The Aging is a normal process associated with a progressive alteration in adaptive responses of the body, causing changes in the structure and function of the different systems, which increase the vulnerability of the elderly to disease. However, this way of aging naturally can be improved if healthylifestyles are adopted from youth, we call this Successful Aging.

When you talk about Successful, you think that the opposite of it is a loser. For this reason, Successful Aging has also been related to other concepts, which do not imply the absence of diseases and disabilities to age well. That is why it has also been called Healthy, effective, productive, active aging among others.

In 2002 the World Health Organization (WHO) mentioned that the term Active Aging expresses the process of optimizing opportunities for health, participation and safety, in order to improve the quality of life of people as they age. This body considers that the approach based on the functioning of old age is useful to generate proposals in public health policies and defines Healthy Aging as the process of promoting and maintaining the functional capacity that allows well-being in old age.

What is Successful Aging?

Thanks to the advancement of science, currently life expectancy has increased in recent years. This implies a greater effort on the part of the health sector not only to prolong life, but to ensure that it is of quality. The current gerontological sciences promote practices that facilitate the functional aging of the elderly.

Successful Aging is a multidisciplinary concept that incorporates mental, physical and emotional health and incorporates psychological, biochemical and social factors. Successful aging is one that occurs with a low probability of suffering from diseases or disability, with a high capacity for physical and cognitive functioning in addition to maintaining interpersonal relationships and participation in productive and social activities.

The importance of this new concept, Successful Aging, is due to a redefinition of the concept of Aging as a stage of decline or progressive and irreversible loss of capabilities. This new meaning of aging emphasizes the possibility of aging in optimal conditions: physical, cognitive, social and emotional functioning. For this, it is important that people start from early adulthood with actions to promote, change or transform their lifestyles, avoiding diseases and therefore increasing the possibility of aging better.

Main Indicators of Successful Aging

The World Health Organization (WHO), in its Report on Aging and Health, insists that the presence of diseases does not say anything about the impact produced on the life of an elderly person and proposes to leave the epidemiological approach based on multimorbidity (suffering at least two chronic and / or acute diseases) and exclusively in medical diagnoses to move to an approach focused on the functioning of the person in their environment.

In this way aging is no longer represented as an inevitable period of decline with diseases that requires the withdrawal of active and productive life. An older adult is considered to have Successful Aging when he meets the following characteristics:

Absence of major chronic diseases

This indicator considers the presence of chronic diseases, considered important, for the health of the elderly:

• Some kind of Cancer
• Lung disease
• Diabetes
• Hypertension
• Heart disease
• Brain Vascular Accident / Disease
• Osteoarthritis / Arthritis
• Osteoporosis

Although this indicator will not always be taken into account, to consider an older adult with Successful Aging. Some of these diseases, such as diabetes, hypertension or arthritis, when diagnosed early, can be adequately controlled, so that none of them involves a disability, even if they suffer more from one of these diseases, so the elderly can have a functional life.

There are four main types of chronic noncommunicable diseases in the elderly:

• Cardiovascular: heart attacks and strokes
• Cancer
• Chronic respiratory diseases: chronic obstructive pulmonary disease (COPD) and asthma
• Diabetes

Absence of disability in activities of daily living

An older adult is considered to be without disabilities when they do not have difficulty or need help to perform six basic activities of daily life:

• Walk through the rooms
• Bath
• Dress
• Eat
• Use the bathroom
• Moving from bed to chair and back

Carrying out or not, and even needing help to carry out these activities, is used to assess the functional status of the elderly. The test that helps us assess them is the Katz Index, which evaluates whether you are dependent or independent to perform these activities.

Absence of difficulty in measures of physical function

To obtain the value of this indicator it is necessary to use the Short Physical Performance Test which consists of three tests, each with a maximum value of 4 points. Successful aging is considered to be older adults who obtained a score greater than 10.

• Balance tests. You will need to hold various positions for 10 seconds. The score will be obtained according to the following criteria: 0: <3 seconds or does not try; 1: 3 to 9.99 seconds; 2: 10-15 seconds.
  • Stand with your feet on each side of the other.
  • Stand in a semi-tandem position: put your feet in a straight line, one side of the other but leaving a space between them.
  • Tandem position: put one foot in a straight line just in front of the other, toe-heel.
• March speed. You must complete a 4 meter round trip. If you cannot walk the 4 meters or return, the test is over. If you manage to do the tour, you will get a score on the following criteria: 1:> 8.7 seconds; 2: 6.21 to 8.7 seconds; 3: 4.82 to 6.2 seconds and 4:> 4.82 seconds.
• Get up from a chair. Two tests are carried out. First, it will be necessary to verify whether or not you can get up from a chair, with or without leaning on your hands. If you can’t get up, the test is over. Then the time required to get up five times in a row from the chair is evaluated. The score will be determined according to time: 1: 16.7 at 60 seconds; 2: 13.7 to 16.69 seconds; 3: 11.2 to 16.69 seconds; 4: <11.19 seconds.

High cognitive performance

To evaluate the cognitive functioning of the elderly, the Folstein Minimum Mental Examination is used . In this test a score between 0 and 30 is obtained, considering as successful aging a score greater than 24 points. This test assesses memory, orientation, attention, language, viso-constructional function, that is, the ability to build, assemble or draw, and praxis, that is, organized movements to carry out a task.

The Folstein test consists of asking questions such as repeating words, remembering them after other questions, indicating the date, the day of the week, doing mental calculations, identifying and describing objects, and copying a picture. This test measures the degree of cognitive impairment as follows: Mild: 19 to 23 points; Moderate: 14 to 18 points and Severe: less than 14 points.

High emotional functioning

To evaluate this indicator, it is necessary to use the Depression Scale of the Center for Epidemiological Studies (CES-D) in older adults. This instrument detects cases of depression based on the symptoms of the last week.

It is a series of 20 statements that must be answered with never or rarely, sometimes, most of the time or almost always. The answers correspond to a score between 0 and 3, the maximum score is 60 points and a score of less than 16 is considered successful aging. Among the statements that comprise this test are the following:

• I had a poor appetite
• I had concentration problems
• I slept without resting
• I felt sad
• I slept more than normal
• Wanted to be dead
• I was unhappy with myself, among others.

High social functioning

This indicator is evaluated using the Multidimensional Scale of Social Support (Social Networks and Social Support Scale ). This instrument assesses the social networks and emotional support of the partner, family and friends. It is based on a series of statements that must be answered with yes or no and the sum of all the evaluated aspects is made.

• Couple:  There is someone special who is with me when I need it, there is a special person with whom I can share my sorrows and joys, I have a special person who comforts me, there is a special person who cares about my feelings.
• Family: My family really supports me, I have the emotional support I need from my family, I can talk about my problems with the family and my family supports me in making decisions.
• Friends: My friends help me, I can count on my friends when things go wrong, I have friends with whom I can share my joys and sorrows, I can talk to my friends about my problems.

Indicators of Successful Aging according to the elderly:

• Enjoy eating
• Spirituality
• Realizations
• Sense of purpose
• Financial security
• Physical appearance
• Productivity
• Mood
• Living place

Healthy Aging and Intrinsic and Functional Capabilities

As people age, they suffer a gradual accumulation of molecular and cellular damage that causes a decrease in physiological reserves. These changes are, to a large extent, inevitable. However, its degree varies considerably between individuals of the same chronological age.

In addition to these changes, exposure to positive and negative environmental influences can influence other health characteristics. Some of these are risk factors, diseases, injuries, and geriatric syndromes.

Intrinsic Capability

The interaction between the health characteristics determine the Intrinsic capacity of a person, this in turn is the combination of all the physical and mental capacities that it has. For example, the psychological traits of the elderly, which help them to face their problems and solve them in a positive way, the resilience they have in the face of everyday problems in their life and their physical capacity to recover favorably from an illness are part of the intrinsic capacities of the elderly.

If older adults can or do some activity, it will not only depend on this ability, but also on the environment in which they live.

Functional Capacity

The Functional Capacity of the elderly is the interaction between the conditions of the person (intrinsic capacities), the environment in which they live as well as the support networks that the elderly have, such as personal contacts (family, friends and neighbors), community and institutional through which he obtains material, instrumental and emotional support.

For example, an older adult who has limited physical capacity will be able to maintain the required mobility if he or she wears an orthopedic support and lives near a means of public transport with access for people with disabilities. A person with the same limitations but in a less favorable environment will find it more difficult. In the previous example, the first person retains their functional abilities while in the second, these are diminished, not because of the disability itself, but because of the unfavorable environment in which they live.

How is Successful Aging Achieved?

The term Successful Aging sometimes seems confusing because within it, we find other concepts such as active, productive, optimal and positive. There are different ways to promote Successful Aging, however, all of them will have the main objective of maintaining and / or promoting the functional capacity of the elderly. Some ways to promote Successful Aging are:

• Minimize risk and disability. The absence or presence of diseases and also the absence or lesser severity of risk factors (diseases or syndromes) are considered. An older adult with decreased functional capacity to continue doing the things that are important to him or her.
• Maximize physical and cognitive ability. High physical capacity is related to the maintenance of physical activity until advanced ages, with excellent cognitive conditions.
• Participate in activities. Have healthy interpersonal relationships and maintain productive activity, regardless of whether it is paid or not.

For the elderly to maintain their physical capacity as much as possible and continue to participate in family and social activities, their functional impairment must be avoided or reduced. To achieve this, it is sometimes necessary for the elderly person to change the environment in which they live: make modifications to their home or move to another with the necessary characteristics to develop within it, with as much independence as possible.

Habits for Successful Aging

Most of the diseases that older adults present are non-communicable diseases. To achieve successful Aging, the risk factors of these conditions must be addressed through strategies, habits and health promotion. These should start in youth and continue throughout life.

There are indications that suggest that some health habits, such as physical activity and a good diet, have an influence on the intrinsic capacities of the elderly, in addition to the already recognized benefits of these: reduction of non-communicable diseases such as diabetes or cardiovascular diseases.

Exercise

Carrying out an exercise or physical activity scheme from youth and throughout life increases life expectancy in addition to bringing various benefits in old age. Exercise during the elderly reduces risks of diseases, improves physical and mental capacities and social response:

• Maintains muscle strength
• Preserves cognitive function
• Reduces levels of anxiety and depression
• Improve self-esteem
• Reduces the risk of coronary heart disease
• Lowers the risk of Diabetes
• There is a better percentage of cerebrovascular accidents
• Facilitates participation in the community
• Promote social networks and intergenerational links

Seniors should start with exercises that promote strength and balance before starting aerobic exercises such as walking. Most of the time, the elderly are recommended to take short walks or hikes near their home, however, although it is a good aerobic exercise for this population group, it does not have any benefit on balance or risk of falls. Therefore, it is important to start with an exercise routine that improves progressive endurance, strength and muscle tone, as well as balance before starting an aerobic routine.

Feeding

During aging there are physiological changes that interfere with the nutrition of the elderly.

• Sensory deficiencies such as loss or decrease of smell and / or taste, decrease appetite.
• Dental health problems can make chewing difficult and cause inflammation in the gums, which leads to poor diet and malnutrition.
• A diet poor in food favors the decrease in gastric acids, which reduces the absorption of iron and vitamin B12, leading to different types of anemia.
• Progressive loss of hearing and vision and osteoarticular diseases limit mobility, affecting the ability of the elderly to go shopping and prepare their food.
• Psychosocial and environmental changes such as depression, loneliness, isolation and lack of economic income have serious repercussions on the diet of the elderly.

Although energy needs decrease with age, the combination of all these factors puts the nutrition of the elderly at risk. However, nutrient requirements do not undergo significant changes, so by reducing food intake, nutrient intake also decreases, leading to malnutrition in old age.

Malnutrition in this period of life manifests itself with the loss of muscle and bone mass and an increased risk of frailty, which is related to the deterioration of cognitive function, decreased self-care capacity and greater dependence on them. Despite the importance of nutrition in old age, it is little diagnosed and there are few nutritional evaluations that are applied to the elderly, which must be treated from a multidisciplinary approach and individualized to each elderly adult.