When older adults face age-related life challenges, anticipating what to expect and how to access potential coping strategies can both prevent and provide the possibility of easier recovery from crises. Aging-Related Preparation (ARP) is defined as the continuum of thoughts and activities about how to age well, often beginning with the awareness of age-related changes, or the anticipation of retirement, and concluding with specifying end-of-life wishes. In the current paper, we introduce the concept of ARP and related formulations regarding plans for aging well, describe both predictors and outcomes of ARP for several the domains of ARP, and consider the elements of ARP within the context of existing social policy. We conclude that ARP is determined by a variety of influences both intrinsic to the older person (e.g., personality, cognitive ability, beliefs about planning, problem-solving skills), linked to social class and education, as well as dependent on family structures, access to and knowledge of options, services, and local community resources, and social policy. We further provide evidence that ARP has positive effects in the domain of pre-retirement planning (for retirement adjustment), of preparation for future care (for emotional well-being), and of ACP (for a good death). However, other domains of ARP, including planning for leisure, housing, and social planning are under-researched. Finally, we discuss policy implications of the existing research.
A review of the aging literature yields 105 operational definitions of “successful aging” in use. These theoretical discrepancies have caused some investigators to question the utility of the concept (Cosco et al., 2014). Investigators who remain committed to the concept acknowledge its conceptual messiness, but have found no consensus for resolution. We propose a revised concept of successful aging, combining a life-course perspective (Rowe & Kahn, 2015) with a neo-Aristotelian theoretical framework. Such a framework justifies certain changes to the definition of “successful aging;” it situates our concept of successful aging within a broader view of human development, is more inclusive, and suggests empirically adequate research questions. Specifically, conceptualizing “successful aging” along neo-Aristotelian lines means defining it as the maintenance of proper human functioning across the life-course and into late adulthood. For Aristotle, proper human functioning entails realizing one’s potential as a “rational social animal,” with rational implying goal-oriented thinking, means-ends reasoning, other forms of instrumental rationality (not excluding emotionality). Social suggests active engagement in a community, within the limits of an individuals’ comfort and ability. These two criteria determine “success” in older age. Recent research on successful aging reveals that absence of disease and disability does not appear to be a constituent of “successful aging.” Therefore, physical health is neither necessary nor sufficient for “success.” Our re-conceptualization of “successful aging” could be tested using confirmatory factor analysis, with social and reasoning/problem-solving factors loading onto a second order Successful Aging factor. This understanding allows for greater empowerment of older adults.
Community Aging in Place-Advancing Better Living for Elders (CAPABLE) consists of an interprofessional team of a registered nurse (RN), occupational therapist (OT), and handyworker that delivers an in-home client-specific package of interventions to optimize function. CAPABLE aims to reduce functional impairment, home hazards, and acute medical services use and is being widely disseminated. To expand CAPABLE to older adults transitioning from the skilled nursing facility (SNF) to home, we developed CAPABLE Transitions, which makes several important modifications to CAPABLE. First, CAPABLE Transitions will be implemented within a Medicare-certified home health agency (CHHA) and delivered to CHHA clients. Second, it will be delivered to CHHA clients with and without dementia. Adding urgency to CAPABLE Transitions’ development, including persons with dementia has the potential to decrease high utilization of services and meet care transition needs. Third, it includes an initial RN care transition visit. Fourth, its services are more intensely delivered at the beginning of the intervention, shortly after SNF discharge. Beginning in the fall of 2020, CAPABLE Transitions will be tested in a feasibility study of 60 older adults discharged from post-acute SNF care to CHHA services in Rochester, NY. We have designed this 3-year feasibility study to consist of yearly recruitment waves that will enable us to iteratively assess and refine the intervention. Following this study, we hope to test CAPABLE Transitions’ effect on improving home time, quality of life, and the use of acute medical services in order to assist older adults in aging in place.
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