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Successful Aging and Subjective Aging: Toward a Framework to Research a Neglected Connection
Sabatini, Serena PhD (https://orcid.org/0000-0002-3618-6949)1*; Rupprecht, Fiona PhD
(https://orcid.org/0000-0002-3547-0497)2; Kaspar, Roman PhD (htpps://orcid.org/0000-0002-5829-
2363)3; Klusmann, Verena PhD (https://orcid.org/0000-0001-7928-7793)4,5; Kornadt, Anna PhD
(https://orcid.org/0000-0002-6634-0812)6; Nikitin, Jana PhD (https://orcid.org/0000-0003-1642-154X)2;
Schönstein, Anton PhD (https://orcid.org/0000-0001-8683-5452)7; Stephan, Yannick8 PhD
(https://orcid.org/0000-0002-8029-8809); Wettstein, Markus PhD (https://orcid.org/0000-0002-3471-
5405)9; Wurm, Susanne PhD (https://orcid.org/0000-0001-6924-8299)10; Diehl, Manfred PhD
(https://orcid.org/0000-0002-2055-3839)11; Wahl, Hans-Werner7 PhD (https://orcid.org/0000-0003-
0625-3239)
1School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United
Kingdom
2Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna,
Vienna, Austria
3Charlotte Fresenius University of Psychology, Hamburg, Germany
4Department of Health, Security, and Society, Furtwangen University, Furtwangen im Schwarzwald,
Germany
5Department of Psychology, University of Konstanz, Konstanz, Germany
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6Institute for Lifespan Development, Family, & Culture, University of Luxembourg, Esch-sur-Alzette,
Luxembourg
7Network Aging Research, Heidelberg University, Heidelberg, Germany
8Euromov, University of Montpellier, Montpellier, France
9Department of Psychology, Humboldt University Berlin, Berlin, Germany
10Department of Prevention Research and Social Medicine, Institute for Community Medicine, University
of Greifswald, Greifswald, Germany
11Department of Human Development and Family Studies, Colorado State University, Fort Collins, US
*Address correspondence to: Serena Sabatini, PhD. Email: s.sabatini@surrey.ac.uk
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Abstract
Research related to subjective aging, which describes how individuals perceive, interpret and
evaluate their own aging, has substantially grown in the past two decades. Evidence from
longitudinal studies shows that subjective aging predicts health, quality of life, and functioning in
later life. However, the existing literature on successful aging has mostly neglected the role of
subjective aging. This paper proposes an extended framework of successful aging linking subjective
aging conceptually and empirically to Rowe and Kahn’s (1997) three original key criteria of successful
aging (i.e., avoiding disease and disability, maintaining high cognitive and physical function, and
engagement with life). A particular focus is placed on subjective aging as an antecedent of successful
aging. A review of the empirical subjective aging literature shows that subjective aging concepts
consistently predict all three of Rowe and Kahn’s criteria of successful aging. Mechanisms underlying
these relations are discussed at three levels, namely psychological, behavioral, and physiological
pathways. The proposed addition also takes into consideration the interconnections between
subjective aging and successful aging throughout the lifespan and across historical time. Finally, we
discuss the importance of facilitating successful aging through systematic interventions that support
more positive views of aging at the individual and societal level.
Keywords: Self-perceptions of aging; healthy aging; mental, physical, and cognitive health;
developmental outcomes; health-enhancing behaviors
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Rowe and Kahn’s MacArthur model of successful aging (1997, 2015) is considered the most
influential successful aging (SA) framework and uses three criteria to define SA: (1) Avoiding disease
and disability; (2) maintaining high cognitive and physical function; and (3) maintaining meaningful
engagement with life. Despite its popularity, over the past decades the MacArthur model of SA has
received several criticisms, including the missing life course perspective of the model (Stowe &
Cooney, 2015), as well as the argument that people with one or more chronic illnesses and with
some level of physical disability may nonetheless interpret their aging as successful (Martinson &
Berridge, 2015). Indeed, according to the stringent criteria of the MacArthur model of SA and the
sole reliance on objective indicators of SA, SA is present in only a small percentage of older adults,
and even less in very old adults (typically below 5%; Tesch-Römer et al., 2022). On the other hand,
moving from solely objective criteria to solely subjective evaluations of successful aging as outcomes
may result in a lack of interindividual variation with very high numbers of older adults describing
themselves as aging successfully (Depp & Jeste, 2006). In an attempt to avoid such extreme
perspectives, we posit that it is crucial to investigate the full range of factors that contribute to SA
and that psychological antecedents of SA, such as subjective aging, need more consideration. Such a
position reflects recent insights in psychology showing the relevance of subjective aging for key
developmental outcomes such as health and cognitive performance. Surprisingly, past work that has
adopted Rowe and Kahn’s model of SA has mostly neglected the construct of subjective aging.
Subjective aging is used in this paper as an umbrella term capturing individuals’ subjective
experiences, beliefs, and evaluations of their own aging (Wurm et al., 2017). The most frequent
concepts and measurement approaches examined in studies on subjective aging in relation to health-
related outcomes are Felt Age, Attitude Toward Own Aging, Aging-Related Cognitions, and
Awareness of Age-Related Change (Shrira et al., 2022; Westerhof et al., 2023). Felt Age describes
how old people feel. Attitude Toward Own Aging comprises an explicit personal, unidimensional
evaluation of age-related changes (Lawton, 1975). Aging-Related Cognitions, as measured by the
Aging-Related Cognitions Scales, are multidimensional and provide scores for ongoing personal
development, as well as physical and social losses (Steverink et al., 2001; Wurm et al., 2007).
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Awareness of Age-Related Change assumes that development always involves gains and losses and
that individuals have an explicit awareness of how their lives have changed due to getting older
(Diehl & Wahl, 2010).
It is important to acknowledge that there are conceptual differences between these concepts
(Klusmann et al., 2020). For example, feeling younger is seen as psychological distancing oneself from
one’s “true” age and age peers. Higher scores on other indicators of subjective aging, such as
Attitudes Toward Own Aging, Aging-Related Cognitions, and Awareness of Age-Related Change,
instead do not imply distancing oneself from one’s own aging. These indicators are generally referred
to as self-perceptions of aging. In Westerhof et al.’s (2023) meta-analysis of subjective aging and
health, 53 out of the 107 included longitudinal studies relied on subjective age, whereas the rest
used self-perception of aging scales, hence, in the context of longitudinal effects on health and
cognitive functioning, both approaches have been used in similar frequency. Both approaches also
exert similar impact on health outcomes, in the range of small effect sizes. Therefore, for the
remainder of the paper, we collectively refer to these concepts as ‘subjective aging’ without
additional differentiation among indicators.
It is also important to mention that the construct of subjective aging is conceptually different
from, but empirically related to age stereotypes and ageism. Whereas age stereotypes refer to how
individuals perceive older adults as a group, subjective aging reflects a person’s own behavioral
experiences of growing older. Negative age stereotypes and ageism have detrimental effects on
health (Chang et al., 2020). Hence, the argument that subjective aging needs better consideration in
the discourse on SA is further supported by the findings of the age stereotype and ageism literature.
However, in this paper, we deliberately focus on subjective aging and its different
operationalizations.
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Subjective Aging and Successful Aging: A Needed Conceptual Connection
Rowe and Kahn (2015) only tangentially elaborated on the connection between subjective
aging and SA besides mentioning that previous critiques of their model “propose (…) greater
attention to individuals’ perceptions of their own aging” (p. 593). We see an important gap here. In
the following, we elaborate on conceptual reasons why subjective aging and SA need to be better
connected and suggest an integrative conceptual framework.
To begin with conceptual reasons, Rowe and Kahn (2015) themselves have argued that SA
should be seen as a goal-directed and lifelong process that presumes active involvement and human
agency. Therefore, studying subjective aging and SA in tandem may provide valuable insights into
how and to what extent individuals can become producers of their own development and aging.
Subjective aging certainly is not the only, but definitely one important factor that has an impact on
those behaviors (e.g., physical activity), resources (e.g., self-efficacy), and self-regulatory processes
(e.g., acceptance of changes) that, over the lifespan, may influence whether individuals meet Rowe
and Kahn’s criteria for SA. A major reason for this argument is that the perception of getting older
increasingly becomes a core element of individuals’ self-concept in later life (Diehl et al., 2014).
Further, subjective aging is influenced by societal views of older age, and these are generally
negative. Hence, incorporating more positively toned subjective aging may be a core issue of what
Rowe and Kahn (2015) described as the need for “reengineering core societal institutions” (p. 594).
Finally, subjective aging may broaden the scope of interventions that promote SA (Diehl et al., 2023).
Figure 1 presents an extended conceptual framework of SA building on Rowe and Kahn’s
(1997, 2015) criteria but with an explicit consideration of subjective aging.
The model acknowledges that several antecedents may influence subjective aging and SA.
The effect of such antecedents on SA may be direct (e.g., health) or indirect through subjective aging
(i.e., subjective aging as a mediator). Although the model visually gives prominence to subjective
aging as a factor neglected in previous discourses on SA, it does not assume that its role for SA is
more relevant than the role of other antecedents.
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The model assumes that subjective aging has the potential to impact all three of Rowe and
Kahn’s criteria of SA (point 1, Figure 1). In terms of pathways operating between subjective aging and
SA outcomes (point 2, Figure 1), the model draws on Levy’s (2009) Stereotype Embodiment Theory,
which postulates that subjective aging can influence health outcomes and mortality through three
pathways, namely psychological, behavioral, and physiological pathways (see the section on
“Pathways” for more details). Moreover, the model proposes a lifespan perspective (point 3, Figure
1) in how subjective aging unfolds and may differentially impact SA outcomes.
Importantly, the positive and negative objective changes that individuals may experience in
the three criteria of SA are also assumed to influence their subjective aging; hence the model expects
bidirectionality between subjective aging and SA (point 4, Figure 1). In parallel, historical-cultural
contexts may shape subjective aging and therefore its effects on SA outcomes (point 5, Figure 1)
(Wettstein et al., 2023). Finally, the effects of subjective aging on SA may potentially be modified
through interventions promoting positive self-perceptions of aging (point 6, Figure 1).
In the following, we aim to provide the strongest empirical evidence in support of the
proposed framework, without claiming that we are providing a comprehensive review of the
literature. At the same time, we aim to identify areas that are empirically less researched or show
conflicting evidence, hence needing more empirical testing in the future.
Subjective Aging as a Protective or Risk Factor of Successful Aging (Model, Point 1)
Evidence Linking Subjective Aging to the Disease, Disability, and Physical Function Related Facets of
Successful Aging
Positive subjective aging is consistently associated with lower risk of mental and physical
health conditions, such as depression, anxiety, rheumatism, cancer, and arthritis (Debreczeni &
Bailey, 2021; Tully-Wilson et al., 2021; Westerhof et al., 2023), lower risk of disability, including lower
risk of frailty, falls, and functional difficulties (e.g., ability to do groceries and prepare one’s own
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meal) (Fundenberger et al., 2022; Li et al., 2021; Sabatini, Wahl, et al., 2023). More positive
subjective aging is associated with better biological aging, as indicated by lower presence of
inflammatory markers and greater telomere length (McLachlan et al., 2020; Stephan, Sutin, Luchetti,
& Terracciano, 2023), and faster walking speed (Stephan et al., 2015). These results are supported by
a meta-analysis comprising more than 100 longitudinal studies with a median observational interval
of approximately 5 years (Westerhof et al., 2023). Moreover, Levy et al. (2002) pointed to the effect
of subjective aging on longevity being comparable to the effect of established risk factors such as
smoking or obesity. To date 20 longitudinal studies (such as Wurm & Schäfer, 2022), have shown that
people with more positive SPA live longer than those with more negative SPA (Westerhof et al.,
2023). The evidence that subjective aging is an important protective or risk factor for the SA domain
of disease and disability is thus strong and consistent.
Evidence Linking Subjective Aging to the Cognitive Function Facet of Successful Aging
More positive subjective aging is associated with better objectively assessed (Debreczeni &
Bailey, 2021) and informant-rated (Stephan et al., 2021) cognitive functioning, and lower dementia
risk (Siebert et al., 2018). In their systematic review of longitudinal research, Tully-Wilson et al.
(2021) found that more negative subjective aging predicted lower cognitive functioning and greater
incidence of dementia-related disorders in the range of small to medium effects. In summary, the
link between subjective aging and cognitive performance is well established (Fernández-Ballbé et al.,
2023).
Evidence Linking Subjective Aging to the Engagement with Life Facet of Successful Aging
Compared to the two previous SA indicators, evidence supporting a link between subjective
aging and engagement with life is more limited. More positive subjective aging has been associated
with more frequent future attendance of formal events focusing on older adults (Schwartz et al.,
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2021), lower loneliness cross-sectionally (Xie et al., 2022), and greater future engagement with social
(Shoushtari-Moghaddam et al., 2022) and leisure activities (Bu et al., 2023). Moreover, bidirectional
associations have been found between positive subjective aging and productive activities, including
volunteering (Huo et al., 2020), provision of advice and emotional support to others (Schwartz et al.,
2021), and engagement in political activities (Shoushtari-Moghaddam et al., 2022). More positive
subjective aging has also been found cross-sectionally associated with caring for grandchildren
(Bordone & Arpino, 2015). Thus, there is emerging evidence showing that subjective aging is also
relevant for promoting engagement with life as the third major facet of SA.
Pathways from Subjective Aging to Successful Aging (Model, Point 2)
As indicated in Figure 1, subjective aging may impact all three of Rowe and Kahn’s criteria of
SA through psychological, behavioral, and physiological pathways (Levy, 2009). All three pathways
are supported by evidence. The psychological pathway captures how more positive subjective aging
may increase self-efficacy, adaptive self-regulation, will to live, and a positive outlook toward the
future (Dutt & Wahl, 2018; Levy et al., 2002; Wurm et al., 2013). The behavioral pathway reflects
how subjective aging influences engagement in health-enhancing behaviors and adaptive behaviors
(Dutt et al., 2016; Sun & Smith, 2017). Lastly, the physiological pathway captures how negative
subjective aging may lead to negative biological processes and, consequently, to health-related
conditions (Schönstein et al., 2022; Stephan, Sutin, Luchetti, & Terracciano, 2023).
A Lifespan Perspective on Bidirectional Associations Between Subjective Aging and Successful
Aging (Model, Points 3 and 4)
Discourses on subjective aging and SA may benefit from adopting a lifespan
perspective for several reasons (Stowe & Cooney, 2015). First, both individuals’ subjective
aging and SA likely change over time, which is not surprising given the dynamic nature of
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aging processes. Importantly, empirical evidence suggests that more negative and loss-
oriented self-views increase with aging (Kornadt et al., 2016). Still, subjective aging is
malleable and subject to change across the lifespan. Heterogeneity in self-perceptions of
one’s present and future aging is particularly pronounced in midlife (Miche et al., 2014).
Variables explaining such heterogeneity include personality factors, beginning signs of one’s
aging (Kornadt et al., 2019), and critical life events (Rupprecht et al., 2022; Turner et al.,
2023) .
Second, lifespan patterns of subjective aging and SA are very likely intertwined, and
the association between subjective aging and SA throughout the lifespan is very likely
bidirectional. Indeed, the positive and negative objective changes that individuals may
experience in the three criteria of SA seem to also influence their subjective aging. Empirical
evidence shows that increases in depressive and anxiety symptoms (Sabatini et al., 2022),
newly diagnosed health conditions (e.g., cancer, cardiovascular events) (Schönstein,
Dallmeier, et al., 2021; Wurm et al., 2020), and greater functional difficulties (Kaspar et al.,
2022) all lead to more negative subjective aging. Bidirectionality might indeed be a critical
element of maintaining or regaining SA. Specifically, the interplay between subjective aging
and SA might end-up in a downward spiral, in which decreasing health may lead to more
negative subjective aging. This, in turn, may undermine the motivation for training, exercise,
intervention, or rehabilitation as well as increase physiological risk constellations, resulting
in poorer SA outcomes.
Third, a lifespan perspective provides opportunities to start optimizing SA from young
adulthood and midlife on. Indeed, according to Stereotype Embodiment Theory (Levy, 2009),
individuals form age-related beliefs early in childhood and these become internalized later in
life and influence how individuals perceive their own aging throughout the lifespan (Levy,
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2009). Recent evidence suggests that subjective experiences of aging are relevant and
related to health outcomes starting in young adulthood (Sabatini, Rupprecht, et al., 2023).
Fourth, the mechanisms linking subjective aging with SA might be different at
different stages of the lifespan (Kornadt et al., 2020). For example, although “continued
engagement with life” might be increasingly driven by health constraints (and less so by
subjective aging) at older ages, subjective aging can help to prevent attributing health
constraints to aging. Hence subjective aging can buffer the detrimental effects of health
events on life engagement and the effects of giving up volunteering on life satisfaction (Huo
& Kim, 2022). Subjective aging might also become more self-relevant (Levy, 2009) and
important at older ages for other SA outcomes as it may help to compensate for loss-related
changes (Baltes, 1997).
Overall, subjective aging processes happening across individuals’ lifetime may have
the potential to enrich Rowe and Kahn’s (2015) emphasis on the role of the life course for
SA.
Historical-Cultural Impact on Subjective Aging: Implications for Successful Aging (Model, Point 5)
Subjective aging may change across historical, secular, and cultural contexts (see
point 4, Figure 1) (Ackerman & Chopik, 2020). For example, Wettstein et al. (2023) found
that when investigating secular change in subjective age across 25 years by comparing birth
cohorts of middle-aged and older adults who had similar ages and were assessed at different
points in time, the later-born cohorts felt younger than the earlier-born. Those from more
recent cohorts also maintained feeling younger longer into advanced old age. More research
is needed to better understand whether historical change (i.e., changes linked to historical
events such as growing up during World War II) and secular change (i.e., changes linked to
growing up in different environmental conditions) impact on how SA and subjective aging
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are interrelated. Further, shared cultural influences certainly impact subjective aging,
although existing data are limited. For example, adults aged 40 years and older in Burkina
Faso, a country in West Africa, felt younger to a lesser extent than their counterparts in a
Western sample (Schönstein, Ngo, et al., 2021).
Subjective (and societal) views on aging may provide an important springboard for models of
SA to consider whether and how the societal perception of what is SA varies across historical
and cultural contexts. For example, North and Fiske (2015) replicated in their meta-analysis
not only the previously established finding that increases in population aging significantly
predicted negative attitudes toward older adults. They also found that cultural individualism
typical for Western countries significantly predicted positive attitudes toward older adults,
whereas the collectivist traditions that exist in rapidly aging Eastern societies did not have
the same effect.
Subjective Aging as an Intervention Target to Promote Successful Aging (Model, Point 6)
Ultimately, subjective aging may provide an avenue to optimize SA; that is, promoting
positive subjective aging might help to avoid as much as possible disease and disability, maintain high
cognitive and physical functioning, and sustain engagement with life (Rowe & Kahn, 1997).
Several interventions have been developed to change middle-aged and older adults’ SPA and
consequently developmental outcomes (Beyer et al., 2019; Diehl et al., 2023; Wolff et al., 2014).
These interventions have used different strategies to increase positive subjective aging. Some
interventions indirectly targeted age stereotypes and subjective aging through promotion of health-
enhancing behaviors (e.g., physical activity and hence providing mastery experiences; Beyer et al.,
2019). Others targeted both subjective aging and health-related behaviors simultaneously (e.g., Diehl
et al., 2023). These interventions typically focus on self-perceptions of aging, and not felt age. They
showed that the promotion of positive, yet realistic subjective aging is possible and effective even
among older adults in poor physical health. However, a major gap in this area of inquiry concerns the
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long-term maintenance of the observed effects. Another unanswered question is whether successful
behavior changes, such as increased engagement in physical activity or eating a healthier diet,
reinforce the maintenance of more positive subjective and successful aging.
Interventions that either actively (e.g., rehabilitative programs; Crocker et al., 2013) or
passively (e.g., self-compassion programs promoting acceptance of age-related challenges and
conditions; Toise et al., 2014) promote adaptation to age-related changes may also have an effect on
subjective aging. Conversely, interventions targeting healthy/successful aging should, by definition,
target diverse and constructive views on aging, given the strong evidence on their health-promoting
role throughout the lifespan (Klusmann et al., 2021).
Concluding Remarks and Future Directions
Throughout the lifespan, individuals’ interpretations of their own aging make a profound
difference in everyday life and whether and how existing opportunity structures are used as
developmental impulses for one’s own life (Diehl & Wahl, 210). In other words, subjective views of
one’s aging play an important role in infusing agency toward SA as well as strengthening the
motivation to invest, for example, in health maintenance, prevention, rehabilitation, training, and
social connectedness. Therefore, including subjective aging in models of SA seems an important step
forward for the implementation of current and future strategies and interventions promoting SA
through the increase of positive subjective aging.
We hope that the suggested conceptual framework may guide future research toward
closing several empirical gaps. First, the impact of subjective aging on engagement with life as a
major socio-behavioral outcome of SA as well as mechanisms underlying this impact need more
research. A major issue is that subjective aging research in general needs more social
contextualization and, thus, overcomes its current centeredness on the individual as the unit of
analysis (Chu et al., 2020; Rupprecht et al., 2022).
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Second, interdisciplinary research, particularly collaborations between the behavioral and
biosciences of aging, is needed to better understand the pathways underlying the associations
between subjective aging and SA, and their interplay. More efforts are needed for example to
examine how various biomarkers act in parallel as well as whether their associations with subjective
aging depend on the specific subjective aging indicator considered, thus moving away from the
approach of evaluating only a single biomarker or a single subjective aging operationalization. For
example, Stephan, Sutin, Luchetti, Aschwanden, et al. (2023) found that poorer cognitive functioning
(memory) was partially mediated through higher fasting glucose, higher cystatin C, higher NT-
proBNP, and accelerated epigenetic aging. In contrast, more negative attitudes toward aging were
related to worse memory through lower Vitamin D3, higher fasting glucose, higher cystatin C, higher
NT-proBNP, and accelerated epigenetic aging.
Third, there is the need to investigate subjective aging as a moderator in the associations
between risk factors and Rowe and Kahn’s indicators of SA. Indeed, it is currently mostly unknown to
what extent positive subjective aging can “eliminate" or buffer the detrimental influence of other risk
factors on SA. Best confirmed currently seems the investment in health behaviors, preventive action,
and physical activity (Diehl et al., 2023; Westerhof et al., 2023). However, the interplay between
subjective aging and other risk factors such as stress, obesity, substance use, or treatment adherence
is less clear.
Fourth, future research needs to intensify the investigation of the potential bidirectional
subjective aging-successful aging interplay. Importantly, the bidirectional association between
subjective aging and SA should be investigated from a lifespan perspective. That is, there is the need
to understand whether negative subjective aging in young adulthood or midlife increases the risk of
"non-successful aging" in late life. Indeed, most of the available evidence focuses on the effect of
subjective aging on SA in the second half of life. How physiological pathways operate in a
bidirectional way between subjective aging and SA outcomes also needs to be understood in a better
way and longitudinal studies are needed to address this topic (Schönstein et al., 2022).
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Fifth, although numerous studies support the links between perceived negative age-related
changes (i.e., negative subjective aging) and lack of SA, evidence on whether perceived positive age-
related changes (i.e., positive subjective aging) can attenuate the detrimental impact of negative
subjective aging on SA is scarce (Diehl et al., 2021). Future studies should investigate the interplay
between positive and negative subjective aging as a resilience or risk factor for successful aging.
Sixth, better understanding of the historical-cultural embeddedness of subjective aging and
SA may help to recognize the historical and cultural relativity and diversity of SA.
In conclusion, we hope to have shown that both from a conceptual and an empirical
perspective, subjective aging deserves more consideration as an important life-long antecedent of
SA.
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Funding
Serena Sabatini was supported by an ESRC (Economic and Social Research Council) Postdoctoral
fellowship [ES/X007766/1].
Conflict of Interest
We have no conflict of interest to declare.
Data Availability
The authors do not report data and therefore the pre-registration and data availability requirements
are not applicable.
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Figures
Figure 1: A Model of Subjective Aging as a Key Factor for Successful Aging
ALT TEXT: Antecedents of subjective aging are sociodemographic, biological and health-related,
motivational contextual, and psychological factors, as well as general views of aging. Subjective
ageing influences risk of disease and disability, maintenance of high cognitive and physical function,
and engagement with life. These, in turn, can all influence subjective aging. Interventions can
promote both more positive subjective aging and decrease risk of disease and disability, promote
maintenance of high cognitive and physical function, and promote engagement with life.
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Figure 1
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