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are resilient and able to cope reasonably well with physical, social, and emotional changes.

       They feel a sense of control over circumstances in their lives. (Lachman, 2005)

      The best way to experience a productive, full, and satisfying old age is to lead a productive, full, and satisfying life prior to old age. Establishing these qualities early on in life creates habits and beliefs that will continue into older adulthood. Tips for successful aging are shown in Table 3.1.

      A number of attributes are vital to successful aging (Walker, 2001). Individuals who are oriented toward the future age successfully. This attribute is defined as the ability to anticipate, to plan, and to hope. Additionally, gratitude, forgiveness, and optimism are important and are described as the need to see the glass as half full, not half empty. Empathy is another key factor in successful aging, which is the ability to imagine the world from someone else’s viewpoint. Finally, reaching out to others and having the desire to do things with people are important attributes (Walker, 2001). Individuals who possess a long-term perspective and engage in positive lifestyle behaviors increase their potential for successful aging.

      Resiliency

      Resilient people share some common qualities that can be cultivated to master any crisis. They stay connected with others, which improves their well-being and quality of life. Resilient people are optimistic and have a sunny outlook on life. They are often spiritual or actively involved in religious faith and know how to overcome negative thinking and difficult times. Resilient people enjoy themselves like children do. They wonder about things, experiment, and laugh. They also give back to others, and the benefit they receive is as great as the support that they are providing. People who help others live longer.

      Table 3.1

      Source: Walker, L. A. (2001, September 16). We can control how we age. Parade, pp. 4–5.

      Resilient people pick their battles and focus on things over which they have some influence and avoid spending time on things they can’t control. They stay healthy by following a good diet and engaging in regular physical activity that tends to buffer stress. Exercise helps to repair neurons in brain areas that are particularly susceptible to stress. Resilient people convert misfortune into good luck and gain strength from adversity. They see negative events as opportunities to better themselves (Howard, 2009). Research conducted by Fry and Keyes (2010) emphasizes resilience. Successful aging and personality addresses the potential to maximize an individual’s potential given particular personality traits or, conversely, the ability of an individual to modify pliable traits that are not compatible with successful aging.

      Case Illustration 3.1 is an example of an older woman who demonstrates resiliency. She is actively engaged in life, financially prepared to manage her expenses, engages in healthy behaviors, and displays optimism.

      Case Illustration 3.1

      Mrs. Lesser is a retired attorney who is 85 years old. She is living comfortably in a retirement community and travels extensively. Her investments, assets, and pensions are more than adequate to meet her personal financial obligations. She plays golf during the summer and swims indoors during the winter. She runs a small business making flowers, eats a well-balanced diet, and has no medical problems. She takes a multivitamin, calcium supplement, vitamin C capsule, fish oil supplement, and vitamin D₃. She attributes her excellent cognitive skills and mental health to her work, healthy diet, active engagement with family and friends, and providing companionship to members of her church who need emotional support. She also believes that the decisions individuals make earlier in life can either help or hinder them later on. Therefore, making healthy lifestyle choices, managing her finances, and staying focused on what is important in life has enabled her to age comfortably.

      Healthy Lifestyle

      Much of what we call aging results from lack of exercise, smoking, other addictions, poor nutrition, falls, and stress. The challenge is to distinguish the late-life conditions that are truly unavoidable from those caused by disuse and lack of movement. However, this distinction is often lost in mainstream elders’ health care, and age denial keeps many who are under 60 from realistically assessing their chances of reaching 80 intact.

      Increased susceptibility to disease often accompanies aging. Age-dependent conditions (those that rise steadily with age) include vision and hearing loss, Type 2 diabetes, hip fracture, Parkinson’s disease, dementia, pneumonia, incontinence, and constipation. Measurements of health and ability show gradual rather than precipitous changes with age, according to the Baltimore Longitudinal Study of Aging.

      To keep older adults healthy, it is important to prevent chronic diseases. Chronic diseases are ongoing (usually lasting a year or more), generally incurable illnesses or conditions that require ongoing medical attention and affect a person’s daily life. Some of the most prevalent and costly chronic diseases include arthritis, cancer, cardiovascular disease, depression, and others that lower the quality of life (Anderson & Horvath, 2004; Hwang, Weller, Ireys, & Anderson, 2004; National Center for Health Statistics, 2008). Approximately 80% of older adults have one chronic condition, and 50% have at least two (Agency for Healthcare Research and Quality, 2005). The Centers for Disease Control and the Merck Company Foundation (2007) have identified five priorities for improving older adults’ health and quality of life: (1) promote healthy lifestyle behaviors, (2) increase older adults’ use of clinical preventive services, (3) address cognitive impairment issues, (4) deal with issues related to mental health, and (5) provide education on planning for serious illness.

      The increasing number of older Americans poses significant challenges for our nation’s public health system. The current focus is to promote health and functional independence to help older adults stay healthy and remain in their homes. When older adults practice healthy behaviors, make use of clinical preventive services, and continue to engage with family and friends, they are more likely to remain healthy and to live independently (Centers for Disease Control and Prevention and the Merck Company Foundation, 2007).

      Exercise

      Exercise is extremely beneficial in all stages of life. Much of older adults’ physical decline stems not from age but from disuse. When they sit all day, year after year, their bones, muscles, and organ systems atrophy, and their self-confidence wanes. However, the ability of exercise to revitalize and invigorate older adults’ lives is now a proven fact (Manson et al., 2002). Reichstadt and colleagues (2010) found that 50% of assisted living community residents reported exercising regularly. Physiological (e.g., glucose level regulation, balance, and coordination), psychological, and social (empowerment, social and cultural integration) benefits of physical activity also foster successful aging (Chodzko-Zajko, Schwingel, & Park, 2009). Guided Practice Exercise 3.3 provides the opportunity to identify benefits associated with exercising and address modifications needed for exercise prescription for older persons.

      Guided Practice Exercise 3.3

      There are tremendous benefits associated with exercise. Guidelines exist that identify the type and frequency of exercises necessary for healthy functioning for older persons. List the types of exercises and benefits of exercises you are familiar with. Now examine how these exercises may need modification for older adults with chronic medical conditions. Share this information with your peers and professional colleagues.

      Exercise regimens that build muscle produce a cascade of positive health effects. Rebuilding and maintaining strength helps to preserve aerobic capacity, keep blood pressure low, retain a healthy blood-sugar tolerance, maintain healthy cholesterol, sustain mineral density of the bones, and stabilize the body’s ability to regulate its internal temperature. Guided Practice Exercise 3.4 illustrates the role of exercise in preventing the development of a chronic disease.

      Guided Practice Exercise 3.4

      An elderly woman maintained her appointment with her primary care physician (PCP) who reported that she had