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Graduate Theses and Dissertations

Graduate College

2011

Successful aging and developmental

adaptation of oldest-old adults
Jinmyoung Cho
Iowa State University

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Successful aging and developmental adaptation of oldest-old adults

Program of Study
Committee:
by
Jinmyoung Cho

A dissertation submitted to the

graduate faculty
in partial fulfillment of the requirements
for the degree of

DOCTOR OF
PHILOSOPHY

Peter Martin,
Major Professor
Christine
Cook
Jennifer
Margrett
Dan
Russell
Mack
Shelley

Iowa State
University
Major: Human Development and
Family Studies

Ames,
Iowa
2011

ii
TABLE OF CONTENTS

LIST OF FIGURES

LIST OF TABLES

vi

ACKNOWLEGEMENTS

vii

ABSTRACT

viii

CHAPTER I. INTRODUCTION

CHAPTER II. LITERATURE REVIEW

Successful Aging

Developmental Adaptation Model

Successful Aging and Developmental Adaptation

Developmental Outcome: Psychological Well-being

Proximal Influences: Physical Health

11

Proximal Influences: Perceived Economic Status

13

Proximal Influences: Cognitive and Physical Functioning

14

Proximal Influences: Social Support

16

Distal Influences: Past Life Experiences

17

Distal Influences: Education

18

Summary of Literature Review

19

Using information from Proxies

19

Research Questions and Hypotheses

21

CHAPTER III. METHOD

24

Participants

24
iii

Missing Data

26

Measures

26

Psychological well-being

29

Physical health

29

Perceived economic status

30

Cognitive functioning

30

Physical functioning

31

Social support

31

Education

32

Past life experiences

32

Analyses

33

CHAPTER IV. RESULTS

37

Successful aging of Oldest-Old Adults

37

The Relationships of Successful Aging Components, Distal Influences, and

Psychological Well-Being

44

Structural Equation Modeling: Happiness Model

51

Measurement Model

52

Covariate Model and Corrected Fully Recursive Model

59

Structural Model for Happiness

61

Alternative Structural Model for Psychological Well-Being

63

iv

CHAPTER V. DISCUSSION
The Criteria of Successful Aging

70
71

Predictors of Psychological Well-Being and Age Differences

72

Psychological Well-Being for Oldest-Old Adults

75

Limitation and Future Directions

80

APPENDIX A. IRB APPROVAL

86

APPENDIX B. PSYCHOLOGICAL WELL-BEING: LIFE SATISFACTION SCALE

89

APPENDIX C. PSYCHOLOGICAL WELL-BEING: BRADBURN AFFECT

BALANCE SCALE

90

APPENDIX D. PHYSICAL HEALTH: THE OLDER AMERICANS RESOURCES

92

APPENDIX E. HEALTH PROBLEMS

93

APPENDIX F. PERCEIVED ECONOMIC STATUS: THE OLDER AMERICANS

RESOURCES

95

APPENDIX G. COGNITIVE FUNCTIONING: MINI-MENTAL STATUS

EXAMINATION

96

APPENDIX H. PHYSICAL FUNCTIONING: THE OLDER AMERICANS

RESOURCES

97

APPENDIX I. SOCIAL RESOURCES: THE OLDER AMERICANS RESOURCES

100

APPENDIX J. EDUCATION

101

APPENDIX K. PAST LIFE EXPERIENCES: A SERIRES OF COGNITIVE

ENGAGEMENT TASKS
REFERENCES

102
103

v
LIST OF FIGURES

Figure 1.

Hypothesized model

Figure 2.

Two-way interaction of physical functioning X happiness

49

Figure 3.

Two-Way interaction of cognitive functioning X happiness

50

Figure 4.

Structural model of happiness

62

Figure 5.

Structural model of positive affect

68

vi
LIST OF TABLES

Table 1.

Summary of Demographic Characteristics

27

Table 2.

Hypothesized Measurement Model

35

Table 3.

Components of Successful Aging

38

Table 4.

Proportion of Successful Aging Criteria

39

Table 5.

Combined Proportion Successful Aging Criteria

40

Table 6.

Alternative Components of Successful Aging

42

Table 7.

Proportion of Alternative Successful Aging Criteria

43

Table 8.

Combined Proportion of Alternative Successful Aging Criteria

44

Table 9.

Models for Hierarchical Multiple Regression

45

Table 10.

Blocked Regression Models for Happiness

46

Table 11.

Correlation Matrix for Measurement Model

53

Table 12.

Factor Loadings for Confirmatory Factor Analysis for Happiness

Model

58

Table 13.

Fit Indices of Happiness Model

59

Table 14.

Factor Loadings for Confirmatory Factor Analysis for Positive Affect

Model

65

Table 15.

Fit Indices of Positive Affect Model

66

Table 16.

Bootstrap Analysis of Indirect Effects

69

vii
ACKNOWLEGEMENTS
First, I wish to express my deepest appreciation and thanks to my major professor and my
mentor, Dr. Peter Martin. He has provided constant patience, advice and encouragement as I have
been working on my graduate studies and my life as an international student. Without his
involvement and support, this study and who I am would not exist. Second, I would like to
express my appreciation to my committee members, Dr. Christine Cook, Dr. Jennifer Margrett,
Dr. Dan Russell, and Dr. Mack Shelley. Their comments and support were invaluable in
completing this dissertation and my doctoral training. In particular, Dr. Cooks emotional
support, Dr. Margretts career counseling, Dr. Russells statistical advice, and Dr. Shelleys
detailed comments made it possible for me to build a strong foundation for my research career.
Third, I would like to thank my colleagues in Elm Hall, it was an enjoyable and wonderful time
with all of you: Joan Baenziger, Grace da Rosa, Wen-Hua Hsieh, Laura Temple Scheetz, Melinda
Heinz, Jennifer Senia, and so on. Fourth, I am also grateful for the opportunity to analyze data
from the Georgia Centenarian Study and would like to express appreciation to Dr. Leonard Poon
who showed a lot of passion for research and the Georgia Centenarian Study team. Fifth, I would
like to thank my parents, my sisters, and parents-in-law for always encouraging me to do my best
and for their love and support in Korea. Most important, I would like to express my great thanks
to my husband, Cheolhwan Yoon. Words cannot describe my appreciation for his emotional and
physical support. I would like to say to him, thank you for being with me.

viii
ABSTRACT

Longevity is important for successful aging. The present research is designed to examine
if oldest-old adults are successful agers or not and what predictors are associated with
psychological well-being among oldest-old adults. Based on Rowe and Kahns (1997& 1998)
successful aging model and Martin and Martins (2002) developmental adaptation model, the
data reported in the current study were collected from proxy reports of 234 centenarians and 72
octogenarians of the Georgia Centenarian Study. Only 15% of octogenarians and no centenarian
satisfied all three criteria of the successful aging model, over 62% of all octogenarians and 47%
of all centenarians satisfied all criteria of an alternative successful aging model that included
subjective health, perceived economic well-being, and perceived happiness. No significant
predictors of successful aging and psychological well-being were found, but two significant
interaction effects suggested that the effects of physical functioning and cognitive functioning on
psychological well-being depended on age. In addition, physical health impairment and social
resources had significant direct effects on psychological well-being and physical functioning,
cognitive functioning, and education had indirect effects on psychological well-being. These
results suggest that an alternative model of successful aging model is needed to understand a
more holistic picture of successful aging among oldest-old adults. It is important for researchers
and practitioners to consider proximal and distal influences for successful aging and
psychological well-being.

1
CHAPTER I. INTRODUCTION
There is an oriental word bullojangsaeng - which means physical immortality or
external life in Korea and China. The desire to live longer and healthy has been an aspiration of
humankind for all ages and in all countries. The advancement of science has resulted in lower
mortality. A consequence of lower mortality in the United States from 17.2 to 8.2 per 1,000
population and increases in life expectancy from 47 years in 1900 to 74 for men and 79 years for
women (Centers for Disease Control and Prevention [CDC], 2004) is that most people in the
United States can expect to live longer. As the population of centenarians, another important
segment of the older population, is expected to grow from 37,000 in 1990 to 850,000 in 2050
(U.S. Bureau of the Census, 2005), it is important for oldest-old adults to understand successful
aging when compared to relatively younger old adults. Therecentgrowthoftheelderly
populationbringschallengesofchronicillnessesandimpairmentsinphysical,cognitive,and
sensoryfunctioning,aswellasdecreasingfinancialandsocialresources(Smith, Borchelt, Maier,
& Jopp,2002),andmanypeoplehaveconcernsabouttheirwellbeinginlaterlife.
Eventhoughwehaveachievedincreasedlongevity,wemightnotbesurewhether
increasinglongevityisconnecteddirectlywithsuccessfulaging.Does leading a longer life
alsoimply leading a longer successful life? Are centenarians to be defined as successful agers?
In other words, is it possible to assert that centenarians have aged successfully?
If age is not the absolute criterion for successful aging, then we should need other
criteria for successful aging. What determines whether individuals are satisfied with their life
and live well into very old age? What are the determinants that influence the quality of later life?
Since the model of successful aging was introduced by Rowe and Kahn (1997 & 1998), several
investigators have explored determinants of quality of later life, successful aging, and subjective

2
well-being among older adults (e.g., Barr, Kirkcaldy, Robinson, Poustie, & Capewell, 2005;
Borg, Hallberg, & Blomqvist, 2006; Depp & Jeste, 2006; Jang, Poon, Kim, & Shin, 2004;
McAuley, Blissmer, Marquez, Jerome, Kramer, & Katula, 2000; Reichstadt, Depp, Palinkas,
Folsom, & Jeste, 2007). Major determinants reported in the literature include overall selfreported health, financial resources, education, health problems, social relations, social supports,
meaning in life, physical functioning, absence of depression, and cognitive impairment. These
findings imply that as oldest-old adults rate their health better, as they have more financial
resources, higher levels of education, fewer health problems, more social relations and support,
better physical functioning and less cognitive impairment, it can be said that they age
successfully and are satisfied with their life. However, are these factors necessary components of
successful aging and high levels of psychological well-being? Are oldest-old adults satisfied with
most of these determinants? If older adults are satisfied with most of these determinants, would it
be fair to say they have aged successfully? Is it possible to define centenarians as successfully
aged if the levels of these determinants are low? How do these factors influence the
psychological well-being of oldest-old adults? What makes some oldest-old adults age better
than others even though they have comparable levels of cognitive status, physical functioning, or
financial status? Are there any other factors such as older adults past life experiences, or a
combination of individuals resources obtained throughout their long life?
Therefore,ithasbecomeimportanttoconsidermultiplefactorsforwellbeinginextreme
latelife.Also,thereisaneedtopaymoreattentiontohowolderadultsfeel,think,enjoy,andare
satisfiedwiththeirlife.Individuals, families, communities, and society have an interest in how
older adults maintain a better quality of life. It might be especially significant to investigate
physical, social, personal, and psychological aspects of well-being so that adults can expect and

3
prepare themselves for a long and healthy life. The general goal, therefore, is to explore whether
oldest-old adults are successful agers, what levels of well-being can be detected among the oldest
old population, and what contributes to a successful life in an aging society.
The purpose of this study is to evaluate a process model of individuals past and
current experiences for aging well by integrating Rowe and Kahns (1997 & 1998) successful
aging model with Martin and Martins (2002) developmental adaptation model using data
from the Georgia Centenarian Study. The overall objectives are to explore whether oldest-old
adults are successful agers or not, to explore whether centenarians are satisfied based on the
criteria of successful aging, to confirm that long lives raise the level of individuals well-being,
and to expand the concept of aging to a spectrum of past and current individual life influences
by examining successful developmental adaptation among centenarians.

4
CHAPTER II. LITERATURE REVIEW
Quality of life is defined by the World Health Organization Quality of Life (WHOQOL)
Group as follows (1995):
Quality of life is individuals perception of their position in life in the context of
the culture and value systems in which they live and in relation to their goals,
expectations, standards and concerns. It is a broad ranging concept that is affected in
complex ways by individuals physical health, psychological state, level of
independence, social relationships, and their relationships to salient features within the
environment. (p. 1405)
This definition encompasses individuals quality of life influenced and correlated not in a
simple but in compound ways by various factors (Bernheim, 1999; Bowling et al., 2003;
Cummins, 1996; Dijkers, 2003; Higgs, Hyde, Wiggins, & Blane, 2003; Pukrop, 2003).
Accordingly, quality of life among older adults should be conceptualized in relation to their
physical, psychological, social, and environmental circumstances (Low & Molzahn, 2007). In the
following literature review, the importance of individual and social support in well-being among
older adults will be highlighted. First, I provide an overview of the successful aging and
developmental adaptation models as conceptual frameworks for this study. Then, I introduce the
model components of developmental outcome, distal and proximal influences, psychological
well-being, physical health, perceived economic status, cognitive and physical functioning,
social support, past life experiences, education, and their effect on psychological well-being in
later life.

5
Successful Aging
The model of successful aging as suggested by Rowe and Kahn (1997 & 1998) is a
conceptual starting point for this work. Rowe and Kahn (1997 & 1998) suggested successful
aging included three main components: low probability of disease and disease-related disability,
high cognitive and physical functional capacity, and active engagement with life. Low
probability of disease refers to the absence, presence, or severity of risk factors for disease as
well as absence or presence of disease itself (Rowe & Kahn, 1997, 1998). High cognitive and
physical functional capacity provides potentials for activity, in other words, what a person
can do, not what he or she does do (Rowe & Kahn, 1997, p. 433). Finally, active engagement
with life is concerned with interpersonal relationship and productive activity. Specifically, Rowe
and Kahn (1997) suggested interpersonal relationships involve contact and transactions with
others, exchange of information, emotional support and direct assistance (Rowe & Kahn, 1997,
pp. 433-434). The combination of these three major components represents the concept of
successful aging (Rowe & Kahn, 1997, 1998). Although Rowe and Kahn suggested three
indicators for successful aging, several critical viewpoints of this model have been offered.
George (2006), for example, argued that the components of successful aging primarily focus on
physical aspects. The notion of subjective perceptions of well-being was not included in the
determinants of successful aging. George (2006) addressed an important question: Is an older
adult successfully aging if he/she is disability-free, physically and cognitive intact, and generally
active, but rates the quality of life as poor? (George, 2006, p. 322). In addition, Lawton (1999)
asserted that the definition of successful aging focused on the maintenance of typical functioning
in midlife and disregarded what may be qualitative change in late life in the value and meaning
of life (Aldwin, Spiro, & Park, 2005; Lawton, 1999). From a life-span developmental perspective,

6
Rowe and Kahns successful aging model failed to address losses, gains, and balance in later life
(Aldwin et al., 2005).
In addition to these critiques, two major points have been disregarded in the successful
aging model. First, Rowe and Kahn (1997 & 1998) overlooked important aspects of aging such
as financial resources, which are necessary for maintaining basic needs in later life. Second, they
disregarded aging as a life-long process. In other words, it might be limiting to evaluate success
at only one point in time. In the next section, the life-long process is discussed with the help of
the developmental adaptation model.
Developmental Adaptation Model
According to the life course perspective, human development is a life-long process (Elder
& Johnson, 2002). This perspective emphasizes the adaptation in the later years as linked to
earlier stages of the life course (Crosnoe & Elder, 2002). Experiences in the past life including
childhood have long-term consequences that might spread to later life, and patterns of adjustment
and functioning in later life occur in trajectories through other life stages (Block, 1993; Elder &
Crosnoe, 2002; Settersten, 1999).

Likewise, the developmental adaptation model developed by Martin and Martin

(2002) offers a model for synthesizing past experiences with available current resources and
adaptational outcomes (Martin, 2002; Martin, Deshpande-Kamat, Poon, & Johnson, in press).
Adaptation is defined as psychosocial adjustment to changing situations (Martin & Martin, 2002),
and early experiences are related to current experiences and outcome variables (e.g., Brown &
Anderson, 1991; Wheaton, 1994). The influence of distal effects such as education and past
cumulative life events on developmental outcomes is an important component within this
theoretical perspective as are individual, social, and economic resources. In other words, a

7
primary consideration of this model involves potential developmental trajectories based on life
histories as well as present resources that play a critical role in successful adaptation. In this
study, education and past life experiences served as distal influences on psychological well-being.
Martin and Martin (2002) specified two major principles of the developmental adaptation
model. First, individual (e.g., cognitive competence, physical functioning, or health), social (e.g.,
social support, and social resources), and economic (e.g., income or economic status) resources
are predictors of present life events. Second, subjective perception of well-being is a response
for evaluating the impact of current experiences on adaptation outcomes (Bishop, 2005). In sum,
this model proposes an important perspective for how current experiences and resources
(proximal influences) contribute to well-being in late and very late life through investigating the
direct and indirect pathways of current and past experiences and resources (Bishop, 2005).
Successful Aging and Developmental Adaptation
In order to evaluate a process model of individuals past and current experiences for
aging well, the successful aging model and the developmental adaptation model were
integrated in this study. There are several reasons for integrating both models. First, the
successful aging model does not include the proximal and distal influences outlined by the
developmental adaptation model. Individual resources highlighted in the developmental adaptation
model might influence low probability of disease and disease-related disability and high cognitive
and physical functional capacity. Moreover, the active engagement component in the successful
aging model seems to correspond to one of the proximal influences and to past life experiences.
Third, even though Rowe and Kahn (1997 & 1998) suggested an important model for aging, the
focus of this model is not on processes of aging. This shortcoming might be

8
supplemented with the developmental adaptation model which approaches the aging process
from a broader developmental perspective (Martin & Martin, 2002).
Therefore, it is proposed that the combination of the three components as outlined in the
successful aging model (i.e., low probability of disease and disease-related disability, high
cognitive and physical functional capacity, and active engagement with life) may serve as
predictors of psychological well-being, viewed as developmental outcome. In other words, the
developmental adaptation model was applied to this study in order to explore distal and proximal
influences of well-being for long-lived individuals. Hypothetically, it can be argued that
psychological well-being among oldest-old adults is influenced by individual resources and
environmental support (social support and financial resources). Most likely, individual resources
and environmental support may play an important role between proximal influences and
psychological well-being.
Therefore, it can be proposed that the successful aging model be integrated in the
developmental adaptation model as shown in Figure 1. Figure 1 provides the hypothesized
model for this proposal. The successful aging model as outlined by Rowe and Kahn (1997 &
1998) takes the role of proximal influences in the developmental adaptation model. In terms of
distal influences, education and past life experiences were included. Education might influence
cognitive functioning as Rowe and Kahn (1997 & 1998) indicated and past life experiences
might be a critical factor for social resources such as social support or perceived economic status
as Martin and Martin (2002) suggested. With regard to proximal influences, individual resources
include two factors: cognitive and physical functioning.

9
Distal influences

Proximal influences Outcome

Figure 1. Hypothesized model.

Of these critical factors, cognitive and physical functioning, physical health (absence of
diseases), and social support are essential components of successful aging. Finally,
developmental outcome, as Ryff (1989) mentioned, refers to psychological well-being in
extremely old adults.
In the following sections, psychological well-being, physical health, perceived economic
status, cognitive and physical functioning, social support, past life experiences, education, and
their effect on psychological well-being in later life are reviewed.
Developmental Outcome: Psychological Well-Being
As one of the positive adaptation outcomes in later life, psychological well-being has
been examined as an indicator of successful adaptation during old and very old age (Smith,

10
Fleeson, Geiselmann, Settersten, & Krunzmann, 1999). Bradburn (1969) considered the
subjective assessment of well-being as the balance between positive and negative affect. These
two dimensions of well-being may be the origin of psychological well-being (Jopp & Rott, 2006).
The two types of affect may have different adaptive functions. Negative affect refers to a
consequence of maladaptive behavior, whereas positive affect may be considered reinforcement
for adaptive or appropriate behavior (Jopp & Rott, 2006).
Another indicator for psychological well-being is life satisfaction. A number of studies
have defined well-being in late life as life satisfaction. Most representative is Neugarten,
Havighurst, and Tobins Life Satisfaction Index (LSI; 1961). Neugarten, Havighust, and Tobin
(1961) proposed that life satisfaction is composed of five indicators: zest, resolution,
congruence, self-concept, and mood tone. These factors are associated with individual subjective
well-being in various ways such as resolution represents an individuals personal acceptance or
responsibility for his or her life situation (Bishop, Martin, & Poon, 2005). Nevertheless, the
structure of this scale has been subject of much debate (Bishop et al., 2005). Liang (1985)
reorganized Neugarten et al.s (1961) scale by suggesting several aspects of the developmental
nature of life satisfaction among older adults by including happiness and congruence (Bishop et
al., 2005). Therefore, Liang (1985)s scale might be useful when older adults rate psychological
well-being which encompasses multiple indicators such as happiness, congruence, positive and
negative affect.
Research on well-being has noted a significant association between well-being and age.
For example, Pinquart (2001) reporting a meta-analysis based on 125 studies found that middleaged and older adults indicated that negative affect slightly increased, but positive affect
decreased over time. Several studies reported that negative affect remained stable throughout late

11
life (Carstensen, Pasupathi, Mayr, & Nesselroade, 2000; Kunzmann, Little, & Smith, 2000),
whereas positive affect decreased (Kunzmann et al., 2000; Stacey & Gatz, 1991). In terms of life
satisfaction, there are different studies that have addressed well-being among centenarians. Dello
Buono, Ureiuoli, and de Leo (1998) reported that centenarians were less satisfied with their life
than younger age groups. On the other hand, in the Georgia Centenarian Study, more
centenarians rated their life satisfaction as fair and good than sexagenarians did (Martin, Poon,
Kim, & Johnson, 1996).
Proximal Influences: Physical Health
Usually, physical health is the most commonly used index to assess the well-being of
individuals. As people grow older, they might perceive that their physical health is not good as it
has been indicated by sensory impairments, lower physical energy, or the onset of diseases (e.g.,
high blood pressure, high level of cholesterol, diabetes, etc.) compared to when they were
younger. The subjective assessment of health might influence an individuals overall
psychological well-being. The importance of physical health for psychological well-being has
been reported in a number of studies. Revicki and Mitchell (1990), for example, found that
physical health was the most important source of life strain among older adults. Physical health
can have a major impact on subjective well-being. For instance, Bishop, Epstein, Kietner, Miller,
and Srinivasan (1986) found that poor health was a significant factor in lower morale. Heidrich
(1993) examined the relationship between physical health and psychological well-being in elderly
women. The results indicated that poor health was associated with more depression and anxiety
and lower levels of positive relationships and autonomy in elderly women. Cohen, Doyle, Turner,
Alper and Skoner (2003) suggested that trait positive affect was related to fewer reported
symptoms when objective disease was held constant through experiments. In other words,

12
controlling for the objective markers of disease such as infection, congestion, and mucus weights,
those higher in trait positive affect reported fewer number of severe disease symptoms, and those
higher in trait negative affect reported more severe symptoms (Cohen & Pressman, 2006).
Self-rated health, related not only to length of life but also to states of health in the years
remaining (Idler & Kasl, 1995, p. S315), is one of the most important determinants for
psychological well-being in later life. Hoeymans, Feskens, Kromhout, and van den Bos (1997)
remarked that self-rated health is a more subjective health indicator, specifying ones perception
and evaluation of ones own health, based on an interpretation of the objective physical and
mental health status, and expectations and comparisons (Cockerham, Sharp, & Wilcox, 1983;
Fienberg, Loftus, & Tanur, 1985; Hoeymans et al., 1997; Idler, 1993; Krause & Jay, 1994; Suls,
Marco, & Yobin, 1991). Because individuals attitudes, motivations and beliefs influence
perceptions of illness and disability, self-rated health is related to psychological well-being (Wu
& Schimmele, 2006). Individual differences in self-rated health might play an important role for
psychological well-being in later life (Wu & Schimmele, 2006). For instance, as psychological
characteristics involve an individuals ability and willingness to adapt to physical change (Kou
& Tsai, 1986), the subjective experience is influenced by various kinds of diseases or illness
histories (Smith, Gerstorf, & Li, 2004; Wu & Schimmele, 2006).
The importance of health among oldest-old adults was shown in the Longitudinal Study
of Danish Centenarians (Andersen-Ranberg, Scholl, & Jeune, 2001). They found that there were
few healthy centenarians in that most Danish centenarians had several common diseases and
chronic conditions such as cardiovascular disease (72%), osteoarthritis (54%), hypertension
(52%), dementia (51%), and ischemic heart disease (28%). Andersen-Ranberg et al. (2001)
concluded that it is a challenge to be free from potentially common diseases until the age of 100.

13
This assertion was supported by another centenarian study. Through the health history
questionnaires of 424 centenarians or their proxies, Evert, Lawler, Bogan and Perls (2003) found
that even though 19% of centenarians were classified as escapers who reached their 100

th

birthday without the diagnosis of common age-related diseases, 81% of centenarians were not
free from common age-related diseases. As mentioned earlier, physical health such as self-rated
health, high prevalence of common diseases and chronic conditions has been related to
psychological well-being in extreme late life.
Proximal Influences: Perceived Economic Status
Compared to other studies investigating the relationship between physical health and
psychological well-being, less research has examined the relationship between psychological
well-being and perceived economic status in later life. Previous research has focused on
investigating the relationship between financial resources and subjective well-being (e.g., Diener,
1984; Diener & Biswas-Diner, 2002; Diener, Sandvik, Seidlitz, & Diener, 1993; George, 1992;
Larson, 1978). Research has suggested that income and assets are significant factors for
subjective well-being (e.g., Fengler & Jensen, 1981; George, 1992; George, Okun, & Landerman,
1985; La Barbera & Grhan, 1997). Specifically focusing on older adults, George (1992) found a
positive bivariate relationship between income and subjective well-being. In other words, older
adults with more financial resources had higher levels of subjective well-being when compared to
older adults with fewer resources.
The relationship between perceived economic status and psychological well-being could
be explained by a possible mediation effect of financial satisfaction which is strongly related to
both income and subjective well-being (Diener et al., 1993; George, 1992). In these studies, the
findings revealed that financial satisfaction takes on direct and indirect roles between income and

14
subjective well-being among elderly individuals. Research concerning the effect of perceived
economic status on the psychological well-being has also focused on physical health and quality
of life. Slivinske, Fitch, and Morawski (1996) examined how financial status/economic resources
directly related to attain services for basic needs in later life. Crystal and Shea (1990) found that
as older adults experienced greater inequality of income after their retirement, their physical
health was influenced negatively. Other researchers have suggested that older adults had trouble
in meeting the basic requirement for living independently and may be faced with lower levels of
quality of life due to the shortage of resources (Stone & Murtaugh, 1990; Spector, 1991). As a
result, it can be argued that there may be significant direct and indirect relationships between
perceived economic status and psychological well-being.
There is a need to focus on income and assets, usually reported for older adults 65 years
old and over. Those reports provide little information about the centenarians economic status
(Goetting, Martin, Poon, & Johnson, 1996). The broad classification covers more than 35 years
ignoring interindividual variability of economic status across individuals life span (Goetting et al.,
1996; Nelson & Dannefer 1992; Quinn, 1987). Goetting et al. (1996) found that, compared to
younger age groups - 60s and 80s -, the sources of income among centenarians were significantly
different with fewer having employment earnings, Social Security benefits, and retirement pensions.
Most centenarians relied on family members assistance, Social Security benefits, and the Medicaid
program (Goetting et al., 1996). Consequently, it is significant to investigate how insufficient levels
of income sources are related to the quality of life among oldest-old adults.

Proximal Influences: Cognitive and Physical Functioning

Physical functioning is defined as the degree of limitation in people s ability to carry out
their activities of daily living (Morgan & Kunkel, 2007, p. 249). Usually, physical functioning

15
refers to the degree to which an individual needs help with basic personal tasks such as bathing,
eating, and getting dressed and with household and independent living tasks (e.g., preparing
meals, shopping, and transportation, Morgan & Kunkel, 2007). Previous research indicated that
as people grow older, functional capacity decreases (Martin et al., 1996; Poon et al., 1992). Also,
the importance of the relationship between physical functioning and psychological well-being
was indicated in several research studies (Bookwala, Harralson, & Parmelee, 2003; Vankova,
Holmerova, Andel, Veleta, & Janeckova, 2008; Windle, & Woods, 2004).
Cognitive functioning refers to maintaining and improving mental skills such as
learning, memory, decision-making, and planning (Floyd, Mimms, & Yelding, 2007, p. 468).
Even though there are individual differences, the prevalence of dementia, the most common form
of cognitive impairment, increases with age, from 5.0% of those aged 7179 years to 37.4% of
those aged 90 and older (Plassman et al., 2007). Several research studies have suggested that
cognitive decline is significantly related to psychological well-being such as depression, life
satisfaction, or quality of life among older adults (Jorm, 2000; Rabbitt, Lunn, Ibrahim, Cobain, &
McInnes, 2008; Sachs-Ericsson, Joiner, Plant, & Blazer, 2005; Yaffe et al., 1999).
Therefore, based on previous research, a high level of both cognitive and physical
functioning may, as proximal influences, have a positive influence on the psychological wellbeing in later life. The importance of the relationship between cognitive and physical functioning
and psychological well-being among oldest-old adults should be assessed for centenarians. As
reported by the Japanese Centenarian Study (Gondo et al., 2006), most centenarians (80%) did
not show sufficiently high levels of physical (activity of daily living) and cognitive functioning
(Mini-Mental Status Examination). Even though their functional ability is lower than that of
younger generations, it is important to assess the level of psychological well-being and the

16
relationship between psychological well-being and cognitive and physical functioning among
centenarians.
Proximal Influences: Social Support
Another important proximal influence on psychological well-being in later life is social
support. A number of research studies have found that people who report a high level of social
support also show enhanced health and well-being (Cohen & Wills, 1985; Krause, 2004; Pierce,
Sarason, & Sarason, 1996; Sarason, Sarason, & Pierce, 1990). For example, social support is
associated with less depression (Cohen & Wills, 1985; Cutrona & Russell, 1987; Roberts &
Gotlib, 1997) and less loneliness (Jones & Moore, 1987; Rook, 1987). In other words, people
who perceive that they have higher levels of social support also report higher levels of wellbeing (Barrera, 1986; Rhodes & Lakey, 1999; Wetherington & Kessler, 1986). For example, a
high level of social support has been associated with affective and cognitive components of wellbeing (Finch, Barrera, Okun, Bryant, Pool, & SnowTurek, 1997; Lu, 1999) and the support from
significant others also helped older adults replenish a sense of meaning in life (Krause, 2004 &
2006). The importance of social support is similar among oldest-old adults. Several studies
pointed out the decrease of the social network because many older adults are widowed and live
alone (Bould, Sanborn & Reif, 1989; Kovar & Stone, 1992; Martin et al., 1996). On the other
hand, Bury and Holme (1991) reported that over 75% of nonagenarians had contact with their
relatives every day or at least once a week. Kovar and Stone (1992) also reported frequent
contact of children with older adults such as visiting, talking, and calling once a week or daily.
In addition, social support networks have been considered as a critical moderatoring
influence on a number of psychological outcomes such as a sense of meaning in life (Cohen &
Wills, 1985; Krause, 2004). Cohen and Wills (1985) discussed the buffering effect of social

17
support: Support may intervene between the stressful event and a stress reaction by attenuating
or preventing a stress appraisal response (p. 312). Support of friends and family members may
be helpful to lower psychological stress such as loneliness and bereavement (Stroebe, Zech,
Stroebe, & Abakoumkin, 2005). Krause (1987) found another buffering effect of social support.
These findings suggested that financial strain had a weak positive effect on depression when
older adults have high information support. Social support is continuously identified as an
important mediating and moderating factor in the relationship between other indicators and
well-being in extreme late life.
Distal Influences: Past Life Experiences
Compared to proximal influences, distal influences defined as experiences that reach
farther into the personal history of individuals (Martin & Martin, 2002, p.79) also show strong
relations to developmental outcomes (Martin, 2002). With a focus on the process of aging, it
might be argued that not only proximal influences have a direct relationship with individuals
well-being. In the course of adult development, distal events such as negative experiences (e.g.,
death of parents or death of children) or salient historical experiences (e.g., wars, natural
disasters, or economic crises) in the past may influence individual development processes
(Martin, 2002). Martin (2002) argued that considering past events is consistent with Thomaes
(1980 & 1992) cognitive theory of adjustment to aging, which maintains that the perception of
life events is necessary to understand adaptation. Accumulation of several events and period of
events may influence an individuals well-being differently (Davies, Avison, & McApine,
1997; Martin, 1995; Martin & Smyer, 1990; Meyers, & Battistoni, 2003; Rindfuss, 1991).
Individuals generate resources for adaptation with challenging events, and these experiences
may influence development in later life (Martin, 2002).

18
Cumulative life experiences may also take on an important role as a determinant for
adaptation and development. Davies et al. (1997) demonstrated that early life events were
significantly associated with depression in late life. In addition, Palmore, Cleveland, Nowlin,
Ramm, and Siegler (1979) reported that cumulative life events were strongly related to measures of
adaptation in the Duke Longitudinal Studies on Aging. Based on previous literature, it can be argued
that past life experiences, as distal influences, are closely related to proximal influences.

Distal Influences: Education

Education is a significant factor as a distal variable that is of great interest in many
cognitive aging studies (e.g., Cummings, Long, Peterson-Hazan, & Harrison, 1998; Fritsch et al.,
2007; Gatz et al., 2001; Nielsen, Lolk, Andersen, Andersen, & Kragh-Sorensen, 1999; Zhang et
al., 1998). Specifically, Alley, Suthers, and Crimmins (2007) highlighted the role of education not
only in long-term cognitive performance but also in old-age cognitive trajectories. Alley et al.
(2007) examined the relationships between education, initial level of cognition, and change of
cognitive function with growth-curve modeling procedures. The results indicated that high level
of education was linked to better initial performance on cognitive tests and to slower cognitive
decline. In addition, Ryff and Heidrich (1997) examined how past life experiences were linked
with present and future well-being among adults. The results indicated that there was an age
difference; educational experiences were among the strongest predictors of well-being,
especially for older adults. Therefore, it can be argued that education, as a distal experience, is a
significant predictor for proximal influences and psychological well-being in later life.

19
Summary of Literature Review
The literature reviewed regarding the developmental adaptation and successful aging models
outlines the major aims for the present study. First, a major consideration of the developmental
adaptation model concerns past experiences as well as present resources that play a critical role in
age-related processes and successful outcomes. Second, the successful aging model includes major
predictors (e.g., physical health, social aspects, and interpersonal relationships) of successful aging,
but this model ignores other aspects such as financial aspects which are necessary for maintaining
basic needs in later life. In addition, the successful aging model did not specify past components of
individuals life. This might be compensated by elements of the developmental adaptation model.
Third, although a number of studies on psychological well-being in later life have attempted to
investigate determinants of psychological well-being, few studies have examined the relationship
between distal factors and proximal

successful aging factors on psychological well-being all at once and with a life-course
perspective.
Using Information from Proxies
Obtaining information from oldest-old adults is not always easy or feasible. Especially in
old age, individuals well-being is affected by their physical health, cognitive status or
functional abilities (Schonemann-Gieck et al., 2003). The different levels of those factors among
older adults often lead to use proxy ratings of health, functional status, or mental health instead
of self-ratings (Bassett, Magaziner & Hebel, 1990; LaRue, Bank, Jarvik, & Hetland, 1979;
Schonemann-Gieck et al., 2003; Weinberger et al., 1992). Using additional information from
proxy informants can be very helpful in studies of older individuals (Loewenstein et al., 2001;
Watkins, Guariglia, Kaye, & Janowsky, 2001). In terms of accuracy of proxy informants, there

20
are a few studies that investigated the comparison of proxy- and self-reported assessments
focusing on reliabilities. Weinberger et al. (1992) compared geriatric clinic patients and their
proxy perceptions of patients functional status. They found there was a high agreement between
self-rated and proxys ratings of functional ability as the functional ability scores of patients
were high. LaRue et al. (1979) investigated whether self-reports and physicians judgments on
older adults overall health would be significantly related. The results suggested there was a
significant relationship between self and physicians reports, so self-reports could offer a valid
measurement for health assessment in old age (LaRue et al., 1979). Bassett et al. (1990)
evaluated correlations between aged women and their proxys responses for four different
mental health measures (i.e., psychological well-being, depression symptoms, cognitive status,
and cognitive functioning). Bassett et al. (1990) reported there was a significant correspondence
between respondents and proxies on cognitive and mental health. These authors also suggested
proxy responses on cognitive and psychological status measures can be substituted with proxy
responses when the original informant is unavailable (Bassett et al., 1990). In addition, several
studies also found that the information from a proxy is reliable and less biased when respondents
are cognitively impaired or depressed (Kane et al., 2005; Tamim, McCusker, & Dendukur, 2002;
Weinberger et al., 1992).
Rodgers and Herzog (1992) indicated that there has been a general consensus among
researchers that proxy respondents should be used in research focusing on oldest-old adults to
avoid biasing the data compared to healthy elderly. This suggestion was supported by the
Chinese Longitudinal Healthy Longevity Study. Gu (2008) argued that more proxies should give
information in place of centenarians compared to younger counterparts (80s and 90s). The
results indicated that proxy use increased with age and the higher proportion of relatives (e.g., a

21
spouse, children and grandchildren) compared to younger counterparts did not show any
potential bias such as disagreement between proxy and participants (Gu, 2008).
Overall, there is evidence that it is possible to substitute information from proxy to selfreported information when the information is not available from respondents in the studies of old
adults. MacDonald, Martin, Margrett, and Poon (2010) showed there was no mean difference in
rating centenarians mental health when rated from different perspectives. Other studies
suggested there are several strengths using proxy information such as a high rate of responses
for measures and relatively objective responses (Ball, Russell, Seymour, Primrose, & Garratt,
2001; Bassett et al., 1990). In addition, more information can be obtained from proxies
(MacDonald et al., 2010). MacDonald et al. (2010) found there were differences in predictors for
mental health from the different perspectives (i.e., self reports, proxy reports, and interviewers).
This result implies that using perspectives of proxies might be helpful not only to substitute
insufficient information of self-reports but also to have different viewpoints of psychological
well-being among oldest-old adults. Therefore, it can be argued that it might be possible to have
more information beyond self-reports.
Research Questions and Hypotheses
Based on these reviews, several research questions and hypotheses were developed for
this study. The major objective of this study is to explore whether centenarians are successful
agers, what determinants would make them successfully aged and to test and evaluate an
integrated model of successful aging and developmental adaptation that would further enhance
our understanding of well-being among older adults, especially oldest-old adults. Specifically,
this investigation tried to answer the following research questions and hypotheses:

22
1. Do long lives compromise successful aging? In particular, compared to octogenarians,
can centenarians be considered as successful agers? Are determinants of successful aging more
favorable for oldest-old adults? If centenarians and octogenarians do not satisfy the criteria of
successful aging (i.e., physical health, cognitive/physical functioning, and engagement with life),
should we conclude that oldest-old adults are not successful agers? What other predictors can we
use as components of successful aging? The following hypothesis is proposed:
Hypothesis 1: Based on the literature, only one third of centenarians and octogenarians
will satisfy the components of successful aging: physical health, cognitive/physical functioning,
and engagement with life. More octogenarians will meet the three components of successful
aging than centenarians. If other predictors, such as self-rated health, perceived economic
status, and psychological well-being, are substituted for physical health or physical/cognitive
functioning, the proportion of centenarians and octogenarians who will meet these alternative
criteria for successful agers will be higher than when compared to the original successful aging
criteria.
2. Do higher levels of successful aging components predict higher levels of psychological
well-being among oldest-old adults? Is there a difference between centenarians and
octogenarians on the relationship between successful aging components and psychological wellbeing? The specific hypothesis suggests:
Hypothesis 2: There will be strong relationships between components of successful
aging (i.e., physical health, perceived economic status, cognitive and physical functioning,
social support, past life experiences, and education) and psychological well-being. There will be
interaction effects between age and successful aging components to predict psychological wellbeing.

23
3. Do higher levels of distal influences predict higher level of psychological well-being
among oldest-old adults? Is there a difference between centenarians and octogenarians on the
relationship between distal influences (education and past life experiences) and psychological
well-being? The following hypothesis is proposed:
Hypothesis 3: Distal influences such as past life experiences and education will be
significant predictors of psychological well-being. Predictors of distal influences on
psychological well-being will be more pronounced in centenarians than in octogenarians.
4. Do distal influences have significant indirect effects on psychological well-being
through proximal influences (determinants of successful aging)? The following hypothesis was
tested:
Hypothesis 4: Education will influence psychological well-being through cognitive
functioning and perceived economic status. In addition, past life experiences will influence
psychological well-being through social support and perceived economic status.
5. How well does the overall hypothesized model combining the successful aging and
developmental adaptation model fit the data? Predictors considered in the above hypotheses
were included in the overall hypothesized model. Considering proximal influences (determinants
of successful aging) and distal influences together, how are those influences related to
psychological well-being? The following proposition is posited:
Hypothesis 5: The overall model of psychological well-being including proximal and
distal influences will fit the data well. Higher levels of cognitive/physical functioning, physical
health, social support, perceived economic status will predict psychological well-being. In
addition, more past life experiences and higher levels of education will have indirect associations
with psychological well-being through successful aging components.

24
CHAPTER III. METHOD
First, this study obtained approval from the Iowa State Universitys Institutional Review
Board (Appendix A) for research involving human participants. Second, the older adults who
participated in Georgia Centenarian Study (GCS, Phase III; Poon et al., 2007) were the focus of
this study. The phase 3 project of the GCS included a population-based sample of centenarians
and near centenarians who were 98 years old and older. In addition, octogenarians were recruited.
The overall project contains four parts: genetics (project 1), neuropathology (project 2),
neuropsychology (project 3), and psychological resources and adaptation (project 4). The main
question of psychological resources and adaptation (project 4) is why some oldest-old adults
continue to adapt very well, whereas others are quite impaired. The focus of project 4 is on four
critical areas of adaptation: functional capacity, cognitive impairment, subjective well-being, and
economic dependency.
Participants
The sampling frame of the Georgia Centenarian Study (GCS, Phase III; Poon et al., 2007),
which provides data for this study, had two components. The first one was to identify the
proportion of all residents of skilled nursing facilities (SNFs) and personal care homes (PCHs) in
a 44-county area in northern Georgia. Based on census proportions, the project recruited residents
of SNFs and PCHs as well as community-dwelling residents. A second recruiting strategy was to
use date-of-birth information in voter registration files. Based on these two components and five
different characteristics (geographic, age, gender, ethnicity and type of residence) a sample of
centenarians and octogenarians was drawn for this study (Poon et al., 2007). The recruited sample
of centenarians and octogenarians included 375 older adults and their proxy informants.
Information was collected through four sequential sessions, and

25
information regarding resources and adaptation of centenarians from the older adults and their
proxies was the focus of this study. Proxy information was used to ascertain several assessments
of centenarians status, such as physical functioning, psychological well-being, physical health,
social support, and past life experiences.
Not all 375 participants were included in this study. Of the 375 participants, 54 proxy
informants (45 centenarians and 9 octogenarians) were excluded because there were no reports on
date used in this study. This indicates only 321 proxies provided information. An additional 15
proxies (8 centenarians and 7 octogenarians) were excluded due to their marginal mental status
scores. This left 306 participants with proxy reports (234 centenarians and 72 octogenarians). Those
three hundred and six participants and their proxy s information were used in this study. Proxies
included children, spouses, grandchildren, siblings, and others. There were significant differences
2

between centenarians and octogenarians in gender, (1, N = 306) = 5.72, p < .05, type of residence,
2

(2, N = 280) = 35.52, p < .001, education, (7, N = 290) = 22.58, p

2

< .01, marital status, (4, N = 278) = 54.15, p < .001, cognitive status levels, (2, N = 306) =
2

63.59, p < .01), and sources of proxy, (4, N = 306) = 63.35, p < .001. The majority of
centenarians (82.5%) and octogenarians (69.4%) were female. Over two thirds of octogenarians
(86.6%) lived in their own homes, whereas less than half of the centenarians (45.5%) lived in
their own homes. As expected, most participants were widowed (centenarians: 86.3%,
octogenarians: 53.7%). More octogenarians had an education beyond a high school degree than
centenarians did (centenarians: 40.4%, octogenarians, 59.6%). More octogenarians (86.1%)
had high levels (MMSE 23) of cognition status functioning than centenarians (32.7%). Most
centenarian proxies were children (75.5%), whereas children (50.7) and spouses (32.4%) made
up the majority of proxies among octogenarians. In addition, in terms of the excluded 54

26
participants information, they had similar characteristics when compared with samples used in
this study. Most of them were female (81.5%), Caucasians (90.7%), widowed (79.6%), almost half
of them (44.4%) lived in private home/apartments, and children were 66% of the proxies.

There was only a significant difference between the excluded and the remaining sample in
2

mental status, (2, N = 373) = 9.22, p < .05. Over a half of the excluded sample (55.6%) had
lower mental status levels (MMSE < 17) whereas 37.6% of the remaining sample had lower
levels of mental status. There was no significant difference in other characteristics. A summary
of demographic characteristics of the remaining sample of 306 can be found in Table 1.
Missing Data
There are several approaches for dealing with missing data; list-wise deletion, pair-wise
deletion, multiple imputations, full-information maximum likelihood (FIML), and expectation
maximization (EM). This study used different approaches to deal with missing data. First,
pairwise deletion was used for correlation and blocked multiple-regression analysis, because it is
possible to maximize the number of cases (Schafer & Graham, 2002; Wayman, 2003). Second,
the full-information maximum likelihood (FIML) procedure was used for structural equation
modeling analysis, because FIML maximizes the fit of the model to the data using all
information (Raykov, 2005).
Measures
Information was available from both oldest-old adults and their proxies. As mentioned
earlier, the perspective of proxies might be useful not only to substitute insufficient information of
self-reports but also to have different viewpoints of psychological well-being among oldest-

27
Table 1
Summary of Demographic Characteristics

Demographic Characteristics

Octogenarians

Centenarians

(n = 72)
n
%

(n = 234)
n
%

5.72

Gender
Female

50

69.4

193

82.5

Male

22

30.6

41

17.5
***

35.52

Type of Residence
Private home/Apartment

58

86.6

97

45.5

Personal care (Assisted Living)

1.5

41

19.2

Nursing home

11.9

75

35.2

Ethnicity

2.02

White/Caucasian

61

84.7

179

76.5

Black/African American

11

15.3

55

23.5
**

22.58

Education
0-4 years

1.5

11

4.9

5-8 years

3.0

53

23.8

Some high school

9.0

26

11.7

18

26.9

43

19.3

Trade school or vocational degree

11.9

28

12.6

Some college

13.4

22

9.9

College Degree

13

19.4

19

8.5

Graduate Degree

10

14.9

21

9.4

High school diploma

(table continues)

28
Table 1 continued

Demographic Characteristics

Octogenarians

Centenarians

(n = 72)
n
%

(n = 234)
n
%

***

54.15

Marital Status
Never married

1.5

4.3

Married

26

38.8

10

4.7

Widowed

36

53.7

182

86.3

Divorced

6.0

4.3

Separated

0.0

0.5
***

63.59

Cognitive status
Low (MMSE 17)

12.5

112

48.3

Mid (18 MMSE 22)

1.4

44

19.0

62

86.1

76

32.7

High (MMSE 23)

**

63.35

Proxy
Children

36

50.7

173

75.5

Spouses

23

32.4

2.2

Grandchildren

1.4

23

10.0

Siblings

2.8

2.6

Others

12.7

22

9.6

p < .05.

**

p < .01.

***

p < .001.

29
old adults. Therefore, all variables in this study were provided by proxy reports except for
the happiness variable.
Psychological well-being. Psychological well-being was examined with happiness based
on Liang's (1985) work on the Life Satisfaction Index A (Appendix B). This scale was only
available for self reports. Three items (I am just as happy now as when I was younger, My
life could be happier than it is now, These are the best years of my life) were used for this
study. The answer is scaled so that -1 = Disagree; 0 = In Between; or 1 = Agree. Three items
were summed and high scores indicated high level of happiness. Within this investigation,
reliability of the Life Satisfaction Index A was = .61.
Positive affect from proxy reports was used as a measure of psychological well-being.
Positive affect was based on the Bradburn Affect Balance Scale (Bradurn, 1969, Appendix C).
Four positive affect items ( = .76) were used in this study. Proxies were asked to rate
centenarians with the following statements for positive affect: During the past two weeks, (1)
Did he/she ever feel pleased about having accomplished something? (2) Did he/she ever feel
particularly excited or interested in something? (3) Did he/she ever feel that things were going
his/her way? (4) Did he/she ever feel on top of the world? Ratings were used with a four-point
Likert scale: 1 = not at all, 2 = once, 3 = several times, 4 = often. Higher scores for positive
affect indicated better well-being.
Physical health. Physical health was assessed with two concepts of health; subjective and
objective health. A subjective perception of health assessment of current status from proxy reports
is comprised of two questions (Fillenbaum, 1988, Appendix D) with original internal consistency
coefficient = .74. Proxies were asked: How would you rate his/her overall health at the present
time excellent, good, fair, or poor? and was scaled so that 0 = poor to 3 =

30
excellent. The other question was, How much do his/her health troubles stand in the way of
his/her doing the things he/she want to do? and was scaled so that 0 = a great deal to 2 = not at
all. Internal consistency for the proxy ratings of this participants was = 0.56. Physical health
was scored so that higher scores indicate higher levels of physical health. Health problems, the
objective aspects of physical health, were assessed with a variety of health problems such as
hearing, visual, poor smell, poor taste, and dizziness (Appendix E). The sum of the number of
those problems was used based on centenarians reports, proxy reports, medical reports, care
facilitys reports, or other available resources for best available information. Higher scores on
health problems indicate more health problem.
Perceived economic status. Perception of economic status adequacy from proxy reports
was assessed with the economic resources scales items from the Duke Older Americans
Resources and Services Procedures (OARS; Fillenbaum, 1988, Appendix F). Proxies assessed
centenarians economic resources (e.g., Are his/her assets and financial resources sufficient to
meet emergencies?, How well does the amount of money he/she has take care of his/her
needs?, and Does he/she usually have enough to buy those little extras, that is, those small
luxuries?). The three items yielded a reliability of = 0.82. Higher scores indicate perceptions
of high economic status.
Cognitive functioning. Mental status was examined with the Mini-Mental Status
Examination (MMSE; Folstein, Folstein, & McHugh, 1975, Appendix G). The MMSE is
commonly used for evaluation of cognitive impairment. The MMSE is composed of five sections;
orientation, registration, attention and calculation, recall, and language. The reliability is 0.98 for
older adults and concurrent validity with the Wechsler Adult Intelligence Scale was 0.78 in the
original study (Folstein et al., 1975). The centenarian performance ranged from 0 to

31
30, and the thirty items yielded a reliability of = 0.87 for this study. A higher score on the
MMSE indicates better mental status.
Physical functioning. Two commonly used dimensions, instrumental activities of daily
living (IADLs; seven items) and physical activities of daily living (PADLs; seven items)
comprise the self-care capacity assessment (Fillenbaum, 1988, Appendix H) with coefficient
= .92 and = .88, respectively. The information was provided by centenarian proxies. In addition,
internal consistency of all 14 items was = 0.94. Examples of IADL questions include the
capability to use the telephone, get to places out of walking distance, go shopping, prepare meals,
do housework, take medicine, and handle own money. The PADL questions asked about the
ability to eat, dress, take care of appearance, walk, get in and out of bed, take a bath, and have
trouble getting to the bathroom. All 14 items were scaled so that 2 = without help (e.g., can clean
floors, etc.); 1 = with some help (e.g., can prepare some things but unable to cook full meals
yourself); or 0 = completely unable to prepare any meals. Physical functioning was scaled so that
higher scores indicate higher levels of self-care capacity.
Latent variables with two indicators (IADLs and PADLs) tended to create problems with
identification (negative degrees of freedom) in the models. Therefore, three indicators were
extracted through exploratory factor analysis: dressing, taking care of appearance, and getting in
and out of bed.
Social support. Social support was measured with three questions in the original
assessment by Fillenbaum (1988) (Appendix I). Questions were answered by centenarian proxies.
How many people does he/she know well enough to visit with in his/her home or in their
homes? About how many times did he/she talk to someone - friends, relatives, or others on the
telephone in the past week? and How many times during the past week did he/she spend some

32
time with someone who does not live with him/her; that is he/she went to see them or they came
to visit him/her, or he/she went out to do things together? Three questions are related to social
resources. Therefore, social support is considered as social resources in this study. The original
reliability coefficient was = .56 (Fillenbaum, 1988) and reliability for this study was = 0.61.
Social resources were scaled so that higher scores indicate higher levels of social resources.
Education. Education was used with one item which asked proxies about centenarians
past schooling. The participants selected one of eight categories; 1 = 0-4 years, 2 = 5-8 years, 3 =
high school incomplete, 4 = high school completed, 5 = post high school, business or trade
school, 6 = 1-3 years college, 7 = 4 years college completed, and 8 = postgraduate school
(Appendix J).
Past life experiences. Past life experiences were defined by a series of cognitive
engagement tasks used in the Victoria Aging Study (Hultsch, Hertzog, Small, & Dixon, 1999,
Appendix K). Past life experiences included seven dichotomous questions such as learning a
foreign language, volunteer work, traveling, preparing income tax, and public speaking. The
seven items were provided by proxies. Cronbachs alpha for this scale was .68. Higher scores
were indicative of greater engagement. Exploratory factor analysis yielded three factors. One,
which was labeled as social productive activities, included learning a foreign language, public
speaking, and volunteering. The second was labeled as managing of personal assets included
preparing income tax and balancing ones checkbook. The third was labeled learning
experiences and included going back to school and participation in a job training program.
These three factors correspond to one of the determinants of successful aging: active engagement
with life. It is assumed that active engagement with life is perceived as past life experiences
for oldest-old adults.

33
Analyses
The descriptive analyses and multiple regression analyses were conducted with SPSS
17.0. Confirmatory factor analyses and latent variable structural equation modeling were
conducted using Mplus 6.1 (Muthn & Muthn, 2004) to examine this studys research questions
and to test hypotheses. Data analyses proceeded in several steps. First, descriptive analyses
(frequencies, means, standard deviations, etc.) were computed for all the variables. Second, crosstabulation was conducted to compare centenarians and octogenarians across the determinants of
successful aging and happiness (hypothesis 1). Specifically, as the purpose of the hypothesis 1
was to try to explore whether oldest-old adults are successful agers and whether they rate
themselves as successful agers, only self-rated variables were used to test hypothesis 1. Third,
correlation analysis was used to evaluate the bivariate relationship between proximal influences,
distal influences, and developmental outcome variables (hypothesis 2 & hypothesis 3). Fourth,
blocked multiple regression analysis was used to assess main and interaction effects of proximal
influences on well-being as well as to investigate distal influences. Gender, ethnicity, and living
conditions (residence) were used as control variables (hypothesis 2, 3 & 4). Finally, the
hypothesized structural model was evaluated (hypothesis 5).
The proposed measurement model is summarized in Table 2. There were seven latent
variables which are composed of one outcome variable, five successful aging determinants, and one
distal variable: psychological well-being (outcome variable), physical health, perceived economic
status, physical functioning, cognitive functioning, social resources (successful aging determinants),
and past life experiences (distal variable). Each of the latent variables has several indicators, so
confirmatory factor analyses were conducted. Then, through structural equation modeling,
significant direct and indirect pathways were assessed for examining the beta

34
coefficients in the hypothesized model. Specifically, bootstrap procedures were conducted to
assess indirect effects among successful aging components (physical functioning, cognitive
functioning, physical health impairment, social resources, and perceived economic status) on
psychological well-being and distal influences (education and past life experience) through
successful aging components on psychological well-being. Based on fit indices of the
measurement and full model, modification indices were used to improve the fit of the model to
the data. Modification indices were inspected to specify and estimate models by either freeing
fixed parameters or fixing free parameters. The Wald test was used to provide information about
the change in chi-square if free parameters were fixed (Hoyle, 1995). Modification indices
suggested that fixing free parameter of two indicators of social resources would significantly
change the fit of the original hypothesized model. When specifying correlated error between the
2

two indicators of social resources, there was a significant difference in that change ( = 10.42,
df = 1, p < .01). Therefore, based on Brown (2006)s suggestion that correlated errors may
occur for items within the same construct, the correlated error between number of people to
know and number of visits was freed for the hypothesized measurement model.
Investigators have suggested several fit indices that should be considered in evaluating
structural equation models (Bentler & Bonett, 1980; Bollen, 1989; Kline, 2005). Based on these
2

suggestions, fit indices of interest included the fit, comparative fit index (CFI), Tucker &

Lewis non-normed fit index (TLI), root mean square error of approximation (RMSEA),
and standardized root mean square residual (SRMSR).

35
Table 2
Hypothesized Measurement Model
Latent Variables
Psychological
Well-Being
(Happiness)

Physical
Health

Perceived
Economic
Status

Physical
Functioning

As happy as was younger

--

--

--

Could be happier

--

--

--

Best years of life

--

--

--

Overall physical health

--

--

--

Comparative health

--

--

--

Number of health problems

--

--

--

Sufficient financial resources

--

--

--

Meet needs

--

--

--

Capacity to buy small luxuries

--

--

--

Dressing

--

--

--

Taking care of appearance

--

--

--

Getting in and out of bed

--

--

--

Indicators

Latent Variables
Cognitive
Functioning

Social
resources

Past Life
Experiences

Orientation

--

--

Registration

--

--

Indicators

(table continues)

36
Table 2 continued
Attention & Calculation

--

--

Recall

--

--

Language

--

--

Number of people to know

--

--

Number of times to talk

--

--

Number of visits

--

--

Social productive activities

--

--

Management of personal assets

--

--

Learning experiences

--

--

Note. Education was added to the model as a single indicator; * denotes indicators for
each latent variable and -- denotes non-indicators for each latent variable.

37
CHAPTER IV. RESULTS
First, cross tabulations were conducted to explore the determinants of successful aging
among centenarians and octogenarians. Second, blocked regression models were examined to
evaluate significant predictors for happiness among oldestold adults. Third, confirmatory factor
analysis was conducted to test a hypothesized measurement model of latent variables for
determinants of successful aging and the developmental adaptation model. Lastly, a
hypothesized structural model of latent variables was examined.
Successful Aging of Oldest-Old Adults
The criteria suggested by Rowe and Kahn (1997 & 1998) were applied to oldest-old adults
whether they could be considered successful agers or not. The three components of successful aging
included: low probability of disease, physical or cognitive capacity, and engagement with life. Even
though there is little agreement about the optimal definition of successful aging nor its measurement
(Bowling, 2007; Jeste, 2005; Lupien & Wan, 2004; Phelan & Larson, 2002), each definition will
follow the most often used operationalization as reviewed by Depp and Jeste (2006). The probability
of disease was defined by Rowe and Kahn (1997 & 1998) not only as the absence or presence of
disease itself, but also the absence, presence or severity of risk factors for disease. The absence of
congestive heart failure, cancer, high blood pressure, Parkinson s disease, and diabetes mellitus were
used for the first definition in this study (Strawbridge, Wallhagen, & Cohen, 2002).
Physical/cognitive capacity, the second component of successful aging, was defined as potential for
activities (Rowe & Kahn, 1997, 1998). A MMSE score higher than 23 and no help was necessary
with activities of daily living for the second definition in this study (von Faber et al., 2001). Lastly,
engagement with life, the final component of successful aging, was defined as interpersonal relations
and productive activities

38
(Rowe & Kahn, 1997, 1998). In terms of interpersonal relations, spending time with
family/friends at least once a week and having three or more people to visit with were used for
the criteria (Montross et al., 2006). In addition, past experience of volunteer work was used for
productive activity (Herzog & Morgan, 1993). Both interpersonal relations and productive
activity were considered together. The criteria used in this study are summarized in Table 3.
Table 3
Components of Successful Aging
Components

Rowe & Kahns definition

Operationalization

Low probability of disease

Not only the absence or

- Absence of congestive heart

presence of disease itself, but

failure, cancer, high blood

also the absence, presence or

pressure, Parkinsons disease,

severity of risk factors for

chronic pulmonary disease,

disease

diabetes mellitus (Strawbridge

et al., 2002)

High physical & cognitive

Potentials for activities

capacity

- Cognitive capacity: MMSE >

23 (Almeida et al., 2006)
- Physical capacity: no help
with ADL (Tate et al., 2003)

Active engagement with life

Interpersonal relations and

- Interpersonal relations:

productive activity

spending time with family

and/or friends at least once a
week & having three or more
people to visit (Montross et
al., 2006)
- Productive activity:
experience of volunteer work
(Herzog & Morgan, 1993)

39
Each component was applied to octogenarians and centenarians, and how many
octogenarians and centenarians satisfied each component was investigated (Table 4). For low
probability of disease, 28.8% of octogenarians and 29.5% of centenarians satisfied this criterion.
Over half of octogenarians (58%) and 4.4% of centenarians satisfied the physical and cognitive
capacity criteria. There was a significant difference in association between age and
2

physical/cognitive capacity among octogenarians and centenarians, (1, N = 295) = 107.67, p

< .001. For engagement with life, 63.5% of octogenarians and 57.5% of centenarians met the
third criterion. Therefore, we can argue that physical and cognitive capacities are critical factors
distinguishing between octogenarians and centenarians (Table 4).

Table 4
Proportion of Successful Aging Criteria
Octogenarians

Centenarians

Low probability of disease

28.8%

29.5%

.01

High physical & cognitive capacity

58.0%

4.4%

107.67

Active engagement with life

63.5%

57.5%

.72

***

***

p < .001.
Next, all three components were applied to investigate how many octogenarians and

centenarians satisfied all criteria. Table 5 shows the combined proportion of participants,
octogenarians and centenarians, who satisfied three components of successful aging. Over 10% of
octogenarians (15.1%) and none of centenarians satisfied all three components of successful aging.
In addition, 15.1% of octogenarians and 27.3% of centenarians did not achieve any of the

40
three components of successful aging. One third (34%) of octogenarians and 18% of
centenarians met two of the three components. Over half of the centenarians and 35.9% of
octogenarians achieved only one component of successful aging. Specifically, it might be worthy
to note that although centenarians had a high probability of disease and lower potential capacities,
39.1% of them had a high level of life engagement. Therefore, based on Rowe and Kahns (1997
& 1998) criteria of low probability of disease, high physical and cognitive capacity, and engaged
lifestyle, we can argue that living longer does not necessarily imply successful aging.

Table 5
Combined Proportion Successful Aging Criteria
Low

High physical

Active

probability

& cognitive

Engaged

of disease

capacity

with life

all satisfied

15.1%

0.0%

2 satisfied

3.8%

0.6%

1.9%

13.7%

28.3%

3.7%

1.9%

15.5%

15.1%

0.0%

18.9%

39.1%

15.1%

27.3%

1 satisfied

none satisfied

Octogenarians

Centenarians

Note. means satisfied and

means not-satisfied.

41
However, are these three criteria the only viable aspects of successful aging among
oldest-old adults? The three criteria have been commonly used to examine successful aging but,
as Kahn (2002) admitted, the successful aging model should be complementary with other
models. Hence, it might also be necessary to expand the definition of successful aging. An
alternative model for successful aging is suggested in this section. First, self-rated health was
used as a criterion instead of low probability of disease. Health status rated as either good or
excellent was considered as an indicator for successful aging (Jorm et al., 1998). Second,
perceived economic status, which was neglected by Rowe and Kahn (1997 & 1998), was
included. As mentioned in the literature review, it is important to pay attention to the economic
status of centenarians in that financial status/economic resources directly and indirectly influence
later life such as access to commercial goods and leisure opportunities, to attain services for
basic needs, physical health, living arrangement, and quality of life (Crystal & Shea, 1990;
Pinquart & Srensen, 2000; Slivinske, Fitch, & Morawski; 1996; Stone & Murtaugh, 1990;
Spector, 1991). Furthermore, economic resources in later life would be presented as a source of
economic security strengthening feelings of independence, autonomy, and predictability (Henry,
1991; Hermalin, Chang, & Roan, 2002). Perceived economic status was defined as the capacity
to meet emergencies, to take care of needs, and to buy small luxuries (Fillenbaum, 1988). The
last indicator for successful aging included psychological aspects in later life, happiness. The top
third of the summary scores of three items (I am just as happy now as when I was younger,
My life could be happier than it is now (reversed), These are the best years of my life)
was used for happiness (von Faber et al., 2001). The alternative criteria used in this study are
summarized in Table 6.
42

Table 6
Alternative Components of Successful Aging
Components

Operationalization

Self-rated health

- Good health: rated as either good or

excellent
- Poor health: rated as either fair or
poor

Perceived economic status

- Better status: able to meet emergencies,

to buy small luxuries, and to take care of
needs fairly & very well
- Poor status: unable to meet emergencies,
to buy small luxuries, and to take care of
needs poorly

Happiness

- Happy: scoring 1 to 3 on the summary

scores of three items (I am just as happy
now as when I was younger, My life
could be happier than it is now (reversed),
These are the best years of my life)
- Unhappy: scoring -3 to 0 on the summary
scores of three items

Each component was applied to octogenarians and centenarians, and how many
octogenarians and centenarians were satisfied with each component was investigated (Table 7).
For self-rated health, 77.5% of octogenarians and 73.0% of centenarians satisfied this
criterion.
Over three quarters of octogenarians (78.8%) and 61.8% of centenarians satisfied the perceived
economic status criterion. There was a significant difference in association between age and
2

perceived economic status among octogenarians and centenarians, (1, N = 286) = 6.49, p < .05.

This indicates a larger proportion of octogenarians satisfied the perceived economic status

43
criterion compared to centenarians. For happiness, 89.8% of octogenarians and 89.7% of
centenarians met the third criteria. Therefore, compared to Rowe and Kahn (1997 & 1998) s
criteria, more oldest-old adults satisfied these alternative aspects of successful aging criteria.

Table 7
Proportion of Alternative Successful Aging Criteria
Octogenarians

Centenarians

Better self-rated health

77.5 %

73.0 %

.57

Better perceived economic status

78.8 %

61.8 %

6.49

High level of happiness

89.8 %

89.7 %

.00

p < .05.
As was done with Rowe and Kahn (1997 & 1998)s successful aging criteria, all three

components for the alternative model were applied to investigate how many octogenarians and
centenarians satisfied all criteria. Table 8 shows the combined proportion of participants,
octogenarians and centenarians, who satisfied the three components of successful aging. A total
of 62.3% of octogenarians and 47.5% of centenarians satisfied all three components of the
alternative model of successful aging. Over 25% of octogenarians (26.3%) and less than half of
centenarians (43.5%) met two of the three components. Over 10% of octogenarians (11.3%)
and 7.3% of centenarians achieved only one component of successful aging. In addition, no
octogenarian and only 1.6% of centenarians did not achieve any of the three components of the
alternative successful aging model.

44
Table 8
Combined Proportion of Alternative Successful Aging Criteria
Better
Self-rated
health
all satisfied

Better
Perceived
economic
status

2 satisfied

7.5%

6.6%

9.4%

23.8%

9.4%

13.1%

1.9%

1.6%

1.9%

0.8%

7.5%

4.9%

0.0%

1.6%

1 satisfied

None satisfied

High level
of
Happiness

Octogenarians

Centenarians

62.3%

47.5%

Note. indicates satisfied and indicates not-satisfied.

The Relationships of Successful Aging Components, Distal Influences, and Psychological

Well-Being
Blocked multiple regression analyses were computed to examine the relationships between
successful aging components and happiness and between distal influence and happiness. In the first
model, age group, gender, ethnicity, and residence were included as covariates (Model 1). Successful
aging components (i.e., physical functioning, cognitive functioning, subjective health, and the
number of health problems), as well as social resources and perceived economic status were included
in the second model predicting happiness among oldest-old adults (Model 2). In the third model, the
six interaction terms of age and each of the successful aging components were included separately
(Model 3). In the fourth model, education, social productive activities, managing personal finances,
and learning experiences, such as job training,

45
were included as distal influences (Model 4). Lastly, the four interaction terms of age and each of
the distal influences were added to the final model separately (Model 5) (Table 9). The models
are summarized in Table 9. Pairwise deletion was used to deal with missing data. One hundred
eighty five cases were included in Model 1 and one hundred and forty seven cases were used in
Model 2 to Model 5.

Table 9
Models for Blocked Multiple Regression
Models

Variables

Model 1

Covariates (age group, gender, ethnicity, and residence) (n = 185)

Model 2

Covariates, Successful aging components (physical functioning, cognitive

functioning, subjective health, the number of health problems, social
resources and perceived economic status) (n = 147)

Model 3

Covariates, Successful aging components, six interaction terms

(age*physical functioning, age*cognitive functioning, age*subjective
health, age*the number of health problems, age*social resources and
age*perceived economic status) (n = 147)

Model 4

Covariates, Successful aging components, distal influences (education,

social productive activities, managing personal finances, and learning
experiences) (n = 147)

Model 5

Covariates, Successful aging components, distal influences, four

interaction terms (age*education, age*social productive activities,
age*managing personal finances, and age*learning experiences) (n = 147)

There was no significant effect of either successful aging components or distal influences
on happiness for the oldest-old adults (Table 10). However, two significant interaction effects of
age and two successful aging components on happiness were found. There were significant
Table 10

Blocked Regression Models for Happiness

Model 1 (n = 185)
Variables

Model 2 (n = 147)

SE

R2

SE

.01

-.30

.31

Gender

-.26

.30

-.07

Ethnicity
Residence

-.61
.00

.30
.00

-.17*
.06

-.59
.00

.32 -.16*
.00
.07

Age

-.34

.29

-.10

-.45

.33

-.13

Physical functioning

-.03

.05

-.09

Cognitive functioning

.01

.05

.08

Subjective health

.29

.18

.15

Health problems

.04

.05

.07

Social resources

-.04

.07

-.06

Perceived economic status

-.03

.10

-.03

R2

.02

.49

-.08

Age* Physical functioning

Age* Cognitive functioning
Age* Subjective health
Age* Health problems
Age* Social resources
Age* PES

(table continues)

4
6
Table 10 (continued)
Model 4 (n = 147)
Variable

SE

Gender

-.27

.32

-.07

Ethnicity
Residence
Age

-.71
.00
-.35

.34
.00
.34

-.20*
.06
-.10

Physical functioning

-.03

.05

-.08

Cognitive functioning

.01

.02

.07

Subjective health

.27

.19

.14

Health problems

.05

.05

.09

Social resources

-.03

.07

-.05

Perceived economic status

-.04

.10

-.04

.09

.09

.13

-.24

.16

-.16

Management of personal assets (MPA)

.14

.23

.06

Learning experiences

.02

.20

.01

Education
Social activities experiences (SAE)

Age* Education

R2

.00

SE

.84

.05

Age* SAE

-.01

Age* MPA

-.48

Age* Learning experiences

+

Note. p < .10. p < .05.

**

.24

p < .01.

***

p < .001.

4
7

48

interaction effects between age and physical functioning ( = -.52, p < .05) and between age and
cognitive functioning ( = -.57, p < .01) across all the models. In other words, the relationships
between cognitive functioning and happiness and between physical functioning and happiness
among oldest-old adults were different for octogenarians and centenarians.

Two simple interaction effects of age on the relationships between physical

functioning and happiness and cognitive functioning and happiness were evaluated. To
examine the two-way interactions (physical functioning X age and cognitive functioning X
age), all predictor variables were mean-centered to calculate the influence of physical
functioning and cognitive functioning on happiness. Then, the relationships between physical
functioning and happiness and between cognitive functioning and happiness were plotted
(Figure 2 and Figure 3) for octogenarians and centenarians.
First, in terms of the relationship between physical functioning and happiness, for
octogenarians, physical functioning was positively associated with happiness (B = .10). For
centenarians, physical functioning had a negative association with happiness (B = -.03; see
Figure 2). Lower levels of physical functioning indicate minimum scores of physical
functioning and higher levels indicate maximum scores of physical functioning (0 for
minimum score, 14 for maximum score). Centenarians at lower levels of physical functioning
experienced higher levels of happiness than octogenarians who had the same levels in
physical functioning (happiness scores: .03 for centenarians, -1.17 for octogenarians).
However, the association changed for higher levels of physical functioning. The levels of
happiness among octogenarians were higher than the levels of happiness among centenarians
who had high levels of physical functioning (happiness scores: -.40 for centenarians, .15 for
octogenarians).

s Happines

49

Physical Functioning
Figure 2. Two-way interaction of physical functioning happiness.

Based on these findings, the interaction effects of age group on the relationship
between physical functioning and happiness were evaluated (Aiken & West, 1991). There
were two post-hoc analyses of simple effects: 1. To determine whether the slopes of the
simple regression lines were significantly different from zero, and 2. To assess if the slopes
for the regression lines differed significantly from one another. The results showed that first,
the simple slopes of physical functioning of centenarians and octogenarians were not
significantly different from zero, t = - .68, p = .50 for centenarians, and t = .61, p = .54 for
octogenarians. Second, the slopes of each regression line (centenarians vs. octogenarians)
did significantly differ from each other, t = - 4.06, p < .001. Two post-hoc analyses indicated
that the relationships between physical functioning and happiness among centenarians and
octogenarians were not significantly different from zero, but there was a difference between
centenarians physical functioning and happiness (negative) and octogenarians physical
functioning and happiness (positive).

50

The second interaction effect of age differences on the relationship between cognitive
functioning and happiness was examined. For octogenarians, cognitive functioning was
positively associated with happiness (B = .10). For centenarians, cognitive functioning had a
negative association with happiness (B = -.02; see Figure 3). Similar to the relationship
between physical functioning and happiness, centenarians at lower levels (minimum score: 0)
of cognitive functioning experienced higher levels of happiness than octogenarians at lower
levels of cognitive functioning (happiness scores: 0.26 for centenarians, -2.68 for
octogenarians). The happiness scores among octogenarians were higher than the levels of
happiness among centenarians at higher levels of cognitive functioning (maximum score: 30;

s Happines

happiness scores: -.40 for centenarians, .35 for octogenarians).

Cognitive Functioning
Figure 3. Two-way interaction of cognitive functioning happiness.

Again, based on these findings interaction effects of age group on the relationship
between cognitive functioning and happiness were examined (Aiken & West, 1991). The
results showed that first, the simple slopes of cognitive functioning of centenarians and

51

octogenarians were not significantly different from zero, t = -.73, p = .47 for centenarians,
and t = 1.04, p = .31 for octogenarians. Second, the slopes of each regression line
(centenarians vs. octogenarians) did significantly differ from each other, t = -3.97, p < .
001. Two post-hoc analyses indicated that the relationships between cognitive functioning
and happiness among centenarians and octogenarians were not significantly different from
zero, but there was a difference between centenarians cognitive functioning and happiness
(negative) and octogenarians cognitive functioning and happiness (positive).

Structural Equation Modeling: Happiness Model

Structural equation modeling was used to examine the hypothesized model. Before
examining the hypothesized model, confirmatory factor analyses to test a measurement model
of latent variables for each of the distal influences, successful aging components, and
happiness were conducted. This evaluation involved five steps: 1. confirmatory factor
analysis for examining the measurement model, 2. including covariates (age, gender,
ethnicity, & residence), 3. investigating a corrected fully recursive model, and 4. examining
the hypothesized structural model.
When testing the measurement model, two issues had to be solved. First, five sections
of the cognitive functioning measure (orientation, registration, attention and calculation,
recall, and language) created problems due to dichotomous measurements, especially when
over 90% of respondents scored the same on particular items. This created a convergence
problem (non-positive definite covariance matrices). Therefore, summary scores of the MiniMental Status Examination (MMSE) were used as a single indicator for cognitive functioning
in the model. Second, two single indicators were used for two latent variables, education and
cognitive functioning (MMSE). Based on Brown (2006)s suggestion, the error variances of
education were fixed to zero. It is assumed that education is entirely free of measurement

52

error (Brown, 2006). For cognitive functioning, we cannot assume that the reliability of
cognitive functioning is perfect. Therefore, I calculated unstandardized errors for cognitive
functioning on the basis of the cognitive functioning s sample variance estimate and internal
consistency estimate (e.g., reliability): x = VAR(cognitive functioning)(1-). Based on this
formulation, the unstandardized errors for cognitive functioning were fixed at 10.53.

Measurement Model
After fixing indicators for two latent variables, the indicators for the measurement
model were computed for the covariance matrix with correlations, means, and standard
deviations (Table 11). In particular, high intercorrelations were obtained for variables
associated with past life experiences (i.e., social productive activities, management of
personal assets, and learning experiences), perceived economic status (i.e., sufficient financial
resources, meet needs, and capacity to buy small luxuries), and physical functioning (i.e.,
dressing, taking care of appearance, and getting in and out of bed). Results of the
confirmatory factor analysis for the happiness model can be found in Table 12. Factor
loadings of the measurement model ranged from .39 to .99. The fit of the measurement model
2

(Model 1) was satisfactory, (df = 143) = 180.22, p = .02, CFI = .98; TLI = .98; RMSEA
= .03 and SRMR = .07 (Table 13).
Table 11

6. Social prod

Correlation Matrix for Measurement Model

7. Managemen

Variables

Covariate
1. Age (octogenarian = 0, centenarian = 1)

2. Gender (male = 0, female = 1)

3. Ethnicity (African Am. = 0, Caucasian = 1)
4. Residence (others = 0, nursing home = 1)

.15*
-.11
.22

**

1
-.06
.11

8. Learning ex
Cognitive Func

9. MMSE sco
Physical Functi
1

10. Dressing

-.09

11. Taking car

Education
5. Education
Past Life Experience

12. Getting in
-.28

**

-.09

.32

**

-.28

**

p < .05.

**

p<

5
3
Table 11 continued.
Variables

.02

.01

.02

-.21**

.06

.04

-.03

.03

-.25

**

.09

.02

.04

-.05

-.00

-.12*

.01

.14*

16.Number of people to know

-.14*

-.13*

.06

-.28**

.14*

.22**

17.Number of times to talk

-.19**

-.09

.11

-.49**

.26**

.32**

.05

.03

.25**

-.16*

.17**

.17**

19.Sufficient financial resources

-.17**

-.05

.35**

-.34**

.39**

.21**

20.Meet needs

-.16**

-.11

.26**

-.33**

.41**

.26**

-.12*

-.12*

.33**

-.24**

.35**

.22**

22.As happy as was younger

-.07

-.01

.07

.06

.09

-.00

23.Could be happier

-.05

.07

-.28**

-.03

-.07

-.20**

24.Best years of life

-.04

.11

.11

-.22**

.08

.08

Physical Health Impairment

13.Overall physical health
14.Comparative health
15.Number of health problems

-.22

***

Social resources

18.Number of visits
Perceived Economic Status

21. Capacity to buy small luxuries

Happiness

p < .05.

**

p < .01.

5
4

Table 11 continued.
Variables

10

11

12

Positive Affect

25.Pleased

-.21**

-.24**

.16*

-.26**

.13*

.26**

.12*

.11

.48**

.44**

.37**

.31**

26.Excited/interested

-.09

-.12**

.07

-.18**

.15*

.21**

.10

.05

.39**

.31**

.26**

.19**

27.Goes ones way

-.07

-.03

.08

-.22**

.10

.04

.04

-.01

.24**

.25**

.22**

.17**

28.On top of the world

-.08

-.09

.01

-.26**

.11

.15*

.09

.05

.28**

.32**

.22**

.29**

Mean

.76

.80

.77

.30

4.45

1.44

1.70

.55

19.24

1.47

1.55

1.52

SD

.43

.40

.42

.46

2.06

.98

.65

.69

9.01

.70

.73

.72

p < .05.

**

p < .01.

(table continues)

5
5
Table 11 continued.
Variables

13

14

15

16

17

18

Physical Health Impairment

13.Overall physical health
14.Comparative health
15.Number of health problems
Social resources
16.Number of people to know
17.Number of times to talk
18.Number of visits
Perceived Economic Status

19

20

21

22

23

24

19.Suf
20.Mee

21. Cap
Happine

1
.44

22.As

**

-.23

**

-.24

.18**
.24

**

.17

**

**

.06

1
.21**

.07
.23

23.Cou

**

.04
.09

24.Bes
*

p < .05

.40

**

.36

**

1
.29**

5
6
Table 11 continued.
Variables

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Positive Affect
25.Pleased

.23**

.20**

.05

.31**

.31**

.33**

.13*

.17**

.14*

.07

-.05

.23** 1

26.Excited/
interested
27.Goes ones
way
28.On top of

.21**

.13*

-.08

.34**

.29**

.20**

.03

.09

.05

.16**

-.03

.23** .54** 1

.23**

.19**

.07

.30**

.11

.16*

.11

.15**

.11

.15**

.13*

.23** .37**

.32** 1

.33*

.31***

-.11

.28**

.21**

.24**

.09

.17**

.11

.16**

.09

.21** .47**

.46**

1.98

.83

3.75

2.44

1.81

1.86

.70

1.33

.74

.17

.77

.78

2.82

.92

1.19

.92

.46

.75

.43

.94

the world

Mean
SD
*

p < .05.

**

p < .01.

-.35

-.25

.88 1.02

.42** 1

2.46

2.65

2.34

1.92

1.06

.99

1.13

1.10

5
7

58
Table 12
Factor Loadings for Confirmatory Factor Analysis for Happiness Model
Measure and Variable
Education
Single indicator
(8 categories for education levels)
Past Life Experiences
Social productive activities

Factor Loading

SE

Standardized
Uniqueness
Factor
Loading

1.00

1.00

1.00

--

.61

.60

Management of personal assets

.56

.08

.33

.50

Learning experiences

.51

.09

.40

.43

1.00

--

10.53

.93

1.00

--

.09

.90

Taking care of appearance

.97

.05

.16

.84

Getting in and out of bed

.99

.05

.12

.88

Overall physical health

-.48

.12

.37

-.63

Comparative health

-.58

.14

.28

-.75

Number of health problems

1.00

--

6.73

.37

.46

.07

.63

.50

1.00

--

.50

.81

.38

.07

.76

.39

.63

.04

.05

.87

1.00

--

.16

.84

.50

.04

.09

.72

1.00

--

.25

.85

Could be happier

.53

.15

.58

.49

Best years of life

.55

.17

.74

.46

Cognitive Functioning
MMSE summary score
Physical Functioning
Dressing

Physical Health Impairment

Social resources
Number of people to know
Number of times to talk
Number of visits
Perceived Economic Status
Sufficient financial resources
Meet needs
Capacity to buy small luxuries
Happiness
As happy as was younger

59
Table 13
Fit Indices of Happiness Model
2

Model

df

1. Measurement Model

180.22

143

.03

.07

.98

.98

273.87

191

.04

.06

.96

.95

243.91

170

.04

.06

.97

.95

277.24

183

.04

.07

.96

.94

RMSEA

SRMR CFI

TLI

2. Covariate Model (Included

covariates)
3. Corrected Fully Recursive
Model
4. Structural Model

Covariate Model and Corrected Fully Recursive Model

The second model was tested to examine the effect of age on all latent variables
(Model 2). Usually, a multiple group analysis is performed to determine differences between
two groups. However, as Bentler and Chou (1987) suggested, the ratio of a sample size to
established parameters in structural equation modeling should be between 5:1 to 10:1. For the
centenarians, the sample sizes of centenarians (n = 137) is over Bentler and Chou (1987)s
suggested ratio (number of parameters: 21, the necessary sample size: 105 to 210). However,
the sample size of octogenarians (n = 71) is below the ratio that Bentler and Chou (1987)
suggested. Thus, the age variable was used as a covariate in the model to examine its direct
effect on all the latent factors. Brown (2006) suggested that a significant direct effect of the
covariate on the latent variables shows population heterogeneity. In other words, the factor
means are different at different levels of the covariate which implies the test of equal latent
means in multiple group analysis (Brown, 2006).

60
The covariate model (Model 2) proved that all factor loadings of the latent variables
(i.e., distal influences, successful aging components, and happiness) were significant. Age
group was included as a covariate (0 = octogenarians, 1 = centenarians) in this model (Model
2

2). The fit of model 2 was acceptable: (df = 191) = 273.87, p = .0001, CFI = .96; TLI
= .95; RMSEA = .04 and SRMR = .06 (Table 13). Specifically, the covariate model (Model
2) showed there were significant direct effects of age group on education ( = -.47, p < .01),
physical functioning ( = -.39, p < .001), and cognitive functioning ( = -.62, p < .001).
These values can be interpreted akin to Cohens d (Cohen, 1992). Cohen (1992) suggested
the effect guidelines (d = .20, .50, and .80 for small, medium, and large effects, respectively).
Therefore, it can be concluded that age differences for education, cognitive functioning and
physical functioning yielded medium effects in this model. In addition, the results suggest
that centenarians had lower levels than octogenarians on education, physical functioning, and
cognitive functioning.
In addition, gender (male = 0, female = 1), ethnicity (African American = 0,
Caucasian = 1) and residence (non-nursing home residents = 0, nursing home residents= 1)
were included as covariates. Even though the relationship of covariates to other model
variables was not the focus of this study, several significant direct effects of those covariates
on latent variables were found. Gender had a significant direct effect on past life experiences
( = -.24, p < .001). In terms of ethnicity, there were significant direct effects on perceived
economic status ( = .34, p < .001), education ( = .29, p < .01), and cognition ( = .15, p
1<

.001). Furthermore, residence of oldest-old adults had direct effects on past life

experience ( = -.33, p < .001), perceived economic status ( = -.33, p < .001), physical
health impairment ( = .30, p < .001), social resources ( = -.54, p < .001), education ( =
-.21, p
2<

.001) and cognition ( = -.52, p < .001). These results suggest that women had fewer

past life experiences, Caucasian had higher levels of perceived economic status, education, and

61
cognition, and nursing home residents had lower levels of most of latent constructs, except
happiness.
Then, a corrected fully recursive model was tested (Model 3). The correlation
between cognitive functioning (MMSE score) and the second indicator of social resources,
the number of times to talk to someone, was .66. This caused a high correlation between two
different latent constructs, cognitive functioning and social resources. Eliminating the second
indicator of social resources distinguished the two different latent constructs. The corrected
2

fully recursive model (Model 3) had an acceptable fit, (df = 170) = 243.91, p = .0002, CFI
= .97; TLI = .95; RMSEA = .04 and SRMR = .06 (Table 13).
Structural Model for Happiness
Structural equation modeling was also used to evaluate the data for the happiness
2

model (Model 4). The happiness model (model 4) had an acceptable fit, (df = 183) =
277.24, p < .001, CFI = .96; TLI = .94; RMSEA = .04 and SRMR = .07 (Table 13). There
were still significant direct effects of age on physical functioning ( = -.20, p < .001), social
resources ( = .19, p < .05), education ( = -.16, p < .01), and cognitive functioning ( = -.53,
p < .001). These results suggest that centenarians had lower levels of physical functioning,
education, cognitive functioning and higher levels of social resources than octogenarians.
The path coefficients of the structural model for happiness were evaluated (Figure 4).
Several pathways were significant. First, physical functioning had a direct effect on physical
health impairment, = -.43, p < .001. In other words, higher levels of physical functioning were
associated with lower levels of physical health impairment. Second, education had a positive
direct influence on cognitive functioning, = .23, p < .001. Thus, more education was associated
with higher levels of cognitive functioning. Third, cognitive functioning had a positive direct
effect on higher levels of social resources, = .66, p < .001, suggesting that higher levels of
cognitive functioning predicted more social resources. Forth, education had a

Distal influences

Proximal influences

Ou
tco
me

Physical
Functioning
Education
Cognitive

23

Functioning
2

R = .47

***

-.25

.
86
***

.
10
Past
Life
Ex
pe
rie
nc
es

-.02
.22
.12

6
2
.

Figur

e
E

t
a

63
marginally significant effect on perceived economic status, = .44, p < .10. In other words,
more education predicted higher levels of perceived economic status among oldest-old adults.
Furthermore, physical health impairment had a significant direct effect on happiness, = -.25,
p < .05, suggesting higher levels of physical health impairment predicted lower levels of
happiness. Only fourteen percent of the variance in happiness was explained.
Based on Figure 4, indirect effects among successful aging components (physical
functioning, cognitive functioning, physical health impairment, social resources, and
perceived economic status) on happiness and distal influences (education and past life
experiences) through successful aging components on happiness were examined. For
example, possible indirect effects such as an indirect effect of physical functioning on
happiness (physical functioning physical health impairment happiness) and indirect
effects of education on happiness (education cognitive functioning social resources
happiness or education perceived economic status happiness) were examined. The
hypothesized structural model was tested 500 times with the bootstrap procedure. The result
showed that there were no significant indirect effects.

Alternative Structural Model for Psychological Well-Being

Even though there was not a problem in the happiness measurement such as skewed
distributions on the three items of happiness, the results did not support the hypothesized
happiness model strongly. There are at least two possible reasons. First, the predictors for
happiness, successful aging components (i.e., cognitive functioning, social resources, and
perceived economic status) and distal influences (i.e., education and past life experience),
may not be the most relevant predictors of happiness among oldest-old adults. Second,
perhaps happiness is not the most representative construct of psychological well-being for
oldest-old adults. Thus, focusing on the latter supposition, positive affect assessed by proxies

64
was included in the model instead of happiness to examine an alternative model. Models
were constructed in the same way as the happiness model; 1. confirmatory factor analysis for
examining the measurement model, 2. including covariates (age, gender, ethnicity, &
residence), 3. investigating a corrected fully recursive measurement model, and 4. examining
the hypothesized structural model. Result of the confirmatory factor analysis for the positive
affect model can be found in Table 14. Factor loadings of the measurement model ranged
from .41 to .99.
2

The fit of the measurement model for positive affect (Model 1) was (df = 162) =
258.94, p < .001, CFI = .96; TLI = .95; RMSEA = .04, and SRMR = .06 (Table 15). The
2

covariate model (Model 2) was tested. The fit of model was acceptable: (df = 213) =
347.88, p < .001, CFI = .95; TLI = .93; RMSEA = .05, and SRMR = .05 (Table 15).
Specifically, the covariate model for positive affect showed significant direct effects of age
group on several latent variables: education, physical functioning, and cognitive functioning.
In other words, there were significant direct effects of age group on education ( = -.39, p
1<

.01), physical functioning ( = -.45, p < .001), and cognitive functioning ( = -.62, p

2<

.001). Just like in the happiness model, the results suggest that centenarians had

lower levels than octogenarians did on education, physical functioning, and cognitive
functioning.
In addition, there were also significant effects of other covariates (gender, ethnicity,
and residence) as were found in the happiness model. Gender had a significant direct effect
on positive affect ( = -.14, p < .05) and past life experiences ( = -.24, p < .001). In terms of
ethnicity, there were significant direct effects on perceived economic status ( = .35, p
3<

.001), education ( = .29, p < .01), and cognition ( = .15, p < .01). Furthermore,

residence of oldest-old adults had direct effects on positive affect ( = -.29, p < .001), past
life experiences ( = -.33, p < .001), perceived economic status ( = -.33, p < .001), physical

65
Table 14
Factor Loadings for Confirmatory Factor Analysis for Positive Affect Model
Measure and Variable

Factor Loading

SE

Standardized
Uniqueness
Factor
Loading

Education
Single indicator

1.00

1.00

Past Life Experiences

Social productive activities

1.00

--

.62

.60

Management of personal assets

.56

.08

.33

.50

Learning experiences

.52

.09

.40

.44

1.00

--

10.53

.93

1.00

--

.09

.91

Taking care of appearance

.96

.05

.16

.84

Getting in and out of bed

.99

.05

.12

.88

Overall physical health

-.52

.12

.34

-.67

Comparative health

-.55

.14

.31

-.71

Number of health problems

1.00

--

6.76

.36

.51

.07

.61

.52

1.00

--

.59

.77

.41

.07

.74

.40

.63

.04

.05

.87

1.00

--

.16

.84

.50

.04

.09

.72

1.00

--

.45

.77

Excited/interested

.85

.08

.51

.70

Goes ones way

.69

.10

.96

.50

On top of the world

.89

.09

.66

.67

Cognitive Functioning
MMSE summary score
Physical Functioning
Dressing

Physical Health Impairment

Social resources
Number of people to know
Number of times to talk
Number of times to spend tome
Perceived Economic Status
Sufficient financial resources
Meet needs
Capacity to buy small luxuries
Positive Affect
Pleased

66
health impairment ( = .34, p < .001), physical functioning ( = -.57, p < .001), social
resources ( = -.55, p < .001), education ( = -.21, p < .001) and cognition ( = -.52, p < .001).
These results suggest that women had experienced fewer life experiences, Caucasians had
higher levels of perceived economic status, education, and cognition, and nursing home
residents had lower levels on all of latent constructs.
Then, a corrected fully recursive model (Model 3) was tested just like in the happiness
model due to a high correlation between cognitive functioning and social resources.
Eliminating the second indicator of social resources distinguished the two different latent
2

constructs. The corrected fully recursive model (Model 3) had an acceptable fit, (df = 191)
= 293.75, p < .001, CFI = .96; TLI = .94; RMSEA = .04 and SRMR = .05 (Table 15).

Table 15
Fit Indices of Positive Affect Model
2

Model

df

RMSEA

SRMR

CFI

TLI

1. Measurement Model

258.94

162

.04

.06

.96

.95

347.88

175

.05

.05

.95

.93

293.75

191

.04

.05

.96

.94

329.35

204

.05

.06

.95

.93

2. Covariate Model
(Included covariates)
3. Corrected Fully
Recursive Model
4. Structural Model

The structural model for positive affect was also examined (Model 4). The positive
2

affect model had a satisfactory fit, (df = 204) = 329.35, p < .001, CFI = .95; TLI = .93;
RMSEA = .05 and SRMR = .06 (Table 15). In addition, there were still significant direct

67
effects of age on education ( = -.16, p < .01), physical functioning ( = -.19, p < .001), and
cognitive functioning ( = -.22, p < .001). Path coefficients of the structural model for
positive affect were evaluated (Figure 5). Several pathways were significant. First, physical
health impairment and social resources had a direct effect on positive affect, = -.35, p < .01
for physical health impairment, and = .53, p < .001 for social resources. In other words,
lower levels of physical health impairment and social resources were associated with higher
levels of positive affect. Second, physical functioning had a direct effect on physical health
impairment, = -.48, p < .001. In other words, higher levels of physical functioning were
associated with lower levels of physical health impairment. Third, education had a positive
direct influence on cognitive functioning, = .23, p < .001. Thus, more education was
associated with higher levels of cognitive functioning. Forth, cognitive functioning had a
positive effect on higher levels of social resources, = .67, p < .001, suggesting that higher
levels of cognitive functioning predicted more social resources. Fifty three percent of the
variance in positive affect was explained.
Based on Figure 5, indirect effects among successful aging components (physical
functioning, cognitive functioning, physical health impairment, social resources, and
perceived economic status) on positive affect and distal influences (education and past life
experiences) through successful aging components on positive affect were examined. For
example, possible indirect effects such as an indirect effect of physical functioning on
positive affect (physical functioning physical health impairment positive affect) and an
indirect effect of education on positive affect (education cognitive functioning social
resources positive affect or education perceived economic status positive affect)
were examined. The hypothesized structural model was tested 500 times with the bootstrap
procedure. The result showed that there were three significant indirect effects on positive
Distal influences

Proximal influences

Outcome

-.48

Physical
Functioning

Cognitive

***

.10
Functioni
ng
2
R =.
***

47
-

.
88

-.09

***

Pas
t
Lif
e
Ex
pe
rie
nc
es

.48

Po
sit
Social
iv
Resources
e
2
R = .37
Af
fe
.01
ct
2
R =
.
**
53
*

-.0
3

6
8

p<.
*

10. p

<
.

P
e
rc

e
E

tatus
R
2

=.
33
***

69

affect: the path from physical functioning through physical health impairment to positive affect
( = .17, p < .05), the path from cognitive functioning through social resources to positive affect
( = .36, p < .001), and the path from education through cognitive functioning and social
resources to positive affect ( = .08, p < .01) (Table 16). All three confidence intervals did not
include zero, suggesting that the three indirect effects of physical health impairment, cognitive
functioning and education on positive affect were significant at the level of 95%.

Table 16
Bootstrap Analysis of Indirect Effects

Indirect effect

Unstandardized
Estimates

SE

t-value

Standardized
Estimates

Confidence
Interval
(95%)

PHY HEAL PA

.22

.09

2.46

.17

(.04, .30)

COG SS PA

.04

.10

3.48

.36

(.16, .55)

EDU COG SS PA

.03

.01

2.85

.08

(.03, .13)

Note. PHY = Physical functioning; HEAL = Physical health impairment; COG = Cognitive
functioning; SS = Social resources; PA = Positive affect

70

CHAPTER V. DISCUSSION
This study provided an understanding of how Rowe and Kahns (1997 & 1998)
successful aging model and Martin and Martins (2002) developmental adaptation model were
applied to oldest-old adults, and how distal and proximal influences (e.g., successful aging
components) are related to psychological well-being among oldest-old adults. Even though the
criteria (i.e., the probability of disease, physical/cognitive capacity, and engagement with life)
suggested by Rowe and Kahns (1997 & 1998) successful aging model have been applied to
older adults in a number of studies (e.g., Bassett, Bourbonnais, & McDowell, 2007; Chou & Chi,
2002; Everarad, Lach, Fisher, & Baum, 2000; Ko, Berg, Butner, Uchino, & Smith, 2007;
McLaughlin, Connell, Heeringa, Li, & Roberts, 2010; Menec, 2003), there is less of a consensus
about the definition and criteria of successful aging and there are conflicting results based on
different measurement operationalizations. Furthermore, a complementary/expanded perspective
for successful aging was suggested by Kahn (2002), and a different approach for the criteria and
measurement of successful aging may be necessary, especially for the oldest-old population
which becomes a new important segment of the general population. Although several studies on
successful aging have recently expanded criteria of successful aging (McLaughlin et al., 2010;
Pruchno, Wilson-Genderson, Rose, & Cartwritght, 2010), the oldest-old population was still
disregarded in these studies.
Four major findings emerged from this study. First, based on the results in this study, the
criteria for successful aging need to be expanded. Second, there were age differences in the
relationships between physical functioning and happiness and between cognitive functioning and
happiness among oldest-old adults. Third, physical health and social resources as successful
aging components are important factors in relationship to positive aspects of psychological well-

71

being among oldest-old adults. Fourth, cognitive functioning and social resources mediate
the impact of education as a distal influence on psychological well-being.
The Criteria of Successful Aging
Rowe and Kahns successful aging model was applied to oldest-old adults in this study.
The components of the successful aging model included low probability of disease, high
cognitive/physical functional capacity, and active engagement in life. The original hypothesis
stated that most centenarians and octogenarians would satisfy all three components of the
successful aging model and a higher proportion of octogenarians would meet the three criteria of
the successful aging model. Only 15.1% of octogenarians and none of the centenarians satisfied
all three components. Results from this study did support this hypothesis partially.
There is one obvious reason why oldest-old adults did not maintain all three components
of the successful aging model. The participants used in the Rowe and Kahn study were 70 to 79
years old (Rowe & Kahn, 1997 & 1998). The participants in this study were over 80 years of age,
and most of them were centenarians. Physical health, which is a critical factor in Rowe and
Kahns aging model defined as the absence of disease and disability, shows dramatic decline after
the age of 80 (Smith, 2003). This might be the primary reason that our participants, especially
centenarians, did not satisfy the criteria of Rowe and Kahn s successful aging model.
Because this hypothesis was unrealistic to maintain in a study on oldest-old adults, an
alternative successful aging model was suggested. The reason to suggest an alternative successful
aging model is that successful aging should not be limited to a few concepts and variables. As Kahn
(2002) admitted, however, the successful aging model should be complementary to other models or
have a broader definition to adjust for the limitation that only a significant number of people could
reach advanced age free of age-associated disease and

72

without appreciable functional deterioration (Strawbridge et al., 2002). Consistent with other
centenarian studies, this study confirmed the fact that it is naturally difficult, if not impossible, to
reach advanced age free of diseases and disability (Foster, 1997; Ivan, 1990; Nagi, 1976; Terry,
Sebastiani, Andersen, & Perls, 2008; Young et al., 2009).
The alternative successful aging model provided us with a different picture of successful
aging for advanced old age. Instead of low probability of disease, high cognitive/physical
functional capacity, and active engagement in life, self-rated health, perceived economic status,
and happiness were included. The results showed that 62.3% of octogenarians and 47.5% of
centenarians met the criteria of the alternative successful aging model. Perhaps the results can
best be interpreted with the compensatory mechanism or resilience. In other words, although
physiological change or functional deterioration is closely associated with increasing age,
psychological and social aspects of aging may not have positive relationships with physiological
changes across the life span (Young et al., 2009). Therefore, certain psychological or social
mechanisms such as happiness, positive affect, and social ties may compensate for physiological
decline and allow some older adults to age successfully (Young et al., 2009). Thus, this
alternative aspect of the successful aging model may contribute to the multidimensional
successful aging construct and help older adults achieve successful aging even under conditions
of physical health limitations and disabilities.
Predictors of Psychological Well-Being and Age Differences
Another aim of this research was to determine what factors influence psychological wellbeing among oldest-old adults. It was originally hypothesized that there would be a strong
relationship between components of successful aging and psychological well-being and distal
influences would predict higher levels of psychological well-being. An additional hypothesis was

73

whether there were age differences in the relationship between proximal and distal predictors
and psychological well-being. Evidence for significant predictors was not found for the outcome
of happiness, a representative construct for psychological well-being in the blocked multiple
regressions. The results of this study did support the first part of the hypothesis.
Even though a number of studies demonstrated that there were significant associations
between psychological well-being/subjective well-being and physical health (Hoeymans et al.,
1997; Smith et al., 2004;Wu & Schimmele, 2006), financial resources (Fengler & Jensen, 1981;
George, 1992), physical functioning (Bookwala et al., 2003; Vankova et al., 2008; Windle &
Wood, 2004), cognitive functioning (Jorm, 2000; Rabbitt et al., 2008; Sachs-Ericsson et al.,
2005; Yaffe et al., 1999), social resources (Barrera, 1986; Cohen & Wills, 1985; Krause, 2004;
Pierce et al., 1996; Rhodes & Lakey, 1999; Sarason et al., 1990; Wetherington & Kessler, 1986),
education (Ryff & Heidrich, 1997), and past life experiences (Davies et al., 1997; Martin, 1995;
Martin & Smyer, 1990; Meyers & Battistoni, 2003; Rindfuss, 1991), the results in this research
were not consistent with previous studies except for physical health. It can be argued that most
previous studies did not include oldest-old adults but adults 60 years and older. Compared to
young-old adults (60s), previous studies demonstrated that decrease of physical and mental
health among oldest-old adults (over age 80) could be critical risk factors for their quality of life
(Field & Cassel, 1997; Lawton, 2001; Wilkinson & Lynn, 2001).
In addition to possible age differences, there may be another reason for this result. One
possible reason that there were few predictors of happiness might be that other factors not
included in this study could be important. Most predictors for happiness among oldest-old adults
in this study related to individual factors (e.g., physical health, physical functioning, cognitive
functioning, past life experiences and educational levels). However, this study did not include

74

family support variables. Intergenerational relationships and family relations in general might be
related more directly to happiness among oldest-old adults.
Although the results of this study were not consistent with previous studies, the
hypothesis that the relationships between physical functioning and happiness and between
cognitive functioning and happiness depends on age was supported. Age group differences were
determined to have a moderating influence on the relationships between physical functioning
and happiness and between cognitive functioning and happiness. There were two significant
interaction effects of age and cognitive functioning and physical function on psychological wellbeing. In other words, for centenarians there were slight negative relationships between physical
or cognitive functioning (slopes: -.03 and -.02, respectively) and psychological well-being,
whereas for octogenarians there were positive relationships between physical or cognitive
functioning (slopes: .10 and .10, respectively) and psychological well-being.
For octogenarians, a general theoretical perspective implies that aging reduces the
capacity of individuals to respond or adapt to stressful events (Smith, 2003). The declines of
cognitive functioning and physical functioning are representative examples of risk factors
among older populations (Smith, 2003). This aspect can explain the positive relationships
between physical/cognitive functioning and happiness among octogenarians. Those
octogenarians who experience the decline of physical/cognitive functioning may also experience
an increase in stress levels. Consequently, their levels of happiness decrease.
In contrast to octogenarians, there were slight negative relationships between
physical/cognitive functioning and happiness among centenarians. One explanation in this case
might be individuals belief that physical and cognitive functioning in later life does not guarantee
happiness. Happiness may be influenced not only by physical or cognitive functioning

75

but also by other factors such as individuals different expectation of their functioning, or
skills such as coping or social relations.
Psychological Well-Being for Oldest-Old Adults
One of goals of this research was to integrate the successful aging model and developmental
adaptation to enhance our understanding of psychological well-being among oldest-old adults. The
original study hypothesis stated that high levels of cognitive/physical functioning, physical health,
social resources and perceived economic status would predict high levels of psychological wellbeing. Furthermore, high levels of education and past life experiences would predict psychological
well-being indirectly through cognitive/physical functioning, physical health, social resources and
perceived economic status. When testing this hypothesis, it was partially supported. Only physical
health status was significantly associated with happiness. Lower levels of physical health predicted
lower levels of happiness. Even though the importance of physical health for happiness was found,
the more specific consideration for significant predictors of psychological well-being should be
investigated. Therefore, another often-used psychological construct, positive affect, was also applied
in this study. This is based on the idea that happiness may not be the most representative construct of
psychological well-being for oldest-old adults. A reason for this difference might be the perceptions
of two different constructs (i.e., happiness and positive affect). Oldest-old adults might perceive
happiness and positive affect differently. Happiness might be interpreted as satisfaction and positive
affect might be perceived as positive emotion (Ryff, 1989). Another explanation for this different
perception is there might be a difference between the goal of one s action and positive mood in
ones experience (Bradburn, 1969). The meaning of happiness entails more than pleasurable feelings
and the goal of individuals actions. On the other hand, positive affect might be

76

interpreted as overall self-ratings of positive emotions. Bradburn (1969) noted that positive affect,
one of two dimensions of psychological well-being, seemed to be related to a series of factors
such as social contact, active interest in the world, and the degree of involvement in the
environment around individuals. Thus, when oldest-old adults consider significant predictors on
psychological well-being for their life, positive affect (i.e., the positive overall self-evaluation of
mood) might be a representative construct for psychological well-being among oldest-old adults.
The bivariate correlations (Table 11) demonstrate different relations for happiness and positive
affect. Comparing correlations of happiness and positive affect with other variables, higher
correlations were obtained for positive affect with other variables such as physical functioning
(i.e., r = .22 to .48) and social resources (i.e., r = .11 to .33) than for happiness with physical
functioning (i.e., r = .00 to .28) and social resources ( r = .02 to .20). This implies that there were
stronger relationships between positive affect and other variables than between happiness and
other variables such as physical health and social resources. Results suggest significant direct
effects of social resources and physical health on positive affect, and there were noteworthy
indirect effects of physical functioning, cognitive functioning, and education on positive affect.
Specifically, in terms of direct effects, high levels of social resources and high levels of physical
health problems were associated with high levels of positive affect. Furthermore, concerning
indirect effects, social resources mediated the relationship between cognitive functioning and
positive affect and cognitive functioning, and social resources mediated the relationship between
education and positive affect. In addition, physical health mediated the relationship between
physical functioning and positive affect, too.
This finding is notable in that both proximal influences and distal influences are significant
predictors for psychological well-being among oldest-old adults. First, physical health

77

plays an important role for psychological well-being. It was not surprising that there was a
significant association between physical health and emotional status in advanced old age. In
addition, previous research indicated that decline of physical functioning and deterioration
of physical health at advanced ages leads to lower levels of psychological status (Young et
al., 2009).
Second, social resources had a pivotal influence on psychological well-being among oldestold adults. The high levels of social resources may lead to high levels of psychological well-being.
From the socio-emotional selectivity perspective, persons in very late life establish and interact with
social relationships that offer high levels of emotional benefits (Carstensen, Isaacowitz, & Charles,
1999). Based on this theory, aging research suggests that socializing, especially selective
socializing, is of importance in older samples (Carstensen et al., 1999; Lang, 2001; Lansford,
Sherman, & Antonucci, 1998). Therefore, the importance of social resources or close relationships
with others is consistent with this theory and previous aging research.

Third, education had an indirect effect on psychological well-being in very late life. A
few previous studies have reported that education is a significant predictor for successful aging
(Chou & Chi, 2002; Strawbridge, Cohen, Shema, & Kaplan, 1996; Vaillant & Mukamal, 2001).
Consistent with these previous studies, high levels of education indicated improved
psychological well-being through cognitive functioning and social resources in this study. The
cumulative effect of education in the past on psychological well-being showed the importance of
past life experiences on lifelong processes. Most successful aging studies have focused on
significant predictors for successful aging as proximal influences such as physical/cognitive
functioning, physical health or social resources. Focusing on education as a distal influence in
this study is noteworthy for suggesting the importance of distal influences on successful aging.

78

Moreover, the importance of education is consistent with the assumption of the developmental
adaptation model that early life experiences play a critical role in current experiences and
successful adaptation (Martin & Martin, 2002).
Even though there are several significant factors for psychological well-being, a couple of
factors did not show significant associations with psychological well-being among oldest-old adults.
The first one is the perceived economic status. Previous studies suggested that income and assets are
significant factors for subjective well-being (e.g., Fengler & Jensen, 1981; George, 1992; George et
al., 1985; La Barbera & Grhan, 1997). In addition, financial status/economic

resources are directly related to obtain services for basic needs in later life (Slivinske et al., 1996).
Even though previous studies demonstrated the importance of economic status/financial resources
in later life, there was no significant relationship between perceived economic status and
psychological well-being in this study. One plausible explanation is that financial resources are
not as important to oldest-old adults. Most oldest-old adults, especially centenarians, rely on
family, community, or societal support, such as Social Security benefits, Medicare, and Medicaid
(Goetting et al., 1996). This might be a reason that oldest-old adults do not pay attention to their
day-to-day financial resources and as a consequence financial resources did not influence their
psychological well-being. Furthermore, older adults often avoid providing financial information
to researchers because of privacy concerns (Beatty & Herrmann, 2002). This is one of the reasons
for missing data for income in many surveys (Yan, Curtin, & Jans, 2010). Perhaps this explains
why there was no significant relationship between perceived economic status and psychological
well-being because the information of perceived economic status might not be accurate.

79

The second variable that was not predictive of subjective well-being was past life
experiences. Although the importance of cumulative life experiences on mental health was
suggested by several previous studies (Davies et al., 1997; Martin, 1995; Martin & Smyer, 1990;
Meyers & Battistoni, 2003; Rindfuss, 1991), there was no significant direct and indirect effect of
past life experiences on other factors including psychological well-being. One possible reason is
that measurement of past life experiences is closely related to learning experiences. So, even
though past life experiences were included as a distal influence with education and contributed
2

to some proportion of variance of perceived economic status (R = .32

2

model, and R = .33

***

***

in the happiness

in the positive affect model), the scales for past life experiences might

overlap with education. Furthermore, another explanation may be that different people have
many different experiences and this may not be captured with an index of cumulative
experiences. Therefore, assessing the importance of particular events would perhaps be more
meaningful than a global index of past life experiences.
The final important discussion point concerns the construct of happiness for oldest-old
adults. The results demonstrated that only physical health was a significant predictor and did not
support the hypothesized model strongly. However, the alternative model for psychological wellbeing showed much stronger relationships among successful aging components, distal influences,
and psychological well-being after including positive affect instead of happiness. Even though
happiness and positive affect are similar constructs in that both of them are positive components
of subjective well-being, and a positive perspective is considered to be a secret of longevity
(Yi & Vaupel, 2002), there may be a difference in definitions and items between happiness and
positive affect. Items for happiness were related to satisfaction with life such as being as happy in
the past, indicating that life could be happier, or evaluating the present as the best years of

80

ones life. Items for positive affect were related to positive feeling states for doing something
such as being pleased about having accomplished something, being excited or interested in
something, or feeling that things were going ones way. In addition to different constructs
between happiness and positive affect, another explanation is that although full-information
maximum likelihood (FIML) was used for structural equation modeling for both models of
happiness and positive affect equally, there was a different assumption to deal with missing
values. Using the positive affect model, it was presumed that missing values of items for positive
affect were completely at random. However, missing values in the happiness model were not
completely at random. The three items of happiness were measured from centenarians who had
higher MMSE scores, whereas positive affect scores were obtained from proxies who reported
on participants regardless of levels of MMSE scores. A direct comparison of equivalent samples
in both models was attempted but did not converge because of limited sample sizes.
In conclusion, the finding that both proximal influences (i.e., physical health, social
resources, cognitive functioning) and distal influences (i.e., education) are simultaneously
significant predictors for the positive aspect of psychological well-being among oldest-old adults
seems to suggest that we should consider multiple pathways and compensation mechanisms that
modify aging-related changes for successful aging (Young et al., 2009). Furthermore, this
finding supports the attempt to integrate two different models (i.e., successful aging and
developmental adaptation) in that it could provide a more comprehensive view of aging
processes and successful developmental adaptation from a developmental perspective.
Limitation and Future Directions
Although findings from this study produced several relevant outcomes in understanding
successful aging and well-being in very late life, several limitations exist that affect the

81

generalization of this studys results. First, the sample of this study was from only one
geographic area of the United States. Other oldest-old adults in different regions might present
different patterns of successful aging and developmental adaptation. In addition, in terms of
ethnicity, the proportions of Caucasians (78.4%) and women (79.4%) were much higher than for
African Americans (21.6%) and male (20.6) participants. Homogeneity may have limited the
interpretation and application of these results to larger populations of oldest-old adults across the
country. Second, most of the variables, except happiness, were obtained from proxy ratings.
Even though most of the indicators were examined by proxy ratings and quite a few papers have
demonstrated that proxy informants are reliable and substitutable for self-rated reports to use
(Ball et al., 2001; Bassett et al., 1990; MacDonald et al., 2010), we need to consider that
disagreement of perspective on psychological aspects might result in differences from using
centenarian self-ratings. Namely, proxy reports might be more objective and realistic compared
to self-ratings, whereas older adults may view life as more or less positive. This suggests that
although older adults capacities in daily activities, physical performance, and cognitive function
may not be optimal as they once were, oldest-old adults may have more positive feelings of
current life (Yi & Vaupel, 2002). Third, although past life experiences as a distal influence was
assessed with the previous experiences when oldest-old adults were young, all indicators were
examined with a cross-sectional design. Therefore, causal inferences on the relationship between
distal influences, proximal influences and developmental outcome cannot be made. Fourth, in the
similar vein with the third limitation, we should consider different time points to assess whether
oldest-old adults are successful agers or not.
We need to consider survivorship effects when interpreting the results. Specifically,
Baltes and Smith (1997) suggested that studies focusing on very old age pay attention to survival

82

and mortality (Baltes, 1997; Baltes, Reese, & Nesselroade, 1988). For example, we can assume
that survivors into very late life at some point in their lives had better scores in some domains
such as health, intelligence, education, and psychological aspects than their counterparts who
died prematurely or were close to death when being assessed (Baltes & Smith, 1997). Therefore,
even though none of the centenarians satisfied the criteria of the successful aging model
compared to 15.1% of octogenarians, they (centenarians) might have at some point in their lives
been functioning better on the three criteria of successful aging than those who had died earlier.
In other words, we should differentiate age differences from selective survivorship in terms of
considering longevity and successful aging.
Finally, the measurements used in this study might not have been appropriate for a
sample of oldest-old adults. For example, the third question of the social resources, How many
times during the past week did he/she spend some time with someone who does not live with
him/her; that is he/she went to see them or they came to visit him/her, or he/she went out to do
things together? asked the number of visits of oldest-old adults and their acquaintances. This
might be a useful item to measure social resources for young-old adults who are easily able to go
out and visit others. However, the restriction of mobility for oldest-old adults may restrict the
number of people they know well enough to visit with. Even though social resources had a
significant influence on psychological well-being among oldest-old adults, the measurements for
this sample may have to be reconsidered.
Despite these limitations, this study revealed interesting insight into the successful aging
model and the psychological well-being of oldest-old adults. This information has numerous
implications for gerontologists and practitioners. In particular, this investigation suggests that the
successful aging model may be limited for oldest-old adults. Researchers and practitioners

83

should consider many different factors for successful aging. For example, three variables (i.e.,
gender, ethnicity, and residence) served as covariates in this study. Several significant effects of
these covariates on several latent constructs were found. In particular, residence, whether
participants lived in a nursing home or not, showed significant effects on all constructs (i.e., past
life experiences, education, physical functioning, cognitive functioning, physical health
impairment, social resources, perceived economic status, and positive affect). Nursing-home
residents had lower levels of past life experiences, education, physical functioning, cognitive
functioning, social resources, perceived economic status and higher levels of physical
impairments than non-nursing home residents. In addition, even though physical health,
physical functioning, and cognitive function were significantly related to psychological wellbeing in this study, most people experience decline of physical health, physical functioning, and
cognitive functioning in very old age. However, this study showed there is another critical factor
for psychological well-being among oldest-old adults: social resources. Therefore,
administrators and service providers within retirement communities, assisted living facilities,
and long-term care facilities may want to provide an environment that offers more opportunities
for social interaction and social resources. One example would be the establishment of familyrelated activities that facilitate social interaction.
Future research on oldest-old adults should use sequential designs when assessing
successful aging. For example, investigators may want to apply the successful aging model to
different cohort groups for several years. Based on this sequential design, the investigators may
be able to explore the simultaneous examination of time and age effects for successful aging.
Other future research should focus on cross-cultural perspectives for successful aging. Aging is a
global phenomenon (United Nations, 2007). For instance, several centenarian studies (e.g.,

84

Okinawa Centenarian Study, Willcox, Willcox, Shimajiri, Kurechi, & Suzuki 2007; New
England Centenarian Study, Perls, 1995; Georgia Centenarian Study, Poon et al., 2007; Swedish
Centenarian Study, Samuelsson et al., 1997; Danish Centenarian Study, Andersen-Ranberg,
Christensen, Jeune et al., 1999; Heidelberg Centenarian Study, Rott, dHeureuse, Schnemann,
Kliegel, & Martin, 2001; Italian Centenarian Study, Franceschi et al., 2000; Korean Centenarian
Study, Choi et al., 2003) have been initiated all over the world. Comparing different centenarian
studies, investigators may be able to explore common patterns and cultural or geographical
differences of longevity including biological, psychological, physical, and social aspects.

It may be difficult to achieve successful aging in extremely late life. There is still no
agreement on the definition of successful aging and future work needs to expand the criteria for
successful aging. In addition, more work needs to be done to examine predictors of successful
aging as parts of developmental processes. Future work will contribute to the study of
successful aging and help older adults achieve successful aging for as long as possible with a
systematic approach to consider the past and present life and with a holistic view to understand
age-related changes and challenges.

85

APPENDIX

86

APPENDIX A
IRB APPROVAL

87

88

89

APPENDIX B
PSYCHOLOGICAL WELL-BEING: LIFE SATISFACTION SCALE
1. I have gotten more of the breaks in life than most people I know.
1

Agree

2 Disagree

Uncertain

2. I am just as happy now as when I was younger.

1

Agree

2 Disagree

Uncertain

3. My life could be happier than it is now.

1

Agree

2 Disagree

Uncertain

4. These are the best years of my life.

1

Agree

2 Disagree

Uncertain

5. As I look back on my life, I am fairly well-satisfied.

1

Agree

2 Disagree

Uncertain

6. I would not change my past life even if I could.

1

Agree

2 Disagree

Uncertain

7. Ive gotten pretty much what I expected out of life.

1

Agree

2 Disagree

Uncertain

90

APPENDIX C
PSYCHOLOGICAL WELL-BEING: BRADBURN AFFECT BALANCE SCALE
Please answer the following in reference to how the centenarian felt during the past few weeks:

During the past few weeks did it ever seem as though your relative was...
1. pleased about having accomplished something?
1

Not at all

2 Once

3 Several times

4 Often

2 Once

3 Several times

4 Often

2 Once

3 Several times

4 Often

2. depressed and very unhappy?

1

Not at all

3. vaguely uneasy?
1

Not at all

4. proud because someone complimented him/her on something he/she had done?

1

Not at all

2 Once

3 Several times

4 Often

5. so restless that he/she couldn't sit long in a chair?

1

Not at all

2 Once

3 Several times

4 Often

6. particularly excited or interested in something?

1

Not at all

2 Once

3 Several times

4 Often

2 Once

3 Several times

4 Often

3 Several times

4 Often

7. bored?
1

Not at all

8. that things were going his/her way?

1

Not at all

2 Once

9. very lonely or remote from other people?

1

Not at all

2 Once

3 Several times

4 Often

91

10. on top of the world?

1

Not at all

2 Once

3 Several times
92

4 Often

APPENDIX D
PHYSICAL HEALTH: THE OLDER AMERICANS RESOURCES
Please describe the centenarians health;
1.How would you rate his/her overall health at the present time?
1 Excellent

2 Good

3 Fair

4 Poor

2.How much do you think his/her health troubles stand in the way of doing the things
that he/she wants to do?
1 Not at all

2 A little or some 3

A great deal

93

APPENDIX E.
HEALTH PROBLEMS
Do you have this problem at the present time?
1. Chest Discomfort at Rest
Yes

No

Unable to obtain

2. Shortness of Breath or Wheezing

Yes

No

Unable to obtain

3. Arthritis (Joint Problems)

Yes
4. Swelling of Feet

No

Unable to obtain

Yes

No

Unable to obtain

No

Unable to obtain

No

Unable to obtain

No

Unable to obtain

No

Unable to obtain

No

Unable to obtain

No

Unable to obtain

5. Weakness
Yes
6. Dizziness
Yes
7. Unsteadiness
Yes
8. Fear of falling
Yes
9. Numbness
Yes
10. Poor Sleep
Yes

94

11. Urinary Incontinence (leakage)

Yes

No

Unable to obtain

Yes

No

Unable to obtain

Yes

No

Unable to obtain

Yes

No

Unable to obtain

12. Bowel Incontinence (leakage)

13. Constipation

14. Headache

95

APPENDIX F.
PERCEIVED ECONOMIC STATUS: THE OLDER AMERICANS RESOURCES
Please answer the following questions:
1.Are his/her assets and financial resources sufficient to meet emergencies?
1

Yes

2 No

2.How well does the amount of money he/she has take care of his/her needs - very well,
fairly well, or poorly?
1

Very well

2 Fairly well

3 Poorly

3. Does he/she usually have enough to buy those little "extras;" that is, those small
luxuries?
1 Yes 2 No

96

APPENDIX G.
COGNITIVE FUNCTIONING: MINI-MENTAL STATUS EXAMINATION
Maximum

Score

5
5

(
(

Orientation
) What is the (year) (season) (date) (day) (month)?
) Where are we (state) (country) (town) (hospital) (floor)?
Registration
) Name 3 objects: 1 second to say each. Then ask the patient all 3 after
you have said them. Give 1 point for each correct answer. Then
repeat them until he/she learns all 3. Count trials and record.
Trials ___________

Attention and Calculation

) Serial 7s. 1 point for each correct answer. Stop after 5 answers.
Alternatively spell world backward.

Recall
) Ask for the 3 objects repeated above. Give 1 point for each correct
answer.

2
1
3

(
(
(

1
1
1

(
(
(

Language
) Name a pencil and watch.
) Repeat the following No ifs, ands, or buts
) Follow a 3-stage command:
Take a paper in your hand, fold it in half, and put it on the floor.
) Read and obey the following: CLOSE YOUR EYES
) Write a sentence.
) Copy the design shown.

_____ Total Score

ASSESS level of consciousness along a continuum ____________
Alert

DrowsyStupor Coma

97

APPENDIX H.
PHYSICAL FUNCTIONING: THE OLDER AMERICANS RESOURCES
1. Can he/she use the telephone . . .
2

without help, including looking up numbers and dialing;

with some help (can answer phone or dial operator in an emergency, but need a
special phone or help in getting the number or dialing); or

is he/she completely unable to use the telephone?

2. Can he/she get to places out of walking distance . . .

2

without help (drive his/her own car, or travel alone on buses, or taxis);

with some help (need someone to help him/her or go with he/she when traveling); or

is he/she unable to travel unless emergency arrangements are made for a specialized
vehicle like an ambulance?

3. Can he/she go shopping for groceries or clothes [assuming subject has trans.]
2

without help (taking care of all shopping needs him/herself, assuming him/her had
transportation);

with some help (need someone to go with him/her on all shopping trips); or

is he/she completely unable to do any shopping?

4. Can he/she prepare his/her own meals . . .

2

without help (plan and cook full meals him/herself);

with some help (can prepare some things but unable to cook full meals him/herself);

is he/she completely unable to prepare any meals?

5. Can he/she do housework . . .

2

without help (can clean floors, etc.);

98

with some help (can do light housework but need help with heavy work); or

is he/she completely unable to do any housework?

6. Can he/she take his/her own medicine . . .

2

without help (in the right dose at the right time);

with some help (able to take medicine if someone prepares it for him/her and/or
reminds him/her to take it); or

is he/she completely unable to take his/her medicines?

7. Can he/she handle his/her own money . . .

2

without help (write checks, pay bills, etc.);

with some help (manage day-to-day buying but need help with managing his/her
checkbook and paying his/her bills); or

is he/her completely unable to handle money?

8. Can he/she eat . . .

2

without help (able to feed him/herself completely);

with some help (need help with cutting, etc.); or

is he/she completely unable to feed him/herself?

9. Can he/she dress and undress him/herself . . .

2

without help (able to pick out clothes, dress and undress him/herself);

with some help or

is he/she completely unable to dress and undress him/herself:

10. Can he/she take care of his/her own appearance, for example combing his/her hair
and (for men) shaving . . .
2

without help

99

1
0

with some help; or

is he/she completely unable to maintain his/her appearance him/herself?

11. Can he/she walk . . .

2

without help (except from a cane);

with some help from a person or with the use of a walker or crutches, etc.; or

is he/she completely unable to walk?

12. Can he/she get in and out of bed . . .

2

without any help or aids;

with some help (either from a person or with the aid of some device); or

is he/she totally dependent on someone else to life him/her?

13. Can he/she take a bath or shower . . .

2

without help;

with some help (need help getting in and out of the tub, or need special
attachments on the tub); or

is he/she completely unable to bathe him/herself?

14. Does he/she ever have trouble getting to the bathroom on time?
2

No

Have a catheter or colostomy

Yes

100

APPENDIX I.
SOCIAL RESOURCES: THE OLDER AMERICANS RESOURCES
Now we would like to ask you some questions about his/her family and friends.
1.

How many people does he/she know well enough to visit with in his/her home or in
their homes?

1
2.

Five or more

2 Three or four

3 One or two

4 None

About how many times did he/she talk to someone - friends, relatives, or others on the
telephone in the past week (either he/she called them or they called him/her)? (IF

S/HE HAS NO PHONE, QUESTION STILL APPLIES.)

1
3.

Once a day or more

2 2-6 times

Once

4 Not at all

How many times during the past week did he/she spend some time with someone who
does not live with him/her; that is he/she went to see them or they came to visit
him/her, or he/she went out to do things together?

Once a day or more

2 2-6 times

Once

4 Not at all

101

APPENDIX J.
EDUCATION
1. How far did he/she go (has he/she gone) in school?
1 0-4 years
2 5-8 years
3 High school incomplete
4 High school completed
5 Post high school, business or trade school
6 1-3 years college
7 4 years college completed
8 Post graduate college

102

APPENDIX K.
PAST LIFE EXPERIENCES: A SERIRES OF COGNITIVE ENGAGEMENT TASKS
For the next items, please check the last time these activities were performed.
1. Did he/she ever learn a foreign language?
1

Yes

No

2. Did he/she ever engage in an on-the-job training program?

1

Yes

No

3. Did he/she typically balance his/her checkbook (take care of finances)?

1

Yes

No

4. Did he/she typically prepare his/her own income taxes?

1

Yes

No

5. Did he/she ever give a public talk or lecture (to a club, service organization, etc.)?
1

Yes

No

6. Did he/she ever do volunteer work for an organization such as a hospital, church,
school, or political party?
1

Yes

No

7. Did he/she ever travel to a foreign country?

1

Yes

No

103

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