Successful Aging:Successful Aging: The Public Policy The Public Policy

ImperativeImperative

Rachel Pruchno, Ph.D.Rachel Pruchno, Ph.D.

UMDNJ-SOMUMDNJ-SOM

Why is Successful Aging Why is Successful Aging Important?Important?

The demographic facts:The demographic facts:– The number of people age 65+ will grow from The number of people age 65+ will grow from

35 million in 2000 to 71 million in 2030.35 million in 2000 to 71 million in 2030. The epidemiologic transition:The epidemiologic transition:

– From acute illness and infectious disease to From acute illness and infectious disease to chronic disease and degenerative illnesseschronic disease and degenerative illnesses

– In 2001 the leading causes of death were In 2001 the leading causes of death were cardiovascular diseases and cancer, followed cardiovascular diseases and cancer, followed by respiratory diseases. (JAMA, 2003)by respiratory diseases. (JAMA, 2003)

The demographic facts + the The demographic facts + the epidemiologic transition = epidemiologic transition = Challenges for public healthChallenges for public health

Public Health ChallengesPublic Health Challenges

Increased health care costsIncreased health care costs– MedicareMedicare

From 2.7% of GDP to 8% by 2030 From 2.7% of GDP to 8% by 2030 (Schulz & Binstock, (Schulz & Binstock, 2006)2006)

– Broader health care systemBroader health care system Uncovered pharmaceuticalsUncovered pharmaceuticals Costly new medical treatments and diagnostic testsCostly new medical treatments and diagnostic tests Expenditures to reach 19% of GDP by 2030 Expenditures to reach 19% of GDP by 2030 (Schulz & (Schulz &

Binstock, 2006)Binstock, 2006)

– Personal resourcesPersonal resources– Family resourcesFamily resources

Successful Aging. . .Successful Aging. . .

If we can figure out how to get the If we can figure out how to get the Baby Boomers to arrive at old age in Baby Boomers to arrive at old age in better shape:better shape:– Society’s health care costs will be Society’s health care costs will be

reducedreduced– Life-long personal resources will be Life-long personal resources will be

savedsaved– Families will be less burdenedFamilies will be less burdened

Successful AgingSuccessful Aging Little agreement re:Little agreement re:

– DefinitionsDefinitions– MeasurementMeasurement– PredictorsPredictors

Is it objective or subjective?Is it objective or subjective? The role of age (Depp & Jeste, 2006)The role of age (Depp & Jeste, 2006)

– The most consistent predictor of successful The most consistent predictor of successful aging was younger ageaging was younger age

– 87% of empirical studies find a significant 87% of empirical studies find a significant relationship between age and successful agingrelationship between age and successful aging

Focus on Old PeopleFocus on Old PeopleRowe & Kahn (1998) MacArthur StudyRowe & Kahn (1998) MacArthur Study 70-79 (70-79 (MM = 74) = 74)

Strawbridge et al. (2002)Strawbridge et al. (2002) 65-99 (65-99 (MM = 75) = 75)

Phelan et al. (2004)Phelan et al. (2004) 65+ (65+ (MM = 80) = 80)

BoBowling & Iliffe (2006)wling & Iliffe (2006) 65+ 65+

34% 65-7034% 65-70

28% 70-7528% 70-75

21% 75-8021% 75-80

17% 80+17% 80+

Montross et al. (2006)Montross et al. (2006) 60+ (60+ (MM = 80.4) = 80.4)

A Developmental A Developmental PerspectivePerspective

No one is born oldNo one is born old Life as part of a continuous and Life as part of a continuous and

dynamic stream with a beginning and dynamic stream with a beginning and an endan end

Lifespan as context for successLifespan as context for success

Schulz & Heckhausen Schulz & Heckhausen (1996)(1996)

Whom to Study? Whom to Study?

Should we be studying only old Should we be studying only old people?people?

Beyond survivor effectsBeyond survivor effects Where to begin?Where to begin?

Mean age of onsetMean age of onset

ArthritisArthritis 55 years55 years

DiabetesDiabetes 51.1 years51.1 years

Emphysema/Chronic Emphysema/Chronic bronchitisbronchitis

60 years60 years

Heart diseaseHeart disease 65.4 years65.4 years

Cancer: Mean Age of OnsetCancer: Mean Age of Onset

BreastBreast 61 years61 years

ColonColon 71 years71 years

EsophagusEsophagus 68 years68 years

ProstateProstate 68 years68 years

SkinSkin 60 years60 years

LungLung 71 years71 years

Defining ‘Success’Defining ‘Success’

Dictionary:Dictionary:– ““having a favorable outcome”having a favorable outcome”– ““obtaining something desired or obtaining something desired or

intended”intended” Thesaurus:Thesaurus:

– ““accomplished”accomplished”– ““flourishing”flourishing”– ““prosperous”prosperous”– ““thriving”thriving”

Can people age Can people age successfully if they have successfully if they have

a chronic condition?a chronic condition?

Rowe & Kahn (1987)’s Rowe & Kahn (1987)’s definition:definition:

– Few or no age-related declinesFew or no age-related declines– Implies that it is possible to reach Implies that it is possible to reach

advanced age relatively free of age-advanced age relatively free of age-associated disease and functionally associated disease and functionally intactintact

– Paradigm shift, but number of persons Paradigm shift, but number of persons experiencing successful aging is smallexperiencing successful aging is small

Rowe & Kahn (1998)Rowe & Kahn (1998)

Ability to maintain low risk of disease Ability to maintain low risk of disease and disease-related disabilityand disease-related disability

High levels of mental and physical High levels of mental and physical health andhealth and

Active engagement with lifeActive engagement with life

New criteria set the bar even higher!New criteria set the bar even higher!

Normal aging vs. optimal Normal aging vs. optimal aging, butaging, but

46% of the general population46% of the general population 88% of people 65+ 88% of people 65+

Have at least one chronic disorder Have at least one chronic disorder (Bodenheimer, Wagner, & Grumbach, 2002)(Bodenheimer, Wagner, & Grumbach, 2002)

Problems with Rowe & KahnProblems with Rowe & Kahn

Focus is on minorityFocus is on minority Based on medical modelBased on medical model Younger age is best predictor of Younger age is best predictor of

successsuccess

Other definitionsOther definitions Schmidt (1994). “Minimal Schmidt (1994). “Minimal

interruption of usual function”interruption of usual function” Baltes & Carstensen (1996). “Doing Baltes & Carstensen (1996). “Doing

the best with what one has”the best with what one has”– Shifts the focus from minority to majorityShifts the focus from minority to majority– Major differentiator: extent to which a Major differentiator: extent to which a

person can have a chronic disease or person can have a chronic disease or functional disability and still be functional disability and still be considered to be aging successfullyconsidered to be aging successfully

Conceptual Dimensions of Conceptual Dimensions of SuccessSuccess

Measureable domains of functioning:Measureable domains of functioning:– ObjectiveObjective– SubjectiveSubjective

Broad societal consensus regarding Broad societal consensus regarding desirabilitydesirability

VariabilityVariability within population within population

Defining Successful Aging in Defining Successful Aging in Younger PeopleYounger People

Objective criteria:Objective criteria:– Avoiding chronic conditions Avoiding chronic conditions – Maintaining functional abilitiesMaintaining functional abilities– Experiencing minimal painExperiencing minimal pain

Subjective evaluation:Subjective evaluation:– Aging wellAging well– Aging successfullyAging successfully– Positive life ratingPositive life rating

Successful Aging?Successful Aging?

CriteriaCriteria Measureable domains Measureable domains

of functioningof functioning Broad societal Broad societal

consensus regarding consensus regarding desirabilitydesirability

VariabilityVariability

Cognitive abilityCognitive ability– Lacks variabilityLacks variability

Social engagementSocial engagement– 13% include13% include– Inconsistent findingsInconsistent findings

Psychological resourcesPsychological resources– 10.6% include10.6% include– Inconsistent constructsInconsistent constructs

*Bowling, 2007*Bowling, 2007

Empirical EvidenceEmpirical Evidence

Testing the 2-factor model of Testing the 2-factor model of successful agingsuccessful aging

Are there people who are successful Are there people who are successful according to one, but not the other according to one, but not the other definition?definition?

To what extent do early influences To what extent do early influences set the stage for successful aging?set the stage for successful aging?

What role do current behaviors have?What role do current behaviors have?

SampleSample

ORANJ BOWLORANJ BOWLOOngoing ngoing RResearch on esearch on AAging in ging in NNew ew

JJersey: ersey: BBettering ettering OOpportunities for pportunities for

WWellness in ellness in LLifeife Eligibility criteria:Eligibility criteria:

– Age 50-74Age 50-74– New JerseyNew Jersey– Able to participate in a 1-hour English Able to participate in a 1-hour English

language phone interviewlanguage phone interview

Why New Jersey?Why New Jersey? NJ’s demographics largely mirror those of U.S. as a wholeNJ’s demographics largely mirror those of U.S. as a whole

Among the 50 states, NJ has 2Among the 50 states, NJ has 2ndnd largest proportion of largest proportion of people age 50+people age 50+

Among the 50 states, NJ has 3Among the 50 states, NJ has 3rdrd fastest growth rate among fastest growth rate among its age 50+ populationits age 50+ population

With 2With 2ndnd highest cancer rate among 50 states, NJ is an highest cancer rate among 50 states, NJ is an efficient source of subjects for aging & debilitating disease efficient source of subjects for aging & debilitating disease studiesstudies

Trend toward ever-increasing urbanization, NJ is a glimpse Trend toward ever-increasing urbanization, NJ is a glimpse of the future (NJ is only state with no designated rural of the future (NJ is only state with no designated rural county.) county.)

NJ among the most ethnically & racially diverse states in NJ among the most ethnically & racially diverse states in USAUSA

Sampling StrategiesSampling Strategies CATI CATI 1+ List-Assisted Random Digit Dial (RDD)1+ List-Assisted Random Digit Dial (RDD)

– Provided by Marketing Systems Group Provided by Marketing Systems Group

Geographically proportional to the Geographically proportional to the population of the State of New Jerseypopulation of the State of New Jersey– No over-sampling for any subgroupNo over-sampling for any subgroup

Coverage:Coverage:– 4% of households of persons 50-74 in NJ are 4% of households of persons 50-74 in NJ are

cell phone only cell phone only – Conservative overall coverage estimate is 91%Conservative overall coverage estimate is 91%

Each region includes a Each region includes a somewhat equal somewhat equal proportion (16% to proportion (16% to 26%) of New Jersey’s 26%) of New Jersey’s population.population.

Sample is released into Sample is released into the CATI system by the CATI system by region.region.

Data collection efforts Data collection efforts focus on a single region focus on a single region for 2 to 3 months at a for 2 to 3 months at a time.time.

Screening & EligibilityScreening & Eligibility

2000 U.S. Census reveals that 2000 U.S. Census reveals that 1,876,194 New Jersey residents were 1,876,194 New Jersey residents were age 50 to 74, suggesting that 22.3% age 50 to 74, suggesting that 22.3% of NJ’s population is age-eligible to of NJ’s population is age-eligible to participateparticipate

Interviews are conducted in English Interviews are conducted in English only and with the research subject only and with the research subject directly. Proxies for those physically directly. Proxies for those physically or mentally incapable of participation or mentally incapable of participation are not allowed.are not allowed.

Within Household SelectionWithin Household Selection If screening determines there to be If screening determines there to be

2+ age-eligible household members, 2+ age-eligible household members, all of these members are rostered all of these members are rostered with one chosen via computerized with one chosen via computerized gender-weighted random algorithmgender-weighted random algorithm

No substitutions permitted No substitutions permitted (e.g., when one member refuses or is incapable (e.g., when one member refuses or is incapable and another is willing to participate, no household and another is willing to participate, no household member may be invited to participate)member may be invited to participate)

The NumbersThe Numbers 151,246 land-line phone numbers in the 151,246 land-line phone numbers in the

populationpopulation 32,678 complete screen (21.6%)32,678 complete screen (21.6%) 9,685 eligible (20.6%)9,685 eligible (20.6%) 5,688 complete interviews (58.7%)5,688 complete interviews (58.7%)

1,060,838 calls made1,060,838 calls made 7.01 average calls made to complete each 7.01 average calls made to complete each

casecase

Response Rates (AAPOR)Response Rates (AAPOR)

Response Response Rate (RR5) Rate (RR5)

Cooperation Cooperation Rate (Coop3)Rate (Coop3)

ORANJ BOWLORANJ BOWL 58.7%58.7% 72.9%72.9%

2006 BRFSS 2006 BRFSS

(National)(National)51.4%51.4% 74.5%74.5%

2006 BRFSS2006 BRFSS

(New Jersey)(New Jersey)46.5%46.5% 63.0%63.0%

ORANJ BOWL ParticipantsORANJ BOWL Participants(N = 5,688)(N = 5,688)

Age 50-74 (mean = 60.7 years; s.d. Age 50-74 (mean = 60.7 years; s.d. = 7.1)= 7.1)

63.7% women; 36.3% men63.7% women; 36.3% men Current marital status:Current marital status:

– 56.7% married56.7% married– 14.2% widowed14.2% widowed– 17.3% divorced17.3% divorced– 9.2% never married9.2% never married

ORANJ BOWL ParticipantsORANJ BOWL Participants(N = 5,688)(N = 5,688)

Mean years of education: 14.5 (s.d. = Mean years of education: 14.5 (s.d. = 2.7)2.7)

Race: Race: – 83.8% White83.8% White– 11.8% African American11.8% African American– 1.6% Asian1.6% Asian

2.8% Hispanic2.8% Hispanic

Measures of Measures of Successful AgingSuccessful Aging

Objective Success: Objective Success: Avoiding Chronic ConditionsAvoiding Chronic Conditions

Self-rated:Self-rated:– Arthritis (40.2%)Arthritis (40.2%)– Hypertension (46.5%)Hypertension (46.5%)– Heart conditions (16.1%)Heart conditions (16.1%)– Cancer (14.7%) Cancer (14.7%) – Diabetes (15.7%)Diabetes (15.7%)– Osteoporosis (20.2%)Osteoporosis (20.2%)– Stroke (3.9%)Stroke (3.9%)– Lung conditions (18.6%)Lung conditions (18.6%)

Objective Success: Objective Success: Maintaining Functional AbilitiesMaintaining Functional Abilities How difficult is it for you to: How difficult is it for you to:

– Walk ¼ mile (26.7%)Walk ¼ mile (26.7%)– Walk up 10 steps without resting (21.3%)Walk up 10 steps without resting (21.3%)– Stand for 2 hours (40.9%)Stand for 2 hours (40.9%)– Stoop and get up (50.7%)Stoop and get up (50.7%)

(% any difficulty)(% any difficulty)

Objective Success: Objective Success: Minimal PainMinimal Pain

““How often are you troubled with pain?”How often are you troubled with pain?”(mean = 1.04; s.d = 1.04)(mean = 1.04; s.d = 1.04)

““How bad is the pain most of the time?”How bad is the pain most of the time?” (mean = 1.00; s.d. = .94)(mean = 1.00; s.d. = .94)

““How often does the pain make it difficult How often does the pain make it difficult for you to do your usual activities?”for you to do your usual activities?”

(mean = .55; s.d. = .88)(mean = .55; s.d. = .88)

4-point Likert scales (0 = low; 3 = high)4-point Likert scales (0 = low; 3 = high)

Subjective SuccessSubjective Success

Rating from 0-10Rating from 0-10– Where ‘0’ means not aging successfully at all Where ‘0’ means not aging successfully at all

and ’10’ means completely successful.and ’10’ means completely successful. (mean = 7.8; s.d. = 1.8)(mean = 7.8; s.d. = 1.8)

– Where ‘0’ means not well at all and ’10’ means Where ‘0’ means not well at all and ’10’ means extremely well to describe how well you are extremely well to describe how well you are agingaging

(mean = 7.8; s.d. = 1.8)(mean = 7.8; s.d. = 1.8)

– Where ‘0’ means the worst possible life and Where ‘0’ means the worst possible life and ’10’ means the best possible life, rate your life ’10’ means the best possible life, rate your life these days.these days. (mean = 7.8; s.d. = 1.6)(mean = 7.8; s.d. = 1.6)

Measurement ModelMeasurement Model

Successful AgingSuccessful Aging

Neither objective nor Neither objective nor subjectivesubjective

Subjective onlySubjective only

Objective onlyObjective only Both objective and Both objective and subjectivesubjective

4 Groups4 Groups

Latent profile analysis:Latent profile analysis:– Neither objectively nor subjectively Neither objectively nor subjectively

successful (N = 445; 8.3%)successful (N = 445; 8.3%)– Objective Success only (N = 472; 8.5%)Objective Success only (N = 472; 8.5%)– Subjective Success only (N = 549; Subjective Success only (N = 549;

10.0%)10.0%)– Both objectively and subjectively Both objectively and subjectively

successful (N = 4,050; 73.1%)successful (N = 4,050; 73.1%)

QuestionsQuestions

To what extent do early influences To what extent do early influences set the stage for successful aging?set the stage for successful aging?

What role do current behaviors have?What role do current behaviors have?

Independent VariablesIndependent Variables

Early InfluencesEarly Influences

Gender (1=male; 2 = female)Gender (1=male; 2 = female) Education (years)Education (years) Never married (0=ever married; 1 = Never married (0=ever married; 1 =

never)never) Race (0 = White; 1 = African American)Race (0 = White; 1 = African American) Prison (0 = no; 1 = yes); 3.5%Prison (0 = no; 1 = yes); 3.5% Childless (0=no; 1 = yes); 17.8%Childless (0=no; 1 = yes); 17.8%

*All analyses control for age*All analyses control for age

Current Health Current Health BehaviorsBehaviors

BMIBMI

Mean = 28.4; Mean = 28.4; SDSD = 6.2 = 6.2 BMI categories:BMI categories:

– Underweight (BMI <18.5) = 1.1%Underweight (BMI <18.5) = 1.1%– Normal (BMI >=18.5 – BMI < 25) = Normal (BMI >=18.5 – BMI < 25) =

29.7%29.7%– Overweight (BMI >=25- BMI < 30) = Overweight (BMI >=25- BMI < 30) =

36.6%36.6%– Obese (BMI>=30 = 32.6%)Obese (BMI>=30 = 32.6%)

Exercise (hours/week)Exercise (hours/week)

Over the past 30 days how much Over the past 30 days how much time did you do any:time did you do any:– VigorousVigorous– ModerateModerate– WalkingWalking

Mean = 4.5 hours (Mean = 4.5 hours (SDSD = 5.2) = 5.2)– 11.7% no exercise11.7% no exercise– 10% 12 hours or more10% 12 hours or more

Alcohol Consumption Alcohol Consumption

‘‘In a typical week, on how many days In a typical week, on how many days do you have at least one drink of do you have at least one drink of alcohol?’alcohol?’– None (54.4%)None (54.4%)– 1 day (15.1%)1 day (15.1%)– 2-3 days (12.9%)2-3 days (12.9%)– 4-5 days (7.0%)4-5 days (7.0%)– 6-7 days (10.6%)6-7 days (10.6%)

Smoke CigarettesSmoke Cigarettes

0=no; 1=yes0=no; 1=yes 15.8% current smokers15.8% current smokers

Current Social RelationshipsCurrent Social Relationships

Married (0 = not married; 1 = Married (0 = not married; 1 = married)married)

Work status (0 = not working; 1 = Work status (0 = not working; 1 = working = 56.1%)working = 56.1%)

Volunteer status (0 = not Volunteer status (0 = not volunteering; volunteering;

1 = volunteering = 42.8%)1 = volunteering = 42.8%)

Social ConnectionsSocial Connections

5-point Likert scale (1=low; 5=high)5-point Likert scale (1=low; 5=high)– Someone listens to youSomeone listens to you– Someone gives you good advice about a Someone gives you good advice about a

problemproblem– Someone shows you love and affectionSomeone shows you love and affection– Someone you can count on to provide Someone you can count on to provide

you with emotional supportyou with emotional support

ReligiosityReligiosity Likert Scales Likert Scales

– To what extent do you consider yourself a To what extent do you consider yourself a spiritual person?spiritual person?

– How often do you attend religious services? How often do you attend religious services? – How often do you read the Bible or other How often do you read the Bible or other

religious literature?religious literature?– How often do you watch or listen to religious How often do you watch or listen to religious

programs on TV or radio?programs on TV or radio?– How often do you pray privately?How often do you pray privately?– To what extent do you consider yourself a To what extent do you consider yourself a

religious person? religious person?

*(Higher score is more religious)*(Higher score is more religious)

ResultsResults

Multinomial Logistic RegressionMultinomial Logistic Regression

Reference group:Reference group:– Successful according to both criteriaSuccessful according to both criteria

Early influencesEarly influences Early influences + current behaviors Early influences + current behaviors

and relationships and relationships

How important are early How important are early influences?influences?

NeitherNeither Objective OnlyObjective Only Subjective Subjective OnlyOnly

AgeAge n.s.n.s. youngeryounger olderolder

GenderGender womenwomen n.s.n.s. womenwomen

EducationEducation lessless lessless lessless

Never marriedNever married moremore moremore moremore

African African AmericanAmerican

n.s.n.s. n.s.n.s. moremore

PrisonPrison moremore moremore moremore

ChildlessChildless n.s.n.s. n.s.n.s. n.s.n.s.

Early Influences, Early Influences, Current BehaviorsCurrent Behaviors

Early Influences, Current Early Influences, Current BehaviorBehavior

Early Early InfluencesInfluences

Early Early Influences & Influences & Current Current BehaviorBehavior

Cox & SnellCox & Snell .10.10 .32.32

NagelkerkeNagelkerke .13.13 .39.39

Pearson Chi-Pearson Chi-squaresquare

4,502, 4,502, dfdf = = 4,215 p 4,215 p = .001= .001

16,721, 16,721, dfdf = = 16,569, p 16,569, p = .20= .20

Unsuccessful are:Unsuccessful are: Early Influences:Early Influences:

– Younger (+)Younger (+)– More likely to be More likely to be

womenwomen– Less likely to be African Less likely to be African

American (+)American (+)– Less educatedLess educated– More likely to have More likely to have

been in prisonbeen in prison– More years of cigarette More years of cigarette

useuse

*Never married no longer sig.*Never married no longer sig.

Current:Current:– Less likely to be Less likely to be

currently marriedcurrently married– Less likely to be Less likely to be

workingworking– Less likely to be Less likely to be

volunteeringvolunteering– More likely to smokeMore likely to smoke– Less likely to drinkLess likely to drink– Higher BMIHigher BMI– Less time exercisingLess time exercising– Poorer social Poorer social

relationshipsrelationships

Subjective Only are:Subjective Only are: Early Influences:Early Influences:

– OlderOlder– More likely to be More likely to be

womenwomen– Less educatedLess educated– More likely to have More likely to have

been in prisonbeen in prison

*Never married, African *Never married, African American, no longer American, no longer significantsignificant

Current:Current:– Less likely to be Less likely to be

currently marriedcurrently married– Less likely to be Less likely to be

workingworking– Less likely to be Less likely to be

volunteeringvolunteering– Less likely to drinkLess likely to drink– Higher BMIHigher BMI– Less time exercisingLess time exercising– Poorer social Poorer social

relationshipsrelationships– More religiousMore religious

Objective only are:Objective only are:

Early Influences:Early Influences:– YoungerYounger– Less educatedLess educated– More likely to have More likely to have

never marriednever married– More likely to have More likely to have

been in prisonbeen in prison

Current:Current:– Less likely to be Less likely to be

currently marriedcurrently married– Less likely to be Less likely to be

workingworking– Less likely to be Less likely to be

volunteeringvolunteering– Less likely to drinkLess likely to drink– Higher BMIHigher BMI– Less time exercisingLess time exercising– Poorer social Poorer social

relationshipsrelationships

The Objective Only vs. The Objective Only vs. the Subjective Only the Subjective Only

Logistic Regression Results:Logistic Regression Results:No differencesNo differences

EducationEducation Never MarriedNever Married African AmericanAfrican American PrisonPrison ChildlessChildless Currently marriedCurrently married Volunteer workVolunteer work Alcohol consumptionAlcohol consumption Current smokerCurrent smoker

Logistic Regression ResultsLogistic Regression ResultsDifferencesDifferences

Subjective Only:Subjective Only:– OlderOlder– More womenMore women– Less likely to be workingLess likely to be working– Higher BMIHigher BMI– Less exerciseLess exercise– Better social relationshipsBetter social relationships– More religiousMore religious

ConclusionsConclusions

Life-span approach enhances Life-span approach enhances perspective on successful agingperspective on successful aging

Objective components of successful Objective components of successful aging can be distinguished from aging can be distinguished from subjective onessubjective ones

Objective and subjective success Objective and subjective success have different predictorshave different predictors

CaveatsCaveats

Younger sampleYounger sample Components of objective success are Components of objective success are

specific to this age groupspecific to this age group Reliance on self-report dataReliance on self-report data Cross-sectional designCross-sectional design

Successful Aging:Successful Aging: The Public Policy Imperative The Public Policy Imperative

Little of aging experience is geneticLittle of aging experience is genetic– Less than 1/4 of the biological process of Less than 1/4 of the biological process of

aging is attributed to genetics (Gurland aging is attributed to genetics (Gurland et al., 2004)et al., 2004)

– The potency of genes that affect aging The potency of genes that affect aging declines even further after age 65 (Finch declines even further after age 65 (Finch & Tanzy, 1997).& Tanzy, 1997).

Lifestyle ChoicesLifestyle Choices

DietDiet ExerciseExercise SmokingSmoking DrinkingDrinking

Social FactorsSocial Factors

MarriageMarriage FamilyFamily FriendsFriends Religiosity Religiosity WorkWork VolunteeringVolunteering

Neighborhood EffectsNeighborhood Effects

Neighborhood DataNeighborhood Data

U.S. Census (2000)U.S. Census (2000) New Jersey Uniform Crime ReportNew Jersey Uniform Crime Report New Jersey Department of New Jersey Department of

Agriculture’s Division of Marketing Agriculture’s Division of Marketing and Development (milk)and Development (milk)

New Jersey’s Department of Law and New Jersey’s Department of Law and Public Safety’s Division of Alcohol Public Safety’s Division of Alcohol Beverage ControlBeverage Control

NeighborhoodNeighborhood

Wealth:Wealth:– % College Degree% College Degree– % Professionals% Professionals– # people with incomes > $150,000# people with incomes > $150,000

NeighborhoodNeighborhood

Social VulnerabilitySocial Vulnerability– % Female headed HH% Female headed HH– % HH on Public Assistance% HH on Public Assistance– % Unemployed males% Unemployed males

NeighborhoodNeighborhood Crime:Crime:

– # Robberies# Robberies– # Rapes# Rapes– # Aggravated Assaults# Aggravated Assaults

NeighborhoodNeighborhoodResidential stabilityResidential stability

– Year HH moved inYear HH moved in– % 5+ years in same HH% 5+ years in same HH

NeighborhoodNeighborhood DensityDensity

– # Bars/pubs# Bars/pubs– # Grocery stores# Grocery stores– # Local convenience stores# Local convenience stores

NeighborhoodNeighborhood

Availability of PhysiciansAvailability of Physicians– # Primary care doctors# Primary care doctors– # Specialists# Specialists

NeighborhoodNeighborhood

Built environment:Built environment:– Connectivity Connectivity (alpha, gamma, (alpha, gamma,

#streets per square mile)#streets per square mile)

– Air Pollution Air Pollution (particulate matter, ozone)(particulate matter, ozone)

Next StepsNext Steps

Connecting neighborhood Connecting neighborhood characteristics and healthcharacteristics and health

Successful Aging:Successful Aging: The Public Policy The Public Policy

ImperativeImperative