Extending the concept of successful ageing to persons ageing with disabilities

Abstract

The dominant model of successful ageing developed by Rowe and Kahn, states that to age well older adults must be free of disease and disability, maintain high levels of cognitive functioning and remain actively engaged in life. However, this model has been criticised for ignoring and marginalising people ageing with disabilities who cannot be considered to be ageing successfully according to these criteria. This is particularly important as increasing numbers of people, with differing levels of physical impairments, are entering old age. A greater understanding of what it means to age well with a disability is therefore needed so that appropriate support and interventions can be made available.

This thesis investigated successful ageing from the perspective of older adults who are ageing with a disability to determine how individuals understand and retain a sense of ageing success in the context of disability and age-related changes. In Study One, insights were gained from older adults ageing with either post-polio syndrome (PPS) or a spinal cord injury (SCI). These were then used as a basis for developing a preliminary model of successful ageing which aims to provide a more inclusive and holistic approach, recognising the position of adults ageing with disabilities within a broader socio-political environment.

A mixed methods approach employing semi-structured in-depth interviews in Study One was used to build upon and extend the existing research in this area. The sample comprised 17 older Australian adults (eight male and nine female) aged 40-78 years (Mean age = 62.12, SD =12.11). Inductive thematic analysis revealed eight themes that contributed to the preliminary model of successful ageing. In Study Two, 367 international participants (194 ageing with a disability, and 173 ageing without a disability, mean age = 56.82, SD = 6.33) completed an online survey designed to test the utility of the themes identified in Study One as predictors of self-rated successful ageing. A series of bivariate correlations, hierarchical multiple regression analyses, and moderation analyses was then conducted to test the relevance of the variables relating to the factors identified as important for successful ageing in Study One.

The lack of disability or chronic conditions was not predictive of subjective assessments of successful ageing. Three potential new factors (psychological growth, respect and security) that contribute additional understanding of ageing successfully in the context of disability were identified. The data provided evidence for more inclusive, revised model of successful ageing, accounting for 40% of the variance in successful ageing scores for participants in this study ageing with a disability and 38% for those ageing without a disability. The results suggest a more nuanced model of successful ageing relating to health and physical functioning than that adopted by the current dominant model. This revised model has implications not only for the current model of successful ageing, but also for future healthcare and government services.