
 Caregiving from family and friends can
help to mitigate disability and allow
elders to remain in the community.
 Older adults also engage in organized
volunteer work. How could the volunteer
work help themselves?
Vaillant’s Model of Aging Well
Vaillant’s Model includes six criteria:
 Three physical health criteria:
1. No physical disability at age 75 (physician-rated)
2. Good subjective physical health (no problem with
3. Length of undisabled life
 Three social engagement and productive work
1. Good mental health (interviewed-rated: career, …)
2. Objective social support (marriage, children, …)
3. Self-rated life satisfaction in 8 domains (marriage,
income-producing work, …..page 310)
Vaillant’s Model of Aging Well (cont)
3. Self-rated life satisfaction in 8 domains:
1) marriage
2) income-producing work
3) children
4) friendship and social contact
5) hobbies
6) community service activities
7) religion
8) recreation/sports
All these six criteria derived from three longitudinal
studies (Vaillant, 2002) on page 310.
Vaillant’s Model of Aging Well (cont)
Four coping strategies:
1. Altruism - is selfless concern for the welfare of
others. It is a traditional virtue in many cultures, and a
core aspect of various religious traditions,
2. Humor – the ability not to take oneself too seriously.
3. Sublimation – artistic creation to resolve conflict and
spinning straw into gold.
4. Suppression – a stiff upper lip, patience, seeing the
bright side.
Wisdom and Optimal Aging
Wisdom – a deep understanding and realizing of
people, things, events or situations, resulting in the
ability to choose or act to consistently produce the
optimum results with a minimum of time and energy.
 Wisdom is a multidimensional construct including 3
1. Cognition – perspicacity or insightfulness.
2. Personality – ego process (emotional balance,
detachment, and integrity).
3. Interpersonal process – justice, generosity, and
Wisdom and Optimal Aging (cont)
Relationship of these 3 domains in wisdom:
 They are not separate but rather support and inform
each other in the wise person, such as the ability to be
calm and detached can facilitate both perspicacity and
moral behavior.
 Wisdom may be contextual (depending on the domain
of knowledge) and culturally specific.
 Wisdom has an action component which should be
focused on long-term goals rather than immediate gain
or gratification.
Wisdom and Optimal Aging (cont)
Vaillant (2002) summarized the definitions of wisdom
from his Harvard survey study:
Empathy, through which one must synthesize both care
and justice.
Tolerance and a capacity to appreciate paradox and
irony even as one learns to manage uncertainty.
Self-awareness combined with an absence or selfabsorption
The capacity to “hear” others say
Perspective, sense of the larger context of life,
realization of two sides to everything, nothing is black
or white. Patience, Sense of the irony of life.
A sense of the connectedness of all things.
Wisdom and Optimal Aging (cont)
How does wisdom affect optimal aging?
 Wisdom is opposite of narcissism (self-absorption and
attachment to desire). The losses and problems in late
life results in increase in narcissism, but wisdom is a
recipe for despair and social isolation (page 315).
 Snowdon (2001) provided a humbling example from his
Nun study on page 316.
 What did you learn from this story?
Religiousness, Spirituality, and
Optimal Aging
Koening et al. (1997) found that religious attendance
was negatively related to depression; however,
listening to or watching religious radio or television
programs was positively related to depression, while
private prayer and Bible reading were apparently
 Religiosity and mental health: Hood et al. (1996)
stated that “… faith buttresses people’s sense of
control and self-esteem, offers meanings that oppose
anxiety, provides hope, sanctions socially facilitating
behavior, enhances personal well-being, and promotes
social integration.
Religiousness, Spirituality, and
Optimal Aging (cont)
Religiosity and physical health (a complex relationship):
 Religious service attendance is often correlated with
good health to participate in social activity in late life.
 Many religions have restrictions that can promote good
health behavior, such as banning smoking, alcohol and
eating meat.
 Participation in organized religion also provides a
course of social support.
Religiousness, Spirituality, and
Optimal Aging (cont)
Stronger religious belief was a predictor of positive
affect among caregivers under chronic stress (Rabbins
et al., 1997).
 However, religiosity may not be an absolute
requirement for optimal aging. Do you agree with this
 If wisdom is a sine qua non for successful aging, one
must ask whether religiosity is necessary for the
development of wisdom. The answer is on page 318.
Ars Moriendi ----- The Art of Dying
Ars moriendi ("The Art of Dying") is the name of
two related Latin texts dating from about 1415
and 1450 which offer advice on the protocols and
procedures of a good death, explaining how to "die
well" according to Christian precepts of the late
Middle Ages.
 “How we die” is the final chapter of the life. In the
late life, death is much more likely to be a slow and
gradual process so that older people in their very
late life can prepare financially, emotionally and
spiritually (ex after hospice training on page 319).
The Art of Dying (cont)
Hospice and palliative care have had a positive
impact on the way in which people die.
 Most people prefer to die at home (King et al.,
2000). Why?
 Death may be welcome in very late life. People
who have outlived spouses, friends, and even
children may feel that it is “their time to go”.
 Most cultures have some concept of what
constitutes a good death (examples of Irish culture
and Buddhist monks on page 320).
The Art of Dying (cont)
Witnessing the death of others can be deeply
spiritual experience.
 Elders who believe in an afterlife often speak of
rejoining their loved ones, which helps to mitigate
their fear of death. Even those without such beliefs,
may feel that they are old enough, that they have
done what they wanted to do, and therefore,
accepted their imminent deaths.
 Wisdom helps us face death.
 What
did you learn from this chapter?