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Prevalence and Factors Associated With Thriving in Older Adulthood: A 10-Year Population-Based Study

¹ Portland State University, Oregon.
² Statistics Canada, Ottawa.
³ University of Ottawa, Canada.
⁴ Kaiser Permanente Northwest Center for Health Research, Portland, Oregon.
⁵ Institute of Health Economics, University of Alberta, Edmonton, Canada.
⁶ Health Utilities Incorporated, Dundas, Ontario, Canada.
⁷ Oregon Health and Science University, Portland.
⁸ McGill University, Montreal, Quebec, Canada.

Address correspondence to Mark S. Kaplan, DrPH, School of Community Health, Portland State University, P.O. Box 751, Portland, OR 97207. E-mail: kaplanm{at}pdx.edu

Background. Interest in the determinants of "successful aging" is growing. Nonetheless, successful aging remains ill defined, and its appropriate measurement is hotly contested. Most studies have focused on the absence of disability or deficits in physical performance as outcomes. The present study extends this research by using the Health Utilities Index Mark 3 (HUI3), a multidimensional measure of health status, to examine the maintenance of exceptionally good health among older participants in the Canadian National Population Health Survey (1994–2004).

Methods. The maintenance of exceptionally good health in old age was examined prospectively among 2432 individuals (65–85 years old at baseline) who met the inclusion criteria. The participants were classified into one of four health trajectories: thrivers (who maintained exceptional health with no or only mild disability), nonthrivers (who experienced a moderate or severe disability), the deceased, and the institutionalized.

Results. In 10 years of follow-up, 190 (8%) were thrivers (HUI3 score 0.89 at all interviews), 1076 (47%) were nonthrivers, 893 (36%) died, and 273 (9%) were institutionalized. The maintenance of exceptionally good health among the elderly participants was related to younger age at baseline, socioeconomic status (higher income), psychosocial factors (including lower psychological distress), and behavioral factors (never smoked and moderate alcohol use).

Conclusions. The maintenance of exceptionally good health in old age is related, at least in part, to modifiable lifestyle factors. However, elevated socioeconomic status also distinguishes those who are able to maintain exceptionally good health.

Key Words: Aging • Epidemiology • Longitudinal • Population health