Synonyms

Aging well; Optimal aging; Positive aging; Productive aging; Successful aging

Definition

The World Health Organization (WHO) defines active aging as “…the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age” (WHO 2002, p. 12). For many years, the WHO has emphasized healthy aging, primarily defined as aging without major pathologies. In the early 1990s, it has begun developing the concept of active aging, jointly with other governmental and nongovernmental organizations initiatives, offering a policy framework that emphasizes the link between activity, health, independence, and aging well. Active aging emerged as a more comprehensive concept than healthy aging, as it considers not only health indicators but also psychological, social, and economic aspects, which are to be looked at the community level, within gender and cultural perspectives.

Currently the WHO’s active aging concept leads the global policy strategy in Europe (Walker 2009). The document produced by the WHO (2002), although not exempt of criticism, was adopted as a guide in many health and social inclusion national plans all over the world and it has definitely changed the dominant approach to old age that for many decades had been grounded in the deficit theories. Some go further considering that it opened the way to a new model of governance of aging (Boudiny and Mortelmans 2011).

History of the Concept

The model of active aging emerged in the aftermath of the demographic changes experienced across most of the western world from the 1950s onward. Its roots date back to the 1960s and to the influential work of Havighurst (1963) in the United States and his activity theory. This author supported the idea that “successful ageing means the maintenance as far and as long as possible of activities and attitudes of middle age” (Havighurst 1963, p. 8), stressing that the maintenance of such activities in later stages of life are associated with higher levels of wellbeing and quality of life. According to the formulation, people should keep active and replace professional activities by others when they have to retire from the labor market, or replace friends by others when the former have died. This activity theory brought an alternative approach to aging in opposition to the theory of disengagement of Cumming and Henry (1961), which considered the mutual withdrawal between old people and society. Eager of a more positive approach to old age, a stage in life that more and more people were achieving, academics and professionals working in the field have welcomed this activity theory and from inception it gathered wide enthusiasm. Later Neugarten (1964) would stress the relevance of being socially engaged and active to age successfully. This became one of the most influential theories to inform aging policies up to the emergence in the late 1980s of the concept of successful aging by Rowe and Kahn (1987, 1997, 1998) in the United States. Slightly more moderate approaches are found in work inspired by the theory of continuity of Atchley (1989) who claims that, despite the importance of maintaining activities of middle age in later life to achieve higher levels of wellbeing in old age, it is not so much the amount of activities that matters but instead the meaning activities carry for the individual. Moreover, alongside the maintenance of meaningful activities, Atchley stresses that processes of adjustment and adaptation also mark later stages of life. Also more moderate is the proposal of Caradec (2007) that offers a conceptual framework to discuss active aging that puts the process of aging in the crossroads of two opposing forces, the pressure toward disengagement and the pressure toward remaining connected to the world. Managing the tension between these two forces is the challenge of aging (l’épreuve). Active aging, in that sense, involves the process but also the outcome of the reorganization of activities that allow us to manage the tension between disengagement and continuity. Caradec further adds that individuals will experience this process differently according to the resources they control, both personal and social (Caradec 2010).

The overarching use of the concept of active aging though was not so much the result of the conceptual developments headed by the academia but rather the outcome of the inclusion of the term in the agenda of some supranational institutions, the one holding the highest impact being the World Health Organization (WHO). The first references to the term active aging can be traced back to some documents issued by the European Union (1999a, b, 2002) and the OECD (2000). In all cases, the term appears alongside the discussion on the challenges of demographic aging. More specifically, active aging is portrayed as the way out from the pressures on welfare systems stemming from the increasing number of older people with some form of dependence or as the way out from the pressures on pension systems.

But the final kick that boosted the concept of active aging to the global arena comes with the WHO declaration on the principles of policy that nations should adopt to promote active aging (WHO 2002). From then onward, there has been a proliferation of policy initiatives at both global, regional, and local levels that follow closely the guidelines put forward by the WHO and that constitute the framework that is taken as a reference across most countries not only for organizations operating in aging-related issues but also for individuals and for the way they experience the aging process.

The Active Aging Model and Its Applications

The concept of active ageing (WHO 2002) is based on three pillars that are mentioned in the definition itself: participation, health, and security. Recently, the International Longevity Centre of Brazil (2015) whose president is Alexandre Kalache, the previous responsible for the active aging approach launched by WHO, released a report titled Active Ageing: A policy framework in response to the longevity revolution. In this piece of work, Kalache revises the concept of active aging to incorporate more recent and new developments in life course perspectives. To the original pillars a new one was added – lifelong learning – that supports all the other pillars and puts information as vital to active aging. Besides formal education, and work-related knowledge acquisition, it presents a more inclusive approach to lifelong learning to diminish vulnerability, namely, among older persons.

The proposed model encompasses six groups of determinants of active aging, each one including several aspects: (1) health and social services (promoting health and preventing disease, health services, continuous care, mental health care); (2) behavioral (smoking, physical activity, food intake, oral health, alcohol, medication); (3) personal (biology and genetics and psychological factors); (4) physical environment (friendly environment, safe houses, falls, absence of pollution); (5) social (social support, violence and abuse, education); and (6) economic (wage, social security, work). These determinants of active aging are embedded in cultural and gender contexts. These so-called determinants, appearing in the model are not mutually exclusive and there are overlaps between them, mixing individual as well as societal aspects and transient and life course issues. The WHO (2002) report recommended that health policy for old people be implemented through Health Plans at global regional, national, and local levels.

According to the WHO document on active aging (WHO 2002), the key aspects of active aging are (1) autonomy which is the perceived ability to control, cope with, and make personal decisions about how one lives on a day-to-day basis, according to one’s own rules and preferences; (2) independence, the ability to perform functions related to daily living – i.e., the capacity of living independently in the community with no and/or little help from others; (3) quality of life that “is an individual’s perception of his or her position in life in the context of the culture and value system where they live, and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept, incorporating in a complex way person’s physical health, psychological state, level of independence, social relationships, personal beliefs and relationship to salient features in the environment”(Harper and Power 1998). As people age, quality of life is largely determined by the ability to maintain autonomy and independence and healthy life expectancy, which is how long people can expect to live without disabilities.

There are some distinctive elements in how the WHO defines active aging in terms of its implications for policy design and for all sorts of interventions in aging-related issues. Firstly, the WHO sees active aging as a domain of collective responsibility. Although one could argue that there is also an orientation to individual responsibility phrased in the statement that individuals must participate in certain types of activities and adopt certain types of behavior, ultimately this is conditioned by the opportunities individuals have to fulfill their potential. Optimizing these opportunities is clearly a domain for societal action and opens the space for a discourse on rights and on state obligations. This is further reinforced by the emphasis the WHO puts on the resources that need to be made available to individuals to maximize their opportunities to age with quality of life.

Secondly, the WHO sees active aging as a process that is materialized in a vast array of multidimensional activities and not exclusively in productive labor-market-related activities. This is very relevant as it clearly distinguishes the WHO approach to active aging from the one of other supranational organizations such as the OECD which focuses on labor market productivity issues associated with population aging. Active aging therefore is not just about creating the conditions to postpone the exit from the labor market of older workers (which has been the dominant topic in many national debates on how to face the challenges of demographic aging for social protection systems) but also about considering the economic and the social value added by other activities not directly related to the labor market (e.g., voluntary work, family care). Furthermore, the WHO concept of active aging includes clearly nonproductive activities as examples of activities with which individuals can engage to achieve quality of life as they age (e.g., spiritual activities).

Thirdly, the concept of active aging of the WHO embeds what one could label as an inclusive approach to the process of aging. It acknowledges that processes are formed along the life course and that the way one lives in old age is largely conditioned by prior phases of life and inscribed in individual life trajectories. It also emphasizes that active aging is a bottom-up process where people participate in building the appropriate conditions to age with quality of life. This is quite important as it grounds active aging in the recognition of differences in how people age and in the need to respect and accommodate the specificities of everybody. Finally, it notes that there are individuals that accumulate disadvantages and as such are at higher risk of being deprived from the chances of aging actively. That is the case of those who have physical and/or cognitive impairments or who are disadvantaged economically.

The objective of the WHO model is to guide policies on aging in order to avoid incapacity and its high financial costs for societies that are facing a deep demographic change toward aging. But in doing so, the concept of active aging looks for ways to reconcile the need to contain social and financial costs of aging with the recognition of rights of older people as well as the recognition of the potential to add value to societies along the life course and also in old age.

Operationalization and Evaluation of Policies Versus Evaluation of Individual Outcomes

The concept of active aging is nevertheless a very complex one, and researchers soon began trying to understand what it means to laypeople as well as finding ways to operationalize and evaluate its applications (e.g., Fernandez-Ballesteros et al. 2010). Bowling reported that the most common perceptions of active aging were having/maintaining physical health and functioning (43%), leisure and social activities (34%), mental functioning and activity (18%), and social relationships and contacts (15%) (Bowling 2008). The predictors of positive self-rated active aging were optimum health and quality of life. More recently, Stenner et al. (2011) described the subjective aspects of active aging by inquiring people about the meaning of the expression “active aging.” The authors have shown that most people mention physical activity but also autonomy, interest in life, coping with challenges, and keeping up with the world. Frequently people mix physical, mental, and social factors and stressed agentic capacities and living by one’s own norms. Stenner et al. (2011) have used this evidence to critically question the deterministic view of the WHO model and have emphasized the need for a “challenge and response” framework, a psychosocial approach to the conflict between facts and expectations and the proactive attitude of people.

In an attempt to test empirically the WHO active aging determinants model, Paúl et al. (2012) arrive to the conclusion that the most important determinants of active aging appears organized in a factor that can be defined as perceived and objective health and independent functioning and a factor where personal determinants like psychological distress, loneliness, personality characteristics, happiness, and optimism emerge as highly relevant to individual active adaptation to the aging process.

In sum, active aging and other similar terms, such as successful aging, positive aging, or aging well, are viewed as scientific concepts operationally portrayed by a broad set of bio-psycho-social factors assessed through objective and subjective indicators as well as being closely related to lay concepts reported cross-culturally by older persons (Fernandez-Ballesteros 2011).

Objective as well as subjective health and functionality seem to be major components of active aging in line with Pruchno et al.’s (2010a, b) findings. By keeping active in the broader sense of the concept, old people can overcome difficulties and keep highly motivated to participate in the social world, and engage in healthy behavior, which in turn has a positive impact in quality of life during the aging process. In line with this, actions targeting active aging have to take into account the prevention of health problems across the life span and the promotion of psychological resilience, avoiding loneliness or increasing happiness and subjective wellbeing. These actions can occur at both the individual and social policy level. Examples of actions at the social policy level are mechanisms that guarantee adequate income and policies to plan retirement and to guarantee the sustainability of pension systems.

Critical Perspectives for the Future

The balance between individual and social responsibility in aging well is probably the key aspect of the active aging model as both contribute to aging outcomes that means people should adopt a healthy life style and stay engaged with society but this can only be achieved in friendly and supportive contexts that guarantee access to a diversity of services and value individual options and dignity.

One major implication of the active aging model as it has been spreading among policy makers is the emphasis it puts on a productivist perspective that focuses mostly on the extension of working life ignoring other forms of nonpaid work (Foster and Walker 2014). The foundational rhetoric of active aging is the recognition of autonomy and capacity of older citizens to engage in meaningful social action, as opposed to disengagement. Therefore it is focused on eliminating age barriers to the participation of older workers in the labor market and it is very hostile to the culture of early exit from the labor market. As a result, it paves the way to a new legitimacy to what is considered successful aging, one that is largely dependent on an almost endless participation in the productive sphere of society (or in some sort of equivalent). In terms of public policies, this translates into pressures toward postponing retirement, into investments in training of older workers, among others. Authors such as Foster and Walker consider that there are other forms of creation of social value that are outside the realm of the labor market and that need to be included in the public policies forum, such as nonpaid family care and voluntary work. Although these are included in the concept of active aging as dimensions of participation, they have a very shy expression in the policy domain.

Other authors go even further in their criticism of the concept of active aging and emphasize its normative dimension (Boudiny 2013). They argue in that respect that the concept encapsulates a standardized approach to aging as strong as the past approaches that would equate aging to frailty and disengagement. In that sense, today as before, it is about prescribing appropriate and socially desirable modes of aging and as such it is about a model of governance of aging bodies. Remaining active and willing to be active become social norms. Those who do not conform, sometimes for reasons they cannot control, to these social norms of aging are “aging badly.”

Despite the criticisms, the model of active aging as a framework to implement individual and societal strategies that foster an aging process marked by quality of life seems to have gathered wide consensus. If those strategies are thought of as multidimensional in their nature, articulating individual and societal responsibilities and focusing on inclusion and participation of all irrespective of age-related constraints or any other constraints, they can pave the way to aging well for the growing generations of people who have higher expectations in terms of the number of years of life they will enjoy but also higher expectations about the quality of life they desire to those years.

Cross-References