Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
PEER REVIEW HISTORY
BMJ Open publishes all reviews undertaken for accepted manuscripts. Reviewers are asked to
complete a checklist review form (see an example) and are provided with free text boxes to elaborate
on their assessment. These free text comments are reproduced below. Some articles will have been
accepted based in part or entirely on reviews undertaken for other BMJ Group journals. These will be
reproduced where possible.
ARTICLE DETAILS
TITLE (PROVISIONAL)
AUTHORS
Lay perspectives of successful ageing: A systematic review and
meta-ethnography
Cosco, Theodore; Prina, Matthew; Perales, Jaime; Stephan,
Blossom; Brayne, Carol
VERSION 1 - REVIEW
REVIEWER
REVIEW RETURNED
THE STUDY
RESULTS & CONCLUSIONS
GENERAL COMMENTS
Eric Brunner
Reader in epidemiology and public health
UCL
07-Mar-2013
What is the definition of a qualitative study? Commonly, it means an
open-ended or semi-open-ended question format. Is that your
definition?
The abstract should contain the psychosocial factors commonly
identified by lay people.
The biomedical concepts of successful ageing are not well defined.
The second version of this article is modified to focus on lay
perspectives of successful ageing. The previous version compared
lay and researcher perspectives, and therefore the article is
simplified. This is a helpful change because the paper is less hybrid.
The aim is now „to augment the largely quantitatively dominated SA
literature with insights from qualitative research‟. The search
strategy is clearly specified. It would be useful to know if the terms
<quality of life> and <ageing> identify additional literature. The
process of study selection usually includes title screening, but this
was not done here. It would be helpful to have a little more detail on
the data extraction method relating to „the ranked importance of SA
components and the percentage of individuals listing each SA
component‟ (p.7). This reviewer is new to the term „metaethnographic‟ and it would be useful, I am sure for many readers, to
have an explanation of the method that was employed. Discussion
of the findings starts with a bold assertion of „divergence from
traditional biomedical conceptualizations of SA‟ (p.10). This
statement needs empirical back-up. The Discussion presents some
interesting perspectives on the scope of the concepts underlying SA.
I recommend strongly that the number of discouraging comments
concerning biomedical views on ageing is reduced, and where they
are retained they should be based on evidence rather than
prejudice. Why seek to publish in a biomedical journal and to
antagonise the core readership?
Specific points
1. What is the definition of a qualitative study? Commonly, it means
an open-ended or semi-open-ended question format. Is that your
definition?
2. Please refer to evidence to support the claim that research on SA
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
is dominated by quantitative studies (p.5).
3. The term „healthy ageing‟ is used in the Introduction. Please
provide some indications of the difference between this term and
SA.
4. The search strategy identified 5336 articles, not 10580. Please
correct the flow diagram.
5. Please consider a better term e.g. qualitative, rather than
exploratory. A study with >1500 participants is not really exploratory.
REVIEWER
REVIEW RETURNED
THE STUDY
RESULTS & CONCLUSIONS
Tim Windsor
Australian Research Council Future Fellow
Flinders University of South Australia
Australia
No competing interests
08-Mar-2013
This manuscript reports a systematic review of qualitative research
concerned with lay perspectives on successful ageing (SA). The
question of what it means to age „successfully‟ is important from a
social policy perspective, and the authors appear to have done a
good job of identifying relevant qualitative studies, and emergent
themes across the studies. Despite these strengths, there were a
number of limitations that left me unconvinced as to whether the
manuscript (at least in its current form) has the potential to make a
significant contribution to the literature.
First, there was no strong case made in the introduction as to why it
is important to consider lay perspectives, and why these would be
expected to be different to researcher-driven perspectives. The
rather broad claim is made that “through the acknowledgement of
qualitative data, quantitative studies may be better informed, with
increased practical relevance and impact”. How exactly do
qualitative studies increase practical relevance and impact? Is there
an appropriate citation to support this claim? The authors distinguish
their review from that of Hung et al on the grounds that the Hung
paper focuses on “healthy ageing”, whereas the current manuscript
focuses on SA. It is not clear what this semantic distinction
represents, particularly as the authors note that conceptions of
successful ageing often have a biomedical focus. This is further
complicated by the fact that “healthy ageing” was included as a
synonym for “successful ageing” in the search strategy (p. 6).
Bowling and Dieppe‟s (2005) review of researcher- and laydefinitions of successful ageing in BMJ should be cited, and how the
current study makes an additional contribution clarified.
A number of successful ageing synonyms were included in the
search strategy, however it is later noted that studies discussing
synonyms of SA, but without specific reference to SA were excluded
from the review. This left me unsure as to why the synonyms were
used. Some more detail on the foundations of the “metaethnographic framework” and how this is applied in identifying and
organizing themes would be helpful for the reader unfamiliar with
qualitative methods.
It was not clear to me what the term „items‟ (p. 8) referred to, and
whether „item‟ is interchangeable with „theme‟. I would usually think
of items as specific questions used in survey research. On p. 9 the
authors indicate that physical functioning/disability was the most
often mentioned of the constituent components of SA. This seems
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
inconsistent with the abstract, and Figure 5. The results reported in
the text of p.9 indicate that several themes (e.g., engagement) were
identified by high percentages of studies (> 80%). However the
maximum percentage value on the Y axis of Figure 5 is 20%. I was
unable to work out how the text on p. 9 mapped onto the results of
Figure 5.
The main theme that is emphasized throughout the discussion is
that biomedical models of SA are not sufficient, and that
psychosocial components are also important to consider. This is an
important point, but it seems to me that it is one already wellestablished in the SA literature (e.g., Bowling & Dieppe, 2005). Even
Rowe and Kahn‟s (1997) model, despite its biomedical focus,
acknowledges the importance of several psychosocial attributes
including supportive social relationships and self-efficacy under the
broader heading of „engagement‟. I felt that more was needed in the
discussion to demonstrate how this study makes a unique
contribution.
References
Bowling, A., & Dieppe, P. (2005). What is successful ageing and
who should define it? BMJ, 331, 1548-1551.
Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The
Gerontologist, 37, 433-440
VERSION 1 – AUTHOR RESPONSE
Reviewer: Eric Brunner
Reader in epidemiology and public health UCL
What is the definition of a qualitative study? Commonly, it means an open-ended or semi-open-ended
question format. Is that your definition?
- Our definition of qualitative research has been clarified as suggested.
“Studies were considered to be qualitative if participants were asked open-ended or semi-open ended
question(s).
The abstract should contain the psychosocial factors commonly identified by lay people.
- Examples of psychosocial factors commonly identified by lay people have been added o the
abstract.
“Laypersons identified psychosocial components, notably engagement, e.g. social engagement, and
personal resources, e.g. attitude, as integral components of SA in more studies than “physiological”
components, such as longevity or physical functioning.”
The biomedical concepts of successful ageing are not well defined.
- The underpinnings of biomedical conceptualisations of successful ageing have been clarified.
“The most popular model of SA, Rowe & Kahn‟s 2 3 conceptualisation of SA is primarily biomedical.
This and other biomedical models of SA focus on physiological or cognitive aspects of health, as
captured by metrics such as the Mini Mental State Exam 4or the Activities of Daily Living scale 5 .
Rowe & Kahn‟s 2 3 model suggests that high cognitive/physical functioning, low risk of illness, and
active engagement comprise SA.
The second version of this article is modified to focus on lay perspectives of successful ageing. The
previous version compared lay and researcher perspectives, and therefore the article is simplified.
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
This is a helpful change because the paper is less hybrid. The aim is now „to augment the largely
quantitatively dominated SA literature with insights from qualitative research‟. The search strategy is
clearly specified.
It would be useful to know if the terms and identify additional literature.
- While the addition of “quality of life” and “ageing” does identify additional literature. The objective of
the current study is to provide a snapshot of the existing literature on lay perspectives of successful
ageing. Therefore, the addition of these terms falls outside of the scope of the current study.
The process of study selection usually includes title screening, but this was not done here.
- During the screening process, labelled “abstract review” in the first draft, titles were also screened;
however this was not included in the text. Thank you for identifying this omission. The text has been
revised to indicate that titles and abstracts were screened.
“Title and abstract review was conducted (TDC & JP), to identify relevant articles for full-text
extraction.”
It would be helpful to have a little more detail on the data extraction method relating to „the ranked
importance of SA components and the percentage of individuals listing each SA component‟ (p.7).
- The data extraction methods for SA components and ranked importance of SA components has
been clarified.
“Information regarding the definitions and components of SA were extracted from authors‟
descriptions and syntheses of participants‟ responses as well as direct quotes from study participants.
Where possible, the percentage of respondents referencing each SA component in a given study was
noted. In studies where participants ranked the relative importance of each SA component, these data
were recorded.
This reviewer is new to the term „meta-ethnographic‟ and it would be useful, I am sure for many
readers, to have an explanation of the method that was employed.
- A further explanation of meta-ethnography has been included.
“The different components of SA were analyzed using a meta-ethnographic framework. Metaethnography is a method with which to synthesize qualitative studies through an inductive analysis
and integration of inter-study themes14.”
Discussion of the findings starts with a bold assertion of „divergence from traditional biomedical
conceptualizations of SA‟ (p.10). This statement needs empirical back-up.
- The opening assertion in the discussion has been supported through a comparison tp the most
recently published review of operational definitions of successful ageing.
“The components of SA identified by the qualitative studies captured in the current review reflect a
divergence from traditional biomedical conceptualizations of SA, highlighting the multidimensionality
and psychosocial emphasis of SA. In contrast to operational definitions captured in the most recent
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
review SA which posit primarily biomedical models 7, attitudinal and engagement components were
most frequently mentioned in the current review. Furthermore, external factors, such as finances and
environment, which are absent in the majority of SA conceptualizations 7, were also frequently
mentioned. The current review highlights the importance of psychosocial and external factors in SA
definitions as well as emphasizes the multidimensional nature of SA. These results suggest that the
incorporation of psychosocial and extrinsic components identified by laypersons into a
multidimensional model of SA is a prudent means with which to augment biomedical
conceptualisations of SA.”
The Discussion presents some interesting perspectives on the scope of the concepts underlying SA.
I recommend strongly that the number of discouraging comments concerning biomedical views on
ageing is reduced, and where they are retained they should be based on evidence rather than
prejudice. Why seek to publish in a biomedical journal and to antagonise the core readership?
- This is a valuable point. The intent was not to antagonise the readership, but rather to highlight a
potential shortcoming. We have rephrased and reframed these comments to emphasise the potential
of lay perspectives to augment and improve biomedical conceptualisations of SA.
For example:
“These results suggest that the incorporation of psychosocial and extrinsic components identified by
laypersons into a multidimensional model of SA is a prudent means with which to augment biomedical
conceptualisations of SA.”
Specific points
1. What is the definition of a qualitative study? Commonly, it means an open-ended or semi-openended question format. Is that your definition?
- Our definition of qualitative research has been clarified as suggested.
“Studies were considered to be qualitative if participants were asked open-ended or semi-open ended
question(s).”
2. Please refer to evidence to support the claim that research on SA is dominated by quantitative
studies (p.5).
- References to the most recent quantitative and qualitative reviews of successful ageing have been
provided.
“The most recent reviews of quantitative definitions of SA 7 and qualitative perspectives of SA 8,
reveal that there are more than twice as many studies examining operational definitions of SA as
there are studies examining lay perspectives of SA.
3. The term „healthy ageing‟ is used in the Introduction. Please provide some indications of the
difference between this term and SA.
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
- Terms for positive states of ageing generally do not have consensus definitions and are specified
within the context of a given study. In the case of Hung. et al.‟s use of “healthy ageing”, they use the
phrase as an “umbrella term” to capture several terms describing positive states of ageing, namely
„successful aging‟, „active aging‟ „positive aging‟, „robust aging‟ and „aging well‟. The difference in
usage of these terms has been clarified.
“Further, whilst Hung, et al. 8 focused on the umbrella concept of “healthy ageing”, which they
describe as capturing, “active ageing” “positive ageing”, “robust ageing”, “ageing well” as well as SA,
the current review focusses specifically on SA. “
4. The search strategy identified 5336 articles, not 10580. Please correct the flow diagram.
- The flow diagram has been corrected to indicate the number of unique articles identified by the
search strategy and to include the updated, i.e. up until March 22, 2013, search strategy.
5. Please consider a better term e.g. qualitative, rather than exploratory. A study with >1500
participants is not really exploratory.
- In line with the clarification of “qualitative study” references to “exploratory” studies have been
deleted.
Reviewer: Tim Windsor
Australian Research Council Future Fellow Flinders University of South Australia Australia
No competing interests
This manuscript reports a systematic review of qualitative research concerned with lay perspectives
on successful ageing (SA). The question of what it means to age „successfully‟ is important from a
social policy perspective, and the authors appear to have done a good job of identifying relevant
qualitative studies, and emergent themes across the studies. Despite these strengths, there were a
number of limitations that left me unconvinced as to whether the manuscript (at least in its current
form) has the potential to make a significant contribution to the literature.
First, there was no strong case made in the introduction as to why it is important to consider lay
perspectives, and why these would be expected to be different to researcher-driven perspectives.
- The importance of including qualitative studies in successful aging research has been clarified.
“The aim of the study is to provide a comprehensive review of studies examining lay perspectives of
SA, in order to augment the largely quantitatively dominated SA literature with insights from qualitative
research. The most recent reviews of quantitative definitions of SA 7 and qualitative perspectives of
SA 8, reveal that there are more than twice as many studies examining operational definitions of SA
than there are studies examining lay perspectives of SA. However, in a study examining several
different SA models, i.e. biomedical, psychosocial and lay models, the multidimensional lay model
was found to be the strongest9. Through the acknowledgement of qualitative data, laypersons are
given a voice to convey which aspects of SA they value 10. The incorporation of layperson
perspectives expands and complements existing quantitative research, with the potential to improve
both the quality and impact of research 11.”
The rather broad claim is made that “through the acknowledgement of qualitative data, quantitative
studies may be better informed, with increased practical relevance and impact”. How exactly do
qualitative studies increase practical relevance and impact? Is there an appropriate citation to support
this claim?
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
- As above, the importance of including qualitative studies has been clarified.
The authors distinguish their review from that of Hung et al on the grounds that the Hung paper
focuses on “healthy ageing”, whereas the current manuscript focuses on SA. It is not clear what this
semantic distinction represents, particularly as the authors note that conceptions of successful ageing
often have a biomedical focus. This is further complicated by the fact that “healthy ageing” was
included as a synonym for “successful ageing” in the search strategy (p. 6). Bowling and Dieppe‟s
(2005) review of researcher- and lay-definitions of successful ageing in BMJ should be cited, and how
the current study makes an additional contribution clarified.
- As noted in response to Reviewer 1, Hung, et al. specify that in the context of their study healthy
ageing is used an umbrella term to capture successful aging as well as several other terms.
A number of successful ageing synonyms were included in the search strategy, however it is later
noted that studies discussing synonyms of SA, but without specific reference to SA were excluded
from the review. This left me unsure as to why the synonyms were used
- Synonyms for successful ageing were included in the search strategy to ensure that all successful
ageing studies were captured. For example, a researcher may use a successful aging synonym in the
keywords, which would be missed if the search strategy online included only successful aging;
however, the study may ask participants “What is successful aging?”, which would meet inclusion
criteria. Accordingly, we chose to err on the side of caution to ensure that every possible instance in
which successful aging was specifically discussed was captured.
. Some more detail on the foundations of the “meta-ethnographic framework” and how this is applied
in identifying and organizing themes would be helpful for the reader unfamiliar with qualitative
methods.
- A further explanation of meta-ethnography has been included.
“The different components of SA were analyzed using a meta-ethnographic framework. Metaethnography is a method with which to synthesize qualitative studies through an inductive analysis
and integration of inter-study themes7”
It was not clear to me what the term „items‟ (p. 8) referred to, and whether „item‟ is interchangeable
with „theme‟. I would usually think of items as specific questions used in survey research.
- As suggested, the term “item” was removed and replaced with component, for example:
“All studies (n=24) included psychosocial components, 83% (20) included biomedical components,
and 58% (14) included external components.”
On p. 9 the authors indicate that physical functioning/disability was the most often mentioned of the
constituent components of SA. This seems inconsistent with the abstract, and Figure 5. The results
reported in the text of p.9 indicate that several themes (e.g., engagement) were identified by high
percentages of studies (> 80%). However the maximum percentage value on the Y axis of Figure 5 is
20%. I was unable to work out how the text on p. 9 mapped onto the results of Figure 5.
- Thank you for bringing this to our attention. The text has been changed to reflect the results
presented in Figure 5.
“A comparison of the percentage of respondents reporting each of the constituent components of SA
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
revealed engagement was mentioned most frequently, followed by perspective and self-awareness.”
- Furthermore, the title of Figure five has been revised to indicate that the values on the Y axis
represent the number of studies, not the percentage.
“Figure 5: Frequency of studies reporting each of the SA components, by region”
The main theme that is emphasized throughout the discussion is that biomedical models of SA are
not sufficient, and that psychosocial components are also important to consider. This is an important
point, but it seems to me that it is one already well-established in the SA literature (e.g., Bowling &
Dieppe, 2005). Even Rowe and Kahn‟s (1997) model, despite its biomedical focus, acknowledges the
importance of several psychosocial attributes including supportive social relationships and selfefficacy under the broader heading of „engagement‟. I felt that more was needed in the discussion to
demonstrate how this study makes a unique contribution.
- The focus of the discussion has been reframed to highlight the ability of lay perspectives of SA to
augment, and potentially improve, biomedical models of SA. As Dr. Windsor highlights, this has been
highlighted by previous studies, e.g. Bowling & Dieppe, 2005. The current makes a unique contributin
to the literature by updating the most recent review of lay perspectives of ageing well (Hung, et. al)
capturing nearly twice as many studies and conducting a much more in-depth analysis of the themes
captured in their review. Through a meta-ethnographic analysis of the themes captured in the
included studies the current review provides an unprecedented level of granularity, breaking down
each component of SA within its broader themes.
References
Bowling, A., & Dieppe, P. (2005). What is successful ageing and who should define it? BMJ, 331,
1548-1551.
Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The Gerontologist, 37, 433-440
- Both references have been included.
“The incorporation of layperson perspectives expands and complements existing quantitative
research, with the potential to improve both the quality and impact of research11, increasing the
validity and practical relevance of SA models 12. “
VERSION 2 – REVIEW
REVIEWER
REVIEW RETURNED
GENERAL COMMENTS
Tim Windsor
ARC Future Fellow
Flinders University
Australia
No competing interests
24-Apr-2013
The authors have done a good job of addressing most of the issues
raised by me in the previous review. There are, however, a few
remaining issues that I believe should be addressed before the
manuscript is accepted for publication.
1) The new content included on pp. 5-6 that compares quantitative
with qualitative studies in the area was not easy to follow. It was not
clear to me what a „quantitative definition‟ is (a definition based on
quantitative data? Use of quantitative data to provide evidence for a
pre-defined model?), or what „operational definitions‟ refer to in this
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
context, and whether they are synomymous with quantitative
approaches. Some clarification here would help in guiding the
reader.
2) My point about the distinction between „healthy ageing‟ vs.
„successful ageing‟ raised in the previous review was not clearly
addressed. The authors now clarify that Hung et al. described
“healthy ageing” as capturing active, positive, and robust ageing,
and ageing well. In contrast, the current study is said to focus on SA.
Yet, the search terms used to identify SA related papers included
„healthy ageing‟ as well as all of the synonyms referred to above as
being captured by Hung et al.‟s umbrella term. This suggests a
strong degree of conceptual overlap between the two terms and
leaves me no clearer as to why this semantic distinction is an
important one to make. In the authors‟ response to the previous
review they noted that the study extends Hung et al.‟s work by
identifying more recent studies, a greater number of studies, and
analysing the concepts around SA in greater depth via the metaethnographic analysis. To me, these are more compelling issues to
refer to in arguing for what the study adds to the literature than
focusing on a conceptual distinction between healthy ageing and SA
that (for me at least) is difficult to follow.
3) Pp. 15-16: “proponents of strictly biomedical models suggest that
psychosocial components should not be included in models of SA”
This statement seems rather strong. As I noted in the previous
review, Rowe and Kahn (cited in the manuscript as a prime example
of the biomedical approach) acknowledge the importance of some
psychosocial components in the context of active engagement. If
some proponents of strict biomedical models do make the explicit
claim that psychosocial components should not be included in SA
models, then relevant citations should be provided. Otherwise this
point should be re-framed to reflect the different emphasis of the
biomedical approach, rather than implying that biomedical
approaches actively eschew psychosocial perspectives.
4) Reference 7 appears to be a duplicate of reference 1.
VERSION 2 – AUTHOR RESPONSE
1) The new content included on pp. 5-6 that compares quantitative with qualitative studies in the area
was not easy to follow. It was not clear to me what a „quantitative definition‟ is (a definition based on
quantitative data? Use of quantitative data to provide evidence for a pre-defined model?), or what
„operational definitions‟ refer to in this context, and whether they are synomymous with quantitative
approaches. Some clarification here would help in guiding the reader.
- The quantitative studies to which we refer are ones in which successfully ageing has been
conceptualised by researchers and quantified, namely via operational definitions. This has been
clarified to acknowledge the contrast between researcher-driven conceptualisation and lay
perspectives of successful ageing.
“The aim of the study is to provide a comprehensive review of studies examining lay perspectives of
SA, in order to augment the many researcher-driven conceptualisations of SA with insights from
qualitative research. The most recent reviews of operational definitions of SA1 and qualitative
perspectives of SA7, reveal that there are more than twice as many studies positing operational
definitions of SA as there are studies examining lay perspectives of SA. However, a study examining
several different SA models, i.e. biomedical, psychosocial and lay models, found the multidimensional
lay model to be the strongest8. Through qualitative studies laypersons are given a platform to voice
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
their opinions and perspectives on research topics9. Therefore, the incorporation of layperson
perspectives expands and complements researcher-driven conceptualisations of SA, with the
potential to improve both the quality and impact of research10, increasing the validity and practical
relevance of SA models 11 .”
2) My point about the distinction between „healthy ageing‟ vs. „successful ageing‟ raised in the
previous review was not clearly addressed. The authors now clarify that Hung et al. described
“healthy ageing” as capturing active, positive, and robust ageing, and ageing well. In contrast, the
current study is said to focus on SA. Yet, the search terms used to identify SA related papers included
„healthy ageing‟ as well as all of the synonyms referred to above as being captured by Hung et al.‟s
umbrella term. This suggests a strong degree of conceptual overlap between the two terms and
leaves me no clearer as to why this semantic distinction is an important one to make. In the authors‟
response to the previous review they noted that the study extends Hung et al.‟s work by identifying
more recent studies, a greater number of studies, and analysing the concepts around SA in greater
depth via the meta-ethnographic analysis. To me, these are more compelling issues to refer to in
arguing for what the study adds to the literature than focusing on a conceptual distinction between
healthy ageing and SA that (for me at least) is difficult to follow.
- Clarification as to why all of the successful ageing related terms were included in the search strategy
have been included.
“This process was repeated across the six databases using the seven SA related phrases. The SA
related terms were included to capture studies that, for example, listed “ageing well” in their keywords,
but asked “What is your definition of successful ageing?” in interviews with participants. If only
“successful ageing” had been used in the search strategy it would have been missed. Therefore, in an
effort to capture every SA instance the seven SA related terms were used in the search strategy. “
The acknowledgement of the update and expansion of Hung, et al.s review has been further noted:
“The current study updates and expands a previous review by Hung, et al. {hung}, collecting,
synthesising, and proving a comprehensive examination of layperson conceptualisations of SA.”
3) Pp. 15-16: “proponents of strictly biomedical models suggest that psychosocial components should
not be included in models of SA” This statement seems rather strong. As I noted in the previous
review, Rowe and Kahn (cited in the manuscript as a prime example of the biomedical approach)
acknowledge the importance of some psychosocial components in the context of active engagement.
If some proponents of strict biomedical models do make the explicit claim that psychosocial
components should not be included in SA models, then relevant citations should be provided.
Otherwise this point should be re-framed to reflect the different emphasis of the biomedical approach,
rather than implying that biomedical approaches actively eschew psychosocial perspectives.
- This section has been reframed to emphasise the ability of psychosocial components to augment
and improve biomedical approached.
“Many of the components identified by layperson as being important (e.g. engagement, selfawareness, perspective, etc.) present the opportunity for the implementation of specific interventions
for modifiable behaviors. For example, aiding individuals in, decreasing depressive symptomology,
social engagement, invoking coping and resilience training, could augment and compliment physical
remediation strategies, as identified by biomedical models, in the pursuit of SA. Therefore, it is
prudent to augment the scope of biomedical models to areas of the lived life that have not been
covered by traditional models of SA.”
4) Reference 7 appears to be a duplicate of reference 1.
The duplicate reference has been deleted.
Downloaded from http://bmjopen.bmj.com/ on March 5, 2016 - Published by group.bmj.com
Lay perspectives of successful ageing: a
systematic review and meta-ethnography
Theodore D Cosco, A Matthew Prina, Jaime Perales, Blossom C M
Stephan and Carol Brayne
BMJ Open 2013 3:
doi: 10.1136/bmjopen-2013-002710
Updated information and services can be found at:
http://bmjopen.bmj.com/content/3/6/e002710
These include:
References
This article cites 46 articles, 11 of which you can access for free at:
http://bmjopen.bmj.com/content/3/6/e002710#BIBL
Open Access
This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-commercial License, which permits use,
distribution, and reproduction in any medium, provided the original work is
properly cited, the use is non commercial and is otherwise in compliance
with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and
http://creativecommons.org/licenses/by-nc/3.0/legalcode
Email alerting
service
Receive free email alerts when new articles cite this article. Sign up in the
box at the top right corner of the online article.
Topic
Collections
Articles on similar topics can be found in the following collections
Geriatric medicine (170)
Public health (1420)
Qualitative research (446)
Notes
To request permissions go to:
http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to:
http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to:
http://group.bmj.com/subscribe/