6210 Week 7 Discussion

  

Discussion – Week 7

Top of Form

Discussion: Psychological Aspects of Aging

What does it mean to age “successfully”? Though the concept of success is relative, theories of successful aging explain factors that support individuals as they grow old. Factors such as maintaining physical and mental activity and disengaging from community obligations contribute to older adults’ ability to function. As a social worker, you must understand these supportive factors in order to address the needs of older clients and their families.

As you will see in this week’s media, situations involving Alzheimer’s or dementia, interpersonal conflict, and grief can complicate the process of successful aging. For this Discussion, you review one of two case studies involving an older woman and apply a theory of successful aging to the case.

To Prepare:

• Review the Learning Resources on psychological aspects      of later adulthood, focusing on key life events and on theories of      successful aging.
• Access the Social Work Case Studies media and explore      the cases of Sara and of Francine.
• Select a theory of successful aging to apply to either Sara’s or Francine’s case.

By 01/12/2021
 

Post a Discussion in which you:

• Identify whether you have chosen to analyze Sara’s or      Francine’s case for the Discussion. 
• Explain key life events that have influenced Sara’s or      Francine’s psychological functioning. Be sure to substantiate what makes      them key in your perspective.
• Explain how you as a social worker might apply a theory      of successful aging to Sara’s or Francine’s case. Be sure to provide support      for your strategy.

Bottom of Form

Required Readings

Zastrow, C. H., Kirst-Ashman, K. K., & Hessenauer, S. L. (2019). Understanding human behavior and the social environment (11th ed.). Cengage Learning.

· Chapter 15, “Psychological Aspects of Later Adulthood” (pp. 672–702)

Newell, J. M. (2019). An ecological systems framework for professional resilience in social work practice. Social Work, 65(1), 65–73. https://doi.org/10.1093/sw/swz044

Teater, B., & Chonody, J. M. (2020). How do older adults define successful aging? A scoping review. International Journal of Aging and Human Development, 91(4), 599–625. https://doi.org/10.1177/0091415019871207

Yousuf-Abramson, S. (2020). Worden’s tasks of mourning through a social work lens. Journal of Social Work Practice, 1–13. https://doi.org/10.1080/02650533.2020.1843146

Required Media

Required Readings
Zastrow, C. H., Kirst-Ashman, K. K., & Hessenauer, S. L. (2019). Understanding human behavior and the social environment (11th ed.). Cengage Learning.

• Chapter 15, “Psychological Aspects of Later      Adulthood” (pp. 672–702)

Chapter 15 Summary 

The following summarizes this chapter’s content as it relates to the learning objectives presented at the beginning of the chapter. Chapter content will help prepare students to

LO 1 Describe the developmental tasks of later adulthood.

Older adults must make a number of developmental psychological adjustments, such as adjusting to re-tirement and lower income and to changing physical strength and health.

LO 2 Understand theoretical concepts about devel-opmental tasks in later adulthood. Theoretical concepts about developmental tasks in later adulthood include integrity versus despair, shifting from work-role preoccupation to self-dif-ferentiation; shifting from body preoccupation to body transcendence; shifting from self-occupation to self-transcendence; conducting a life review; the im-portance of self-esteem; the significance of having a high level of life satisfaction; the negative effects of low status and ageism; the prevalence of depression and other emotional problems; and the significance of spirituality and religion.

LO 3 Summarize theories of successful aging. Three theories of successful aging are the activity theory, the disengagement theory, and the social re-construction syndrome theory.

LO 4 Understand the impact of key life events on older people. Significant life events for older people may include marriage, death of a spouse, widowhood, remar-riage, parenting adult children, grandparenthood, and great-grandparenthood.

LO 5 Understand guidelines for positive psycho-logical preparations for later adulthood. Suggestions for positive psychological preparations by younger adults for later adulthood include engag-ing in good health practices, forming close personal relationships, preparing financially, having interests and hobbies, forming positive self-identities, looking toward the future, learning to cope with crises, and learning to cope with death.

LO 6 Summarize material on grief management and death education.

Guidelines are presented on grief management and death education, relating to a dying person, relating to survivors, and becoming more comfortable with the idea of one’s own eventual death 

COMPETENCY NOTES The following identifies where Educational Policy (EP) competencies and behaviors are discussed in the chapter.

EP 6a. Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks to engage with clients and constituencies

EP 7b. Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in the analysis

of assessment data from clients and constituencies. (All of this chapter.) The content of this chapter is focused on social work students acquiring both of these behaviors in work-ing with older persons.

EP 1. Demonstrate Ethical and Professional Behavior (p. 677, 678, 680, 684, 699, 700)

WEB RESOURCES

See this text’s companion website at www.cengagebrain.com for learning tools such as chapter quizzes, videos, and more.

Copyright 

Newell, J. M. (2019). An ecological systems framework for professional resilience in social work practice. Social Work, 65(1), 65–73. https://doi.org/10.1093/sw/swz044
Teater, B., & Chonody, J. M. (2020). How do older adults define successful aging? A scoping review. International Journal of Aging and Human Development, 91(4), 599–625. https://doi.org/10.1177/0091415019871207
Yousuf-Abramson, S. (2020). Worden’s tasks of mourning through a social work lens. Journal of Social Work Practice, 1–13. https://doi.org/10.1080/02650533.2020.1843146
Required Media

Walden University, LLC. (2021). Social work case studies [Interactive media]. https://class.waldenu.edu

• Navigate to Sara and to      Francine. 

Walden University, LLC. (2021). Models of grieving [Interactive media]. https://class.waldenu.edu

Walden University, LLC. (2021). Social work case studies [Interactive media]. https://class.waldenu.edu

· Navigate to Sara and to Francine. 

Walden University, LLC. (2021). Models of grieving [Interactive media]. https://class.waldenu.edu

Follow rubric

Initial Posting: Content

14.85 (49.5%) – 16.5 (55%)

Initial posting thoroughly responds to all parts of the Discussion prompt. Posting demonstrates excellent understanding of the material presented in the Learning Resources, as well as ability to apply the material. Posting demonstrates exemplary critical thinking and reflection, as well as analysis of the weekly Learning Resources. Specific and relevant examples and evidence from at least two of the Learning Resources and other scholarly sources are used to substantiate the argument or viewpoint.

Follow-Up Response Postings: Content

6.75 (22.5%) – 7.5 (25%)

Student thoroughly addresses all parts of the response prompt. Student responds to at least two colleagues in a meaningful, respectful manner that promotes further inquiry and extends the conversation. Response presents original ideas not already discussed, asks stimulating questions, and further supports with evidence from assigned readings. Post is substantive in both length (75–100 words) and depth of ideas presented.

Readability of Postings

5.4 (18%) – 6 (20%)

Initial and response posts are clear and coherent. Few if any (less than 2) writing errors are made. Student writes with exemplary grammar, sentence structure, and punctuation to convey their message.

Article

How Do Older Adults
Define Successful
Aging? A
Scoping Review

Barbra Teater
1
and Jill M. Chonody

2

Abstract

Successful aging is a prominent theory that describes the aging process and the

expected activities and behaviors older adults should engage in or exhibit to age

successfully. Although this theory is used to gauge the extent to which older adults

are aging successfully, older adults’ experiences and perspectives of what successful

aging means to them are missing from the theory. A five-step scoping review frame-

work was used to explore and synthesize the existing research that investigated

older adults’ perspectives on successful aging. Twelve main themes were found

and ranged from the importance of social relationships and interactions to having

a good death. Findings indicated older adults do not define successful aging as strictly

as is found in the literature. Old age and the aging process from the views of older

adults provide future directions for theory development and research.

Keywords

aging, successful aging, older adults, scoping review, aging theory

1
Department of Social Work, College of Staten Island, City University of New York, Staten Island,

NY, USA
2
Boise State University, Boise, ID, USA

Corresponding Author:

Barbra Teater, College of Staten Island, 2

8

00 Victory Blvd. 2A, 201, Staten Island, NY

10

314, USA.

Email: barbra.teater@csi.cuny.edu

The International Journal of Aging

and Human Development

0(0) 1–2

7

! The Author(s) 201

9

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.

11

77/009141501987

12

07

journals.sagepub.com/home/ahd

Article

The International Journal of Aging
and Human Development
2020, Vol. 91(4) 599–625

© The Author(s) 2019
Article reuse guidelines:

sagepub.com/journalsPermissions.nav
DOI: 10.1177/0091415019871207

journals. sagepub. com/ home/ ahd

600 The International Journal of Aging and Human Development 91(4)

Aging is a socially constructed phenomenon and how it is perceived and expe-
rienced is influenced by culture, societal expectations, and individuals’ lived
experiences (Brooks, 2010; Chonody & Teater, 2018). Old age has historically

been defined through governmental policies by establishing a specific chrono-
logical age to denote an “older person” and is used to determine eligibility for

particular services (e.g., age 67 to receive Social Security benefits in the United
States if born after 1960). Likewise, expectations and explanations of behaviors
of people who are classified as “older” adults have been presented through

sociological, psychological, and gerontological theories, including disengage-
ment theory (Cumming & Henry, 1961), productive ageing (Bass, Caro, &

Chen, 1993), activity theory (Havighurst, 1961), healthy ageing (White House
Conference on Ageing, 2015), successful ageing (Rowe & Kahn, 1997), and
active aging (World Health Organization, 2002). However, over the past 15 to

20 years, successful aging has become a prominent aging paradigm in the sub-
stantive literature, yet a close examination of successful aging reveals that the

voices of older adults are missing. This is a significant flaw in theory develop-
ment in that older adults’ experiences and perspectives play an essential role

in

understanding and explaining aging. Therefore, this scoping review aims to

review the literature to explore and synthesize the existing research that inves-
tigated older adults’ views and definitions of successful aging.

Literature Review

Theories and Frameworks of Aging

Historically, the coming of old age was seen as a time associated with disease
and disability and as disengagement theory proposed, a period of withdrawal or

disengagement from social interactions and activities (Cumming & Henry,
1961). Relatedly, activity theory purports that old age is a time when older

adults adjust, redefine, and substitute their roles and activities in an attempt
to maintain their sense of self (Havighurst, 1961). Over time, theorists began
rejecting these premises, and positive theories of aging that focused on health

and activity were proposed. Productive aging is one such theory and argues that
older adults needed to remain active and productive through engagement in

social activities and through the production of goods and services via paid
and volunteer employment, thus reducing their reliance on social services
(Bass et al., 1993). The more recent concept of healthy aging, which is defined

as “living a long productive, meaningful life and enjoying a high quality of life”
(White House Conference on Ageing, 2015), also aims to maximize older adults’

physical, social, and mental well-being to promote independence and reduce
burdens on others. Yet, both of these theories fail to consider social and

2 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 601

environmental factors that contribute to the extent to which one can age
“healthy” (Mendes, 20

13

).

More current aging theories, such as active aging and successful aging, were
developed as a counter response to theories that focused on decline, loss, and
disengagement. Active aging is a positive policy framework that focuses on the
connection of health and activity through six determinants: health and social
services; behavioral; personal; physical; social; and economic, with cross-cutting
determinants of culture and gender. Active aging was developed by the World
Health Organization (2002) as a policy framework to assist governments in
promoting and supporting active aging, which they defined as:

[T]he process of optimizing opportunities for health, participation, and security in

order to enhance quality of life as people age [ . . . ] The word ‘active’ refers to

continuing participation in social, economic, cultural, spiritual, and civic affairs,

not just the ability to be physically active or to participate in the labor force. [. . .]

Active aging aims to extend healthy life expectancy and quality of life for all people

as they age, including those who are frail, disabled, and in need of care. (p. 12)

Finally, successful aging is achieved when individuals exhibit the following: (a)
low probability of disease and disability, (b) high cognitive and physical func-
tional capacity, and (c) high social activity and engagement in social relation-
ships (Rowe & Kahn, 1997). Many argue that this theory pushed too far in the
other direction whereby older adults are being held to unrealistic standards in
order to be “successful” (Foster & Walker, 2015; Martinson & Berridge, 2015;
Morell, 2003; Rubinstein & de Medeiros, 2015; Teater & Chonody, 2017;
Walker, 2009). Furthermore, the focus on remaining free of disease and disabil-
ity fails to acknowledge the natural changes that occur in an aging body (Teater
& Chonody, 2017) and implies “hostility toward ageing bodies” (Morell, 2003,
p. 69). In addition, successful aging assumes that “through individual choice and
effort” one can age successfully and remain physically and socially active (Rowe
& Kahn, 1997, p. 37). This individualist view supports reduction in governmen-
tal policies that “provide social and other supports for [older adults] . . . and,
notably, to address the social and structural inequalities that create illness and
disability in the first place” (Martinson & Berridge, 2015, p. 63).

Although successful aging aims to take a more positive view of aging by focus-
ing on health promotion, activity, and the positive features of aging, it was devel-
oped without the input of older adults’ views and experiences or an evaluation of
the extent to which the theory’s principles and premises adequately depict the lived
experiences of older adults. Without exploring “how the social meanings ascribed
to aging interact with individuals’ lived experiences of the aging process,” aging is
being socially constructed and defined by culture instead (Brooks, 2010, p. 238).

Teater and Chonody 3

602 The International Journal of Aging and Human Development 91(4)

Measuring Successful Aging

Successful aging has been used to explain the aging process but has also been

used as the basis for determining the extent to which older adults are aging

successfully. For example, Kim (2008) developed a 31-item instrument to mea-

sure successful aging on a 5-point Likert-type scale (1 ¼ never; 5 ¼ always),
which was comprised of items on autonomous life, self-realization, active par-

ticipation in life, satisfaction with children, self-acceptance, and acceptance of

others. Phelan, Anderson, LaCroix, and Larson (2004) developed the successful

aging questionnaire where 20 factors of successful aging, consisting of aspects of

psychological, social, physical, and functional health, were identified from the

existing literature where older adults rated on a 3-point Likert-type scale how

important they believed each attribute was to successful aging (1 ¼ not impor-
tant, 2 ¼ neutral, and 3 ¼ important). The older adults in Phelan et al.’s study
reported that health, freedom from disability, life satisfaction, close personal

relationships, staying active and involved, maintaining independence, meeting

needs, adapting to aging-related changes, self-acceptance, and mastery were

most important, which supported the successful aging theory.
Both Kim and Phelan et al.’s studies assessed successful aging by predefining

the factors versus asking older adults to define successful aging themselves,

which may create an inaccurate picture of reality. Hilton, Gonzalez, Saleh,

Maitoza, and Anngela-Cole (2012) highlighted a weakness in Phelan et al.’s

study, which is the failure to include financial security and religiosity/spiritual-

ity; factors older adults often mention as important to their well-being. The

potential incongruence between predefining the factors of successful aging and

self-assessment by older adults was underscored in a mixed-methods study

where quantitative scores on physical, social, and psychocognitive functions

indicated lower levels of successful aging among a group of older adults who

qualitatively considered themselves to have aged successfully (von Faber et al.,

2001). In addition, Montross et al. (2006) found 92% of community-dwelling

older adults aged 60 years and older to perceive themselves as aging successfully

despite experiencing a disease or disability. Such studies point to the need for

more open-ended measures given that the current views on aging are not

informed by older adults’ perspectives but, rather, by what others—often

academic researchers—think older adults need (Clarke & Warren, 2007).

The Subjective Experience of Older Adults in Defining Successful Aging

The incongruence found between predefined measures of successful aging and

self-assessment may be related to variations among older adults given they are a

heterogeneous group. Therefore, theories of aging should incorporate differing

views of the aging experience based on gender, culture, health status, and

other identities as such dimensions could help or hinder the aging process

4 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 603

(Martinson & Berridge, 2015). For example, older adults in non-Western soci-
eties may not subscribe to the ideals of successful aging as they may value
interdependence and family relations more than the promotion of autonomy,
independence, and individual responsibility (Amin, 2017). Moreover, accessibil-
ity to resources is not equitable, which can shape how people age. Narrative or
life history research may be useful in further capturing how aging is understood
among different groups of older adults, and “allow for the examination of how
perceptions of aging may vary at different times and across the shifting contexts
of people’s lives” (Dionigi, Horton, & Bellamy, 2011, p. 416). Such knowledge
allows for a more accurate representation of experiences, referred to as bio-
graphical aging, which enables older adults to adapt to or cope with life chal-
lenges while also creating alternative meanings of the aging process based on
experience and understanding of the self (Chapman, 2005; Dionigi et al., 2011).
Acknowledging individual life stories allows for alternative explanations of
aging and the aging process that can be valued and accepted among different
groups of older adults, thus refuting the belief that all older adults should be
held to one standard of “successful” aging.

This scoping review aims to begin this challenge by (a) identifying any exist-
ing research that examined the perspectives of older adults on their views of
successful aging, (b) summarizing the themes found in this research, (c) com-
paring older adults’ views and definitions to successful aging, and (d) providing
future directions for the conceptualization of old age and the aging process
based on the views of older adults.

Methodology

A scoping review framework was used to explore existing research on older
adults’ perspectives of successful aging. A scoping review is “a form of knowl-
edge synthesis that addresses an exploratory research question aimed at map-
ping key concepts, types of evidence, and gaps in research related to a defined
area or field by systematically searching, selecting, and synthesizing existing
knowledge” (Colquhoun et al., 2014, pp. 1292–1294). The aim of a scoping
review is not to critique the methodology of the studies reviewed but rather to
synthesize the evidence on a topic of interest (Arksey & O’Malley, 2005).

The five steps in conducting a scoping review were followed as described by
Levac, Colquhoun, and O’Brien (2010). The first step is to identify the research
question, which was as follows: How do older adults define successful aging?”
Given our interest in how participant driven research yields a conceptualization
of successful aging, we delimited our research question to exclude researcher-
driven ideas of successful aging. The second step in this process was to identify
relevant studies. For this review, academic databases (Academic Search Premier;
Abstracts in Social Gerontology; Family & Society Studies Worldwide;
PsycINFO; Social Work Abstracts) were searched using the following search

Teater and Chonody 5

604 The International Journal of Aging and Human Development 91(4)

terms: successful aging, active aging, productive aging, healthy aging, attitudes,
older adults. The positive aging theories of active aging, productive aging, and
healthy aging were included in the search to review whether the studies were
exploring successful aging in addition to these other positive theories, for exam-
ple, asking older adults to define or provide examples of successful aging (see
Lewis, 2013). Articles were limited to those available in English and published
from 2002 to 2017. The search of the literature yielded 366 articles.

The third step in a scoping review is to determine whether each of the studies
met the inclusion criteria. In addition to the parameters set around publication
years and availability in English, the inclusion criteria included research on
successful aging from the perspective of older adults through open-ended ques-
tions to determine older adults’ definitions, experiences, and perspectives of
successful aging (e.g., “What does successful aging mean to you?”; “What is
involved in the process of successful aging?”). Articles where the researchers
predefined successful aging were excluded, for example, when researchers uti-
lized preexisting measures of successful aging or predefined the possible key
elements of successful aging. Both researchers independently reviewed all 366
abstracts identified in the search. Once this process was complete, 56 articles
were identified for possible inclusion. The researchers discussed this list together
and reviewed the abstracts again to resolve any uncertainties of whether to
include or exclude the article. After this process, 42 articles remained, and the
full articles were downloaded. Upon reviewing these articles, an additional
12 articles were excluded primarily because upon closer examination, it was
found that the researcher versus participants were delineating the definition
for successful aging.

The fourth step involved charting the data or findings of the review. For this
review, a data extraction form was created to chart the data, which included
demographics of the sample, research design, instruments used, questions asked,
sampling method, data analysis, and findings. The researchers worked together
to develop this form, and then each researcher independently extracted data
from the first two articles in the final list. This process helped to determine
whether extraction was aligned with the research question (Levac et al., 2010).
These extractions were discussed, and then the researchers divided the remaining
articles for independent extraction. Once this process was complete, researchers
discussed their extractions and once again explored how each article aligned
with the purpose of the review. An additional eight articles were found to be
slightly off topic; that is, the findings were focused on an element of aging, such
as the meaning of death, but participants were not asked to provide their per-
spective on successful aging. Thus, the final sample of articles used in this review
was 22. Table 1 provides a summary of these studies.

The final fifth step involved collecting, summarizing, and reporting the
results. To summarize and synthesize the findings, the researchers each indepen-
dently reviewed all the data extraction forms and created a list of themes found

6 The International Journal of Aging and Human Development 0(0)

605

T
a
b
le

1
.
A

S
u
m
m
a
ry

o
f

th
e

S
tu
d
ie
s
In
c
lu
d
e
d
in

th
e
R
e
v
ie
w
.

A
u
th
o
r(
s)

D
e
m
o
g
ra
p
h
ic
s

D
e
si
g
n
/A
n
a
ly
se
s

Q
u
e
st
io
n
s

M
a
jo
r
T
h
e
m
e
s
(s
u
b

th
e
m

e
s)

A
m
in

(2
0
1
7
)

7
M
a
le
s;
5

fe
m
a
le
s

M
e
an

a
g
e

¼
7
1
.5

ye
a
rs
;

ra
n
g
e
:
6
0
–
9
0

B
a
n
g
la
d
e
sh
i

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

S
e
m
i-
st
ru
c
tu
re
d
in
te
r-

v
ie
w
s

(f
a
c
e
-t
o
-f
ac
e
o
r

o
ve
r
th
e
p
h
o
n
e
)

G
ro
u
n
d
e
d

th
e
o
ry

;
th
e
–

m
at
ic
c
o
d
in
g
st
ra
te
g
y

1
.
W

h
e
n
yo
u
th
in
k
a
b
o
u
t

yo
u
r

li
fe
,

w
h
at

th
in
g
s
d
o
yo
u
li
k
e
le
a
st
a
b
o
u
t

b
e
in
g
th
e
a
g
e
yo
u

a
re

?

2
.
W

h
a
t

w
o
u
ld

m
ak
e
yo
u
sa
ti
sf
ie
d
in

o
ld

a
g
e
?

3
.
W

h
a
t
d
o
yo
u

th
in
k
it
m
e
a
n
s
to

a
g
e

w
e
ll
?

4
.
W

h
a
t
d
o
yo
u
th
in
k
o
n
e
n
e
e
d
s
to

fe
e
l
c
o
n
te
n
t
in

o
ld
a
g
e
?

A
d
a
p
ta
ti
o
n
to

th
e

a
g
in
g

b
o
d
y
;
fi
n
a
n
c
ia
l

se
c
u
ri
ty

;
fa
m
il
y

a
n
d

in
te
rg
e
n
e
ra
ti
o
n
a
l

c
ar
e
;

so
c
ia
l

p
a
rt
ic
ip
at
io
n

C
h
e
n

(2
0
1
5
)

1
4
F
e
m
a
le
s

M
e
an

a
g
e
¼

7
3
.2
8
y
e
a
rs
;

ra
n
g
e
:
6
0
–
9
0

T
a
iw
a
n

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

O
p
e
n

–

e
n
d
e
d

,
in
-d
e
p
th

se
m
i-
st
ru
c
tu
re
d
in
te
r-

v
ie
w
s

In
d
u
c
ti
v
e
a
n
a
ly
si
s
w
it
h

c
o
n
st
a
n
t
c
o
m
p
a
ra
–

ti
v
e
m
e
th
o
d

N
o
t
p
ro
v
id
e
d

B
e
in
g
h
e
a
lt
h
y
;
n
o
fi
n
a
n
c
ia
l
w
o
rr
ie
s;

m
ai
n
ta
in
in
g
c
o
n
n
e
c
ti
o
n
s
w
it
h
fa
m
il
y

a
n
d
fr
ie
n
d
s;
a
g
o
o
d
d
e
a
th

C
h
o
n
g,
N
g
,

W
o
o
,
a
n
d

K
w
a
n
(2
0
0
6
)

4
0
F
e
m
a
le
s;
1
8

m
al
e

s
(6
0
þ)

2
0
fe
m
a
le
s;
1
7
m
a
le
s

(m
id
d
le

a
g
e
d
;

ra
n
g
e
:
4
0
–
5
9
)

H
o
n
g
K
o
n
g

M
ix
tu
re

o
f
c
o
m
m
u
n
it
y

d
w
e
ll
in
g
a
n
d
re
si
d
e
n
–

ti
a
l
c
a
re

F
o
c
u
s
g
ro
u
p
s
w
it
h
5
–
8

p
a
rt
ic
i

p
a
n
ts

e
a
c
h

“
In
d
iv
id
u
a
l
u
n
it
s
o
f
m
e
a
n
–

in
g
”

w
e
re

re
c
o
rd
e
d
b
y

tw
o
m
e
m
b
e
rs

o
f

re
se
a
rc
h
te
a
m

a
n
d

th
e
n
c
o
m
p
a
re
d

“
A
t
e
a
c
h
fo
c
u
s
g
ro
u
p
,
th
e
p
a
rt
ic
i-

p
a
n
ts
w
e
re

in
v
it

e
d
to

a
rt
ic
u
la
te

th
e
ir
n
o
ti
o
n
s
o
f
p
o
si
ti
ve

a
g
e
in
g
,
to

g
iv
e
p
e
rs
o
n
a
l
e
x
a
m
p
le
s,
a
n
d
to

id
e
n
ti
fy

th
e
fa
c

to
rs

th
a
t
w
o
u
ld

a
ff
e
c
t

h
o
w

th
e
y
a
g
e
d
w
e
ll
o
r
p
o
s-

it
iv
e
ly
”
(p
.
2
4
8
)

U
n
d
e
rs
ta
n
d
in
g
o
f
p
o
si
ti
ve

a
ge
in
g:
g
o
o
d

h
e
a
lt
h
;
h
av
in
g

a
p
o
si
ti
ve

a
tt
it
u
d
e
;

a
c
ti
v
e
p
a
rt
ic
ip
a
ti
o
n
;
h
av
in
g
g
o
o
d
so
c
ia
l

a
n
d
fa
m
il
y

su
p
p
o
rt

;
fi
n
a
n
c
ia
l
se
c
u
ri
ty

Fa
ct
o
rs

a
ff
e
ct
in
g
p
o
si
ti
ve

a
ge
in
g:
g
e
tt
in
g
a
n

e
a
rl
y
st
a
rt
;
a
d
o
p
ti
n
g
a
h
e
a
lt
h
y
li
fe
st
y
le
;

th
in
k
in
g
p
o
si
ti
ve
ly
;
p
ro
m
o
ti
n
g
fa
m
il
y

a
n
d
in
te
rp
e
rs
o
n
a
l
re
la
ti
o
n

sh
ip

s;
b
u
il
d
–

in
g
u
p
fi
n
a
n
c
ia
l
re
so
u
rc
e
s;
p
re
fe
rr
e
d

li
v
in
g
a
rr
an
g
e
m
e
n
ts

C
o
ll
is
a
n
d

W
a
te
rf
ie
ld

(2
0
1
4
)

3
F
e
m
a
le
s;
3
m
al
e
s

M
e
an

a
g
e
¼
7
9
ye
a
rs
;

ra
n
g
e
:
7
5
–
9
0

E
n
g
la
n
d

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

In
te
rv
ie
w
s

G
ro
u
n
d
e
d
th
e
o
ry

-o
p
e
n

c
o
d
in
g
;
a
x
ia
l

c
o
d
in
g
in
te
r

v
ie
w
s;

E
x
p
lo
re
d
:

1
.
W

h
a
t
‘s
u
c
c
e
ss
fu
l
a
g
in
g
’
m
e
a
n
t
to

th
e
p
a
rt
ic
ip
a
n
ts

2
.
W

h
y
th
e
y
fe
lt
th
e
y
h
a
d
a
g
e
d

su
c
c
e
ss
fu
ll
y

U
n
d
e
rs
ta
n
d
in
g

p
a
in

;
p
e
rc
e
p
ti
o
n
s
o
f
a
g
in
g

(p
e
rc
e
p
ti
o
n
s
o
f
o
th
e
rs
;
a
tt
it
u
d
e
s
o
f

h
e
a
lt
h
c
a
re

p
ro
fe
ss
io
n
a
ls
;
d
is
a
b
il
it
y
;

a
d
a
p
ta
ti
o
n
)

(c
o
n
ti
n
u
e
d
)

7

606

T
a
b
le

1
.
C
o
n
ti
n
u
e
d
.

A
u
th
o
r(
s)
D
e
m
o
g
ra
p
h
ic
s
D
e
si
g
n
/A
n
a
ly
se
s
Q
u
e
st
io
n
s

M
a
jo
r
T
h
e
m
e
s
(s
u
b
th
e
m
e
s)

3
.
R
e
c
o
ll
e
c
ti
o
n
o
f
p
a
in
fu
l
e
p
is
o
d
e
s

4
.
M
e
th
o
d
s
o
f
c
o
p
in
g
w
it
h
p
a
in

5
.
If

a
n
d
h
o
w

p
a
in

re
so
lv
e
d

6
.

H
o
w

th
e
y
th
o
u
g
h
t
th
a
t
p
a
in
d
if
fe
rs

w
h
e
n
yo
u
n
g
e
r
ve
rs
u
s
th
a
n
o
ld
e
r

7
.
C
u
rr
e
n
t
e
x
p
e
ri
e
n
c
e
s
w
it
h
o
f
p
a
in
,

if
a
n
y

8
.
H
o
w

th
e
ir
e
x
p
e
ri
e
n
c
e
o
f
p
a
in

c
o
m
p
a
re
d
w
it
h
th
a
t
o
f
o
th
e
r
o
ld
e
r

p
e
o
p
le

9
.
In

th
e
li
g
h
t
o
f
th
e
ir
u
n
d
e
rs
ta
n
d
in
g

o
f

su
c
c
e
ss
fu
l
a
g
in
g

,
h
o
w

th
is
m
ig
h
t

b
e
in
h
ib
it
e
d
b
y
p
a
in

D
io
n
ig
i
e
t
a
l.

(2
0
1
1
)

2
1
F
e
m
a
le
s

M
e
an

a
g
e
¼
8
3
.3

ye
a
rs
;

ra
n
g
e
:
7
5
–
9
2

M
id
d
le

c
la
ss

C
a
u
c
a
si
a
n
s

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

In
-d
e
p
th

in
te
rv
ie
w

s

In
d
u
c
ti
ve

a
n
al
y
si
s

a
p
p
ro
a
c
h
;
n
a
rr
a
ti
ve

c
o
n
te
n
t
a
n
al
y
si
s

In
c
lu
d
e
d
:

1
.
D
o
yo
u
h
av
e
a
n
y
h
o
b
b
ie
s
o
r
re
g
–

u
la
r
a
c
ti
v
it
ie
s
th
a
t
y
o
u
e
n
jo
y
?

P
le
a
se

d
e
sc
ri
b
e
.

2
.
W

h
a
t
d
o
e
s
su
c
c
e
ss
fu
l
a
g
in
g
m
e
a
n

to

yo
u
?

3
.
W

h
a
t
d
o
e
s
th
e

te
rm

o
ld

m
e
a
n
to

yo
u
?

4
.
P
le
a
se

d
e
sc
ri
b
e
yo
u
r
c
u
rr
e
n
t

h
e
a
lt
h
st
a
tu
s”

(4
0
6
).

P
e
rc
e
p
ti
o
n
s
o
f
b
e
in
g

o
ld
;

d
e
fi
n
it
io
n
s
o
f

su
c
c
e
ss
fu
l
a
g
in
g

G
u
e
ll
,
S
h
e
fe
r,

G
ri
ff
in
,
a
n
d

O
g
il
v
ie

(2
0
1
6
)

1
2
F
e
m
a
le
s;
1
5
m
a
le
s

1
0
w
e
re

6
5
–
6
9
ye
a
rs

o
ld
;

7
w
e
re

7
0
–
7
4
;

1
0

w
e
re

7
5
–
8
0

N
o
rf
o
lk
,
E
n
g
la
n
d

C
o
m
m
u
n
it
y
d
w
e
ll
in
g
S
e
m
i-
st
ru
c
tu
re
d
in
te
r-

v
ie
w
;
th
e
m
a
ti
c
d
a
ta

a
n
al
y
si
s

O
p
e
n
c
o
d
in
g
sy
n
th
e
si
ze
d

in
to

c
a
te
g
o
ri
e
s

E
x
p
lo
re
d
:
e
ve
ry
d
ay

a
c
ti
v
it
ie
s
a
n
d

m
o
ti
v
a
ti
o
n
s;
li
fe
st
y
le

o
p
p
o
rt
u
n
i-

ti
e
s;
c
h
o
ic
e
a
n
d
m
o
ti
v
a
ti
o
n
s

a
c
ro
ss

th
e
se
a
so
n
s
a
n
d
th
e
ir
li
fe

c
o
u
rs
e
;
a
sp
ir
at
io
n
s
in
to

o
ld
e
r
a
g
e

A
sp
ir
a
ti
o
n
s
o
f
a
c
ti
v
e
li
v
in
g
(p
o
si
ti
ve

a
tt
i-

tu
d
e
,
k
e
e
p
in
g
b
o
d
y
a
n
d
m
in
d
a
c
ti
v
e
,

te
n
si
o
n
b
e
tw

e
e
n
st
ay
in
g
b
u
sy

a
n
d

st
ay
in
g
a
c
ti
ve
);
p
ra
c
ti
c
e
s
o
f
a
c
ti
v
e

li
v
in
g
(b
e
in
g
o
u
t
a
n
d
a
b
o
u
t,
p
u
rp
o
se
fu
l

a
c
ti
v
it
ie
s,
a
d
a
p
ti
v
e
a
c
ti
v
e
n
e
ss
);
so
c
ia
l

c
o
n
te
x
t
o
f
a
c
ti
v
e
li
v
in
g
(s
o
c
ia
l
m
o
ti
–

v
at
o
rs

a
s
fa
c
il
it
a
to
rs
,
so
c
ia
l
li
m
it
a
ti
o
n
s

a
s
b
a
rr
ie
rs
)

(c
o
n
ti
n
u
e
d
)
8

607

T
a
b
le
1
.
C
o
n
ti
n
u
e
d
.
A
u
th
o
r(
s)
D
e
m
o
g
ra
p
h
ic
s
D
e
si
g
n
/A
n
a
ly
se
s
Q
u
e
st
io
n
s
M
a
jo
r
T
h
e
m
e
s
(s
u
b
th
e
m
e
s)

H
il
to
n
e
t
a
l.

(2
0
1
2
)

3
8
F
e
m
a
le
s;
2
2
m
a
le
s

M
e
an

a
g
e
¼
6
1
;

ra
n
g
e
:
5
0
–
8
4

L
a
ti
n
o
(a
)

W
e
st
e
rn

st
a
te
s
in

th
e

U
n
it
e
d
S
ta
te
s

F
a
c
e
-t
o
-f
ac
e
in
te
rv
ie
w
s
to

fi
ll
o
u
t
q
u
e
st
io
n
n
ai
re

(m
a
in
ly
c
lo
se

e
n
d
e
d

q
u
e
st
io
n
s)

G
ro
u
n
d
e
d

th
e
o
ry
;
d
e
sc
ri
p
–

ti
v
e
st
a
ti
st
ic
s

D
e
m
o
g
ra
p
h
ic
s
a
n
d
h
e
a
lt
h
st
a
tu
s;

P
h
e
la
n
’s
sc
a
le

o
f
su
c
c
e
ss
fu
l
a
g
in
g
;

a
n
d

“
W

h
e
n
yo
u
th
in
k
a
b
o
u
t
a
g
in
g

w
e
ll
,
w
h
at

c
o
m
e
s
to

m
in
d
?
P
le
a
se

te
ll
u
s
w
h
a
t
su
c
c
e
ss
fu
l
a
g
in
g
m
e
a
n
s

to
yo
u
.”

G
o
o
d
h
e
a
lt
h
;
in
d
e
p
e
n
d
e
n
c
e
;
st
ay
in
g

a
c
ti
v
e
a
n
d
in
vo
lv
e
d
;
fa
m
il
y
a
n
d
so
c
ia
l

re
la
ti
o
n
sh
ip
s;
se
lf
-c
a
re
;
a
c
c
e
p
ti
n
g
th
e

a
g
in
g
p
ro
c
e
ss
;
p
o
si
ti
ve

a
tt
it
u
d
e
s;

c
o
g
–

n
it
iv
e
fu
n
c
ti
o
n
in
g;
fi
n
a
n
c
ia
l
w
e
ll
-b
e
in
g
;

sp
ir
it
u
a
li
ty

a
n
d
tr
an
sc
e
n
d
e
n
c
e

H
o
rd
e
r,
F
ra
n
d
in
,

a
n
d
L
a
rs
so
n

(2
0
1
3
)

9
F
e
m
a
le
s;
1
5
m
a
le
s

M
e
an

a
g
e
¼
8
1
;

ra
n
g
e
:
7
7
–
9
0

W
e
st
e
rn

S
w
e
d
e
n

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

In
d
iv
id
u
a
l
in
te
rv
ie
w
s

C
o
n
te
n
t
a
n
al
y
si
s

E
x
p
lo
re
d
th
o
u
g
h
ts

a
n
d
fe
e
li
n
g
s
re
la
t-

e
d
to

su
c
c
e
ss
fu
l
a
g
in
g;
o
p
e
n
in
g

q
u
e
st
io
n
:
“
P
le
as
e
te
ll
m
e
w
h
a
t

su
c
c
e
ss
fu
l
a
g
in
g
m
e
a
n
s
to

yo
u
.”
(3
)

S
e
lf
-r
e
sp
e
c
t
th
ro
u
g
h
a
b
il
it
y
to

k
e
e
p
fe
ar

o
f
fr
a
il
ty

a
t
a
d
is
ta
n
c
e
(h
av
in
g
su
ff
ic
ie
n
t

b
o
d
il
y
re
so
u
rc
e
s
fo
r
se
c
u
ri
ty

a
n
d

o
p
p
o
rt
u
n
it
y
);
st
ru
c
tu
re
s
th
a
t
p
ro
m
o
te

se
c
u
ri
ty

a
n
d
o
p
p
o
rt
u
n
it
ie
s
(s
a
ti
sf
a
c
–

ti
o
n
w
it
h
o
n
e
’s
fi
n
a
n
c
ia
l
si
tu
at
io
n
;

se
c
u
ri
ty

a
n
d
o
p
p
o
rt
u
n
it
ie
s
in

th
e

c
lo
se
st

c
o
n
te
x
t)
;
fe
e
li
n
g
v
a
lu
a
b
le

in

re
la
ti
o
n
to

th
e
o
u
ts
id
e
w
o
rl
d
(f
e
e
li
n
g

n
o
ti
c
e
d
a
n
d
a
p
p
re
c
ia
te
d
in

so
c
ia
l

re
la
ti
o
n
s;
e
n
g
a
g
e
m
e
n
t
in
a
c
ti
v
it
ie
s
th
a
t

p
ro
v
id
e
p
le
a
su
re

o
r
b
e
n
e
fi
t)
;
c
h
o
o
si
n
g

g
ra
ti
tu
d
e
in
st
e
a
d
o
f
w
o
rr
ie
s
(c
h
o
se

g
ra
ti
tu
d
e
fo
r
n
o
t
b
e
in
g
a
s
b
a
d
a
s

o
th
e
rs
;
d
e
n
y
in
g
d
if
fi
c
u
lt
ie
s;
a
c
c
e
p
ti
n
g

th
in
g
s
yo
u
c
a
n
n
o
t
c
h
a
n
g
e
)

H
su

(2
0
0
7
)

4
8
.1
%

fe
m
a
le
;
5
1
.9
%

m
al
e

(N
¼
5
9
4
)

3
0
.3
%

w
e
re

6
5
–
6
9
ye
a
rs
;

2
4
.7
%

w
e
re
7
0
–
7
4
;

2
4
.8
%

w
e
re

7
5
–
7
9
;

2
0
.2
%

w
e
re

8
0
þ

T
a
iw
a
n
C
o
m
m
u
n
it
y
d
w
e
ll
in
g

S
u
rv
e
y
s
c
o
n
d
u
c
te
d
v
ia

fa
c
e
-t
o
-f
ac
e
in
te
rv
ie
w
s

C
o
n
te
n
t
a
n
al
y
si
s;

fa
c
to
r
a
n
al
y
si
s

2
3
p
re
d
e
te
rm

in
e
d
it
e
m
s
a
b
o
u
t
su
c
–

c
e
ss
fu
l
a
g
in
g
a
n
d
“
W

h
a
t
d
o
yo
u

th
in
k
a
re

th
e
e
ss
e
n
ti
a
l
c
o
m
p
o
–

n
e
n
ts

o
f
a
n
id
e
a
l
a
n
d
sa
ti
sf
a
c
to
ry

o
ld
-a
g
e
li
fe
?”

P
h
y
si
c
a
l
h
e
a
lt
h
(4
7
.4
%
);
fa
m
il
y
a
n
d
so
c
ia
l

su
p
p
o
rt

(2
8
.7
%
);
e
c
o
n
o
m
ic
se
c
u
ri
ty

(1
7
.8
%
);
sp
ir
it
u
a
l
w
e
ll
-b
e
in
g
(1
6
.9
%
);

e
n
v
ir
o
n
m
e
n
t
a
n
d
so
c
ia
l
p
o
li
c
y
(1
1
.7
%
);

e
n
g
a
g
e
m
e
n
t

w
it
h
li
fe

(7
.5
%
)

(c
o
n
ti
n
u
e
d
)
9

608

T
a
b
le
1
.
C
o
n
ti
n
u
e
d
.
A
u
th
o
r(
s)
D
e
m
o
g
ra
p
h
ic
s
D
e
si
g
n
/A
n
a
ly
se
s
Q
u
e
st
io
n
s
M
a
jo
r
T
h
e
m
e
s
(s
u
b
th
e
m
e
s)

Jo
p
p
e
t
a
l.

(2
0
1
5
)

N
¼
2
9
1
(1
5
1
A
m
e
ri
c
a
n
s;

1
5
5

G
e
rm

a
n
s)
;
g
e
n
d
e
r

w
a
s
n
o
t
sp
e
c
if
ie
d

U
.S
.
sa
m
p
le
¼
2
1
%

A
fr
ic
a
n

A
m
e
ri
c
a
n
;
7
%

A
si
a
n

A
m
e
ri
c
a
n
;
6
6
%

W
h
it
e

G
e
rm

a
n
sa
m
p
le
¼

1
0
0
%

W
h
it
e

A
g
e
ra
n
g
e
:
1
5
–
9
6
(1
0
3

“
y
o
u
n
g
p
e
o
p
le
”
;
9
2

“
m
id
d
le
-a
g
e
d
”;
a
n
d

9
6
“
o
ld
e
r
a
d
u
lt
s”
)

M
ix
tu
re
o
f
c
o
m
m
u
n
it
y
d
w
e
ll
in
g
a
n
d
re
si
d
e
n
–
ti
a
l
c
a
re

In
d
iv
id
u
a
l
in
te
rv
ie
w
s;

g
ro
u
n
d
e
d

th
e
o
ry

O
p
e
n

c
o
d
in
g
,
c
lu
st
e
ri
n
g
,
a
n
d

th
e
m
e
id
e
n
ti
fi
c
a
ti
o
n

1
.
W

h
a
t
is
su
c
c
e
ss
fu
l
a
g
in
g
in

yo
u
r

v
ie
w
?

2
.
W

h
a
t
is
in
vo
lv
e
d
in

th
e
p
ro
c
e
ss

o
f

su
c
c
e
ss
fu
l
a
g
in
g
?

H
e
a
lt
h
(8
1
7
%
);
so
c
ia
l
re
so
u
rc
e
s
(6
5
.7
%
);

a
c
ti
v
it
ie
s/
in
te
re
st
s
(5
5
.9
%
);
v
ir
tu
e
s/

a
tt
it
u
d
e
s/
b
e
li
e
fs
(5
1
.0
%
);
w
e
ll
-b
e
in
g

(4
9
.3
%
);
li
fe

m
a
n
a
ge
m
e
n
t/
c
o
p
in
g

(3
5
.9
%
);
fi
n
a
n
c
ia
l
re
so
u
rc
e
s
(3
1
.4
%
);

a
g
in
g
/a
g
e
a
s
a
to
p
ic
(2
5
.5
%
);
in
d
e
p
e
n
–

d
e
n
c
e
(1
7
.6
%
);
m
e
a
n
in
g
in
li
fe
(1
4
.7
%
);

g
ro
w
th
/m

a
tu
ra
ti
o
n
(1
4
.4
%
);
re
sp
e
c
t/

st
a
tu
s
(1
3
.7
%
);
e
d
u
c
a
ti
o
n
/k
n
o
w
le
d
g
e

(1
2
.1
%
);
m
ic
ro
e
n
v
ir
o
n
m
e
n
t
(9
.5
%
);

so
c
ie
ty
/m

ic
ro
e
n
v
ir
o
n
m
e
n
t
(8
.2
%
);

o
th
e
r
(2
.3
%
)

L
a
d
it
k
a
e
t
a
l.

(2
0
0
9
)

N
¼
3
9
6

7
4
.9
%

fe
m
a
le
s

D
iv
e
rs
e
p
a
rt
ic
ip
a
n
ts
,

in
c
lu
d
in
g
A
fr
ic
an

A
m
e
ri
c
a
n
s,
A
m
e
ri
c
a
n

In
d
ia
n
s,

C
h
in
e
se

,

H
is
p
a
n
ic
,
V
ie
tn
a
m
e
se
;

W
h
it
e
M
e
an

a
g
e
¼
7
1
.0

U
n
it
e
d
S
ta
te
s—

9
st
a
te
s

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

4
2
fo
c
u
s
g
ro
u
p
s
C
o
n
st
an
t

c
o
m
p
a
ri
so
n
m
e
th
o
d
s

A
sk
e
d
to

p
ro
v
id
e
a
d
e
sc
ri
p
ti
o
n
o
f

“
so
m
e
o
n
e

w
h
o

yo
u
th
in
k
is

a
g
in
g
w
e
ll
”

L
iv
in
g
to

a
d
v
a
n
c
e
d
a
g
e
;
h
av
in
g
g
o
o
d

p
h
y
si
c
a
l
h
e
a
lt
h
;
h
av
in
g
a
p
o
si
ti
ve

m
e
n
ta
l
o
u
tl
o
o
k
;
b
e
in
g
c
o
g
n
it
iv
e
ly

a
le
rt
;
h
av
in
g
a
g
o
o
d
m
e
m
o
ry
;
a
n
d

b
e
in
g
so
c
ia
ll
y
in
vo
lv
e
d

L
e
w
is
(2
0
1
1
)

1
6
F
e
m
a
le
s;
1
0
m
a
le
s

1
0
0
%

A
la
sk
a
n
N
a
ti
ve
s

(

A
N

)

A
g
e
ra
n
g
e
:
6
1
–
9
3

6
B
ri
st
o
l
B
ay

C
o
m
m
u
n
it
ie
s

In
te
rv
ie
w
s
th
a
t
u
ti
li
ze
d

th
e
“

e
x
p
la
n
a
to
ry

m
o
d
e
l
in
te
rv
ie
w

p
ro
–

to
c
o
l”

1
5
q
u
e
st
io
n
s
c
o
ve
re
d
th
e
se

to
p
ic
s:

“
h
o
w

A
N

E
ld
e
rs

d
e
fi
n
e
su
c
c
e
ss
fu
l

a
g
in
g
;
h
o
w

th
e
ir
a
g
in
g
p
ro
c
e
ss

a
ff
e
c
ts

th
e
ir
e
m
o
ti
o
n
a
l,
sp
ir
it
u
a
l,

F
o
u
r
e
le
m
e
n
ts

w
e
re

im
p
o
rt
a
n
t
to

e
ld
e
r-

sh
ip

(r
e
:

su
c
c
e
ss
fu
l
a
g
e
in
g

):
e
m
o
ti
o
n
a
l

w
e
ll
-b
e
in
g
;
c
o
m
m
u
n
it
y
e
n
g
a
g
e
m
e
n
t;

sp
ir
it
u
a
li
ty
;
p
h
y
si
c
a
l
h
e
a
lt
h (c
o
n
ti
n
u
e
d
)

10

609

T
a
b
le
1
.
C
o
n
ti
n
u
e
d
.
A
u
th
o
r(
s)
D
e
m
o
g
ra
p
h
ic
s
D
e
si
g
n
/A
n
a
ly
se
s
Q
u
e
st
io
n
s
M
a
jo
r
T
h
e
m
e
s
(s
u
b
th
e
m
e
s)

(S
W

A
la
sk
a
)

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

G
ro
u
n
d
e
d
th
e
o
ry
,
in
d
u
c
–

ti
v
e
a
p
p
ro
a
c
h
;
in
te
r-

ra
te
r
re
li
a
b
il
it
y

c
h
e
c
k
e
d
w
it
h
K
a
p
p
a

st
a
ti
st
ic
(M

¼
.8
7
)

a
n
d
c
o
g
n
it
iv
e
w
e
ll
-b
e
in
g
;
a
n
d
if

th
e
ir
c
o
m
m
u
n
it
y
is
su
p
p
o
rt
iv
e
o
f

th
e
m

a
g
in
g
su
c
c
e
ss
fu
ll
y
”

L
e
w
is
(2
0
1
3
)

1
6
F
e
m
a
le
s;
1
0
m
a
le
s
1
0
0
%
A
la
sk
a
n
N
a
ti
ve
s
A
g
e
ra
n
g
e
:
6
1
–
9
3
6
B
ri
st
o
l
B
ay
C
o
m
m
u
n
it
ie
s
(S
W
A
la
sk
a
)
C
o
m
m
u
n
it
y
d
w
e
ll
in
g
In
te
rv
ie
w
s
th
a
t
u
ti
li
ze
d
th
e
“
e
x
p
la
n
a
to
ry
m
o
d
e
l
in
te
rv
ie
w
p
ro
–
to
c
o
l”
G
ro
u
n
d
e
d
th
e
o
ry
,
in
d
u
c
–
ti
v
e
a
p
p
ro
a
c
h
;
in
te
r-
ra
te
r
re
li
a
b
il
it
y
c
h
e
c
k
e
d
w
it
h
K
a
p
p
a
st
a
ti
st
ic
(M
¼
.8
7
)
1
5
q
u
e
st
io
n
s
c
o
ve
re
d
th
e
se
to
p
ic
s:
“
h
o
w
A
N
E
ld
e
rs
d
e
fi
n
e
su
c
c
e
ss
fu
l
a
g
in
g
;
h
o
w
th
e
ir
a
g
in
g
p
ro
c
e
ss
a
ff
e
c
ts
th
e
ir
e
m
o
ti
o
n
a
l,
sp
ir
it
u
a
l,
a
n
d
c
o
g
n
it
iv
e
w
e
ll
-b
e
in
g
;
a
n
d
if
th
e
ir
c
o
m
m
u
n
it
y
is
su
p
p
o
rt
iv
e
o
f
th
e
m
a
g
in
g
su
c
c
e
ss
fu
ll
y
”

O
p
ti
m
is
m

w
a
s
th
e
k
e
y
fi
n
d
in
g
;
it
w
a
s

fo
u
n
d
in

e
a
c
h
o
f
th
e
m
e
s
re
la
te
d
to

e
ld
e
rs
h
ip
;
th
a
t
is
,
m
ai
n
ta
in

a
p
o
si
ti
ve

o
u
tl
o
o
k
w
a
s
e
ss
e
n
ti
a
l
to

e
ld
e
rs
h
ip
/

su
c
c
e
ss
fu
l
a
g
e
in
g

M
o
rt
im
e
r,
W
a
rd
,

a
n
d
W

in
e
fi
e
ld

(2
0
0
8
)

1
4
F
e
m
a
le
s

A
g
e
ra
n
g
e
:
6
0
–
8
9

A
d
e
la
id
e
,
A
u
st
ra
li
a

C
o
m
m
u
n
it
y
d
w
e
ll
in
g
S
e
m
i-
st
ru
c
tu
re
d
in
te
r-
v
ie
w
s;

T
h
e
m
a
ti
c
a
n
a
ly
si
s
w
it
h

in
te
rp
re
ti
ve

p
h
e
n
o
m
e
–

n
o
lo
g
ic
al
a
n
a
ly
–

se
s
fr
a
m
e
w
o
rk

W
h
a
t
d
o
e
s
su
c
c
e
ss
fu
l
a
g
e
in
g
m
e
a
n

to
yo
u
?

P
e
rs
o
n
a
l
a
g
e
n
c
y
(a
d
ap
ta
b
il
it
y
;
n
a
tu
re
;

h
e
a
lt
h
;
li
fe

o
f
th
e
m
in
d
;
fi
n
a
n
c
e
;
sp
ir
i-

tu
a
l
a
n
d
se
lf
-e
x
p
re
ss
io
n
);
so
c
ia
l
v
al
u
e

(i
n
te
rp
e
rs
o
n
a
l;
g
e
n
e
ra
ti
v
it
y
;
a
ff
il
ia
–

ti
o
n
s;
v
a
lu
e
);
q
u
a
li
ty

o
f
li
fe

/d
e
at
h
(l
if
e

q
u
a
li
ty
;
sp
ir
it
u
a
li
ty
;
d
e
a
th
;
a
u
to
n
o
m
y
;

a
u
th
e
n
ti
c
it
y
)

N
g
u
ye
n
a
n
d

S
e
a
l
(2
0
1
4
)

2
7
F
e
m
a
le
s;
1
7
m
a
le
s

2
1
H
m
o
n
g
;
2
3
C
h
in
e
se

A
g
e
ra
n
g
e
:
6
0
–
1
0
0

(C
h
in
e
se
),
6
1
–
9
5

(H
m
o
n
g
);

H
m
o
n
g
a
ll
e
m
ig
ra
te
d
fr
o
m

L
a
o
s
to

U
n
it
e
d
S
ta
te
s;

C
h
in
e
se
w
e
re

a
m
ix

o
f
im
m
ig
ra
n
ts

a
n
d

U
.S
.-
b
o
rn

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

In
te
rv
ie
w
s
w
it
h
se
m
i-

st
ru
c
tu
re
d
n
a
rr
a
ti
ve

in
q
u
ir
y

G
ro
u
n
d
e
d
th
e
o
ry
;
o
p
e
n

c
o
d
in
g
fo
r
e
m
e
rg
e
n
t

th
e
m
e
s;
W

il
c
o
x
o
n

si
g
n
e
d
ra
n
k
su
m

te
st
;

c
h
i-
sq
u
a
re
;
d
e
sc
ri
p
–

ti
v
e
st
a
ti
st
ic
s

D
e
sc
ri
b
e
so
m
e
o
n
e
yo
u
k
n
o
w

w
h
o

yo
u
c
o
n
si
d
e
r
to

b
e
a
g
e
in
g
w
e
ll
;

d
e
sc
ri
b
e
so
m
e
th
in
g
s
o
r
p
e
o
p
le

th
a
t
m
ak
e
yo
u
h
a
p
p
y
;
sc
a
le
s
fo
r

se
lf
-r
e
p
o
rt
e
d
h
e
a
lt
h
,
sa
ti
sf
a
c
ti
o
n

w
it
h
li
fe

H
m
o
n
g:
p
h
y
si
c
a
l
h
e
a
lt
h
a
n
d
m
o
b
il
it
y
;

m
e
n
ta
l
h
e
a
lt
h
;
h
a
rm

o
n
io
u
s
re
la
ti
o
n
–

sh
ip
s;
p
o
si
ti
ve

fa
m
il
y
re
la
ti
o
n
sh
ip
s;

ta
n
g
ib
le

fa
m
il
y
su
p
p
o
rt
;
fi
n
a
n
c
ia
l
st
a
–

b
il
it
y
;
so
c
ia
l
e
n
g
a
g
e
m
e
n
t;
re
li
g
io
u
s

fa
it
h

C
h
in
e
se
:
p
h
y
si
c
a
l
h
e
a
lt
h
a
n
d
m
o
b
il
it
y
;

m
e
n
ta
l
h
e
a
lt
h
;
p
o
si
ti
ve

a
tt
it
u
d
e
s;

sh
e
d
d
in
g
re
sp
o
n
si
b
il
it
ie
s;
p
o
si
ti
ve

fa
m
il
y
re
la
ti
o
n
sh
ip
s;
fi
n
a
n
c
ia
l
st
a
b
il
it
y
;

(c
o
n
ti
n
u
e
d
)
11

610

T
a
b
le
1
.
C
o
n
ti
n
u
e
d
.
A
u
th
o
r(
s)
D
e
m
o
g
ra
p
h
ic
s
D
e
si
g
n
/A
n
a
ly
se
s
Q
u
e
st
io
n
s
M
a
jo
r
T
h
e
m
e
s
(s
u
b
th
e
m
e
s)

so
c
ia
l
e
n
g
a
g
e
m
e
n
t;
re
li
g
io
u
s
fa
it
h
;

a
c
c
o
m
p
li
sh
m
e
n
ts
;
vo
lu
n
te
e
r
w
o
rk

N
im
ro
d
a
n
d

B
e
n
-S
h
e
m

(2
0
1
5
)

7
2
%

fe
m
a
le
s
(N

¼
2
0
7
)

M
e
an

a
g
e
¼
7
8
.7
5
;
ra
n
g
e
:

6
5
–
9
3

U
n
it
e
d
S
ta
te
s
C
o
m
m
u
n
it
y
d
w
e
ll
in
g
In
te
rv
ie
w
s

C
o
n
st
ru
c
ti
v
is
ts

g
ro
u
n
d
e
d
th
e
o
ry

a
n
d
si
tu
at
io
n
–

a
l
a
n
a
ly
si
s

W
h
a
t
a
d
v
ic
e
w
o
u
ld

y
o
u
g
iv
e
m
e
o
n

h
o
w

to
a
c
h
ie
ve

su
c
c
e
ss

fu
l
a
g
e
in
g
?

In
ve
st
m
e
n
ts

m
ad
e
a
t
e
a
rl
ie
r
li
fe

st
a
g
e
s;

p
re
se
rv
in
g
q
u
a
li
ti
e
s
c
o
n
tr
ib
u
te
s
to

w
e
ll
-b
e
in
g
;
in
te
rn
a
l
re
so
u
rc
e
s
th
a
t

p
ro
v
id
e

c
o
p
in
g
st
ra
te
g
ie
s

R
e
ic
h
st
a
d
t,

D
e
p
p
,

P
a
li
n
k
a
s,
F
o
ls
o
m
,

a
n
d
Je
st
e
(2
0
0
7
)

5
3
%

fe
m
a
le
s
(N

¼
7
2
)

A
g
e
ra
n
g
e
:
6
0
–
9
9

S
a
n
D
ie
g
o
,

C
A

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

S
e
m
i-
st
ru
c
tu
re
d
fo
c
u
s

g
ro
u
p
s
w
it
h
“
fu
n
n
e
l

in
te
rv
ie
w

d
e
si
g
n
”

G
ro
u
n
d
e
d
th
e
o
ry
H
o
w
w
o
u
ld

yo
u
d
e
fi
n
e
su
c
c
e
ss
fu
l

a
g
e
in
g
?
W

h
a
t
a
re

th
e
n
e
c
e
ss
a
ry

c
o
m
p
o
n
e
n
ts

o
f
su
c
c
e
ss
fu
l
a
g
e
in
g
?

3
3
F
a
c
to
rs

w
e
re

id
e
n
ti
fi
e
d
w
it
h
4
m
aj
o
r

th
e
m
e
s:
a
tt
it
u
d
e
/a
d
a
p
ta
ti
o
n
;
se
c
u
ri
ty
/

st
a
b
il
it
y
;
h
e
a
lt
h
/w
e
ll
n
e
ss
;
e
n
g
a
g
e
m
e
n
t/

st
im
u
la
ti
o
n

R
e
ic
h
st
a
d
t,

S
e
n
gu
p
ta
,

D
e
p
p
,
P
a
li
n
k
a
s,

a
n
d
Je
st
e
(2
0
1
0
)

5
9
%

fe
m
a
le
s
(N

¼
2
2
)

M
e
an
a
g
e
¼

8
0
;

ra
n
g
e
:
6
4
–
9
6

8
6
%

W
h
it
e
S
a
n
D
ie
g
o
,

C
A
C
o
m
m
u
n
it
y
d
w
e
ll
in
g

In
te
rv
ie
w
s
G
ro
u
n
d
e
d
th
e
o
ry
H
o
w
w
o
u
ld
yo
u
d
e
fi
n
e
su
c
c
e
ss
fu
l
a
g
e
in
g
?
W

h
a
t
is
im
p
o
rt
a
n
t
to

a
g
in
g

su
c
c
e
ss
fu
ll
y
?
H
o
w

h
av
e
yo
u
r
li
fe

e
x
p
e
ri
e
n
c
e
s
in
fl
u
e
n
c
e
d
th
e
c
o
u
rs
e

o
f
yo
u
r
li
fe

a
n
d
h
o
w

y
o
u
a
g
e
?

W
h
a
t
a
re

yo
u
r
su
g
g
e
st
io
n
s
o
n

h
o
w

to
a
g
e
w
e
ll
a
n
d
re
c
o
m
m
e
n
–

d
a
ti
o
n
s
fo
r
sp
e
c
if
ic
in
te
rv
e
n
ti
o
n
s

to
p
ro
m
o
te

h
e
a
lt
h
y
a
g
e
in
g
?

S
e
lf
-a
c
c
e
p
ta
n
c
e
/s
e
lf
-c
o
n
te
n
tm

e
n
t
(r
e
a
li
s-

ti
c
se
lf
-a
p
p
ra
is
a
l;
a
re
v
ie
w
o
f
o
n
e
’s
li
fe
;

fo
c
u
si
n
g
o
n
th
e
p
re
se
n
t)
;
e
n
g
a
g
e
m
e
n
t

w
it
h
li
fe
/s
e
lf
-g
ro
w
th

(n
o
v
e
l
p
u
rs
u
it
s;

g
iv
in
g
to

o
th
e
rs
;
so
c
ia
l
in
te
ra
c
ti
o
n
s;

p
o
si
ti
v
e
a
tt
it
u
d
e
s)

R
o
m
o
e
t
a
l.

(2
0
1
2
)

6
4
%

fe
m
a
le
s
(N
¼
2
2
)
M
e
an
a
g
e
¼

7
8
.3
;

ra
n
g
e
:
5
9
–
9
7

2
3
%
A
fr
ic
a
n
A
m
e
ri
c
an
;
3
2
%

C
h
in
e
se
;

2
0
%

L
a
ti
n
o
(a
);

2
0
%
W
h
it
e

S
a
n
F
ra
n
c
is
c
o
,
C
A

C
o
m
m
u
n
it
y
d
w
e
ll
in
g

S
e
m
i-
st
ru
c
tu
re
d
,
o
p
e
n
–

e
n
d
e
d
in
te
rv
ie
w
s

G
ro
u
n
d
e
d
th
e
o
ry

R
e
se
a
rc
h
e
rs

h
av
e
c
o
m
e
u
p
w
it
h
th
e

te
rm

“
su
c
c
e
ss
fu
l
a
g
in
g.
”
W

h
a
t
c
o
m
e
s
to

m
in
d
w
h
e
n
yo
u
h
e
a
r

th
a
t
te
rm

?
D
o
yo
u
fe
e
l
li
k
e
yo
u

h
av
e
a
g
e
d
su
c
c
e
ss
fu
ll
y
?
D
o
yo
u

fe
e
l
o
ld
?

A
g
in
g
m
e
a
n
s
“
li
v
in
g
in

a
n
e
w

re
a
li
ty
”

(a
c
k
n
o
w
le
d
g
e
th
is
n
e
w

re
a
li
ty
;
re
je
c
t

th
e
n
e
w

re
a
li
ty
);
su
c
c
e
ss
fu
l
a
g
in
g
w
a
s

a
c
h
ie
ve
d
th
ro
u
g
h
a
d
a
p
ta
ti
o
n
a
n
d

c
o
p
in
g
st
ra
te
g
ie
s
(c
o
n
ti
n
u
e
d
)
12

611

T
a
b
le
1
.
C
o
n
ti
n
u
e
d
.
A
u
th
o
r(
s)
D
e
m
o
g
ra
p
h
ic
s
D
e
si
g
n
/A
n
a
ly
se
s
Q
u
e
st
io
n
s
M
a
jo
r
T
h
e
m
e
s
(s
u
b
th
e
m
e
s)

R
o
za
n
o
v
a
,
N
o
u
la
s,

S
o
u
th
w
ic
k
,
a
n
d

P
ie
tr
za
k
(2
0
1
5
)

9
6
.9
%

m
al
e
s
(N

¼
2
,0
2
5
)

A
g
e
ra
n
g
e
:
6
0
–
9
6

S
a
n
F
ra
n
c
is
c
o
,
C
A

C
o
m
m
u
n
it
y
d
w
e
ll
–

in
g
ve
te
ra
n
s

3
o
p
e
n
-e
n
d
e
d
q
u
e
st
io
n
s

o
n
a

su
rv
e
y

T
h
e
m
a
ti
c
a
n
al
y
si
s
“
ro
o
te
d

in
a
n
in
d
ic
a
ti
ve

a
p
p
ro
a
c
h
to

te
x
tu
–

a
l
d
a
ta
”

In
yo
u
r
v
ie
w
,
w
h
a
t
fa
c
to
rs

a
re

m
o
st

im
p
o
rt
a
n
t
to

su
c
c
e
ss
fu
l
p
h
y
si
c
a
l,

e
m
o
ti
o
n
a
l,
a
n
d
c
o
g
n
it
iv
e
a
g
e
in
g
?

“
W

h
a
t
yo
u
d
o
”
(h
e
al
th

b
e
h
av
io
rs
;
so
c
ia
l

e
n
g
a
g
e
m
e
n
t;
m
ai
n
ta
in

g
o
o
d
fu
n
c
ti
o
n
)

w
a
s
th
e
m
o
st

p
ro
m
in
e
n
t
th
e
m
e
fo
r

e
a
c
h
o
f
th
e
th
re
e
q
u
e
st
io
n
s;
th
e

se
c
o
n
d
m
o
st

c
o
m
m
o
n
th
e
m
e
w
a
s

“
w
h
o
yo
u
a
re
”
(p
e
rs
o
n
a
li
ty

a
n
d
e
x
p
la
n
a
to
ry

st
y
le
;
m
o
ra
l
c
o
m
p
a
ss
;

e
m
o
ti
o
n
a
l
d
is
p
o
si
ti
o
n
);
e
x
te
rn
a
l
fa
c
–

to
rs

(e
.g
.,
h
e
a
lt
h
c
a
re
)
w
e
re

la
st

c
o
m
m
o
n
a
c
ro
ss

th
e
d
o
m
a
in
s

T
a
te
,
L
a
h
,
a
n
d

C
u
d
d
y
(2
0
0
3
)

1
0
0
%
m
al
e
s
(N

¼
1
,7
7
1
)

C
an
a
d
a

C
o
m
m
u
n
it
y
d
w
e
ll
in
g
W

W
II

C
a
n
a
d
ia
n
A
ir

F
o
rc
e
ve
te
ra
n

O
p
e
n
-e
n
d
e
d
q
u
e
st
io
n
o
n

su
rv
e
y
C
o
n
te
n
t
a
n
al
y
si
s

W
h
a
t
is
yo
u
r
d
e
fi
n
it
io
n
o
f
su
c
c
e
ss
fu
l

a
g
e
in
g
?
W
o
u
ld

y
o
u
sa
y
yo
u
h
av
e

su
c
c
e
ss
fu
ll
y
a
g
e
d
?

2
0
C
o
m
p
o
n
e
n
t
th
e
m
e
s;
m
o
st

fr
e
q
u
e
n
t

th
e
m
e
s
p
ro
v
id
e
d
:
h
e
a
lt
h
a
n
d
d
is
e
as
e
;

p
h
y
si
c
a
l,
m
e
n
ta
l,
a
n
d
so
c
ia
l
a
c
ti
v
it
y
a
n
d

w
e
re

m
o
re

li
k
e
ly
to

b
e
fo
u
n
d
in

d
e
fi
–

n
it
io
n
s
th
a
t
in
c
lu
d
e
d
in
te
re
st
;
h
av
in
g

g
o
a
ls
;

fa
m
il
y
;

o
r
d
ie
t

T
a
te
,
S
w
if
t,
a
n
d

B
ay
o
m
i
(2
0
1
3
)

1
0
0
%
m
al
e
s
(N

¼
1
,7
4
5
;

5
,8
9
8
n
a
rr
a
ti
ve
s)

C
an
a
d
a
C
o
m
m
u
n
it
y
d
w
e
ll
in
g
W
W
II
C
a
n
a
d
ia
n
A
ir
F
o
rc
e
ve
te
ra
n
O
p
e
n
-e
n
d
e
d
q
u
e
st
io
n
o
n
su
rv
e
y
C
o
n
te
n
t
a
n
al
y
si
s

W
h
a
t
is
yo
u
r
d
e
fi
n
it
io
n
o
f
su
c
c
e
ss
–

fu
l
a
g
e
in
g
?

2
1
T
h
e
m
e
s
w
it
h
8
6
su
b
th
e
m
e
s:
h
e
a
lt
h
—

g
e
n
e
ra
l;
h
e
a
lt
h
—
p
h
y
si
c
a
l;
h
e
a
lt
h
—

c
o
g
n
it
iv
e
;
h
e
a
lt
h
sy
st
e
m
;
a
tt
it
u
d
e
;

h
a
p
p
in
e
ss
;
li
v
in
g
a
n
d
d
y
in
g
;
p
h
y
si
c
a
l

a
c
ti
v
it
y
;
le
is
u
re

a
c
ti
v
it
y
a
n
d
in
te
re
st
s;

li
fe
st
y
le
;
b
e
in
g
p
ro
d
u
c
ti
v
e
o
r
c
o
n
tr
ib
–

u
ti
n
g
;
c
o
p
in
g
;
a
d
ju
st
m
e
n
t;
a
c
c
e
p
ta
n
c
e
;

a
d
a
p
ta
ti
o
n
;
sp
ir
it
u
a
li
ty
/f
ai
th
;
re
la
ti
o
n
–

sh
ip
s—

in
ti
m
a
te
;

re
la

ti
o
n
sh
ip
s—

in
ti
–

m
at
e
;
re
la
ti
o
n
sh
ip
s—

fa
m
il
y
;
re
la
ti
o
n
sh
ip
s—

c
o
m
p
an
io
n
sh
ip
;
re
la
–

ti
o
n
sh
ip
s—

so
c
ie
ty
;
in
d
e
p
e
n
d
e
n
c
e
;
li
fe

e
x
p
e
ri
e
n
c
e
;
q
u
a
li
ty

o
f
li
fe
13

612 The International Journal of Aging and Human Development 91(4)

across the studies. The researchers compared their lists and discussed their
findings to ensure that the data were represented and summarized appropriately.
Table 2 provides these themes alongside the article author(s).

Findings

As Table 2 illustrates, there were 12 main themes that were identified across the

22 studies exploring older adults’ views and definitions of successful aging. Each
of the 12 themes is described in detail later.

Social Relationships

and Interactions

Elements of social relationships and interactions were present across 19 of the 22
studies where older adults defined successful aging as consisting of or incorpo-
rating the following: maintaining connections with family and friends; having

good family and social support; family and intergenerational care; social
engagement and participation; social resources; and having status, appreciation,
and respect in social relations. In describing the importance of social relation-

ships and interactions, the older adults highlighted the need to have good rela-
tionships and engagement with spouses, family, friends, and children (Amin,
2017; Chong et al., 2006; Dionigi et al., 2011; Hilton et al., 2012; Mortimer et al.,

2008; Nguyen & Seal, 2014; Rozanova et al., 2015; Tate et al., 2003, 2013) and,
for some, friendships were even more indispensable than family (Chen, 2015).

The need for help and support from partners/spouses, children, neighbors, and
friends as one grows older was highlighted, but also an opportunity to have a
sense of belonging and being needed through caretaking, particularly for grand-

children (Amin, 2017) or being taking care of by their children by living with
them, having support from them, or receiving frequent visits from them (Hsu,
2007; Nguyen & Seal, 2014). For some older adults, receiving support and feel-

ing loved enabled them to keep from worrying (Horder et al., 2013) and family
well-being was viewed as related to their healthy aging experience and good
health (Nguyen & Seal, 2014) as well as useful in adjusting to changes in later

life (Nimrod & Ben-Shem, 2015).
Social engagements in the community were also important and provided self-

satisfaction, an opportunity to gain respect, and social inclusion or belonging
(Amin, 2017; Jopp et al., 2015; Lewis, 2011; Mortimer et al., 2008; Reichstadt
et al., 2010; Rozanova et al., 2015; Tate et al., 2013). The older adults described

having access to social supports and providing social supports to family, friends,
and neighbors helped to ward off boredom and loneliness and was a source of

encouragement or motivation in staying healthy (Guell et al., 2016; Laditka
et al., 2009; Nguyen & Seal, 2014) even when such activities were undertaken
because of social expectations (e.g., keeping up the house; watching grandchil-

dren; Guell et al., 2016).

14 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 613

Table 2. Themes of Successful Aging.

Themes Frequency Authors

1. Social Relationships

and Interactions

19 Amin (2017); Chen (2015); Chong et al. (2006);

Dionigi et al. (2011); Guell et al. (2016); Hilton

et al. (2012); Horder et al. (2013); Hsu (2007);

Jopp et al. (2015); Laditka et al. (2009); Lewis

(2011); Mortimer et al. (2008); Nguyen and Seal

(2014); Nimrod and Ben-Shem (2015); Reichstadt

et al. (2007, 2010), Rozanova et al. (2015); Tate

et al.

(2003, 2013)

2. Positive Thinking,

Attitude, and

Optimism

17 Chong et al. (2006); Collis and Waterfield (2014),

Dionigi et al. (2011); Guell et al. (2016); Hilton

et al. (2012); Horder et al. (2013); Jopp et al.

(2015); Laditka et al. (2009); Lewis (2011, 2013);

Nguyen and Seal (2014); Nimrod and Ben-Shem

(2015); Reichstadt et al. (2007, 2010); Rozanova

et al. (2015); Tate et al. (2003, 2013)

3. Being Healthy 15 Chen (2015); Chong et al. (2006); Dionigi et al.

(2011); Hilton et al. (2012); Horder et al. (2013);

Hsu (2007); Jopp et al. (2015); Lewis (2011);

Mortimer et al. (2008); Nguyen and Seal (2014);

Nimrod and Ben-Shem (2015); Reichstadt et al.

(2007); Rozanova et al. (2015); Tate et al.

(2003, 2013)

4. Financial Security 13 Amin (2017); Chen (2015); Chong et al. (2006);

Hilton et al. (2012); Horder et al. (2013); Hsu

(2007); Jopp et al. (2015); Mortimer et al. (2008);

Nguyen and Seal (2014); Nimrod and Ben-Shem

(2015); Reichstadt et al. (2007); Rozanova et al.

(2015); Tate et al. (2003)

5. Acceptance and

Adaptation

13 Amin (2017); Collis and Waterfield (2014); Guell

et al. (2016); Hilton et al. (2012); Horder et al.

(2013); Hsu (2007); Jopp et al. (2015); Laditka et al.

(2009); Mortimer et al. (2008); Romo et al. (2012);

Rozanova et al. (2015); Tate et al. (2003, 2013)

6. Engagement

with Life

13 Chen (2015); Chong et al. (2006); Guell et al. (2016);

Hilton et al. (2012); Horder et al. (2013); Hsu
(2007); Jopp et al. (2015); Mortimer et al. (2008);
Nimrod and Ben-Shem (2015); Reichstadt et al.

(2007, 2010); Tate et al. (2003, 2013)

7. Spirituality 11 Amin (2017); Hilton et al. (2012); Hsu (2007); Jopp

et al. (2015); Lewis (2011); Mortimer et al. (2008);

Nguyen and Seal (2014); Nimrod and Ben-Shem

(2015); Rozanova et al. (2015); Tate et al.

(2003, 2013)

(continued)

Teater and Chonody 15

614 The International Journal of Aging and Human Development 91(4)

Positive Thinking, Attitude, and Optimism

Elements of positive thinking, attitude, and optimism were present in 17 studies
and included maintaining a positive attitude and mental outlook, celebrating
and accepting old age, being happy and satisfied with life, choosing gratitude
instead of worries, having peace of mind, maintaining emotional well-being,
engaging in positive thinking and being optimistic, having self-acceptance and
self-contentment, focusing on the present, acknowledging accomplishments,
investing in oneself, and engaging in humor and happiness. The older adults
described the need to maintain a positive attitude despite changes due to aging,
such as not being able to perform the same activities that one could when
younger (Chong et al., 2006). When faced with physical changes and challenges,
such as illness or chronic pain, the older adults described the need to let go and
accept the illness or pain and not let it affect one’s emotions or feel sad about
one’s circumstances (Chong et al., 2006; Hilton et al., 2012; Laditka et al., 2009;
Nguyen & Seal, 2014). The utilization of coping strategies (Collis & Waterfield,
2014) and taking a “get on with it” approach (Guell et al., 2016) where one looks
forward not backwards and experiences contentment, investment in oneself, and
celebrates and accepts old age (Dionigi et al., 2011; Nimrod & Ben-Shem, 2015;
Reichstadtet al., 2007, 2010; Tate et al., 2013) were important when coping with
aging-related changes.

Older adults also described accepting life the way it is, which includes both
happiness and sorrow (Horder et al., 2013) and maintaining an optimist outlook
(Lewis, 2011, 2013; Reichstadt et al., 2007) and positive attitude to move
through grievances and stressful situations (Nguyen & Seal, 2014; Tate et al.,
2003). In doing so, one can have peace with oneself, less worry, better health due

Table 2. Continued.

Themes Frequency Authors

8. Environment and

Social Policy

7 Hsu (2007); Jopp et al. (2015); Mortimer et al.

(2008); Nimrod and Ben-Shem (2015); Reichstadt

et al. (2007); Rozanova et al. (2015); Tate

et al. (2013)

9. Autonomy and

Independence

7 Hilton et al. (2012); Jopp et al. (2015); Mortimer

et al. (2008); Nguyen and Seal (2014); Nimrod and

Ben-Shem (2015); Tate et al. (2003, 2013)

10. Cognitive Health 6 Hilton et al. (2012); Laditka et al. (2009); Nguyen and

Seal (2014); Rozanova et al. (2015); Tate et al.

(2003, 2013)

11. Physically Active 6 Amin (2017); Dionigi et al. (2011); Guell et al. (2016);

Laditka et al. (2009); Tate et al. (2003, 2013)

12. Having a Good

Death

2 Chen (2015); Horder et al. (2013)

16 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 615

to less distress when problems arise, and the ability to live fully and enjoy life

(Jopp et al., 2015; Lewis, 2011, 2013; Reichstadt et al., 2007). Finally, the older

adults reported the importance of acknowledging and reflecting on their accom-

plishments of the past and feeling a sense of pride (Nguyen & Seal, 2014; Tate

et al., 2013) and the importance of keeping a good sense of humor (Nimrod &

Ben-Shem, 2015; Rozanova et al., 2015; Tate et al., 2003, 2013).

Being Healthy

Being healthy was described by older adults as contributing to successful aging

across 15 of the 22 studies where having good physical and mental health, self-

care, sufficient bodily resources for security and opportunities (e.g., mobility),

and engaging in healthy behaviors was viewed as important. Being healthy was

described as the ability to take care of oneself and everyday life, such as being

able to eat, get to places, sleep and to get out of bed, maintain good mobility—

even with assistance—maintain a sense of independence, and keeping busy and

engaged in life (Chen, 2015; Chong et al., 2006; Dionigi et al., 2011; Horder

et al., 2013; Hsu, 2007; Nguyen & Seal, 2014). Being healthy involved making

healthy lifestyle choices, such as participating in exercise, eating healthy, main-

taining a good weight, stress management, vitamin use, medication manage-

ment, avoiding the sun, not smoking, and drinking alcohol in moderation

(Hilton et al., 2012; Nguyen & Seal, 2014; Nimrod & Ben-Shem, 2015;

Reichstadt et al., 2007; Rozanova et al., 2015; Tate et al., 2003, 2013).
It is important to note that some older adults did not equate being healthy

with no disease or medical problems (Chen, 2015; Lewis, 2011; Reichstadt et al.,

2007) and some form of chronic illness was seen as a natural part of growing

older (Nguyen & Seal, 2014). Rather, being healthy meant the ability to adapt

and cope with the changes that come with disease, disability, chronic illness, and

pain by maintaining a sense of independence and ability to self-care to some

degree. Yet, for other older adults, particularly those who were described as

being moderately to highly physically active, being healthy did encompass

aspects of exercise and regular physical activity as important (Dionigi et al.,

2011; Mortimer et al., 2008), and the absence of aches and pains, disease, and

major illness (Hilton et al., 2012; Horder et al., 2013; Jopp et al., 2015; Tate

et al., 2013), especially when it could significantly impede upon mobility

(Nguyen & Seal, 2014) and place a burden on close friends and family

(Horder et al., 2013; Hsu, 2007).

Financial Security

Financial security was cited among the older adults as important to successful

aging in 13 studies. Financial security included the following: no financial wor-

ries; financial resources and well-being; satisfaction with one’s financial

Teater and Chonody 17

616 The International Journal of Aging and Human Development 91(4)

situation; economic security, particularly from environmental and social poli-

cies; and tangible support from family members. Financial security was partic-

ularly important in terms of having enough money through paid employment or

retirement/pension, to support oneself in meeting basic needs, meet living

expenses, access and maintain health insurance, and maintain a sense of inde-

pendence (Chen, 2015; Chong et al., 2006; Hilton et al., 2012; Horder et al.,

2013; Hsu, 2007; Jopp et al., 2015; Nguyen & Seal, 2014; Nimrod & Ben-Shem,

2015; Rozanova et al., 2015; Tate et al., 2003). There was an exception to this

among a group of Hmong older adults who reported the need to have tangible

support from family members where they expected their children to provide

financial assistance in buying groceries and paying bills (Nguyen & Seal,

2014). Having financial security was reported by the older adults to contribute

to one’s ability to have less worries and more a sense of security, to be able to

engage in life and participate in activities one enjoys (Horder et al., 2013;

Reichstadt et al., 2007), and to have good care in old age (Mortimer et al., 2008).

Acceptance and Adaptation

Elements of acceptance and adaptation as contributing to successful aging was

included by older adults across 13 of the 22 studies, which was defined by the

following: adapting to the aging body, accepting the aging process, life manage-

ment/coping, living in a new reality, growth/maturation, and living to advanced

age. The older adults stressed the need to adapt to the normal physical changes

of the body, such as graying hair, changes to eyesight and hearing, mobility, and

chronic diseases (e.g., diabetes, arthritis) without much complaint and being

able to take 1 day at a time and accept the new role of “old” with dignity by

having realistic expectations (Amin, 2017; Guell et al., 2016; Hilton et al., 2012;

Mortimer et al., 2008; Rozanova et al., 2015; Tate et al., 2003, 2013). Even when

older adults experienced chronic pain, they discussed being able to age success-

fully by leading a normal life and accepting that pain is a consequence of aging

that one can accept and adjust by making adaptations to lessen the pain or

discomfort (Collis & Waterfield, 2014). Adaptations to the physical changes

associated with aging could include using assistive devices, engaging in lower

impact activities, reducing activities at a gradual level to keep one’s self-respect,

and replacing activities all together (Guell et al., 2016; Horder et al., 2013; Tate

et al., 2013).
Many older adults also reported the need to continue to live, mature, and

work on oneself in old age by setting goals, taking up new challenges, and

resolving difficulties (Jopp et al., 2015; Laditka et al., 2009; Rozanova et al.,

2015). This involved not viewing age as a punishment, but accepting age and

aging and living for many years in a new reality where physical changes occur,

but such changes merely require the older adult to perceive situations

18 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 617

differently; those who are able to react and adapt were more likely to view aging
as successful (Romo et al., 2012; Tate et al., 2013).

Engagement With Life

In 13 studies, older adults mentioned engagement with life as important to
successful aging, which included continuing to be productive and contribute
to society, being out and about, staying active and involved, engagement in
activities that provide pleasure or benefit, and goals. Remaining active in activ-
ities that one likes to do, such as hobbies, reading, journaling, writing, philos-
ophizing, and travel, and being involved in the community, such as through
volunteering, engagement with cultural activities, church, or senior citizen’s
association, or providing child care to grandchildren was viewed as important
to successful aging (Chen, 2015; Chong et al., 2006; Hilton et al., 2012; Horder
et al., 2013; Hsu, 2007; Jopp et al., 2015; Mortimer et al., 2008; Nimrod & Ben-
Shem, 2015; Reichstadt et al., 2007, 2010; Tate et al., 2003, 2013). The older
adults reported that being engaged and active did not necessarily mean being
physically active, but more getting out of the house and being busy and engaged
and trying new things, which could include a combination of physical and sed-
entary activities (Guell et al., 2016; Reichstadt et al., 2010). Being engaged in life
was related to feeling valuable, and being able to contribute gave a sense of
satisfaction and a purpose in life (Horder et al., 2013; Nimrod & Ben-Shem,
2015; Reichstadt et al., 2007).

Spirituality

Spirituality, which encompassed spiritual well-being, meaning in life, moral
compass, and religious faith, was discussed as an element of successful aging
in 11 studies. The older adults defined spirituality as finding peace in later life
(Amin, 2017); having spiritual understanding and relying on God (Hilton et al.,
2012); celebrating one’s spirit and connecting with something beyond oneself
(Mortimer et al., 2008; Tate et al., 2013); and feeling joy, a sense of tranquillity,
security, hope, and to be happy and peaceful (Hilton et al., 2012; Hsu, 2007;
Nguyen & Seal, 2014; Nimrod & Ben-Shem, 2015; Tate et al., 2003). Some older
adults expressed that getting old was a gift from heaven and being involved in
church, religion, and spirituality was important, gave meaning or a sense of
purpose in life, and helped in preparing for the end of life (Jopp et al., 2015;
Lewis, 2011; Rozanova et al., 2015).

Environment and Social Policy

Older adults in 7 of the 22 studies reported the importance of environmental and
social policy to successful aging, which included education, security and stability
in one’s living environment, nature, housing, health care, and having basic needs

Teater and Chonody 19

618 The International Journal of Aging and Human Development 91(4)

provided. Many older adults expressed the importance of the environment in
contributing to the extent to which they could age successfully. For example,
the importance of quality health care, receipt of free or affordable health care,
access to work, governmental pensions to assist in meeting basic needs, and
having a good education to help in understanding the world and what it means
to be an adult (Hsu, 2007; Jopp et al., 2015; Rozanova et al., 2015; Tate et al.,
2013). One’s living environment also contributed to successful aging whereby the
environment was safe in terms of design (e.g., no stairs; Nimrod & Ben-Shem,
2015) and gave access to nature (Mortimer et al., 2008), or where supports and
resources, such as housekeeping, meals, and activities, were accessible and pro-
vided (Nimrod & Ben-Shem, 2015; Reichstadt et al., 2007).

Autonomy and Independence

Older adults mentioned autonomy and independence, including personal dignity
and authenticity, as an important element to successful aging across 7 of the 22
studies. Autonomy and independence was described as being able to do things
that one likes to do without help, living independently, taking care of oneself
without depending on others, and maintaining good mobility and well-
functioning motor skills, or if needing assistance with mobility, not being bed-
bound (Hilton et al., 2012; Jopp et al., 2015; Nguyen & Seal, 2014; Nimrod &
Ben-Shem, 2015; Tate et al., 2003, 2013). Autonomy and independence was
equated with having a sense of freedom, enabled the older adults to maintain
personal dignity, and contributed to the retention of the authentic self (Horder
et al., 2013; Mortimer et al., 2008).

Cognitive Health

Cognitive health was mentioned as important aspects of successful aging in six
studies, which included good cognitive functioning, being cognitively or men-
tally alert, and keeping active mentally. Cognitive health was defined as having
minimal memory loss, remaining alert, retaining mental activity, and having an
active mind (Hilton et al., 2012; Nguyen & Seal, 2014; Tate et al., 2013), includ-
ing remembering details from the past (Laditka et al., 2009). The older adults
reported that maintaining cognitive health required them to engage in certain
activities, such as mental exercise, reading, playing games, learning new things,
challenges oneself, and engaging in hobbies and creative activities (Rozanova
et al., 2015; Tate et al., 2003).

Physically Active

In six of the studies, engaging in physical activity and keeping active as impor-
tant to successful aging was reported. Some of the older adults described the
need to keep physically active by keeping physically fit and working out, such as

20 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 619

participating in sports or golf (Tate et al., 2003, 2013). Individuals who were

found to be more moderately or highly active described a sense of self-

responsibility for their health in older age and believed that keeping physically

active by getting out and doing things would delay old age whereas individuals

who were found to be inactive did not mention physical activity or exercise as

important to successful aging (Dionigi et al., 2011). Keeping physically active

was not always necessarily about exercise but, rather, having an engaged and

active life where engagement in physical activity was part of socializing, work-

ing, or for a purpose, such as walking to get a newspaper (Guell et al., 2016;

Laditka et al., 2009).

Having a Good Death

Having a good death was mentioned by older adults in 2 of the 22 studies, which

was defined not necessarily as longevity but, rather, as “being able to die at

home surrounded by family members in comfort and warmth” (Chen, 2015,

p. 224). Older adults not only mentioned their own death but also the threat

they experienced by the health, well-being, and death of close relatives and

friends and, especially, a spouse (Horder et al., 2013).

Discussion

The results of this scoping review address a gap in the literature by providing a

synthesis of the research on older adults’ definitions and descriptions of success-

ful aging. Through a greater understanding of older adults’ lived experiences

and perspectives, the basic premises of successful aging can be further evaluated

for its ability to capture the aging process. Across the 12 main themes found in

the 22 studies included in this review, older people identified both internally

and externally controlled elements of aging. That is, older adults relayed their

experience of and perspective on successful aging as a combination of social,

psychological, physical, financial, environmental, and spiritual aspects. While

they included good health and mental, physical, and social well-being, they also

acknowledged that getting older comes with changes, such as decreased mobil-

ity, sensory impairments, disease, disability, chronic illness, and pain; things that

are often beyond one’s control. However, successful aging can still be achieved

when positive thinking, spirituality, adaptation, and acceptance are used.

Moreover, external resources, such as finances and environmental factors may

also help or hinder one’s ability to successfully age. The findings provide a

holistic view of older adulthood that encompasses a large number of facets

that may be influencing an older person’s individual experience of aging.

As we have seen with past theoretical models, reductionism does not facilitate

understanding and can promote oppressive thinking, such as the premises of

Teater and Chonody 21

620 The International Journal of Aging and Human Development 91(4)

disengagement theory, which suggests that older adults should leave the social
and economic arena.

In fact, when comparing this study’s findings to successful aging, a wider
range of factors is found than those suggested by the theory, which focuses
primarily on what one does. “Success” is denoted by a low probability of disease
and disability, high cognitive and physical functioning, and high engagement in
social relationships (Rowe & Kahn, 1997), and individual responsibility is
placed in high regard as a preventative measure for physical, cognitive, and
social decline The older adults in this study do not report that high physical
functioning is equated with successful aging, but, rather, engaging in social,
cognitive, and physical activities are important while also being realistic and
accepting that one will experience changes and challenges to engaging in such
activities due to natural changes in the aging body. Therefore, one needs to
accept such changes as natural and normal and make adaptations versus
merely giving up and concluding they are unsuccessful at aging. Furthermore,
the absence of internal factors that facilitate to assist one in coping and accept-
ing challenges and changes that occur in the “natural” and “normal” aging
process misses key resilience and protective factors present in older people.
This is a limited view of aging and one that also assumes a level playing field
in making healthy choices and access to services and resources. This study’s
findings highlight this gap in theory in that older adults point out that aging
successfully is dependent on external factors, such as financial security, the envi-
ronment, and social policies to meet basic needs, have safe housing, and gain
access to health care. Such external factors influence the extent to which one can
engage in social activities, address health concerns and changes, make healthy
choice (e.g., purchase healthy meals), and engage in life, including physical
activities. The message from the older adults appeared clear in that aging
comes with natural changes and difficulties that cannot always be avoided,
but aging successfully requires the utilization of their social and psychological
supports to adapt, accept, move forward, and maintain a sense of self, pride,
and dignity.

Implications for Future Research and Theory Development

This scoping review has highlighted that successful aging is more complex and
varied across older adults than has been described through aging theories, which
points to several implications for future research and theory development. First,
future aging theories should continue to explore the elements of aging that are of
importance to older adults and the factors that they have experienced or per-
ceive as contributing factors to aging in a positive way instead of relying on
factors identified by theorists and academic researchers. As the findings from
this review highlight, there is variation among older adults on the factors that
contribute to aging successfully or positively with a strong focus on social

22 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 621

relationships and interactions and one’s state of mind over being free of disease
and disability and maintaining high levels of social, cognitive, and physical
activity. The older adults also acknowledged external factors of financial secu-
rity and the environment and social policy as factors that mediate one’s ability
to age successfully. Future theories should reflect more realistic experiences of
aging, including natural changes that will occur, such as graying hair, sensory
changes, and decreased mobility, versus viewing successful or positive aging as
avoiding or fighting such changes. In addition, theories should reflect how older
adults’ access to financial resources, their environments, and social policies help
or hinder their ability to age positively versus viewing aging as the sole respon-
sibility of the individual.

Second, future research exploring the experiences and perspectives of older
adults should carefully consider the way questions are asked and how this makes
a difference to the way in which older adults will respond. For example, Hilton
et al. (2012) found:

when asked to describe someone who is aging well, older adults mention things like

longevity, how good a person looks for his/her age, good genes in the family, and

being able to do things one would not expect of a person that age. Yet, when they

were asked about their own aging, older adults describe a different set of more

personal characteristics. (p. 197)

Using a biographical approach, such as narrative and life history research that
utilizes open-ended questions can encourage older adults to talk about what is
important to them. For example, asking questions such as “Can you tell me how
you feel about growing older?” (Clarke & Warren, 2007, p. 468) or “Please tell
me what successful aging means to you” (Horder et al., 2013, p. 3) would elicit
greater depth and allow for discovery of meaningful factors that positively sup-
port the aging process.

Third, future research should solicit the experiences and perspectives of older
adults among differing groups that explores and highlights intersectionality
issues, such as race/ethnicity, nationality, social class, social identity, gender
identity, sexual orientation, disability status, health status, and geographical
location. The findings from this review demonstrated variations among what
older adults found to be contributing factors to, and their definitions of, suc-
cessful aging based on their demographics and characteristics, and it is impor-
tant for theory to give voice to those who may be marginalized or vulnerable due
social structural barriers. One theory of aging may not be sufficient to adequate-
ly explain the aging process or positive aging for all but, rather, several theories
across differing groups of older adults may be warranted. Beginning with a
theory that incorporates the perspectives and lived experiences of older adults
provides a foundation for creating new theory to address intersectionality or
apply existing theory (e.g., critical race theory, queer theory) when applicable.

Teater and Chonody 23

622 The International Journal of Aging and Human Development 91(4)

Finally, theorists should consider the naming of aging theories and the explic-

it and implicit messages they relay. Successful aging is a strengths-based theory

of aging, but it also implies particular meanings through its name alone. For

example, Jopp et al. (2015) recognizes successful aging combines “aging—typi-

cally associated with retirement, reduced activity, and various forms of loss—

with success, signifying strength, achievement, and productivity,” which creates

“an illusory standard and unrealistically encourage[es] older adults to maintain

the achievement orientation of their youth” (p. 92).

Conclusion

Giving voice to older adults and their views on aging elevates theory develop-

ment and research by creating a context whereby older people are not just

written about, but rather, they are included in the process. Old(er) age is a

goal that most hope to achieve, and in turn, most would concur that they

would like to maintain their ability to self-determine. Part of that self-

determination is defining aging in one’s own terms and implementing strategies

that help one meet challenges headlong, just as we would do at any other age.

The findings from this review suggest that we elevate the strengths and resilience

found in older people while also supporting changes that occur during the aging

process through progressive approaches to care, support, programing,

and policy.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,

authorship, and/or publica

tion of this article.

Funding

The authors received no financial support for the research, authorship, and/or publica-

tion of this article.

References

Amin, I. (2017). Perceptions of successful aging among older adults in Bangladesh: An

exploratory study. Journal of Cross Cultural Gerontology, 32, 191–207.
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological frame-

work. International Journal of Social Research Methodology, 8, 19–32.
Bass, S. A., Caro, F., & Chen, Y. (Eds.). (1993). Achieving a productive aging society.

Westpoint, CT: Greenwood Publishing Group.
Brooks, A. T. (2010). Aesthetic anti-ageing surgery and technology: Women’s friend or

foe? Sociology of Health & Illness, 32, 238–257.
Chapman, S. A. (2005). Theorizing about aging well: Constructing a narrative. Canadian

Journal on Aging, 24(9), 18.

24 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 623

Chen, L. (2015). Rethinking successful aging: Older female volunteers’ perspectives in

Taiwan. Asian Journal of Women’s Studies, 21, 215–231.
Chong, A. M., Ng, S., Woo, J., & Kwan, A. Y. (2006). Positive ageing: The views of

middle-aged and older adults in Hong Kong. Ageing & Society, 26, 243–265.
Chonody, J. M., & Teater, B. (2018). Social work practice with older adults: An actively

aging framework for practice. Thousand Oaks, CA: SAGE Publications.
Clarke, A., & Warren, L. (2007). Hopes, fears and expectations about the future: What

do older people’s stories tell us about active ageing? Ageing & Society, 27, 465–488.
Collis, D., & Waterfield, J. (2014). The understanding of pain by older adults who con-

sider themselves to have aged successfully. Musculoskelet Care, 13, 19–30.
Colquhoun, H. L., Levac, D., O’Brien, K. K., Straus, S., Tricco, A. C., Perrier, L., . . .

Moher, D. (2014). Scoping reviews: Time for clarity in definition, methods, and

reporting. Journal of Clinical Epidemiology, 67, 1291–1294.
Cumming, E., & Henry, W. (1961). Growing old: The process of disengagement. New

York, NY: Basic Books.
Dionigi, R. A., Horton, S., & Bellamy, J. (2011). Meanings of aging among older

Canadian women of varying physical activity levels. Leisure Sciences, 33, 402–419.
Foster, L., & Walker, A. (2015). Active and successful aging: A European policy per-

spective. The Gerontologist, 55, 83–90.
Guell, C., Shefer, G., Griffin, S., & Ogilvie, D. (2016). Keeping your body and mind

active: An ethnographic study of aspirations of healthy ageing. BMJ Open,

6, e009973.
Havighurst, R. J. (1961). Successful aging. The Gerontologist, 1, 8–13.
Hilton, J. M., Gonzalez, C., A., Saleh, M., Maitoza, R., & Anngela-Cole, L. (2012).

Perceptions of successful aging among older Latinos in cross-cultural context. Journal

of Cross Cultural Gerontology, 27, 183–199.
Horder, H. M., Frandin, K., & Larsson, M. E. H. (2013). Self-respect through ability to

keep fear of frailty at a distance: Successful ageing from the perspective of community-

dwelling older people. International Journal of Qualitative Studies on Health and Well-

Being, 8, 20194.
Hsu, H. (2007). Exploring elderly people’s perspectives on successful aging in Taiwan.

Ageing & Society, 27, 87–102.
Jopp, D. S., Wozniak, D., Damarin, A., K., de Feo, M., Jung, S., & Jeswani, S. (2015).

How could lay perspectives on successful aging compliment scientific theory? Findings

from a U.S. and a German life-span sample. The Gerontologist, 55, 91–106.
Kim, D. B. (2008). The study on the development of the Korean elderly’s successful aging

scale. Korean Journal of Social Welfare, 60, 211–231.
Laditka, S. B., Corwin, S. J., Laditka, J. N., Lui, R., Tseng, W., Wu, B., . . . Ivey, S. L.

(2009). Attitudes about aging well among a diverse group of older Americans:

Implications for promoting cognitive health. The Gerontologist, 49, S30–S39.
Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the

methodology. Implementation Science, 5, 69.
Lewis, J. P. (2011). Successful aging through the eyes of Alaska Native elders. What it

means to be an elder in Bristol Bay, AK. The Gerontologist, 51, 540–549.
Lewis, J. P. (2013). The importance of optimism in maintaining healthy aging in rural

Alaska. Qualitative Health Research, 23, 1521–1527.

Teater and Chonody 25

624 The International Journal of Aging and Human Development 91(4)

Martinson, M., & Berridge, C. (2015). Successful aging and its discontents: A systematic

review of the social gerontology literature. The Gerontologist, 55(1), 58–69.
Mendes, F. R. (2013). Active aging: A right or a duty? Health Sociology Review,

22, 174–185.
Montross, L. P., Depp, C., Daly, J., Reichstadt, J., Golshan, S., Moore, D., . . . Jeste,

D. V. (2006). Correlates of self-rated successful aging among community-dwelling

older adults. American Journal of Geriatric Psychiatry, 14, 43–51.
Morell, C. M. ( ). Empowerment and long-living women: Return to the rejected body.

Journal of Ageing Studies, 17, 69–85.
Mortimer, P. M., Ward, L., & Winefield, H. (2008). Successful ageing by whose defini-

tion? Views of older, spiritually affiliated women. Australasian Journal on Ageing,

27, 200–204.
Nguyen, A. L., & Seal, D. W. (2014). Cross-cultural comparison of successful aging

definitions between Chinese and Hmong elders in the United States. Journal of

Cross-Cultural Gerontology, 29, 153–171.
Nimrod, G., & Ben-Shem, I. (2015). Successful aging as a lifelong process. Educational

Gerontology, 41, 814–824.
Phelan, E. A., Anderson, L. A., LaCroix, A. Z., & Larson, E. B. (2004). Older adults’

views of ‘successful aging’: How do they compare with researchers’ definitions?

Journal of American Geriatrics Society, 52, 211–216.
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. The American Journal of Geriatric Psychiatry,

15, 194–201.
Reichstadt, J., Sengupta, G., Depp, C. A., Palinkas, L. A., & Jeste, D. (2010). Older

adults’ perspectives on successful aging: Qualitative interviews. The American Journal

of Geriatric Psychiatry, 18, 567–575.
Romo, R. D., Wallhagen, M. I., Yourman, L., Yeung, C. C., Eng, C., Micco, G., . . .

Smith, A. K. (2012). Perceptions of successful aging among diverse elders with late-life

disability. The Gerontologist, 53, 939–949.
Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The Gerontologist, 37, 433–440.
Rozanova, J., Noulas, P., Southwick, S. M., & Pietrzak, R. H. (2015). Perceptions of

determinants of successful aging among older U.S. veterans: Results from the national

health and resilience in veterans study. The American Journal of Geriatric Psychiatry,

23, 744–753.
Rubinstein, R. L., & de Medeiros, K. (2015). Successful aging,’ gerontological theory and

neoliberalism: A qualitative critique. The Gerontologist, 55, 34–42.
Tate, R. B., Lah, L., & Cuddy, E. (2003). Definition of successful aging by elderly

Canadian males: The Manitoba follow-up study. The Gerontologist, 43, 735–744.
Tate, R. B., Swift, A. U., & Bayomi, D. (2013). Older men’s lay definitions of successful

aging over time: The Manitoba follow-up study. The International Journal of Aging

and Human Development, 76, 297–322.
Teater, B., & Chonody, J. (2017). Promoting actively aging: Advancing a framework for

social work practice with older adults. Families in Society, 98, 137–145.
von Faber, M., Bootsma-van der Wiel, A., van Exel, E., Gussekloo, J., Lagaay, A. M.,

van Dongen, E., . . . Westendorp, R. G. J. (2001). Successful aging in the oldest

26 The International Journal of Aging and Human Development 0(0)

Teater and Chonody 625

old: Who can be characterized as successfully aged? Archives of Internal Medicine,
161, 2694–2700.

Walker, A. (2009). Commentary: The emergence and application of active aging in
Europe. Journal of Aging & Social Policy, 21, 75–93.

White House Conference on Ageing. (2015). White House conference on aging: Final
report. Retrieved from https://whitehouseconferenceonaging.gov/2015-whcoa-final-
report

World Health Organization. (2002). Active ageing: A policy framework. Retrieved from
http://www.who.int/ageing/publications/active_ageing/en/

Author Biographies

Barbra Teater is professor of Social Work and MSW Program director at the
College of Staten Island and is affiliated with the Graduate Center at the City
University of New York.

Jill M. Chonody is associate professor of Social Work and MSW Program
director at Boise State University.

Teater and Chonody 27

An Ecological Systems Framework for
Professional Resilience in Social Work Practice

Jason M. Newell

The cumulative effects of chronic work-related stress pervasively and persistently affect the
well-being of the human services workforce. As a preventive measure, the ongoing commit-
ment to self-care strategies and resources is essential in maintaining a healthy and resilient
professional quality of life. This article describes a holistic approach to cultivating profes-
sional resilience through the ongoing practice of self-care. A model for self-care using an
ecological systems framework with activities across the biological, interpersonal, organiza-
tional, familial, peer-related, spiritual, and recreational aspects of the biopsychosocial self is
proposed. Within this model, emphasis is placed on the role of compassion satisfaction and
vicarious resilience as key components to fostering meaningful and rewarding careers for
social workers.

KEY WORDS: burnout; compassion fatigue; compassion satisfaction; professional resilience;
self-care

F or those who self-select the pursuit of acareer in human services work, social workis far more than a career path, it is a call to
embrace a professional life of deep, meaningful, and
rewarding service. Congruent with the mission,
values, and humanitarian spirit of the social work
profession (National Association of Social Work-
ers [NASW], 2009), social workers dedicate their
professional lives to providing services to those
who are poor, vulnerable, underserved, underpriv-
ileged, or otherwise suffering in some way. Yet
many social workers find themselves unprepared
for the chronic day-to-day exposure to clients and
the emotionally distressing narratives of their myr-
iad psychosocial problems.

The implications of nearly three decades of
practice research have demonstrated that the emo-
tionally challenging aspects of direct social work
practice have potentially deleterious and some-
times consequential psychological effects on social
workers themselves. This research bears particu-
lar relevance for students and newly degreed social
work professionals pursuing careers in child wel-
fare, clinical social work, disaster mental health,
military social work, and other forms of trauma-
related care (Gilin & Kauffman, 2015; D. Greene,
Mullins, Baggett, & Cherry, 2017; Knight, 2010).
It has been suggested that stress-related condi-
tions such as professional burnout, secondary trau-

matic stress, vicarious traumatization, and compas-
sion fatigue may be underestimated “occupational
hazards” for those providing social work services
(Pryce, Shackelford, & Pryce, 2007).

The wealth of evidence in the literature on
the emotional effects of direct social work prac-
tice clearly implies the need for well-developed
and comprehensive training and education on the
practice of self-care as an ongoing professional
behavior for all social workers (Strand, Abramovitz,
Layne, Robinson, & Way, 2014). Yet the emotional
and psychological risks associated with being in
direct practice with vulnerable populations, and the
essential utilization of self-care strategies to address
this important aspect of human services work, has
been an overlooked issue in the academy of social
work education (D. Greene et al., 2017; Newell &
MacNeil, 2010). The need for continued student
education, training, and professional development
at the undergraduate and graduate levels is sup-
ported by NASW, which encourages

the recognition by social work education pro-
grams of their critically important roles in edu-
cating social work students about the practice
of professional self-care by integrating such
content into existing student standards, poli-
cies, foundation and advanced curriculums,
field practicum, and assignments and projects.
(NASW, 2009, p. 270)

doi: 10.1093/sw/swz044 © 2019 National Association of Social Workers 65

D
ow

nloaded from
https://academ

ic.oup.com
/sw

/article-abstract/65/1/65/5669845 by 81695661, O
U

P
on 22 January 2020

Notwithstanding the evidence in the literature
supported by NASW, the most recent revision to
the Educational Policy and Accreditation Stan-
dards by the Council on Social Work Education
(CSWE) makes no direct mention of the im-
portance of including material on the practice of
self-care in social work educational curriculum or
course content (CSWE, 2015). The lack of re-
quired content on self-care as a component of
social work education at the BSW and MSW lev-
els of practice may be a contributing factor to the
higher rates of indirect trauma and professional
burnout in social work practice. It has been noted
that some social work students graduate from their
professional training programs with little knowl-
edge or ability to appropriately use self-care as an
ongoing and essential practice behavior (Gilin &
Kauffman,2015;Newell,2017).Furthermore,many
social work students may be exiting their programs
and entering the workforce without the profes-
sional training to recognize or address the signs
and symptoms of professional burnout, compas-
sion fatigue, and the indirect or vicarious effects of
trauma-related care (D. Greene et al., 2017).

To address this demanding issue for professional
social workers, this article conceptualizes profes-
sional resilience using a multidimensional frame-
work for the practice of self-care. Grounded in
the ecological systems perspective, a fundamen-
tal approach to social work practice, the proposed
framework conceptualizes self-care as a broader set
of practice behaviors pertaining to the whole per-
son, including the physical, interpersonal, organi-
zational, familial, and spiritual domains of the psy-
chosocial self. The model emphasizes self-care as
a holistic set of personal and professional prac-
tice behaviors cultivated through the positive and
growth-promoting aspects of direct practice. Fur-
thermore, the model offers an alternative approach
to addressing the inherent stress in social work
practice by focusing on the rewarding aspects of
the work, rather than the potentially deleteri-
ous effects, as described in the literature using
terms such as “vicarious traumatization,” “sec-
ondary traumatic stress,” “compassion fatigue,” and
“professional burnout.”

LITERATURE REVIEW
Conceptualizing Resilience
Human resilience is a broad construct that has been
studied as an adaptive response to stressful external

stimuli and as the use of coping skills as modera-
tors or buffers to the effects of stress and trauma
(Kent, Davis, & Reich, 2014; van der Walt, Suli-
man, Martin, Lammers, & Seedat, 2014; Yehuda,
Flory, Southwick, & Charney, 2006). The con-
cept of resilience has been examined as a func-
tion of healthy development across the life span
in infants, children, adolescents, adults, and fami-
lies (Masten, 2001; Walsh, 2015). From a cognitive
perspective, resilience has been studied as the vari-
ous ways human beings appraise, process, and regu-
late the emotions attached to external stimuli, with
emphasis on the application of positive thoughts
and emotions to promote psychological well-being
(Duckworth, Steen, & Seligman, 2005; Fredrick-
son, 2004). As a function of spirituality, resilience
has been examined in the form of demonstrating
compassion for the care of others, honoring one’s
own personal and spiritual sense of morality, and
adhering to personal and professional values and
ethics (Pyles, 2018; Seagar, 2014; Wicks & May-
nard, 2014).

The collective literature on the construct of re-
silience reveals no universally agreed-on opera-
tional definition for the term “resilience” (R. R.
Greene & Dubus, 2017). Studies examining resil-
ience often use the term interchangeably with
other similar personality attributes or character-
istics such as hardiness, personal growth, positive
adaptation, and psychological well-being (Luthar,
Cicchetti, & Becker, 2000). The American Psy-
chological Association (2016) described resilience as
“the process of adapting well in the face of adver-
sity, trauma, tragedy, threats or significant sources
of stress—such as family and relationship problems,
serious health problems or workplace and financial
stressors” (para. 1). A broader definition describes
resilience as a multifaceted process of well-being
demonstrated by “a sustained adaptive effort that
prevails despite challenge, as a bouncing back or
recovery from a challenge, and as a process of learn-
ing and growth that expands understanding, new
knowledge, and new skills” (Kent et al., 2014, p. xii).

Professional Resilience in Social Work
Practice
The term “professional resilience” has been used
across the fields of human services work including
counseling, social work, education, psychotherapy,
and other health-related professions to describe
the process by which those who provide services

66 Social Work Volume 65, Number 1 January 2020

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

to vulnerable or at-risk populations thrive within
inherently stressful work conditions (Hegney, Rees,
Eley, Osseiran-Moisson, & Francis, 2015; Hernandez,
Gangsei, & Engstrom, 2007; Skovholt & Trotter-
Mathison, 2011). A recent shift in the trauma lit-
erature indicates a stronger focus on constructs
that define and measure the growth-promoting
aspects of both direct and indirect trauma expo-
sure, rather than the adverse effects. An example
of this paradigm shift from the direct trauma liter-
ature is the conceptualization of posttraumatic
growth (PTG) in comparison with posttraumatic
stress. Studies examining PTG in survivors of trau-
ma emphasize positive changes that occur in the
sense of self, in relationships with others, and in
overall quality of life perspective (Easton, Coohey,
Rhodes, & Moorthy, 2013; Saimos, Rodzik, &
Abel, 2012; Tedeschi & Calhoun, 2004).

Similar to the conceptual evolution of PTG,
research in the area of indirect trauma exposure
has revealed an attempt to bring balance to the
consequential effects of trauma treatment includ-
ing vicarious traumatization, secondary traumatic
stress, and compassion fatigue. Such constructs
have focused solely on the emotionally challeng-
ing aspects of providing direct services to those
who are vulnerable and suffering (Newell, Nelson-
Gardell, & MacNeil, 2016). In contrast, the term
“vicarious resilience” describes the process of trau-
ma recovery as having the potential to foster resil-
ience and growth, not only in the client, but in the
clinician as well (Hernandez et al., 2007). The pro-
cess of vicarious resilience occurs through prac-
tice with clients who, through the healing process,
overcome the effects of trauma through their redis-
covery of the meaningful aspects of life (Engstrom,
Hernandez, & Gangsei, 2008). A more commonly
cited term in this area is the concept of compassion
satisfaction, which refers to those aspects of human
services work that provide professional success,
reward, and fulfillment (Conrad & Keller-Guen-
ther, 2006; Stamm, 1999). Elements of compas-
sion satisfaction include positive interactions with
clients such as celebrating client successes, the for-
mation of meaningful and supportive relationships
with colleagues, the personal and spiritual satisfac-
tion of being in a helping profession, and the posi-
tive professional interactions that occur as benefits
of membership in a helping organization or com-
munity (R. R. Greene & Dubus, 2017; Kapoulistas
& Corcoran, 2015).

Self-Care as a Holistic Process: An
Ecological Systems Perspective

The term “self-care” is common to the discourse
of professional social workers; however, the actual
practice of professional self-care has not been oper-
ationalized in the ways of standardized approaches
to client treatment. Professional self-care has been
described as both a process and a defined set of
practice skills and strategies to mitigate the emo-
tionally challenging effects of providing services
to individuals, families, or communities (Skinner,
2015). Although there are no well-established or
rigorously tested models of self-care practice or
intervention, synthesis of the research literature
anecdotally suggests that the best approach to pro-
fessional resilience is an individualized combina-
tion of strategies at the personal and the organi-
zation levels (Cox & Steiner, 2013; Grise-Owens,
Miller, & Eaves, 2016; Lee & Miller, 2013). The
ecological systems perspective is useful in concep-
tualizing self-care as both a personal and a profes-
sional practice that includes aspects related to phys-
iological health behaviors, interpersonal coping,
organizational strategies, time with family and
friends, recreational activities, and spirituality (R.
R. Greene & Dubus, 2017). Taking a holistic ap-
proach to self-care allows for the application of
various strategies to promote positive professional
quality of life and an overall sense of physical and
emotional well-being.

One of the major premises of the ecological sys-
tems theory is the idea of homeostasis, which refers
to a human system’s drive and collective ability
to maintain its fundamental nature, even during
times of sudden or intense change (Payne, 2014;
Walsh, 2015). Another principle of systems the-
ory suggests that the collective system and all of its
domains naturally adapt and adjust to maintain bal-
ance or equilibrium as a homeostatic state. In terms
of self-care, as the occupational domain directly
influences all other domains in the collective sys-
tem, too much human energy expended in the
stress of work activities takes valuable energy and
resources away from other areas (positive health
behaviors, time with family and friends, spiritual
and recreational activities). Hence, maintaining an
ongoing plan of self-care helps to create a healthy
work–life balance, which will hopefully recipro-
cally contribute to professional resilience and over-
all well-being.

Newell / An Ecological Systems Framework for Professional Resilience in Social Work Practice 67

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

Figure 1: Ecological Systems Framework for Holistic Self-Care

Given the breadth of the concept of stress and
its application across micro and macro domains,
the ecological systems perspective provides a use-
ful way of thinking about, understanding, and con-
ceptualizing the impact of stress on the personal
and professional lives of social workers. Using the
holistic approach proposed in the ecological sys-
tems framework, self-care activities across several
domains consisting of biophysiological, interper-
sonal, organizational, familial, peer-related, spiri-
tual, and recreational activities all contribute to a
comprehensive method of practice. Figure 1 pro-
vides an illustration of the ecological systems per-
spective as it applies to the practice of self-care.

Applying the Ecological Systems
Framework
Simple strategies for self-care at the individual
level range from maintaining positive health behav-
iors, spiritual activities, recreational activities, posi-
tive forms of self-expression, and connections with
family members and close friends. With regard to

the physiological domain of self-care, the most log-
ical place to begin is with “the basics” by assess-
ing activities related to physical well-being. Positive
health behaviors such as meal planning, sleep habits,
regular exercise and physical activity, and leisure
time are essential to the self-care process (Bush,
2015; Grise-Owens et al., 2016). If the need for an
improved meal plan and exercise routine is an iden-
tified area of self-care, it is best to start with one
reasonable health behavior goal or objective (that
is, avoid “pie in the sky” goals). For example, setting
a goal to complete a marathon is only reasonable
for someone who is interested in training to be a
marathon runner. Whereas completing a marathon
is a reasonable long-term goal, a reasonable short-
term goal is to make time to take a brisk walk at
least once each workday for one month. This is
also true when setting food intake and food behav-
ior goals. Healthy eating goals can be as simple as
making a commitment to buying healthy food
items and packing a sensible lunch rather than
relying on vending machines or fast food as daily

68 Social Work Volume 65, Number 1 January 2020

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

sources of nutrition; substituting water for soda,
coffee, or other caffeinated beverages; or leaving
one’s office or computer space to eat lunch for a
mental break in a nonworking space.

Social workers understand the value and impor-
tance of human relationships in sustaining personal
and professional resilience and well-being over
time. When social workers allow work responsi-
bilities to take time away from family and friends,
there is potential for adding an additional layer of
stress from the guilt and shame that comes from
neglecting those who are most important in our
lives. In the absence of individual and familial self-
care, the chronic emotional demands of social work
practice may result in the depletion of empathy
resources to provide care for both the self and oth-
ers, leaving an empty reservoir of compassion and
empathy for families, friends, and other loved ones.
Therefore, part of the practice of self-care is to pre-
serve one’s natural empathy by valuing and pro-
tecting time for the experience of joy, laughter, and
compassion with family, friends, and other loved
ones (Giles, 2014; Pennebaker & Smyth, 2016).
The use of social support from family, pets, and
close friends has been shown to buffer the effects
of occupational stress, which ultimately contributes
to both the process of self-care and an over-
all sense of personal and professional well-being
(Grise-Owens et al., 2016; Viswesvaran, Sanchez,
& Fisher, 1999).

Organizational self-care begins with simple strat-
egies such as avoiding procrastination and allo-
cating sufficient work time to complete required
assignments, reports, or documentation. Protecting
calendar time, which for some is simply learning
to control one’s calendar, is an essential time man-
agement skill that includes not only setting reason-
able deadlines, but also actively prioritizing per-
sonal and professional obligations. Social workers
may find that taking a task-centered approach, by
setting specific goals and objectives for each day of
the week and remaining dedicated to these tasks
when possible, is useful in developing time man-
agement skills. A thorough assessment of out-of-
office calendar time (meetings, home visits, and so
on) and time spent working in the office may prove
useful in determining areas in which time may be
used more efficiently.

Before developing a formal strategy for orga-
nizational self-care, it is beneficial to examine
the impact of agency philosophy, culture, climate,

administrative structure, policies, and procedures
on agency providers and the clients they serve
(Lee & Miller, 2013). For example, the presence
of an agency culture that values the use of sup-
portive supervision, particularly for those new to
the social work profession, is useful in building
organizational resilience and professional efficacy
(Cox & Steiner, 2013). Social work practice is
grounded in the ability to develop healthy rela-
tionships through effective forms of communica-
tion. Supervisors play a vital role in cultivating pro-
fessional resilience by providing effective relational
guidance, support, education, and practice wisdom
during times of stress and professional insecurity
(Skovholt & Trotter-Mathison, 2011). Social sup-
port from professional colleagues through acts such
as assistance with administrative duties, insight into
difficult cases, or comfort during times of crisis
have been suggested as helpful for social workers
(Maslach, 2003).

Like the other components of the holistic ap-
proach to self-care, spirituality or having a spiri-
tual life is individually unique. Spirituality has been
defined as a “devotion to the immaterial part of
humanity and nature, rather than worldly things
such as possessions; an orientation to people’s reli-
gious, moral, or emotional nature” (Barker, 2014,
p. 409). Other components of spirituality include
self-perception, adherence to personal values and
ethics, belief in the existence and influence of a
higher power, and the formation of meaning-
ful relationships with others who are like-minded
subscribers to a common cause for social justice
and peace, a process described as “healing justice”
(Pyles, 2018). The presence of spirituality has been
shown to buffer the effects of workplace stress and
contribute to overall well-being as a vital source
of resilience and renewal for individuals and fam-
ilies (Brelsford & Farris, 2014; Csiernik & Adams,
2002).

The practice of spiritual self-care involves the
development and maintenance of spiritually or
religiously based practices as buffers to the effects
of personal and professional stress and as sources
of self-renewal and overall well-being. Strategies
for maintaining the religious component of spir-
itual self-care include regularly attending faith-
based services and activities, participating in reli-
gious observations and rituals, and praying (Falb
& Pargament, 2014). Nonreligiously based com-
ponents of spiritual self-care include engaging in

Newell / An Ecological Systems Framework for Professional Resilience in Social Work Practice 69

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

Table 1: Suggestions for Developing a Comprehensive Plan of Self-Care

Self-Care Domain Suggested Strategies

Biological Balanced diet and nutrition; adequate sleep schedule; regular exercise regime; moderation
in alcohol use; utilization of health and mental health days to recover from physical or
emotional illness, including grief work

Interpersonal Maintenance of professional boundaries with clients; creating a healthy balance between
personal and professional obligations; use of adaptive rather than maladaptive coping skills;
active engagement of anxiety associated with clients through techniques such as
mindfulness, self-talk, and self-awareness; use of psychotherapy, counseling, or support
group help (particularly for those with a personal trauma history)

Organizational Seeking out organizations with missions consistent with personal values and career
aspirations; ongoing participation in education, training, and professional development
opportunities; active participation supervision and ongoing mentorship; engaging in
supportive relationships with professional colleagues; setting realistic goals and objectives
for the workday or workweek; using coffee and lunch breaks for non-work-related
activities; participating in the celebration of client success and fulfillment; maintaining a
realistic worldview about the impact of client work on the self

Familial Ongoing use of social support from family and close friends; participation in nonstressful
family events; engaging in “no technology” dinners and family time; scheduling family
and couples vacation time; participating in children’s activities, school functions, and sports
events (if applicable); protecting time to celebrate special family events, birthdays, or
anniversaries; scheduling nonfamily time to catch up with close friends; caring for and
spending time with family pets

Spiritual Attending faith-based services regularly; engaging in positive forms of self-expression and
self-revitalization, for example, yoga, meditation, philanthropic activities

Recreational Reading; drawing; painting; sculpting; team sports; cooking; hiking; swimming; movies;
other outdoor activities or forms of positive self-expression; any activity personally or
professionally fostering the use of joy, humor, or laughter

positive forms of self-expression and revitalization
such as painting, journaling, inspirational reading,
and playing or listening to music (Baldwin, 1990;
Gladding, 2011; Pennebaker & Smyth, 2016). The
application of activities of healing and self-renewal
such as the use of conscious relaxation, yoga, and
meditation have also been suggested as positively
influencing spirituality and well-being (Richards,
Campenni, & Muse-Burke, 2010). Finally, recre-
ational activities that involve separation from the
work environment, particularly those involving a
deeper connection to a natural environment such
as hiking, swimming, or camping, may also be a
source of spiritual healing and self-care for some
direct practitioners (Falb & Pargament, 2014; Pearl-
man & Saakvitne, 1995). Table 1 provides sugges-
tions for developing a comprehensive plan of self-
care across the biological, interpersonal, organiza-
tional, familial, spiritual, and recreational domains
of the psychosocial self.

SOCIAL WORK PRACTICE AS SELF-CARE
Professional resilience represents the positive out-
comes of social work practice as they balance
the negative and sometimes deleterious effects of

human services work with those who are vulnera-
ble or suffering. Social workers garner the profes-
sional education, skills, and abilities to practice self-
care; it seems the biggest challenge is the pledge to
embrace self-care as an essential and ongoing prac-
tice behavior. For social workers who have dedi-
cated their lives to caring for others, practicing
self-care may seem counterintuitive. However, main-
taining a plan of professional self-care requires lit-
tle more than applying the basic theories, skills, and
knowledge used to facilitate consumers through
the process of case management and treatment
planning. Therefore, training in the practice of self-
care becomes a matter of commitment and culti-
vation. For example, fundamental to the practice
of social work is the assessment of human behavior
as it interfaces with the social environment; para-
doxically, this core competency can be applied to
the practitioner to gain valuable insights into both
personal and professional patterns of behavior.
Other mainstays of social work practice, such as the
utilization of problem-solving and task-centered
approaches, can easily be applied when creating a
useful, functional, and ongoing plan of professional
self-care. The use of strengths-based practice can be

70 Social Work Volume 65, Number 1 January 2020

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

used to identify areas of professional or client suc-
cess as an analytic of the positive aspects of work-
ing within human services organizations. Finally,
the use of psychosocial assessment skills to com-
prehensively examine personal and professional
areas in need of improvement may prove helpful in
determining future self-care goals and objectives.

DISCUSSION
Professional awareness of the importance of self-
care in the practice community has been acknowl-
edged and supported by NASW, defining self-care as

a core essential component to social work prac-
tice [that] reflects a choice and commitment to
become actively involved in maintaining one’s
effectiveness as a social worker in preventing
and coping with the natural, yet unwanted, con-
sequences of helping. (NASW, 2009, p. 269)

The practice of self-care has been described as
the “key to professional resilience” (Newell, 2017),
generally in the form of “professional” self-care,
which fails to acknowledge that self-care is a holis-
tic practice with domains that move beyond the
professional setting. Although there are various
recommended components to developing and
maintaining self-care, and some suggested formu-
lations for how to prepare or construct a self-
care plan, the practice and process of maintain-
ing an ongoing plan of personal and professional
self-care is subjective to the individual practitioner
(Cox & Steiner, 2013; Lee & Miller, 2013). The
term “self-care” is in many ways defining, mean-
ing the approach to this practice is specific to the
interpersonal and physical needs of the individual,
the demands of the organization, balancing family
responsibilities, and other life dimensions. There-
fore, finding the right combination of activities to
promote a healthy balance between personal and
professional obligations should be the overarch-
ing goal in developing an ongoing plan of self-
care. The ecological systems framework described
in this article proposes a practical approach to
establishing, maintaining, and articulating self-care
practices. There is adequate research on the vari-
ous approaches to the practice of self-care, but few
models of this practice have been empirically vali-
dated. This is a logical next step for future research
and training initiatives.

Social work provides the great privilege of
focusing practice and research on the well-being

of others, with commitment that is unparalleled in
other professions. The reward for providing ser-
vices to those who are poor, vulnerable, under-
served, or suffering comes in the form of gratitude
and joy in knowing our consumers’ quality of life
improves because of the work that we do (Pooler,
Wolfer, & Freeman, 2014). The breadth of research
evidence on the effects of social work practice on
practitioners themselves has led the profession to
a place of understanding and acceptance that the
cumulative stress effects of social work practice
may negatively affect provider well-being. Hence,
committing to a plan of self-care as an ongoing
practice behavior is essential for social work profes-
sionals, not only for themselves, but for the better-
ment of the consumers of their services. Our pro-
fession has lost far too many earnest social workers
dedicated to the values, mission, and humanitarian
spirit of social work to the indirect effects of trauma
and professional burnout. To address this issue, the
social work profession and the academy of social
work education have a duty to promote the ongo-
ing practice of self-care through training and con-
tinuing education as an ethical imperative to both
future and current social worker practitioners. SW

REFERENCES
American Psychological Association. (2016). The road to

resilience. Washington, DC: Author. Retrieved from
http://www.apa.org/helpcenter/road-resilience.aspx

Baldwin, C. (1990). Life’s companion: Journal writing as a
spiritual quest. New York: Bantam Books.

Barker, R. L. (2014). The social work dictionary (6th ed.).
Washington, DC: NASW Press.

Brelsford, G. M., & Farris, J. R. (2014). Religion and
spirituality: A source of renewal for families. In
R. J. Wicks & E. A. Maynard (Eds.), Clinician’s guide
to self-renewal (pp. 355–365). New York: Oxford
University Press.

Bush, A. D. (2015). Simple self-care for therapists: Restorative
practices to weave through your workday. New York:
W. W. Norton.

Conrad, D., & Keller-Guenther, Y. (2006). Compassion
fatigue, burnout, and compassion satisfaction among
Colorado child protection workers. Child Abuse &
Neglect, 30, 1071–1080.

Council on Social Work Education. (2015). Educational
policy and accreditation standards. Retrieved from
https://www.cswe.org/getattachment/Accreditatio
n/Accreditation-Process/2015-EPAS/2015EPAS_
Web_FINAL .aspx

Cox, K., & Steiner, S. (2013). Self-care in social work: A guide
for practitioners, supervisors, and administrators. Washing-
ton, DC: NASW Press.

Csiernik, R., & Adams, D. W. (2002). Spirituality, stress,
and work. Employee Assistance Quarterly, 18(2), 29–37.

Duckworth, A. L., Steen, T. A., & Seligman, M.E.P. (2005).
Positive psychology in clinical practice. Annual Review
of Clinical Psychology, 1, 629–651.

Easton, S. D., Coohey, C., Rhodes, A. M., & Moorthy, M. V.
(2013). Posttraumatic growth among men with

Newell / An Ecological Systems Framework for Professional Resilience in Social Work Practice 71

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

histories of child sexual abuse. Child Maltreatment, 18,
211–220.

Engstrom, D., Hernandez, P., & Gangsei, D. (2008). Vicari-
ous resilience: A qualitative investigation into its
description. Traumatology, 14(3), 13–21.

Falb, M. D., & Pargament, K. J. (2014). Spiritual coping
resources for the self-renewal of clients and therapists.
In R. J. Wicks & E. A. Maynard (Eds.), Clinician’s
guide to self-renewal (pp. 335–353). New York: Oxford
University Press.

Fredrickson, B. L. (2004). The broaden-and-build theory
of positive emotions. Philosophical Translational Royal
Society of London B Biological Sciences, 359, 1367–1377.

Giles, C. A. (2014). Self-renewal through natural empathy.
In R. J. Wicks & E. A. Maynard (Eds.), Clinicians guide
to self-renewal (pp. 119–129). New York: Oxford
University Press.

Gilin, B., & Kauffman, S. (2015). Strategies for teaching
about trauma to graduate social work students. Journal
of Teaching in Social Work, 35, 378–396. doi:10.1080
/08841233.2015.1065945

Gladding, S. T. (2011). The creative arts in counseling (4th ed.).
Alexandria, VA: American Counseling Association.

Greene, D., Mullins, M., Baggett, P., & Cherry, D. (2017).
Self-care for helping professionals: Students’ perceived
stress, coping self-efficacy and subjective experiences.
Journal of Baccalaureate Social Work, 22(17), 1–16.

Greene, R. R., & Dubus, N. (2017). Resilience in action: An
information and practice guide. Washington, DC: NASW
Press.

Grise-Owens, E., Miller, J., & Eaves, M. (2016). The A-to-Z
self-care handbook for social workers and other helping
professionals. Harrisburg, PA: The New Social Worker
Press.

Hegney, D. G., Rees, C. S., Eley, R., Osseiran-Moisson, R.,
& Francis, K. (2015). The contribution of individual
psychological resilience in determining the profes-
sional quality of life of Australian nurses. Frontiers in
Psychology, 6, 1–8. doi:10.3389/fpsyg.2015.01613

Hernandez, P., Gangsei, D., & Engstrom, D. (2007). Vicari-
ous resilience: A new concept in work with those
who survive trauma. Family Process, 46, 229–241.

Kapoulistas, M., & Corcoran, T. (2015). Compassion fatigue
and resilience: A qualitative analysis of social work
practice. Qualitative Social Work, 14(1), 86–101.

Kent, M., Davis, M. C., & Reich, J. W. (2014). The resilience
handbook: Approaches to stress and trauma. New York:
Routledge.

Knight, C. (2010). Indirect trauma in the field practicum:
Secondary traumatic stress, vicarious trauma, and
compassion fatigue among social work students and
their field instructors. Journal of Baccalaureate Social
Work, 15(1), 31–54.

Lee, J., & Miller, S. (2013). A self-care framework for social
workers: Building a strong foundation for practice.
Families in Society, 94, 96–103.

Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The construct
of resilience: A critical evaluation and guidelines for
future work. Child Development, 71, 543–562.

Maslach, C. (2003). Burnout: The cost of caring. Cambridge,
MA: Malor Book.

Masten, A. S. (2001). Ordinary magic: Resilience processes
in development. American Psychologist, 56, 227–238.

National Association of Social Workers. (2009). Profes-
sional self-care and social work. In Social work speaks:
National Association of Social Workers Policy Statements,
2009–2012 (8th ed., pp. 268–272). Washington, DC:
NASW Press.

Newell, J. M. (2017). Cultivating professional resilience in direct
practice: A guide for human service professionals. New
York: Columbia University Press.

Newell, J. M., & MacNeil, G. A. (2010). Professional burn-
out, vicarious trauma, secondary traumatic stress, and
compassion fatigue: A review of theoretical terms,
risk factors, and preventive methods for clinicians and
researchers. Best Practices in Mental Health: An
International Journal, 6(2), 57–68.

Newell, J. M., Nelson-Gardell, D., & MacNeil, G. (2016).
Clinician response to client traumas: A chronological
review of constructs and terminology. Journal of
Trauma, Violence, & Abuse, 17, 306–313. doi:10.1177
/1524838015584365

Payne, M. (2014). Modern social work theory (4th ed.). New
York: Oxford University Press.

Pearlman, L. A., & Saakvitne, K. W. (1995). Trauma and the
therapist: Countertransference and vicarious traumatization
in psychotherapy with incest survivors. New York: W. W.
Norton.

Pennebaker, J. W., & Smyth, J. M. (2016). Opening up by
writing it down: How expressive writing improves health
and eases emotional pain. New York: Guilford Press.

Pooler, D. K., Wolfer, T., & Freeman, M. (2014). Finding joy
in social work II: Intrapersonal sources. Social Work,
59, 213–221. doi:10.1093/sw/swu020

Pryce, J. G., Shackelford, K. K., & Pryce, D. H. (2007).
Secondary traumatic stress and the child welfare professional.
Chicago: Lyceum Books.

Pyles, L. (2018). Healing justice: Holistic self-care for change
makers. New York: Oxford University Press.

Richards, K. C., Campenni, C. E., & Muse-Burke, J. L.
(2010). Self-care and well-being in mental health
professionals: The mediating effects of self-awareness
and mindfulness. Journal of Mental Health Counseling,
32, 247–264.

Saimos, C., Rodzik, A. K., & Abel, L. M. (2012). Secondary
traumatic stress and adjustment in therapists who
work with sexual violence survivors: The moderating
role of posttraumatic growth. British Journal of
Guidance & Counselling, 40, 341–356.

Seagar, M. (2014). Mind as a dimension & compassion as a
relationship issue. Journal of Compassionate Health Care,
1, Article 3. doi:10.1186/s40639-014-0003-y

Skinner, J. (2015). Social work practice and professional
self-care. In K. Corcoran & A. R. Roberts (Eds.),
Social workers’ desk reference (3rd ed., pp. 130–139).
New York: Oxford University Press.

Skovholt, T. M., & Trotter-Mathison, M. (2011). The
resilient practitioner: Burnout prevention and self-care
strategies for counselors, therapists, teachers, and health
professionals (2nd ed.). New York: Routledge.

Stamm, B. H. (1999). Secondary traumatic stress: Self-care issues
for clinicians, researchers, and educators. Baltimore: Sidran
Press.

Strand, V. C., Abramovitz, R., Layne, C. M., Robinson, H.,
& Way, I. (2014). Meeting the critical need for
trauma education in social work: A problem-based
learning approach. Journal of Social Work Education, 50,
120–135.

Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic
growth: Conceptual foundations and empirical
evidence. Psychological Inquiry, 15(1), 1–18.

van der Walt, L., Suliman, S., Martin, L., Lammers, K., &
Seedat, S. (2014). Resilience and post-traumatic stress
disorder in the acute aftermath of rape: A compara-
tive analysis of adolescents versus adults. Journal of
Child & Adolescent Mental Health, 26, 239–249.
doi:10.2989/17280583.2014.923433

Viswesvaran, C., Sanchez, J. I., & Fisher, J. (1999). The role
of social support in the process of work stress: A meta-
analysis. Journal of Vocational Behavior, 54, 314–334.

Walsh, F. (2015). A family resilience framework. In K. Cor-
coran & A. R. Roberts (Eds.), Social workers’ desk

72 Social Work Volume 65, Number 1 January 2020

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

reference (3rd ed., pp. 427–433). New York: Oxford
University Press.

Wicks, R. J., & Maynard, E. A. (2014). Clinician’s guide to
self-renewal: Essential advice from the field. New York:
Oxford University Press.

Yehuda, R., Flory, J. D., Southwick, S., & Charney, D. S.
(2006). Developing an agenda for translational studies
of resilience and vulnerability following trauma
exposure. Annals of the New York Academy of Sciences,
1017, 379–396.

Jason M. Newell, PhD, LICSW, is professor and social work
program director, Department of Behavioral and Social Sciences,
University of Montevallo, 737 Main Street, Station 6180,
Montevallo, AL 35115; e-mail: jnewell2@Montevallo.edu.

Original manuscript received September 12, 2018
Final revision received August 12, 2019
Editorial decision September 9, 2019
Accepted September 12, 2019
Advance Access Publication December 8, 2019

Newell / An Ecological Systems Framework for Professional Resilience in Social Work Practice 73

D
ow
nloaded from
https://academ
ic.oup.com
/sw
/article-abstract/65/1/65/5669845 by 81695661, O
U
P
on 22 January 2020

© 2020 National Association of Social Workers. Copyright of Social Work is the property of
Oxford University Press / USA and its content may not be copied or emailed to multiple sites
or posted to a listserv without the copyright holder’s express written permission. However,
users may print, download, or email articles for individual use.

1

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).

Sessions: Case histories. Laureate International Universities Publishing.

Sara

Sara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment

with her 48-year-old daughter, Stephanie, and six cats. Sara and her daughter have

lived together for the past 10 years since Stephanie returned home after a failed

relationship and was unable to live independently. Stephanie has a diagnosis of bipolar

disorder, and her overall physical health is good. Stephanie has no history of treatment

for alcohol or substance use; during her teens she drank and smoked marijuana but no

longer uses these substances. When she was 16 years old, Stephanie was hospitalized

after her first bipolar episode. She had attempted suicide by swallowing a handful of

Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her.

She has been hospitalized three times in the past 4 years when she stopped taking her

medications and experienced suicidal ideation. Stephanie’s current medications are

Lithium, Paxil®, Abilify®, and Klonopin®.

Stephanie recently had a brief hospitalization as a result of depressive symptoms. She

attends a mental health drop-in center twice a week to socialize with friends and

receives outpatient psychiatric treatment at a local mental health clinic for medication

management and weekly therapy. She is maintaining a part-time job at a local

supermarket where she bags groceries and is currently being trained to become a

cashier. Stephanie has active Medicare and receives Social Security Disability (SSD).

Sara has recently been hospitalized for depression and has some physical issues. She

has documented high blood pressure and hyperthyroidism, she is slightly underweight,

and she is displaying signs of dementia. Sara has no history of alcohol or substance

use. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and

receives Social Security benefits and a small pension. She attends a day treatment

program for seniors that is affiliated with a local hospital in her neighborhood. Sara

attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van service is

provided free of charge.

A telephone call was made to Adult Protective Services (APS) by the senior day

treatment social worker when Sara presented with increased confusion, poor attention

to daily living skills, and statements made about Stephanie’s behavior. Sara told the

social worker at the senior day treatment program that, “My daughter is very

argumentative and is throwing all of my things out.” She reported, “We are fighting like

cats and dogs; I’m afraid of her and of losing all my stuff.”

Home Visit

During the home visit, the APS worker observed that the living room was very cluttered,

but that the kitchen was fairly clean, with food in the refrigerator and cabinets. Despite

the clutter, all of the doorways, including the front door, had clear egress. The family

lives on the first floor of the apartment building and could exit the building without

difficulty in case of emergency. The litter boxes were also fairly clean, and there was no

sign of vermin in the home.

2

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).
Sessions: Case histories. Laureate International Universities Publishing.

Upon questioning by the APS worker, Sara denied that she was afraid of her daughter

or that her daughter had been physically abusive. In fact, the worker observed that

Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature.

When asked about the bruise, Stephanie reported that she had gotten it when her

mother tried to grab some items out of her arms that she was about to throw out.

Stephanie admitted to throwing things out to clean up the apartment, telling the APS

worker, “I’m tired of my mother’s hoarding.” Sara agreed with the description of the

incident. Both Sara and Stephanie admitted to an increase in arguing but denied

physical violence. Sara stated, “I didn’t mean to hurt Stephanie. I was just trying to get

my things back.”

The APS worker observed that Sara’s appearance was unkempt and disheveled, but

her overall hygiene was adequate (i.e., clean hair and clothes). Stephanie was neatly

groomed with good hygiene. The APS worker determined that no one was in immediate

danger to warrant removal from the home but that the family needed a referral for

Intensive Case Management (ICM) services. It was clear there was some conflict in the

home that had led to physical confrontations. Further, the house had hygiene issues,

including trash and items stacked in the living room and Sara’s room, which needed to

be addressed. The APS worker indicated in her report that if not adequately addressed,

the hoarding might continue to escalate and create an unsafe and unhygienic

environment, thus leading to a possible eviction or recommendation for separation and

relocation for both women.

As the ICM worker, I visited the family to assess the situation and the needs of the

clients. Stephanie said she was very angry with her mother and sick of her compulsive

shopping and hoarding. Stephanie complained that they did not have any visitors and

she was ashamed to invite friends to the home due to the condition of the apartment.

When I asked Sara if she saw a problem with so many items littering the apartment,

Sara replied, “I need all of these things.” Stephanie complained that when she tried to

clean up and throw things out, her mother went outside and brought it all back in again.

We discussed the need to clean up the apartment and make it habitable for them to

remain in their home, based on the recommendations of the APS worker. I also

discussed possible housing alternatives, such as senior housing for Sara and a

supportive apartment complex for Stephanie. Sara and Stephanie both stated they

wanted to remain in their apartment together, although Stephanie questioned whether

her mother would cooperate with cleaning up the apartment. Sara was adamant that

she did not want to be removed from their apartment and would try to accept what

needed to be done so they would not be forced to move.

Sessions

Stephanie mentioned she was dissatisfied with her mother’s psychiatric treatment and

felt she was not getting the help she needed. She reported that her mother was very

anxious and was having difficulty sleeping, staying up until all hours of the night, and

buying items from a televised shopping network. Sara’s psychiatrist had recently

3

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).
Sessions: Case histories. Laureate International Universities Publishing.

increased her Zyprexa prescription dosage to help reduce her agitation and possible

bipolar disorder (as evidenced by the compulsive shopping), but Stephanie did not feel

this had been helpful and wondered if it was contributing to her mother’s confusion. I

asked for permission to contact both of their outpatient treatment teams, and the

request was granted.

I then arranged to meet with Sara and her psychiatrist to discuss her increased anxiety

and confusion and the compulsive shopping. I requested a referral for neuropsychiatric

testing to assess possible cognitive changes or decline in functioning. A test was

scheduled, and it indicated some cognitive deficits, but at the end of testing, Sara told

the psychologist who administered the tests she had stopped taking her medications for

depression. It was determined Sara’s depression and discontinuation of medication

could have affected her test performance and it was recommended she be retested in 6

months. I suggested a referral to a geriatric psychiatrist for Sara, as she appeared to

need more specialized treatment. Sara’s psychologist agreed.

Because they had both stated that they did not want to be removed from their home, I

worked with Sara and Stephanie as a team to address cleaning the apartment. All

agreed that they would begin working together to clean the house for 1 hour a day until

arrangements were made for additional help from family members. To alleviate Sara’s

anxiety around throwing out the items, I suggested using three bags for the initial

cleanup: one bag was for items she could throw out, the second bag was for “maybes,”

and the third was for “not ready yet.” I scheduled home visits at the designated cleanup

time to provide support and encouragement and to intervene in disputes. I also

contacted Sara’s treatment team to inform them of the cleanup plans and suggested

that Sara might need additional support and observation as it progressed.

We then discussed placement for at least some of the cats, because six seemed too

many for a small apartment. Sara and Stephanie were at first adamant that they could

not give up their cats, but with further discussion admitted it had become extremely

difficult to manage caring for them all. They both eventually agreed to each keep their

favorite cat and find homes for the other four. Sara and Stephanie made fliers and

brought them to their respective treatment programs to hand out. Stephanie also

brought fliers about the cats to her place of employment. Three of the four cats were

adopted within a week.

During one home visit, Stephanie pulled me aside and said she had changed her

mind—she did not want to continue to live with her mother. She requested that I

complete a housing application for supportive housing stating, “I want to get on with my

life.” Stephanie had successfully completed cashier training, and the manager of the

supermarket was pleased with her performance and was prepared to hire her as a part-

time cashier soon. She expressed concern about how her mother would react to this

decision and asked me for assistance telling her.

4

© 2021 Walden University, LLC. Adapted from Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014).
Sessions: Case histories. Laureate International Universities Publishing.

We all met together to discuss Stephanie’s decision to apply for an apartment. Sara was

initially upset and had some difficulty accepting this decision. Sara said she had fears

about living alone, but when we discussed senior living alternatives, Sara was adamant

she wanted to remain in her apartment. Sara said she had lived alone for a number of

years after her husband died and felt she could adjust again. I offered to help her stay in

her apartment and explore home care services and programs available that will meet

her current needs to remain at home.

Parker Family Episode 2

© 2013-2021 Walden University, LLC 1

Parker Family Episode 2
Program Transcript

PARKER: Ever since my husband died, there’s been no one to talk to. It’s just,
really, no one. And when Stephanie is home, I just feel so alone.

FEMALE SPEAKER: What about the day center you go to? Isn’t that helping?

PARKER: I don’t like it. What makes me really feel good, though, is when I go
shopping, buying things. And my kittens. I love my cats. Oh, have you seen
them? I have pictures. Just take a look. Look! These are so cute. My babies.

FEMALE SPEAKER: Yes, they’re very cute. And wow, you have a lot of them.

PARKER: Oh, well, it’s their home, too, not just Princess Stephanie’s.

FEMALE SPEAKER: The day program you’re attending, are you seeing a
psychiatrist there?

PARKER: Yes. Dr. Lewin.

FEMALE SPEAKER: May I ask how that’s going?

PARKER: He says that I’m depressed.

FEMALE SPEAKER: In the pictures you showed me, you just talked about the
cats, but I also saw all the things you keep around you, the hoarding. I
understand how depressed you been since your husband passed away. How
alone you’ve felt.

[SIGH] But I would like us to try and set up a plan to begin to address the
hoarding. It’s very clear that that’s one of the big issues that’s affecting your
relationship with Stephanie and your life together. Can we try that?

PARKER: I don’t like it when we fight. She’s still my baby, too. Yes, I want to try.

Parker Family Episode 2
Additional Content Attribution

MUSIC:
Music by Clean Cuts

Parker Family Episode 2

© 2013-2021 Walden University, LLC 2

Original Art and Photography Provided By:
Brian Kline and Nico Danks

Discussion – Week 7

Top of Form

Discussion: Psychological Aspects of Aging

What does it mean to age “successfully”? Though the concept of success is relative, theories of successful aging explain factors that support individuals as they grow old. Factors such as maintaining physical and mental activity and disengaging from community obligations contribute to older adults’ ability to function. As a social worker, you must understand these supportive factors in order to address the needs of older clients and their families.

As you will see in this week’s media, situations involving Alzheimer’s or dementia, interpersonal conflict, and grief can complicate the process of successful aging. For this Discussion, you review one of two case studies involving an older woman and apply a theory of successful aging to the case.

To Prepare:

· Review the Learning Resources on psychological aspects of later adulthood, focusing on key life events and on theories of successful aging.

· Access the Social Work Case Studies media and explore the cases of Sara and of Francine.

· Select a theory of successful aging to apply to either Sara’s or Francine’s case.

By 01/12/2021
Post a Discussion in which you:

· Identify whether you have chosen to analyze Sara’s or Francine’s case for the Discussion. 

· Explain key life events that have influenced Sara’s or Francine’s psychological functioning. Be sure to substantiate what makes them key in your perspective.

· Explain how you as a social worker might apply a theory of successful aging to Sara’s or Francine’s case. Be sure to provide support for your strategy.

Bottom of Form

Required Readings

Zastrow, C. H., Kirst-Ashman, K. K., & Hessenauer, S. L. (2019). Understanding human behavior and the social environment (11th ed.). Cengage Learning.

· Chapter 15, “Psychological Aspects of Later Adulthood” (pp. 672–702)

Newell, J. M. (2019). An ecological systems framework for professional resilience in social work practice. Social Work, 65(1), 65–73. https://doi.org/10.1093/sw/swz044

Teater, B., & Chonody, J. M. (2020). How do older adults define successful aging? A scoping review. International Journal of Aging and Human Development, 91(4), 599–625. https://doi.org/10.1177/0091415019871207

Yousuf-Abramson, S. (2020). Worden’s tasks of mourning through a social work lens. Journal of Social Work Practice, 1–13. https://doi.org/10.1080/02650533.2020.1843146

Required Media

Required Readings

Zastrow, C. H., Kirst-Ashman, K. K., & Hessenauer, S. L. (2019). Understanding human behavior and the social environment (11th ed.). Cengage Learning.
· Chapter 15, “Psychological Aspects of Later Adulthood” (pp. 672–702)

Chapter 15 Summary

The following summarizes this chapter’s content as it relates to the learning objectives presented at the beginning of the chapter. Chapter content will help prepare students to
LO 1 Describe the developmental tasks of later adulthood.
Older adults must make a number of developmental psychological adjustments, such as adjusting to re-tirement and lower income and to changing physical strength and health.
LO 2 Understand theoretical concepts about devel-opmental tasks in later adulthood. Theoretical concepts about developmental tasks in later adulthood include integrity versus despair, shifting from work-role preoccupation to self-dif-ferentiation; shifting from body preoccupation to body transcendence; shifting from self-occupation to self-transcendence; conducting a life review; the im-portance of self-esteem; the significance of having a high level of life satisfaction; the negative effects of low status and ageism; the prevalence of depression and other emotional problems; and the significance of spirituality and religion.
LO 3 Summarize theories of successful aging. Three theories of successful aging are the activity theory, the disengagement theory, and the social re-construction syndrome theory.
LO 4 Understand the impact of key life events on older people. Significant life events for older people may include marriage, death of a spouse, widowhood, remar-riage, parenting adult children, grandparenthood, and great-grandparenthood.
LO 5 Understand guidelines for positive psycho-logical preparations for later adulthood. Suggestions for positive psychological preparations by younger adults for later adulthood include engag-ing in good health practices, forming close personal relationships, preparing financially, having interests and hobbies, forming positive self-identities, looking toward the future, learning to cope with crises, and learning to cope with death.
LO 6 Summarize material on grief management and death education.
Guidelines are presented on grief management and death education, relating to a dying person, relating to survivors, and becoming more comfortable with the idea of one’s own eventual death

COMPETENCY NOTES The following identifies where Educational Policy (EP) competencies and behaviors are discussed in the chapter.
EP 6a. Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks to engage with clients and constituencies
EP 7b. Apply knowledge of human behavior and the social environment, person-in-environment, and other multidisciplinary theoretical frameworks in the analysis
of assessment data from clients and constituencies. (All of this chapter.) The content of this chapter is focused on social work students acquiring both of these behaviors in work-ing with older persons.
EP 1. Demonstrate Ethical and Professional Behavior (p. 677, 678, 680, 684, 699, 700)
WEB RESOURCES
See this text’s companion website at www.cengagebrain.com for learning tools such as chapter quizzes, videos, and more.
Copyright

Newell, J. M. (2019). An ecological systems framework for professional resilience in social work practice. Social Work, 65(1), 65–73. https://doi.org/10.1093/sw/swz044

Teater, B., & Chonody, J. M. (2020). How do older adults define successful aging? A scoping review. International Journal of Aging and Human Development, 91(4), 599–625. https://doi.org/10.1177/0091415019871207

Yousuf-Abramson, S. (2020). Worden’s tasks of mourning through a social work lens. Journal of Social Work Practice, 1–13. https://doi.org/10.1080/02650533.2020.1843146

Required Media

Walden University, LLC. (2021). Social work case studies [Interactive media]. https://class.waldenu.edu
· Navigate to Sara and to Francine. 

Walden University, LLC. (2021). Models of grieving [Interactive media]. https://class.waldenu.edu

Walden University, LLC. (2021). Social work case studies [Interactive media]. https://class.waldenu.edu
· Navigate to Sara and to Francine. 
Walden University, LLC. (2021). Models of grieving [Interactive media]. https://class.waldenu.edu

Follow rubric

Initial Posting: Content
14.85 (49.5%) – 16.5 (55%)
Initial posting thoroughly responds to all parts of the Discussion prompt. Posting demonstrates excellent understanding of the material presented in the Learning Resources, as well as ability to apply the material. Posting demonstrates exemplary critical thinking and reflection, as well as analysis of the weekly Learning Resources. Specific and relevant examples and evidence from at least two of the Learning Resources and other scholarly sources are used to substantiate the argument or viewpoint.

Follow-Up Response Postings: Content
6.75 (22.5%) – 7.5 (25%)
Student thoroughly addresses all parts of the response prompt. Student responds to at least two colleagues in a meaningful, respectful manner that promotes further inquiry and extends the conversation. Response presents original ideas not already discussed, asks stimulating questions, and further supports with evidence from assigned readings. Post is substantive in both length (75–100 words) and depth of ideas presented.

Readability of Postings
5.4 (18%) – 6 (20%)
Initial and response posts are clear and coherent. Few if any (less than 2) writing errors are made. Student writes with exemplary grammar, sentence structure, and punctuation to convey their message.