Building communities that promote successful aging

Abstract

Despite the fact that, in a few years, a fifth of the US population will be older than 65 years and people will be living a third of their lives after retirement, we have developed few avenues that would permit older adults to play meaningful roles as they age and few institutions to harness the experience that older adults could contribute to society. In fact, older adults constitute this country's only increasing natural resource--and the least used one. In this article we consider the rationale for developing institutions that harness the abilities and time of older adults, rather than focusing solely on their needs. Such an approach would decrease the structural lag between a social concept of retirement as unproductive leisure and an aging population that is larger, healthier, and with a need for more productive opportunities. Gerontologically designed opportunities for contribution on a large social scale could well provide a national approach to primary prevention to maintain health and function in older adults.

Full text

216
SUCCESSFUL
AGING
Building
Communities
That
Promote
Successful
Aging
LINDA
P.
FRIED,
MD,
MPH,
Baltimore,
Maryland;
MARC
FREEDMAN,
MS,
Berkeley,
California;
THOMAS
E.
ENDRES,
Washington,
D.C;
and
BARBARA
WASIK,
PhD,
Baltimore,
Maryland
Despite
the
fact
that,
in
a
few
years,
a
fifth
of
the
US
population
will
be
older
than
65
years
and
people
will
be
living
a
third
of
their
lives
after
retirement,
we
have
developed
few
avenues
that
would
permit
older
adults
to
play
meaningful
roles
as
they
age
and
few
institutions
to
harness
the
experience
that
older
adults
could
contribute
to
society.
In
fact,
older
adults
constitute
this
country's
only
increasing
natural
resource-and
the
least
used
one.
In
this
article
we
consider
the
rationale
for
developing
insti-
tutions
that
harness the
abilities
and
time
of
older
adults,
rather
than
focusing
solely
on
their
needs.
Such
an
approach
would
decrease
the
structural
lag
between
a
social
concept
of
retirement
as
unpro-
ductive
leisure
and
an
aging
population
that
is
larger,
healthier,
and
with
a
need
for
more
productive
opportunities.
Gerontologically
designed
opportunities
for
contribution
on
a
large
social
scale
could
well
provide
a
national
approach
to
primary
prevention
to
maintain
health
and
function
in
older
adults.
(Fried
LP,
Freedman
M,
Endres
TE,
Wasik
B.
Building
communities
that
promote
successful
aging.
In:
Successful
Aging.
WestJ
Med
1997;
167:216-219)
T
he
end
of
the
20th
century
is
rife
with
major
social
fluxes.
We
live
in
an
aging
society
in
which,
at
birth,
people
can
expect
to
live
into
their
70s
and
80s,
com-
pared
with
their
40s
at
the
beginning
of
the
century.
People
are
living
longer,
and
they
are
living
more
of
these
years
in
good
health.
In
the
postretirement
years,
more
than
half
of
people
aged
65
and
older
are
now
without
disability,
although
80%
have
one
or
more
chronic
diseases.
Despite
the
much
increased
likelihood
of
living
long
lives,
our
society
has
not
evolved
its
vision
of
what
old
age
entails.
Our
social
vision
of
aging
no
longer
involves
poverty
and
deprivation
to
the
degree
it
did
even
30
years
ago.
The
prevailing
social
images
of
old
age
offer
two
major
alternatives:
fear
of
decrepitude,
dependency,
and
relegation
to
a
rocking
chair,
or
at
the
other
extreme,
idealized
images
of
limitless
recreational
time
in
a
retirement
community,
often
segregated
from
other
age
groups
and
the
vicissitudes
of
daily
life.
In
contrast
to
our
social
images,
Eric
Erikson
and
others
have
posited
that
the
major
developmental
task
that
underlies
successful
aging
is
generativity-that
is,
defining
one's
life
contributions
and
ensuring
one's
legacy
through
active
participation
in
meaningful,
con-
tributory
roles:
the
chance
to
"give
back."
And
yet,
there
are
few
opportunities
for
older
adults
to
engage
in
such
meaningful
roles
or
leave
such
a
legacy
in
the
postre-
tirement
years,
and
even
fewer
designed
for
having
an
effect
at
a
scale
beyond
one-on-one
interaction.
This
has
been
described
as
"structural
lag,"1,2
where
the
"norms,
policies
and
practices
are
out
of
step
with
the
demo-
graphic
realities
and
policies
of
an
aging
society."
To
decrease
this
structural
lag,
we
need
to
re-envision
what
successful
aging
in
an
aging
society
could
mean.
Thus,
there
are
few
opportunities
for
older
adults
to
serve
their
own
developmental
needs,
and
they
are,
in
the
main,
marginalized
from
productivity
while
having
a
surfeit
of
time.
In
fact,
retirement
is
occurring
earlier
and
lasting
longer
than
ever
before,
as
more
people,
men
especially,
are
retiring
in
their
50s.
Among
those
aged
55
to
64,
only
53%
worked
for
pay
in
1989,
along
with
22%
of
those
aged
65
to
74
and
4%
of
those
75
and
older.3
During
this
period
of
retirement,
older
adults
are,
to
a
large
degree,
marginalized
from
productivity
while
having
a
surfeit
of
time.
And
yet,
being
able
to
make
a
contribution
has
been
described
as
an
essential
element
of
"successful
aging."4
Consistent
with
this,
it
has
been
reported
that
women
who
participated
in
a
vol-
untary
organization
or
activity
had
greater
longevity
From
the
Welch
Center
for
Prevention,
Epidemiology
and
Clinical
Research
and
the
Center
for
Social
Organization
of
Schools,
Johns
Hopkins
University,
Baltimore,
Md
(Drs
Fried
and
Wasik);
Public/Private
Ventures,
Berkeley,
Ca
(Mr
Freedman);
and
the
Corporation
for
National
Service,
Washington,
DC
(Mr
Endres).
This
work
was
supported
in
part
by
funding
from
the
Retirement
Research
Foundation
and
the
Corporation
for
National
Service.
Reprint
requests
to
Linda
P.
Fried,
MD,
MPH,
2024
E
Monument
St,
Ste
2-600,
Baltimore,
MD
21205.
E-mail:
Ifried@welchlink.welchjhu.edu.

WJM,
-
Ocoe
199-Vol-----
----
167
N.
P
rm
o
i
n
Sucsf
l
Aaina
.
-Fre
et
al
1
7
over
a
30-year
period
than
those
who
did
not,
control-
ling
for
age,
their
own
education,
and
their
husband's
occupational
status.5
In
a
2.5-year
follow-up
of
the
MacArthur
Successful
Aging
study,
participation
in
volunteer
activities
was
predictive
of
improved
func-
tioning
in
older
adults,
with
32%
lower
risk
of
poor
physical
function
in
those
so
involved,
independent
of
the
effect
of
being
active
physically.6
Casual
or
low-
intensity
involvements
in
such
activities,
however,
may
not
confer
these
benefits.
There
is
some
preliminary
evidence
from
this
same
study
that
the
amount
of
time
that
one
is
involved
in
formal
volunteering
activities
is
important
in
conferring
health
benefits,
with
greater
time
involvement
predictive
of
the
level
of
physical
functioning
two
years
later
(T.
Seeman,
PhD,
Department
of
Gerontology,
University
of
Southern
California,
Los
Angeles,
written
communication,
July
1997).
In
addition,
there
is
evidence
that
organized
behavior
is
among
the
best
predictors
of
survival.7
Thus,
in
concordance
with
the
theories
of
Eric
Erikson.8
it
may
be
that
successful
aging
is
related
to
the
opportunity
to
accomplish
the
adult
development
tasks
of
late
life:
integration
and
generativity.
Defining
and
ensuring
one's
legacy
is
a
core
part
of
this
task.
According
to
Erikson,
this
is
essential
to
psychological
well-being
in
late
life
and,
thus,
to
successful
aging.
It
also
appears
that
meeting
these
developmental
needs,
in
some
circumstances,
may
also
confer
health
and
func-
tional
benefits.
It
is
known
that
remaining
active
has
health
benefits
important
to
successful
aging.
Physical
and
cognitive
activity,
along
with
social
engagement
(supports
and
networks),
are
related
to
improved
health
and
function
with
aging.
Regular
physical
activity,
both
of
moderate
and
high
intensity,
are
associated
in
older
adults
with
lower
frequencies
of
heart
disease
and
diabetes
mellitus,
maintenance
of
weight,
more
beneficial
levels
of
other
cardiovascular
disease
risk
factors,
better
physical
func-
tion,
and
lower
likelihood
of
disability
and
dependen-
cy.4'6'9-41
Positive
social
supports
and
social
networks
are
also
independently
protective
of
health
and
functioning
as
people
age.6
Social
activity
has
also
been
related
to
improved
health,
functioning,
and
happiness.12
Some
early
research
supports
the
"use
it
or
lose
it"
admonition
for
cognition,
as
well
as
for
physical
activi-
ty;
it
may
be
that
staying
cognitively
active
helps
protect
memory
as
people
age.'3'14
Therefore,
remaining
active
physically,
cognitively,
and
socially
and
making
a
con-
tribution
all
appear
important
to
health
and
well-being
in
late
life.
Some
of
these
types
of
activities
that
are
asso-
ciated
with
better
health
may
be
difficult
to
accomplish
in
a
retirement
community
setting
or
in
isolation
and,
yet,
may
be
highly
important
for
successful
aging
in
their
own
right.
The
consistency
and
intensity
of
involvement
in
such
activities
may
also
be
necessary
to
affect
the
well-being
of
older
persons.
This
aging
society
is
increasingly
conscious
of
the
need
to
find
ways
to
help
a
population
that
is
living
longer
also
be
healthier.
Population-based
and
clinical
methods
are
needed
to
develop
optimal
prevention
and
treatment
modalities
and
thus
reduce
the
number
of
years
of
late
life
lived
sick
and
disabled.
Such
efforts
should
also
help
to
decrease
resulting
health
care
costs
and
care
needs.
Researchers
in
clinical
medicine
and
public
health
are
actively
engaged
in
defining
the
pre-
vention
and
health
promotion
practices
that
will
reduce
the
incidence
of
disease
and
prevent
disability
and
dependency
in
older
adults.
In
addition,
we
need
to
develop
approaches
for
health
promotion
and
primary
prevention
that
might
be
available
to
older
adults
on
a
broad
social
scale.
In
part,
this
could
be
accomplished
by
creating
widely
accessible
opportunities
for
older
adults
to
remain
active
and
productive.
This
country
has
many
other
pressing
social
needs
in
addition
to
its
aging
society.
One
is
the
need
to
improve
the
outcomes
of
children
in
our
society:
their
literacy,
education,
and
personal
well-being.
In
fact,
the
educa-
tional
levels
of
children
will
be
predictive
of
their
future
health
outcomes
as
they
become
the
next
generation
of
older
adults.
Public
schools,
providing
the
education
of
most
of
the
children
in
this
country,
are
underfunded
and
overworked,
needing
more
human
capital
to
serve
increasingly
needy
children
while
having
less
available
for
this
important
mission.
Research
data
identify
a
par-
ticularly
high-risk
period:
the
progress
of
children
to
the
third
grade
is
a
major
predictor
of
their
subsequent
edu-
cational
and
occupational
outcomes.
Children
who
do
not
learn
to
read
by
the
third
grade
are
at
risk
for
failure
in
school."5
Undereducated
families
are
ill
equipped
to
support
literacy
activities
in
the
home.
Older
adults
could
provide
this
support
and
the
attention
needed
to
teach
young
children
to
read.
Also,
many
families
with
working
parents
have
been
faced
with
the
problem
of
time
famine.
As
a
result
of
this,
they
have
less
time
to
work
on
literacy
activities
in
the
home.
Many
children
would
benefit
from
the
presence
and
support
of
more
adults
and
from
more
stability
in
their
lives.
Older
adults
could
possibly
offer
some
of
this
stability,
caring,
and
consistency,
which
is
essential
to
learning,
as
well
as
the
richness
of
their
experience
and
presence
as
role
models.
Older
adults
could
provide
social
capital
needed
to
directly
support
the
educational
needs
and
the
outcomes
of
children.
At
the
same
time,
older
adults
could
be
investing
in
the
development
of
the
well-educated
work-
force
essential
to
the
future
stability
of
their
own
entitle-
ment
programs,
Social
Security
and
Medicare.
Thus,
a
possible
area
for
creating
generative
opportu-
nities
for
older
adults
is
through
creating
meaningful
roles
for
their
serving
in
schools.
This
could
provide
a
way
to
enhance
successful
aging
through
social
pro-
grams,
through
generative
institutions.
Such
an
approach
could
also
provide
a
new
societal
image
of
the
opportu-
nities
and
roles
of
people
as
they
age,
in
this
case
playing
unique
and
much-needed
roles
supporting
the
education-
al
outcomes
of
children.
If
such
roles
were
developed
at
a
large
enough
scale
and
were
designed
for
maximum
effects
on
the
needs
of
children
in
schools,
the
aggregate
effect
of
a
large
number
of
older
adults
participating
WJM,
October
1997-Vol
167,
No.
4
Promotinq
Successful
Aqinq-Fried
et
al
21 7

~
~ ~ ~
nationally
could
be
to
support
educational
improvement
on
a
population
basis.
The
visibility
of
new,
mature
human
capital
supporting
the
well-being
and
learning
of
children
in
schools-through
nurturing
and
enriching
roles
that
do
not
displace
paid
workers
but
support
their
effectiveness-could
offer
an
image
for
a
positive,
suc-
cessful
aging
and
a
new,
synergistic
intergenerational
social
contract
of
the
future.
This
contract
is
one
in
which
the
older
generation
are
looked
to,
after
retirement,
to
leave
their
legacy
through
strengthening
the
abilities
of
the
younger
generation.
Such
cultural
generativity
is
developmentally
appropriate
for
those
who
have
com-
pleted
their
own
child-rearing
responsibilities."6
The
key
to
having
a
substantial
effect,
simultaneous-
ly,
in
meeting
unmet
needs
while
improving
the
well-
being
of
older
adults
on
a
population
basis
is
to
design
programs
that
are
attractive
to
older
adults,
support
their
effectiveness
and
maximize
both
their
contribution
and
the
health
benefits
and
that
are
available
on
a
large
scale.
One
approach
to
this
is
currently
being
assessed
in
a
pilot
demonstration
program
entitled
the
"Experience
Corps."
This
pilot
program,
in
five
US
cities,
places
older
adults
in
elementary
schools
to
serve
the
needs
of
the
schools
and
children
using
a
unique
gerontologic
design
to
meet
the
goals
described
earlier.
The
elements
of
the
model
were
drawn
from
gerontologic
theory
of
what
would
produce
maximum
recruitment,
retention,
and
effectiveness
of
older
adults;
from
public
health
research
of
what
would
provide
the
greatest
benefit
of
health
and
well-being
of
participants;
from
30
years
of
experience
in
the
most
effective
elements of
existing
senior
service
programs;
and from
the
experience
of
small
programs
around
the
country
in
which
older
adults
are
assisting
in
schools.
In
the
Experience
Corps,
older
adults
serve
at
least
15
to
20
hours
a
week
to
receive
maximal
health
benefits
and
to
allow
them
to
take
on
meaningful
roles
in
the
schools
and
to
ensure
stability
in
those
roles.
Roles
developed
in
this
pilot
program
range
as
follows:
from
tutoring
individual
or
groups
of
chil-
dren
in
reading,
mathematics,
or
computers
and
support-
ing
the
ability
of
teachers
to
meet
children's
needs
by
reading
to
small
groups
within
the
class,
to
developing
enrichment
programs
for
the
children
ranging
from
a
people's
court
for
conflict
resolution
or
teaching
social-
ized
play
during
recess,
to
reviving
and
staffing
unused
school
libraries,
to
programs
that
enhance
attendance.
Roles
are
designed
based
on
what
a
principal
and
teachers
consider
are
their
greatest
needs
and
in
collab-
oration
with
the
school.
To
attract
older
adults
to
such
intensive
service,
the
adults
receive
an
incentive
of
either
a
small
stipend
or
in-kind
benefits.
The
other
essential,
gerontologically
supportive
aspects
of
the
pro-
gram
are
that
participants
receive
extensive
training
to
extend
their
effectiveness
in
their
roles.
There
is
a
sup-
portive
infrastructure
for
ongoing
problem
solving.
Participants
work
in
teams
of
six
to
ten
for
the
greatest
effectiveness
and
to
augment
their
ability
to
solve
prob-
lems
too
big
for
any
one
person
to
change
by
them-
selves.
This
arrangement
also
helps
to
develop
positive
social
networks
and
support,
and
the
members
are
able
to
fill
in
for
one
another
in
the
event
of
illness.
Enough
teams
are
placed
in
a
single
school
to
make
a
visible
dif-
ference
in
the
school
environment
and
to
affect
school
outcomes.
This
pilot
program,
jointly
developed
and
sponsored
by
the
Corporation
for
National
Service,
Johns
Hopkins
University
(Baltimore,
Maryland)
and
Public/Private
Ventures,
with
funding
from
the
Corporation
and
the
Retirement
Research
Foundation,
is
currently
under
evaluation
to
assess
its
feasibility
and
the
short-term
effect
on
the
well-being
of
participating
older
adults.
It
has
been
successful
in
recruiting
older
adults,
often
from
the
neighborhoods
the
schools
are
in,
with
a
commitment
to
improving
the
outcomes
for
the
children
in
their
communities.
Retention
and
enthusiasm
by
both
the
participants
and
schools
are
high.
Ongoing
maturation
of
the
model
will,
it
is
hoped,
offer
success-
ful
methods
for
generative
roles
that
enhance
outcomes
for
both
the
participating
older
adults
and
children
that
can
be
brought
to
a
larger
scale.
There
is
substantial
validity
to
developing
programs
that
would
permit
older
adults
on
a
large
scale
to
help
improve
the
educational
outcomes
of
the
next
genera-
tion.
Children
in
our
society
could
benefit
from
a
greater
presence
of
older
adults
in
their
lives.
The
model
of
cre-
ating
new,
generative
roles
for
older
adults
could
be
expanded
to
other
areas
of
needs,
as
well-for
example,
in
public
health,
the
environment,
or
supporting
inde-
pendent
living
of
other
older
persons.
Meeting
these
needs
could
provide
opportunities
for
increased
activity,
engagement,
generativity,
and
social
support
for
older
adults,
as
well
as
opportunities
to
use
their
skills
and
gain
new
ones.
Successful
aging
could
well
be
enhanced
by
increased
opportunity
for
"work
that
will
outlive
the
self'
and
that
"creates
a
legacy."'6
Conclusion
We
have
an
aging
society
that
marginalizes
older
adults,
limiting
their
ability
to
contribute
their
skills
and
time
to
our
society.
At
the
same
time,
the
health
and
adult
devel-
opment
needs
of
older
adults
include
maintaining
activi-
ty
levels
and
engagement
with
others
and
having
oppor-
tunities
to
"give
back"
and
leave
a
legacy.
With
a
declin-
ing
support-dependency
ratio
and
rising
costs
of
entitle-
ment
programs
for
older
adults,
our
society
is
becoming
restive
about
the
current
social
contract
of
entitlements
without
return
contributions.
These
two
strands
of
social
change,
along
with
unmet
social
needs,
provide
not
just
problems.
They
offer
an
opportunity
for
revising
our
social
contract
toward
one
of
mutual
benefit
and
engage-
ment.
We
propose
that
health
promotion
efforts
for
older
adults
can
meet
social
policy
in
the
creation
of
meaning-
ful
service
programs
for
older
adults
on
a
large
social
scale.
One
such
demonstration,
of
a
gerontologic
model
for
high-intensity,
critical-mass,
senior
service
on
behalf
of
children,
is
described
above.
This
deserves
replication.
It
could
provide
the
backbone
for
making
less
intensive
service
more
effective.
It
could
also
offer
a
model
that
218
WIM,
October
1997-Vol
167,
No.
4
Promoting
Successful
Aging-Fried
et
al

WJM,
October
1997-Vol
167,
No.
4
Promoting
Successful
Aging-Fried
et
al
219
could
be
extended
to
large-scale
programs
in
which
older
adults
can
help
meet
other
social
needs
in
public
health,
independent
living,
and
the
environment.
Such
genera-
tive
institutions
could
facilitate
the
ability
of
older
adults
to
leave
a
collective,
as
well
as
individual,
legacy.
Ultimately,
large-scale
opportunities
for
older
adults
to
remain
engaged
in
society
and
productive
should
enhance
the
health
and
function
of
our
aging
population.
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