Successful Aging and Resilience: Applications for Public Health, Health Care, and Policy

  • Matthew Lee SmithEmail author
  • Caroline D. Bergeron
  • Carly E. McCord
  • Angela K. Hochhalter
  • Marcia G. Ory


Last weekend, Albert celebrated his 78th birthday with his children, grandchildren, and a few of his closest friends. Two of his granddaughters presented a moving tribute to Albert and his lifelong friend Patricia, who was also in attendance. Patricia was beloved by Albert’s grandchildren; they were planning a big party for Patricia’s 80th birthday next year. The tribute of photos and videos set to Albert and Patricia’s favorite songs showed the striking differences in the challenges and successes Albert and Patricia had experienced over their years as friends.


Successful aging Active for life Physical activity Resilience Technology 

Last weekend, Albert celebrated his 78th birthday with his children, grandchildren, and a few of his closest friends. Two of his granddaughters presented a moving tribute to Albert and his lifelong friend Patricia, who was also in attendance. Patricia was beloved by Albert’s grandchildren; they were planning a big party for Patricia’s 80th birthday next year. The tribute of photos and videos set to Albert and Patricia’s favorite songs showed the striking differences in the challenges and successes Albert and Patricia had experienced over their years as friends.

Albert was born in a poor farming community. His father raised Albert and his younger brother on a farm after the death of Albert’s mother. Together, the three raised the crops that sustained the family. A few photos and some pencil drawings Albert created as a young boy showed the ups and downs of farm life from year to year; from bumper crops to years of drought. The boys attended school when they could. Albert finished the 11th grade, then enlisted in the Army. His enlistment photo showed a young boy who was proud to serve his country and excited to find a more consistent way of life.

Patricia was raised in a small farming community near Albert’s farm and was in school with Albert for the years he attended. Patricia’s mother had inherited a large fortune from her parents, and her father was a writer for several newspapers across the state. The family enjoyed living in the rural area, and traveled extensively when Patricia and her siblings were on break from school.

In the summer after their 11th grade, Albert and Patricia took a road trip in Patricia’s new car. It was a chance to show Albert part of the country before he reported for duty. One day, a horrible car accident on a country road hundreds of miles from home changed the teenagers’ lives forever. Albert nearly lost his left leg, but after months in various hospitals far from home, he found himself back on the farm. He was forever thankful to Patricia’s family for the visits and support while he was recovering in the hospitals. It was during his long hospital stays that he met his wife, a young nurse. However, the photos of his early 20s and throughout his life showed his continuous need for walking aids—a cane, walker, and now a wheelchair. He was discharged from the Army because of the injury even before he began serving. He always told his grandchildren “this bad leg is the best thing that ever happened to me because it brought me your beautiful Grandmother!”

Patricia was also injured severely in the accident. She remembers almost nothing of her six months in the hospital. Her family brought in specialists from around the country, and she was able to recover fully from her injuries. However, she never forgave herself for the car accident that damaged her friend’s leg. She saw the accident as her burden to carry, despite Albert’s efforts to console her.

Now ages 78 and almost 80, Albert and Patricia were living full but very different lives. Both had married young. Albert lost his family’s farm after several years of drought and had to find new work. Patricia followed in her father’s footsteps as a newspaper writer. She lost her job due to cutbacks at the paper a few years after Albert lost his job. She decided to spend her time volunteering at a local charity rather than moving away for a new job. Both friends lost their spouses about 10 years ago. Albert relied heavily on Patricia’s support and the kindness of his family to help him grieve. He found new hobbies to occupy his time after his wife’s death and was especially enjoying the feeling of accomplishment and new friendships. Patricia saw her husband’s death as punishment for the accident she felt she had caused so many years ago. Since his death she has been more solitary.

Recently Albert and Patricia were dealing with declining health. Albert saw this as an opportunity to teach Patricia the things he had learned throughout his life about dealing with illness and changing abilities. They were becoming closer than ever—attending chronic disease self-management workshops and cooking healthy meals together. Patricia’s daughter was thrilled to see how recent videos showed her mother smiling and enjoying life. Secretly, the party attendees wondered whether the most recent photos showed a budding romance between Albert and Patricia. They were both greeting their newest health challenges as opportunities for a new take on life, and there certainly seemed to be a lot of dancing lately!

The stories of Albert and Patricia are examples of typical older adults in the United States who have met the challenges of their lives in a variety of ways using their personal and social resources. Older adults like Albert and Patricia are now living longer, yet there remains great debate whether extended life expectancies translate into more quality years (Pew Research Center, 2013; Underwood, Bartlett, Partridge, Lucke, & Hall, 2009; Wareham, 2016). In addition, the aging population has become more diverse in terms of race, ethnicity, culture, identity, disability, and socioeconomic status (Mather, Jacobsen, & Pollard, 2015; U.S. Census Bureau, 2014). This has resulted in a plethora of studies to understand better aging processes and the experiences of older adults in a rapidly aging society. Among the factors contributing to the diversity in aging trajectories are patterns of responses to challenges experienced throughout the lifespan. In this chapter, we will use the experiences of our fictitious characters to explore the concepts of successful aging and resilience. First, we describe successful aging and the contribution of resilience to the process of successful aging. Second, we discuss steps that can be taken by individuals, organizations, and communities to enhance older adults’ resilience, and ultimately promote healthy and successful aging for all.

Successful Aging

Successful aging is a concept, an approach, a model, an experience, and an outcome (Katz & Calasanti, 2014). It first emerged when Rowe and Kahn (1987) portrayed normal aging as a continuum that spanned from “usual” to “successful.” The differences in performance between younger adults and older adults without pathological conditions fell along this continuum. The researchers found that older adults as a group did not perform as well as younger adults as a group; however, within the older adult group, one shows little or no performance difference when compared to younger adults. Performance that was similar to that of the younger group was then considered evidence of successful aging.

Rowe and Kahn’s (1987) classic study set the stage for multidisciplinary explorations of what it means to age successfully. A few years later, Baltes and Baltes (1990) suggested that successful aging requires some type of adaption to meet life’s challenges. They introduced the Selection, Optimization and Compensation (SOC) Framework, which posits that adaptation to challenges in older age involves systematic reallocation of resources to pursue new goals, maintain functioning, and regain functioning (Baltes & Smith, 2003; Heckhausen, Dixon, & Baltes, 1989; Martin et al., 2014). When SOC processes are not effective or efficient, they can be maladaptive. However, when the result of adaptation, including the SOC processes, leaves one ideally positioned to reach his or her goals, we call that successful aging (Baltes & Carstensen, 1996).

In 2003, Inui described successful aging as a “dynamic equilibrium,” and argued that the study of successful aging should integrate a multidisciplinary biopsychological approach (Kahana, Kahana, & Lee, 2014; Inui, 2003). The dynamic equilibrium he described involved capacity in multiple domains to function well as the circumstances of one’s life changed. Functioning well meant performing in domains on which an individual places high value. Despite certain trait-like determinants of one’s capacity to adapt, he emphasized the role of the individual in defining what is meant by being successful. Functioning well in a domain to which a person assigns little value is not the goal; rather, one who is aging successfully is adapting in ways that promote optimal functioning in domains he or she values most. Domains of functioning may be physiological, psychological, or sociological; ailing health and limited physical function do not preclude successful aging (Young, Frick, & Phelan, 2009).

Countless other models of successful aging are now in use, most of which include the following themes (Fowler, Gasiorek, & Giles, 2015; Inui & Frankel, 1991; Martinson & Berridge, 2014; von Faber et al., 2001; Young, Frick, & Phelan, 2009).
  1. 1.

    Successful aging happens across the lifespan

  2. 2.

    Successful aging occurs in response to challenges

  3. 3.

    Successful aging is defined uniquely for each individual to the degree that individual goals and preferences differ

  4. 4.

    The capacity for successful aging is partially under one’s control (e.g., through learning) and partially predetermined (e.g., genetic predisposition)

  5. 5.

    Successful aging incorporates many domains, including but not limited to health, social, biological, and psychological domains.

In Fig. 1, we offer a hypothetical schematic of an individual’s performance in three key domains over time. The purpose is to illustrate that domain-specific performance varies over time and can be categorized in some cases as successful, as usual, or as less than successful or “deficient” in others. How might this hypothetical model apply to our fictitious characters Patricia and Albert? How would we represent what Patricia’s performance might look like following her husband’s death? She had always fared well physically. Psychologically she was devastated by the car accident with Albert, and also by her husbands’ death, although her late life volunteering brought some life satisfaction. Patricia was always somewhat socially isolated and pulled away from others following her husband’s death, although meeting Albert again in later life brought a renewed companionship. In contrast, we see that Albert starts off higher goes through some declines, but still stays at a relatively high level on social and psychological domains, despite his physical limitations and disabilities.
Fig. 1

An individual’s performance in physical, psychological and social domains varies in the degree to which successful aging is achieved over time

For the most part, both theoretical and objective descriptions of successful aging match older adults’ self-reported perceptions of the concept, as it is represented in the literature (Decancq & Michiels, 2017; Kok, Aartsen, Deeg, & Huisman, 2017; Lee, Kahana, & Kahana, 2017; Tkatch et al., 2017). Older adults define successful aging as an ongoing multidimensional process that is distinct from chronological age (Reichstadt, Depp, Palinkas, Folsom, & Jeste, 2007). They report that successful aging requires having a positive attitude, coping with change, accepting limitations that cannot be overcome, being secure and stable long term (e.g., social support through valued relationships, knowing one would be taken care of in declining health), practicing spiritual beliefs and receiving spiritual blessing, and proactively staying engaged both socially and cognitively (Laditka et al., 2009; Lee et al., 2017; Reichstadt et al., 2007). Older adults also place high value on maintaining basic physical functioning, being free of major life-threatening disease, and feeling independent (Laditka et al., 2009; von Faber et al., 2001).

However, older adults with long-term physical impairments also report aging successfully despite their physical disability, inviting a revised definition of successful aging (Molton & Yorkston, 2017). Similarly, although staying cognitively alert and having a good memory is among the most highly valued successes among older adults (Laditka et al., 2009; Sharkey, Sharf, & St. John, 2009), older adults living with a cognitive impairment such as dementia may still experience successful or “meaningful” aging (Harris, 2008; Williamson & Paslawski, 2016). It is believed that an individual’s level of resilience, defined as one’s ability to adapt well in the face of significant life stressors (American Psychological Association, 2017), may be what enables an older person to thrive and age successfully (Williamson & Paslawski, 2016).

Successful Aging and Resilience

Resilience is a long, ongoing process developed across the life course through previous experience of hardship, such as the death of a loved one, the loss of a job, and a serious illness (American Psychological Association, 2017; Bolton, Praetorius, & Smith-Osborne, 2016). Emotional distress is common in the lives of those who have developed resilience (American Psychological Association, 2017). While both nature and nurture play a role in most psychological constructs (Coll, Bearer, & Lerner, 2014), resilience is increasingly being viewed as a personal resource that can be learned and developed regardless of one’s physical, cognitive, social, and cultural background (American Psychological Association, 2017; Harris, 2008).

A number of internal and external protective factors or resources are associated with the emergence of resilience in the face of challenges. Some internal characteristics include self-esteem, self-efficacy, hope, tolerance, sense of humor, spirituality, sense of purpose, and self-acceptance (Bolton et al., 2016; Windsor, Hunter, & Browne-Yung, 2015). Better health and well-being, which incorporates some of the internal factors listed above, is also associated with greater resilience (Centre for Policy on Ageing, 2014). External protective factors associated with higher levels of resilience include social engagement, social support from within and outside one’s family (e.g., through encouragement and reassurance), as well as economic resources (American Psychological Association, 2017; Bolton et al., 2016; Centre for Policy on Ageing, 2014). These predictors or prerequisite conditions (the exact role and necessity has not been fully defined) appear throughout studies of resilience across all ages and are potential targets of intervention when aiming to promote successful aging.

Resilience can also occur over time, with positive adaptation revealed after a period of what initially appears to be maladaptive. Resilience can also fade over time, with negative consequences of trauma emerging only with advancing age after years of successful coping (King, King, Vickers, Davison, & Spiro, 2007).

Figure 2 sets the stage for how we think about the possibility for resilience in the face of given challenges over the course of the lifespan. Challenges faced at different points—Albert’s and Patricia’s car accident, for example—are labeled at the bottom of the figure. Each challenge impacts domains of functioning to different degrees, represented in the bar graphs. For example, a car accident with associated injury in adolescence may heavily challenge an individual’s physical domain when compared to the loss of employment or spouse in mid-life or older adulthood. Conversely, psychological and social domains may be heavily and disproportionately challenged with the death of a spouse in older adulthood. Individuals possess or have access to a wide range of resources with which to meet a challenge. Examples of internal and external resources are represented in pie graphs at the top of the figure. Here we have represented a growing reserve of resources over the lifespan. Absolute “amount” of resources and types of resources available do not grow linearly across the lifespan—individuals experience differing resources at different times.
Fig. 2

Resilience is possible when one can draw on the appropriate internal and external resources to meet the demands of a given challenge

For example, we know that Albert had fewer financial resources than Patricia to draw on at the time of their car accident, but Albert may have had more self-efficacy for overcoming challenges and other resources than Patricia had developed at that time. When these two individuals faced job loss, the loss of their spouses, and now new illnesses, the composition of their available resources also likely differed. When available resources are sufficient to meet the demands of a new challenge, there is the possibility for resilience.

Resilience is associated with both the success of overcoming a specific challenge as well as post-adversity growth (Chang & Yarnal, 2017; Earvolino-Ramirez, 2007; Hayman, Kerse, & Consedine, 2017; Park & Fenster, 2004). In other words, through resilience, one not only adapts but also becomes better off, healthier, or grows after the event. Individuals like Albert who experienced hardship across the life course may therefore be more resilient in later life because they learned and grew from those personal experiences.

One particularly adaptive response to adversity is post-traumatic growth following major life events in older adulthood such as a fall, heart attack, cancer, abuse, or natural disaster (Garnefski, Kraaij, Schroevers, & Somsen, 2008; Thornton & Perez, 2006). In their study of falls among older women, Bergeron, Friedman, Messias, Spencer, and Miller (2016) found that aging women would make specific decisions after experiencing a fall, an event they characterized as unexpected and sudden, leaving them feeling “stupid” and “helpless” (Bergeron et al., 2016). Some of these decisions included getting back to normal by deliberately engaging once again in their regular routines as soon as possible after the fall or seeking and obtaining assistance and spiritual support, all of which are reflective of internal and external protective factors inherent to resilience. Making these post-fall decisions also helped them be more proactive, for example, by implementing safety measures to prevent future falls, which illustrates some type of post-stress growth (Bergeron et al., 2016).

A similar example occurred among older adults during and after Hurricane Katrina. Greene (2007) shared the narrative of three older individuals who walked through miles of water “passing dead bodies along the way” (p. 61), but who, thanks to their faith and family and community support through collective meals and shared supplies and information, were able to adapt and survive. Personal growth in such circumstances included an increased acknowledgement of others’ needs in times of trouble as well as a greater sense of appreciation for life (Greene, 2007).

Improvement in the face of challenge is particularly relevant to successful aging as defined by Rowe and Kahn (1987) because it explains how one might move beyond usual aging toward the extreme of the aging continuum, which they defined as “successful.” Patricia, in our example, seems to be meeting the onset of new chronic illnesses with resilience and success; she is learning new things and enjoying new activities with her life-long friend. High levels of resilience may also be associated with other positive outcomes such as lower depression and longevity (Bergeron & Smith, In press; MacLeod, Musich, Hawkins, Alsgaard, & Wicker, 2016).

Lens Metaphor: Successful Aging Through Resilience

Figure 1 depicted how functioning varies across domains during usual day-to-day experiences. Figure 2 illustrated the differences in domains challenged based on adverse life events and possible resources needed for resilience. Figure 3 shows a schematic of what we call the “lens” through which challenges are experienced. We think of each person’s unique resources and perspective on life as a lens through which challenges “pass”. The predictors and prerequisite conditions for resilience occur to varying degrees in each person’s unique lens, which is framed with one’s past history and within a particular social and environmental context (e.g., economic resources, supportive physical environments).
Fig. 3

Resilience is demonstrated when performance in one or more domains improves following adaptation to a challenge such as a major illness. The degree of adaptation achieved depends on the characteristics of the “lens” through which the challenge is experienced

Repeated exposure to adversity can have a particularly strong effect on one’s lens, yet still provide opportunity for resilience especially when supportive environments deflect personal adversity. The majority of African Americans frequently experience episodes of racism and social and economic disparities throughout the life course. The “John Henryism” hypothesis suggests that African Americans who respond to these psychosocial stressors with continuous and persistent high effort may be driving up their prevalence of hypertension or other stress-related physical health problems (James, 1994). On the other hand, DeNisco (2011) found that the higher the resilience among African American women between 33 and 85 years old living with diabetes, the lower their blood sugar (HbA1c) levels were, suggesting that resilience may influence the physical domain. Similarly, Becker and Newsom (2005) reported that African Americans’ determination, tenacity, perseverance, and spirituality may be contributing to their successes in the face of chronic illnesses.

Regarding the lenses of Albert and Patricia, the event of the car accident passed through their individual lenses and produced very different results. Albert’s family did not have the financial resources to travel to see him or bring in specialists to direct his treatment. The result was lasting damage to his leg, but a positive experience in what was gained during the challenge. Perhaps the ups and downs of his childhood helped prepare him for this particular challenge in young adulthood. Patricia, on the other hand, had the advantage of support from her family and specialists to guide her care. Physically she recovered well, but she was plagued by the guilt of the situation for years. Patricia may have been resilient in the physical domain, but psychologically, she was less resilient to the car accident. Individuals may be aging successfully in some domains but not in others.

In Fig. 3, we introduce the concept of one’s unique lens at a time when a major challenge—in this case, a major debilitating even like Albert’s leg injury after the car accident—presents itself. After experiencing that event through a unique lens, functioning in various domains may or may not change. Improvements from before to after the event represent resilience in response to personal loss. Figure 3 shows an improvement in the social domain, perhaps due to reconnecting with friends and family during a time of great need. This gain would only be possible if the lens through which one experienced an injury like Albert’s enabled reconnection with others in new ways. Unlike functioning in the social domain, Fig. 3 depicts a dramatic decline in physical domain functioning following the event relative to the physical functioning before the event. This sharp decline may or may not have been preventable; in this case, the initial result is maladaptive.

Possibilities for Promoting Resilience and Successful Aging Among Older Adults

Building resilience is a personal journey that varies based on individual reactions and experiences to traumatic and adverse events throughout the life course (American Psychological Association, 2017). If an older person does not have high levels of resilience to cope effectively with the challenges associated with aging (e.g., illness, the death of a loved one) and therefore age successfully, it may be possible to enhance his or her resilience by addressing the internal and external factors that are associated with resilience. Enhancing factors such as health, self-acceptance, self-esteem, spirituality, social interactions, and economic resources have the potential to help older adults better control their health and situation after a stressful event. In this section of this chapter, we provide suggestions of evidence-based healthcare and public health interventions to foster resilience among older adults. We also discuss how communities can play a role in promoting resilience and successful aging in later life.

Healthcare and public health interventions . There are several opportunities to promote resilience and successful aging in healthcare settings even in the absence of specific health problems. The patient-centered medical home is a model of care that has been endorsed by a number of leading medical professional organizations (Agency for Healthcare Research and Quality, 2017; Patient-Centered Primary Care Collaborative, 2012). Among the principles of care that make this model particularly appropriate for promoting successful aging are establishing a long-term patient–physician relationship, focusing on the whole patient rather than a specific health condition, and actively involving the patient and his or her goals. There is evidence that medical homes contribute to improved health behaviors, healthcare quality, patient satisfaction, and health outcomes (Patient-Centered Primary Care Collaborative, 2012).

Medical practitioners such as primary care providers can foster resilience to usual age-related deficits during routine healthcare encounters by promoting healthy lifestyles (Windsor et al., 2015) such as encouraging patients to intentionally incorporate glucose monitoring into existing routines to promote self-efficacy, or promoting the use of organizational tools for medication adherence.

Other types of health professionals such as psychologists can also help older adults by screening for mental health issues such as depression (Bergeron & Smith, In press), conducting one-on-one strength perspective counseling to assess and put into practice one’s spirituality and resilience to readjust during hardship (Langer, 2004), or by engaging their older patient in mindfulness meditation training to improve their ability to cope and enhance their well-being (Davidson & McEwen, 2012).

Technology can be used to make daily tasks easier, increase independence, and improve physical and emotional health (President’s Council of Advisors on Science and Technology, 2016), which all contribute to building resilience. For example, personal emergency response systems can be used to alert someone, such as a family member, if an older adult has fallen (AARP, 2010). However, because the effectiveness of these systems are limited by their reactive nature and often the button is not being worn or is not pressed at the time of the fall, this technology has been improved through the use of accelerometers to detect falls.

More and more proactive technologies are being released to help people stay safe as they age in place (Adler & Mehta, 2014; Ory, Smith, & Dahlke, 2016; President’s Council of Advisors on Science and Technology, 2016). For example, motion sensors installed in homes, carpets, and beds can create individualized trends based on a person’s typical day-to-day activities or set with trigger points to identify potential problematic situations. This type of system may detect a fall and alert a caregiver via text message when an individual gets up from bed and does not return after thirty minutes. It may also detect a urinary tract infection due to an increase in the number of trips to the bathroom. Other biomarker technologies can alert older adults and their caregivers of meaningful deviations in weight, blood sugar, and heart rate, to name a few, and result in earlier intervention. Technology also increases opportunities for social support through social media, video and phone contact, and even connect individuals to medical staff and behavioral health services from a distance (McCord et al., 2011).

A variety of health promotion interventions are also available to promote successful aging in the context of challenges posed by what Rowe and Kahn (1987) might have labeled “usual aging.” For example, the Active for Life® initiative disseminated two evidence-based physical activity programs for older adults into community settings for the promotion of older adult health (Wilcox et al., 2008). Initiatives like Active for Life® rely on behavioral processes to increase physical activity through goal setting, problem solving, and feedback. Texercise Select is an example of a multimodal lifestyle enhancement program that includes educational sessions, interactive discussions, and opportunities to engage in structured physical activity (Ory et al., 2015). It has been shown to enhance psychosocial mediators often associated with resilience such as perceived efficacy and social support for engaging in healthy behaviors (Wilcox et al., 2006).

The A Matter of Balance program (Healy, 2008; Smith, Ory, Belza, & Altpeter, 2012; Tennstedt, 1998) is an example of a fall prevention intervention that is widely disseminated and extensively evaluated. Falls are a challenge that is associated with a downward spiral of health and well-being. Fear of falling often facilitates behaviors that actually increase the likelihood of falling (e.g., reductions in physical activity, depressive symptomatology, limitations in daily activities). The evidence-based A Matter of Balance activity program is intended to diminish the fear of falling and increase physical activity by targeting attitudes and behaviors associated with a predisposition for falls. Participation in the program leads to improved self-efficacy for preventing and managing falls, decreased disruption of daily activities, and improvements in measures of mental health (Ory et al., 2009). Each of these factors is associated with greater likelihood of avoiding future falls or improved managements of the consequences of injurious falls.

Chronic disease self-management programs (like those our characters Albert and Patricia attended) and family caregiver interventions are designed for longer term challenges in older adulthood (Ory et al., 2013b). Interventions that provide skills training and ongoing peer or professional support for individuals facing illnesses (e.g., diabetes or heart disease) and those facing the stressors involved in caring for a loved one bring about measurable improvements in health behaviors, health-related outcomes, and healthcare utilization (Ory et al., 2013a). In addition to teaching what one needs to know to meet daily challenges, education and skills training boost motivation and self-efficacy for carrying out recommended tasks (Bazargani, Besharat, Ehsan, Nejatian, & Hosseini, 2011; Bodenheimer, Lorig, Holman, & Grumabach, 2006; Chodosh et al., 2005; Lorig & Holman, 2003). As a whole, family caregiver interventions can improve general well-being, depression, and caregiving burden (Cassie & Sanders, 2008; Marziali & Garcia, 2011).

Other programs that help to address the various predictors of resilience include the Retired and Senior Volunteer Program (RSVP) program, which promotes engagement of older adults in all sorts of community activities (Corporation for National & Community Service, n.d.), and TimeSlips which provides hope and improves well-being of people living with dementia through creative engagement (McFadden & Basting, 2010; TimeSlips, n.d.). Further, the 9-week Resilient Aging program was recently created to promote growth of resilient attitudes and behaviors among older adults by targeting self-efficacy and older adults’ wellness domains, including the physical, social, and emotional domains (Fullen & Gorby, 2016). Given the growth of the aging population, emphasis on successful aging, and better understanding of factors associated with resilience, it is likely that additional evidence-based programs will be needed in the future to promote resilience and successful aging.

The role of communities. Communities can play an important role in helping their residents be resilient and healthy. 8 80 City is an international project where cities are encouraged to work for everyone from 8 to 80 years old (8 80 Cities, 2017). Currently, in 6 continents, 37 countries, and more than 250 communities, 8 80 brings citizens together to improve mobility and public spaces such as parks and streets to improve the quality of life of its residents (8 80 Cities, 2017). 8 80 also increases a community’s engagement and cohesiveness (8 80 Cities, 2017), which positively contributes to the resilience process (Windsor et al., 2015).

Very similar to this initiative is the World Health Organization’s Age-Friendly Cities (AFC) Program (World Health Organization, 2017b). In the AFC program, 500 communities are making improvements on eight domains—community and health care, transportation, housing, social participation, outdoor spaces and buildings, respect and social inclusion, civic participation and employment, and communication and information—to be more inclusive of older adults (World Health Organization, 2017a). Most of these domains can help older adults enhance their resilience in older adulthood. For example, as resilience is associated with social interactions, having free or discounted bus passes through changes in the transportation domain or preventing age discrimination in the workplace can enable older adults to work and volunteer in later years, which may increase their sense of purpose, self-esteem, socialization, and ultimately promote resilience (Centre for Policy on Ageing, 2014).

Local, state, and national policies and efforts are also needed to provide greater economic stability for older adults, which can help them better manage traumatic, expensive events. Although social security payments for retired workers in the United States are inadequate at only $1,369 per month (Social Security Administration, 2017), programs and tools exist to provide hope for economically insecure older adults (National Council on Aging, 2017b). For example, the Senior Community Service Employment Program has helped 65,000 low-income older Americans receive paid employment (National Council on Aging, 2017c). The free EconomicCheckUp® tool also exists to help older adults assess their own economic situation and learn about different options, such as eligibility for financial assistance programs, to achieve greater economic security (National Council on Aging, 2017a).


Resilience is an extraordinary and positive response to a challenge or stressor. When looking through the right lens, rather than merely “getting through” a hard time, the resilient response is one that adapts to the challenge where functioning in one or more domain is better after adapting than before the challenge occurred. When the growth produced by resilience leaves one functioning better than expected in a domain that he or she deems important, resilience can produce successful aging. As we have seen in the example of Albert and Patricia, it is possible to facilitate adaptive responses by working to enhance older adult’s internal and external resources. Improving these various factors through the recommended behavioral, technological, and community responses can help older adults get through hardship and age successfully.


  1. 8 80 Cities. (2017). About us. Retrieved from
  2. AARP. (2010). Medical alert devices to the rescue. Retrieved from
  3. Adler, R., & Mehta, R. (2014). Catalyzing technology to support family caregiving. Retrieved from
  4. Agency for Healthcare Research and Quality. (2017). Transforming the organization and delivery of primary care. Retrieved from
  5. American Psychological Association. (2017). The road to resilience. Retrieved from
  6. Baltes, M. M., & Carstensen, L. L. (1996). The process of successful ageing. Ageing and Society, 16(4), 397–422.CrossRefGoogle Scholar
  7. Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. Successful Aging: Perspectives from the Behavioral Sciences, 1(1), 1–34.Google Scholar
  8. Baltes, P. B., & Smith, J. (2003). New frontiers in the future of aging: From successful aging of the young old to the dilemmas of the fourth age. Gerontology, 49(2), 123–135.CrossRefGoogle Scholar
  9. Bazargani, R. H., Besharat, M. A., Ehsan, H. B., Nejatian, M., & Hosseini, K. (2011). The efficacy of chronic disease self management programs and tele-health on psychosocial adjustment by increasing self-efficacy in patients with CABG. Procedia-Social and Behavioral Sciences, 30, 830–834.CrossRefGoogle Scholar
  10. Becker, G., & Newsom, E. (2005). Resilience in the face of serious illness among chronically ill African Americans in later life. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(4), S214–S223.CrossRefGoogle Scholar
  11. Bergeron, C. D., Friedman, D. B., Messias, D. K. H., Spencer, S. M., & Miller, S. C. (2016). Older women’s responses and decisions after a fall: The work of getting “back to normal”. Health Care for Women International, 37(12), 1342–1356.CrossRefGoogle Scholar
  12. Bergeron, C. D., & Smith, M. L. (In press). The impact of physical challenges on the mental health of the aging population. In K. L. D. Maller (Ed.), The Praeger handbook of mental health and the aging community. Santa Barbara, CA: Praeger.Google Scholar
  13. Bodenheimer, T., Lorig, K., Holman, H., & Grumabach, K. (2006). Patient self-management of chronic disease in primary care. JAMA, 288(19), 2469–2475.CrossRefGoogle Scholar
  14. Bolton, K. W., Praetorius, R. T., & Smith-Osborne, A. (2016). Resilience protective factors in an older adult population: A qualitative interpretive meta-synthesis. Social Work Research, 40(3), 171–182.CrossRefGoogle Scholar
  15. Cassie, K. M., & Sanders, S. (2008). Chapter 12: Familial caregivers of older adults. Journal of Gerontological Social Work, 50(S1), 293–320.CrossRefGoogle Scholar
  16. Centre for Policy on Ageing. (2014). Resilience in older age. Retrieved from
  17. Chang, P.-J., & Yarnal, C. (2017). The effect of social support on resilience growth among women in the Red Hat Society. The Journal of Positive Psychology, 1–8. Scholar
  18. Chodosh, J., Morton, S. C., Mojica, W., Maglionce, M., Suttorp, M. J., Hilton, L., et al. (2005). Meta-analysis: Chronic disease self-management programs for older adults. Annals of Internal Medicine, 143(6), 427–438.CrossRefGoogle Scholar
  19. Coll, C. G., Bearer, E. L., & Lerner, R. M. (2014). Nature and nurture: The complex interplay of genetic and environmental influences on human behavior and development. New York, NY: Psychology Press.CrossRefGoogle Scholar
  20. Corporation for National & Community Service. (n.d.). RSVP. Retrieved from
  21. Davidson, R. J., & McEwen, B. S. (2012). Social influences on neuroplasticity: Stress and interventions to promote well-being. Nature Neuroscience, 15(5), 689–695.CrossRefGoogle Scholar
  22. Decancq, K., & Michiels, A. (2017). Measuring successful aging with respect for preferences of older persons. The Journals of Gerontology: Series B.
  23. DeNisco, S. (2011). Exploring the relationship between resilience and diabetes outcomes in African Americans. Journal of the American Association of Nurse Practitioners, 23(11), 602–610.CrossRefGoogle Scholar
  24. Earvolino-Ramirez, M. (2007). Resilience: A concept analysis. Nursing Forum, 42(2), 73–82.CrossRefGoogle Scholar
  25. Fowler, C., Gasiorek, J., & Giles, H. (2015). The role of communication in aging well: Introducing the communicative ecology model of successful aging. Communication Monographs, 82(4), 431–457.CrossRefGoogle Scholar
  26. Fullen, M. C., & Gorby, S. R. (2016). Reframing resilience: Pilot evaluation of a program to promote resilience in marginalized older adults. Educational Gerontology, 42(9), 660–671.CrossRefGoogle Scholar
  27. Garnefski, N., Kraaij, V., Schroevers, M. J., & Somsen, G. A. (2008). Post-traumatic growth after a myocardial infarction: a matter of personality, psychological health, or cognitive coping? Journal of Clinical Psychology in Medical Settings, 15(4), 270–277.CrossRefGoogle Scholar
  28. Greene, R. R. (2007). Reflections on Hurricane Katrina by older adults: Three case studies in resiliency and survivorship. Journal of Human Behavior in the Social Environment, 16(4), 57–74.CrossRefGoogle Scholar
  29. Harris, P. B. (2008). Another wrinkle in the debate about successful aging: The undervalued concept of resilience and the lived experience of dementia. The International Journal of Aging and Human Development, 67(1), 43–61.CrossRefGoogle Scholar
  30. Hayman, K. J., Kerse, N., & Consedine, N. S. (2017). Resilience in context: The special case of advanced age. Aging & Mental Health, 21(6), 577–585.CrossRefGoogle Scholar
  31. Healy, T. C. (2008). The feasibility and effectiveness of translating a matter of balance into a volunteer lay leader model. Journal of Applied Gerontology, 27(1), 34–51.CrossRefGoogle Scholar
  32. Heckhausen, J., Dixon, R. A., & Baltes, P. B. (1989). Gains and losses in development throughout adulthood as perceived by different adult age groups. Developmental Psychology, 25(1), 109–121.CrossRefGoogle Scholar
  33. Inui, T. S. (2003). The need for an integrated biopsychosocial approach to research on successful aging. Annals of Internal Medicine, 139(5_Part_2), 391–394.CrossRefGoogle Scholar
  34. Inui, T. S., & Frankel, R. M. (1991). Evaluating the quality of qualitative research. Journal of General Internal Medicine, 6(5), 485–486.CrossRefGoogle Scholar
  35. James, S. A. (1994). John Henryism and the health of African-Americans. Culture, Medicine and Psychiatry, 18(2), 163–182.CrossRefGoogle Scholar
  36. Kahana, E., Kahana, B., & Lee, J. E. (2014). Proactive approaches to successful aging: One clear path through the forest. Gerontology, 60(5), 466–474.CrossRefGoogle Scholar
  37. Katz, S., & Calasanti, T. (2014). Critical perspectives on successful aging: Does it “appeal more than it illuminates”? The Gerontologist, 55(1), 26–33.CrossRefGoogle Scholar
  38. King, L. A., King, D. W., Vickers, K., Davison, E. H., & Spiro, A., 3rd. (2007). Assessing late-onset stress symptomatology among aging male combat veterans. Aging & Mental Health, 11(2), 175–191.CrossRefGoogle Scholar
  39. Kok, A. A., Aartsen, M. J., Deeg, D. J., & Huisman, M. (2017). Capturing the diversity of successful aging: an operational definition based on 16-year trajectories of functioning. The Gerontologist, 57(2), 240–251.PubMedGoogle Scholar
  40. Laditka, S. B., Corwin, S. J., Laditka, J. N., Liu, R., Tseng, W., Wu, B., et al. (2009). Attitudes about aging well among a diverse group of older Americans: Implications for promoting cognitive health. Gerontologist, 49 Suppl 1(1), S30–S39.CrossRefGoogle Scholar
  41. Langer, N. (2004). Resiliency and spirituality: Foundations of strengths perspective counseling with the elderly. Educational Gerontology, 30(7), 611–617.CrossRefGoogle Scholar
  42. Lee, J. E., Kahana, B., & Kahana, E. (2017). Successful aging from the viewpoint of older adults: Development of a brief successful aging inventory (SAI). Gerontology, 63(4), 359–371.CrossRefGoogle Scholar
  43. Lorig, K., & Holman, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26(1), 1–7.CrossRefGoogle Scholar
  44. MacLeod, S., Musich, S., Hawkins, K., Alsgaard, K., & Wicker, E. R. (2016). The impact of resilience among older adults. Geriatric Nursing, 37(4), 266–272.CrossRefGoogle Scholar
  45. Martin, P., Kelly, N., Kahana, B., Kahana, E., Willcox, B. J., Willcox, D. C., et al. (2014). Defining successful aging: A tangible or elusive concept? The Gerontologist, 55(1), 14–25.CrossRefGoogle Scholar
  46. Martinson, M., & Berridge, C. (2014). Successful aging and its discontents: A systematic review of the social gerontology literature. The Gerontologist, 55(1), 58–69.CrossRefGoogle Scholar
  47. Marziali, E., & Garcia, L. J. (2011). Dementia caregivers’ responses to 2 internet-based intervention programs. American Journal of Alzheimer’s Disease & Other Dementias, 26(1), 36–43.CrossRefGoogle Scholar
  48. Mather, M., Jacobsen, L. A., & Pollard, K. M. (2015). Aging in the United States. Population Reference Bureau, 70(2), 1–21.Google Scholar
  49. McCord, C. E., Elliott, T. R., Wendel, M. L., Brossart, D. F., Cano, M. A., Gonzalez, G. E., et al. (2011). Community capacity and teleconference counseling in rural Texas. Professional Psychology: Research and Practice, 42(6), 521–527.CrossRefGoogle Scholar
  50. McFadden, S. H., & Basting, A. D. (2010). Healthy aging persons and their brains: Promoting resilience through creative engagement. Clinics in Geriatric Medicine, 26(1), 149–161.CrossRefGoogle Scholar
  51. Molton, I. R., & Yorkston, K. M. (2017). Growing older with a physical disability: A special application of the successful aging paradigm. The Journals of Gerontology: Series B, 72(2), 290–299.Google Scholar
  52. National Council on Aging. (2017a). Am I making the most of my money? Retrieved from
  53. National Council on Aging. (2017b). Economic security for seniors facts. Retrieved from
  54. National Council on Aging. (2017c). Senior community service employment program. Retrieved from
  55. Ory, M. G., Ahn, S., Jiang, L., Smith, M. L., Ritter, P. L., Whitelaw, N., et al. (2013a). Successes of a national study of the chronic disease self-management program: Meeting the triple aim of health care reform. Medical Care, 51(11), 992–998.CrossRefGoogle Scholar
  56. Ory, M. G., Smith, M. L., Kulinski, K. P., Lorig, K., Zenker, W., & Whitelaw, N. (2013b). Self-management at the tipping point: Reaching 100,000 Americans with evidence-based programs. Journal of the American Geriatrics Society, 61(5), 821–823.CrossRefGoogle Scholar
  57. Ory, M. G., Smith, M. L., Howell, D., Zollinger, A., Quinn, C., Swierc, S. M., et al. (2015). The conversion of a practice-based lifestyle enhancement program into a formalized, testable program: From texercise classic to texercise select. Frontiers in Public Health, 3, 291. Scholar
  58. Ory, M. G., Smith, M. L., Wade, A. F., Mounce, C., Larsen, R. A. A., & Parrish, R. (2009). Falls prevention as a pathway to healthy aging: Statewide implementation and dissemination of an evidence-based program. College Station, TX: Texas A&M Health Science Center.Google Scholar
  59. Ory, M. G., Smith, M. L., & Vollmer Dahlke, D. (2016). Technological solutions for extended independence. Aging Today, 37(6), 1–2.Google Scholar
  60. Park, C. L., & Fenster, J. R. (2004). Stress-related growth: Predictors of occurrence and correlates with psychological adjustment. Journal of Social and Clinical Psychology, 23(2), 195–215.CrossRefGoogle Scholar
  61. Patient-Centered Primary Care Collaborative. (2012). Benefits of implementing the primary care patient-centered medical home: A review of cost & quality results, 2012. Retrieved from
  62. Pew Research Center. (2013). Living to 120 and beyond: Americans’ views on aging, medical advances and radical life extension. Retrieved from
  63. President’s Council of Advisors on Science and Technology. (2016). Independence, technology, and connection in older age. Retrieved from
  64. Reichstadt, J., Depp, C. A., Palinkas, L. A., Folsom, D. P., & Jeste, D. V. (2007). Building blocks of successful aging: a focus group study of older adults’ perceived contributors to successful aging. American Journal of Geriatric Psychiatry, 15(3), 194–201.CrossRefGoogle Scholar
  65. Rowe, J. W., & Kahn, R. L. (1987). Human aging: Usual and successful. Science, 237(4811), 143–149.CrossRefGoogle Scholar
  66. Sharkey, J. R., Sharf, B. F., & St. John, J. A. (2009). “Una persona derechita (staying right in the mind)”: Perceptions of Spanish-speaking Mexican American older adults in South Texas colonias. Gerontologist, 49 Suppl 1(1), S79–S85.CrossRefGoogle Scholar
  67. Smith, M. L., Ory, M. G., Belza, B., & Altpeter, M. (2012). Personal and delivery site characteristics associated with intervention dosage in an evidence-based fall risk reduction program for older adults. Translational Behavioral Medicine: Practice, Policy and Research, 2(2), 188–198.CrossRefGoogle Scholar
  68. Social Security Administration. (2017). Fact sheet. Retrieved from
  69. Tennstedt, S. (1998). A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 1998(6), P384–P392.CrossRefGoogle Scholar
  70. Thornton, A. A., & Perez, M. A. (2006). Posttraumatic growth in prostate cancer survivors and their partners. Psycho-Oncology, 15(4), 285–296.CrossRefGoogle Scholar
  71. TimeSlips. (n.d.). About. Retrieved from
  72. Tkatch, R., Musich, S., MacLeod, S., Kraemer, S., Hawkins, K., Wicker, E. R., et al. (2017 Epub). A qualitative study to examine older adults’ perceptions of health: Keys to aging successfully. Geriatric Nursing. Scholar
  73. US Census Bureau. (2014). An aging nation: The older population in the United States. Retrieved from
  74. Underwood, M., Bartlett, H. P., Partridge, B., Lucke, J., & Hall, W. D. (2009). Community perceptions on the significant extension of life: An exploratory study among urban adults in Brisbane, Australia. Social Science & Medicine, 68(3), 496–503.CrossRefGoogle Scholar
  75. von Faber, M., Bootsma-van der Wiel, A., van Exel, E., Gussekloo, J., Lagaay, A. M., van Dongen, E., et al. (2001). Successful aging in the oldest old: Who can be characterized as successfully aged? Archives of Internal Medicine, 161(22), 2694–2700.CrossRefGoogle Scholar
  76. Wareham, C. S. (2016). Substantial life extension and the fair distribution of healthspans. Journal of Medicine and Philosophy, 41(5), 521–539.CrossRefGoogle Scholar
  77. Wilcox, S., Dowda, M., Griffin, S. F., Rheaume, C., Ory, M. G., Leviton, L., et al. (2006). Results of the first year of active for life: Translation of 2 evidence-based physical activity programs for older adults into community settings. American Journal of Public Health, 96(7), 1201–1209.CrossRefGoogle Scholar
  78. Wilcox, S., Dowda, M., Leviton, L. C., Bartlett-Prescott, J., Bazzarre, T., Campbell-Voytal, K., et al. (2008). Active for Life: Final results from the translation of two physical activity programs. American Journal of Preventive Medicine, 35(4), 340–351.CrossRefGoogle Scholar
  79. Williamson, T., & Paslawski, T. (2016). Resilience in dementia: Perspectives of those living with dementia. Canadian Journal of Speech-Language Pathology and Audiology, 40(1), 1–15.Google Scholar
  80. Windsor, T. D., Hunter, M. L, & Browne-Yung, K. (2015). Ageing well: Building resilience in individuals and communities. Retrieved from
  81. World Health Organization. (2017a). Age-friendly in practice. Retrieved from
  82. World Health Organization. (2017b). WHO global network for age-friendly cities and communities. Retrieved from
  83. Young, Y., Frick, K. D., & Phelan, E. A. (2009). Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging. Journal of the American Medical Directors Association, 10(2), 87–92.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Matthew Lee Smith
    • 1
    Email author
  • Caroline D. Bergeron
    • 1
  • Carly E. McCord
    • 1
  • Angela K. Hochhalter
    • 2
  • Marcia G. Ory
    • 1
  1. 1.Center for Population Health and Aging, Texas A&M UniversityCollege StationUSA
  2. 2.Baylor Scott & White Healthcare, Texas A&M Health Science CenterCollege StationUSA

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