Biological, Social-Environmental, And Psychological

BASIC AhJD APPLIED SOCIAL PSYCHOLOGY, 22(3), 199-212 Copyright © 2000, Lawrence Erlbaum Associates, Inc.

Biological, Social-Environmental, and Psychological Dialecticism: An Integrated Model of Aging Dean D. Von Dras and Herman T. Blumenthal ., • . . • ..

Aging and Development Program Department of Psychology Washington University, St. Louis

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Noting social-environmental and psychological factors as moderators of biological systems, a dialecticism involving these forces is proposed to account for physical changes and declines throughout adulthood. A sampling of research indicating psychosocial and social-cognitive constructs, lifestyle, and contextual elements to influence rates of morbidity and mortality is presented, and how these factors may advance the aging clock is discussed. A contextually grounded model of older adults' health behavior decision making is also introduced, and several areas where social psychologists may become active in research that illuminates processes of successful aging are described.

To be bom and to die are common to all animals, but there are specifically diverse ways in which these phenomena occur. (Aristotle, trans. 1984) The questions of how people mature and why people grow old have been the focus of theory and scientific investigation since the time of Aristotle. Modem theories of human aging have posited causative neurobiologica! processes that produce changes in behavior, cognition, and psychophysical function with increasing age (cf Bondareff, 1985; Botwinick, 1984; Salthouse, 1991). The homeostatic concept of aging posits that aging is part of a physiologic ontogenedc program or "master plan" regulated by the neuroendocrine system (Timiras, 1978). With advancing age this system, designed to maintain a balance between opposing biological mechanisms, progressively wanes, thereby creating imbalances expressed as manifestations of aging. Dilman (1981) demonstrated that over time there is a programmed progressive elevation in the hypothalamic set point to incoming endocrine signals so that a higher level ofthe incoming hormones is required to activate the hypothalamus. He also showed that the imbalances deriving from such phenomena can give rise to obesity, prediabetes, atherosclerosis, cancer, immunosuppression, menopause, and osteoporosis. The extent to wbich behaviors may play a role in tbe foregoing is depend-

Requests for reprints should be sent to Dean D. Von Dras, University of Wisconsin-Green Bay, Human Development Program, 2420 Nicolet Drive, Green Bay, WI 54311, E-mail: [email protected]

ent on cerebral influences on the hypotbalamus. Stein-Behrens and S^x)Isky (1992) addressed this aspect ofthe problem in studies focusing on the relation between physical and cognitive stress and aging, under the guise of stress as an accelerator of normal aging and aging as a time of impaired ability to cope with stress. Their particular focus is on the changes during stress on the hypotbalamic-pituitary-adrenocortical axis that result in a hypersecretion ofthe adrenal steroid homiones. They attribute the same spectrum of disorders as Dilman to the hypersecretion of adrenal homiones. In addition, they note that the hippocampal neurotis are a prime target of tbese bomiones and that there is a positive correlation of adrenal bypersecretion in Alzheimer's disease and affective disorders. Although it is evident that biopatbological changes in tbe brain result in impairment of various behaviors, tbe extreme of which is manifested in dementia, tbe evidence that is emerging in the disciplines of neuroendocrinology and psychoneuroimmunology is that social and cognitive events not associated witb identifiable brain cbanges, at least by presently available techniques, can initiate biological changes. In tbe context of aging then, we are on the boms of a dilemma: Biological changes in the brain associated with aging may be responsible for tbe emergence of psychological and behavioral change, but tbere is also the possibility tbat social-environmental and psychological factors may initiate biological changes. Assxmiing such a tautology, it is expected tbat there should be correspondent relations between social, psychological, and biological systems. In this article we suggest such relations and advo-

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cate that social psycbologists play important roles in understanding adult developmental processes and in delineating processes of successful aging. BIOLOGICAL DETERMINISM VERSUS A BIOLOGICAL, SOCIAL-ENVIRONMENTAL, AND PSYCHOLOGICAL DIALECTICISM A traditional and widely held view of adult maturational processes is that human aging is a progressive and irreversible process determined by one's genetic predisposition that culminates in death (Jones, 1959). This has led to a perspective of biological determinism from which various processes of adult development and aging have been viewed, and which has proposed that changes in bebavior across adulthood reflect age-related changes in the biology of the brain and its many subsystems (Bondareff, 1985). When considering adaptive person-environment transactions, however, this purely biological orientation appears too restrictive to account for the wide range of individual variation in pattems of biological and psychological growth, maintenance, and change across the life course (Birren & Cunningham, 1985). There is, however, a different biological perspective that may provide greater flexibility than the foregoing traditional view. Martin (1997) argued that although there are genetic programs that specify fetal development, postnatal growth, and sexual maturity, there is no genetic program that specifies senescence—only one that specifies maximum life span. Biological aging changes are caused by random events such as by-products of normal oxygen metabolism and the inactivation of protein by glucose metabolism, so-called advanced glycosylation end products (AGE products). There are also defense systems acquired in the course of evolution that, in accord with Darwin's (1859/1975) principle serve to maximize reproductive capacity ofthe species, which for humans is the age period between about 15 and 30 years. Al^er about age 30, these defense systems progressively wane because they are subject to the same random events tbat directly cause aging changes. Blumenthal (1997) demonstrated that this concept of causes and defenses also applies to aging of the brain. Indeed, Darwin's (1859/1975) principle of evolution suggests an interaction between genetic and environmental factors. Thus, to hypothesize biological processes as the sole causal mechanism of human aging would be incomplete. A more accurate hypothesis, one reflective of and in accord with Darwin's theory, is that of a bio-psycho-social dialecticism. From such an integrated perspective, the causal processes of adult development and aging are not reducible to biological, nor to social factors alone (see Bengston, Burgess, & Parrott, 1997, for a brief review of social theories of aging). Elather, biological, social-environmental, and psychological forces operate diaiectically, the viability of tbe bi-

ological being a necessary platform for life but influenced to a large extent by the impact the other two bave on basic homeostatic and adaptative processes. Thus recognizing this collectivity, the processes of human aging are seen not to be under rigid genetic control, but rather subject to sociocultural and environmental influences, free choice, and adaptation (Birren & Cunningham, 1985). Further, noting the influence psychological processes exert on underlying biological systems (Kiecolt-Glaser & Glaser, 1986; Maier, Watkins, & Fleshner, 1994; Vogt, 1992), tbe constructs of primary and secondary aging (i.e., change as a function of biological system exhaustion, insult, or wear and tear) are suggested not to be orthogonal but rather related processes occurring simultaneously along a continuous time-life dimension (Von Dras & Blumenthai, 1992), where changes in the person's functional abilities, capacities, and potentials across the life course reflect the collective effects of biological, social-environmental, and psychological factors (see Blumenthal, 1983, for a more in-depth discussion of aging-disease processes). AN INTEGRATED MODEL OF AGING As suggested in previous reviews (e.g., Ory, Abeles, & Lipman, 1992; Siegler, 1989; Siegler & Costa, 1985; Vogt, 1992), biological predisposition, psychological events, and social-environmental conditions interactively influence disease processes and rates of mortality. A model of aging that integrates these forces is shown in Figure 1. What is important to note about the integrated model of aging represented in Figure 1 is that all factors causally impact the aging control mechanisms or "aging clock" located in the brain. Thus, as described by Eisdorfer and Wilkie (1977) and by Everitt (1983), within the brain, neurons of higher brain centers associated with the regulation of biological aging activate the hypothalamus and pyramidal and extrapyramidal systems, which in turn mediate neuroendocrine and autonomic nervous systems' activity and the metabolism of skeletal muscles. Subsequent release of peripheral neurotransmitters and hormones by glandular systems (e.g., pituitary, adrenal, thyroid, thymus) is suggested to regulate the course of tissue aging and target organ's (e.g., heart, kidney, pancreas) homeostasis, with deficient or excessive levels of circulating hormones (e.g., corticosteroids, catecholamines) leading to a disruption of homeostatic processes and peripheral organ damage, thereby accelerating the rate of aging. Regarding potential effects that may be found within the brain itself, prolonged exposure to stressful events (e.g., depression, stress of warfare) that stimulate the production ofthe adrenal steroid hormone glucocorticoid hydrocortisone has been indicated to cause dendrite atrophy and eventual cell loss of hippocampal neurons, resulting in impairment of learning and memory (cf Bremner, 1998; Sapolsky, 1996; Stein-Behrens & Sapolsky, 1992). Thus, as Sapolsky (1996) proffered, prolonged stress and excessive exposure to

INTEGRATED MODEL OF AGING

Time/Life CadtiniiaiD

FIGURE 1

An integrated model of aging. 1

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glucocorticoid may "influence the likelihood of'successful' hippocampal and cognitive aging" (p. 750). Tangentially, with reference to the term successful aging, it is noted that aging research has traditionally focused on declines and losses of various sorts (e.g., in cognitive ability, functional capacity, size of social network), as well as rates of mortality and morbidity as indexes to gauge what normally occurs as one ages (Rowe & Kahn, 1987). Recognizing individual differences in the rates of change over the life course, however, recent tbeory and research has been directed at tbe study, explanation, and attainment of successful aging (Baltes, 1997; Rowe & Kahn, 1987, 1998; Schulz & Heckhausen, 1996); positing that with the appropriate regulation of factors such as nutrition, lifestyle, and environment, the individual may live to the end ofthe maximal human life span of roughly 120 years (Shock, 1977), enjoying continued and above-average functioning in many different life domains (e.g., cognitive ability, physical health, social activity). Thus conceptually, one defmition of successful aging is that of a prolongation or maintenance of youthful abilities and extended healthfulness at levels above the average of one's cohort or the performance standards of previous generations.' Following this definition, a very optimistic and lib-

' Arguably, this definition of successful aging is extremely nanow in that it suggests goals beyond the reach of most older people. A broader conceptualization, one more health promoting and person-enhancing, adopts an individual needs perspective and characterizes successful aging as a "desired aspiration" (Sullivan & Fisher, 1994, p. 72), where, bearing in mind one's unique situation and circumstances, optimal health, adaptive functioning, and well-being are preferred goals. This broader, individual-centered definition of successful aging is embraced and espoused in later discussion.

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eral example of a 70-year-old person's successful aging would be a depiction of an individual who, along with the wisdom attained via life's experiences, possesses relatively similar levels of cognitive ability, physical vitality and healthfulness, and involvement in career, community, and social activities enjoyed during young adulthood or midlife. An implicit assumption of the integrated model of aging in Figure 1 is that tbere are very gradual and normally occurring changes and reductions in various organ systems' functioning over time. For the purposes of recognizing individual variability in this process of change, slow and very slow rates of decrement and change may be respectively construed as normal and successful aging, whereas a high rate of decrement and change in systems' functioning and viability would denote an acceleration of aging. Correspondingly then, relying on the rates of morbidity and mortality as dependent variables, and genetic predispositions, psychological and social-environmental factors as quasi-independent variables, this integrated model becomes a method by which to assess the interactive influences of biological, social, and psychological factors on rates of change across the life continuum. In the following sections, social-environmental and psychological factors suggested to influence rates of morbidity and mortality, and how these factors may advance the aging clock are discussed.

Lifestyle Influences

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With an individual's transcending development from young adulthood to midlife, and then onto later adulthood, there is generally an increase in risk for disease and a decline in health and functionality (Jackson, 1999). Since 1980, the leading causes of death among older adults in the United States have respectively been diseases of the heart, cancers, and cerebrovascular disease. These diseases account for 70% of all deaths in those 65 years of age and older, and are projected to remain the major causes of death in older adults through the year 2020 (Jackson, 1999). Yet despite the increased probability of poor health in later life, it is important to note that the occurrence and course of many late-life diseases often stem from lifestyle habits initiated at early points in the person's development (e.g., cigarette smokers who begin smoking in their late teen years and continue to do so throughout the adult years are likely to manifest symptoms of heart and lung disease in midlife). Indeed, unhealthy lifestyles have been recognized to influence 50% of all-cause mortality in the United States (Michael, 1982). Thus, lifestyle modifications such as losing weight, limiting alcohol intake, stopping smoking, mcreasing aerobic activity, maintaining key nutrients and minerals, and reducing intake of sodium and fats have been well-noted prescriptions to help prevent common later adulthood diseases such as arthritis, hypertension, noninsulin-dependent diabetes, osteoporosis, heart disease.

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and atherosclerosis (Wilcox & King, 1999). For example, a lifestyle intervention to slow or stop coronary atherosclerosis, which consisted of a low-fat vegetarian diet, aerobic exercise, stress management training, smoking cessation, and group psychosocial support, indicated a reduction in artery stenosis and fewer cardiac events in participants able to maintain comprehensive changes in diet and lifestyle, whereas control-group participants showed an increase in artery stenosis and twice as many cardiac events (Omish et al., 1998). Less intensive lifestyle interventions have also shown beneficial effects (e.g., Dunn et al., 1999). For instance, an intervention for obese women that consisted of a low-fat diet and increased everyday lifestyle activity (e.g., walking instead of driving short distances, taking stairs instead ofthe elevator), was found just as effective as diet and structured aerobic exercise in lowering weight, systolic blood pressure, serum lipids, and lipoprotein levels (Andersen et al., 1999). Thus, because later life may be perceived as a time that includes declines in physical functioning and bealthfulness, a more optimistic outlook is afforded by the easy to apply, prescriptive lifestyle changes that prevent illness, allow more years of healthy living, and extend longevity. Further, it is important to note that the influence of lifestyles on health and disease processes across the life course provides key evidence arguing against a rigid biological control of aging, and in support of the integrated model. Moreover, it logically follows that lifestyle modifications that lower risk for disease and mortality may also slow or prevent an acceleration of aging.

Psychosocial Moderators Additional support for an integrated model of aging comes from research fields suggesting interrelations between psychosocial factors and biophysiological homeostasis. One of the most noted areas is psychoneuroimmunology (Kiecolt-Glaser & Glaser, 1986; Maier et al., 1994), where psychosocial factors (e.g., anxiety, bereavement, emotions of love, work stress) have been suggested to dynamically influence the production of circulating hormones, neuropeptides, and blood cells that servea specialized role in the immune system's defense against invading agents. With theconsequences being both positive (i.e., high perceived supportiveness of social relationships being suggested to promote the ability to resist infection and occurrence of illness; e.g., Cohen, 1991; Cohen, Doyle, Skoner, Rabin, & Gwaltney, 1997; Kiecolt-Glaser, Fisher, et al., 1987) and negative (i.e., high psychological stress suggested to deplete and weaken the immune system's response; e.g., Kennedy, Kiecolt-Glaser, & Glaser, 1988; Kiecolt-Glaser et al., 1986; Kiecolt-Glaser, Glaser, et al., 1987; Marucha, Kiecolt-Glaser, & Favagehi, 1998; Tomei, Kiecolt-Glaser, Kennedy, & Glaser, 1990). For example, caregivers of patients with Alzheimer's disease were found to have poorer antibody response to viral vaccina-

tion (Kiecolt-Glaser, Glaser, Gravenstein, Malarkey, & Sheridan, 1996) and slower wound healing (Kiecolt-Glaser, Marucha, Malarkey, Mercado, & Glaser, 1995) as a result of the chronic stress they endured, whereas heightened immune system functioning has been observed in individuals who reported the stress-buffering effects of strong feelings of social belongingness (Kennedy, Kiecolt-Glaser, & Glaser, 1990). Correspondingly, research exploring how neuroendocrine function may be associated with aspects of one's social environment indicated lower levels of urinary catecholamines and cortisol in older men who reported higher frequencies of receiving emotional support (e.g., feeling loved) and instrumental support (e.g., receiving help with daily tasks), and who had more children, relatives, and friends in their social network (Seeman, Berkman, Blazer, & Rowe, 1994), again suggesting a reduction in stress response occurs via positive aspects of one's interpersonal relationships. Overall, psychosocial factors (e.g., perceived stress, aspects of social support) have been indicated to influence blood flow, body temperature, levels of circulating hormones, and immune function (Maier et al., 1994). In relation to the integrated model, psychosocial forces are suggested to affect higher centers ofthe central nervous system that in turn influence homeostatic processes of the hypothalamus, neuroendocrine system, and autonomic nervous system, all which are components ofthe brain's aging clock. Consequently then, changes in systems' homeostatic processes due to psychosocial factors, which result in increases in risk of disease and mortality, may connote an advancement or acceleration ofthe aging clock. Research in diabetes and cancer further suggests psychosocial variables as causal antecedents of biophysiological response and rate of change across the life course. For example, coping style, personality constellation, psychopathological predispositions, and social support have all been found to significantly affect the diabetic's glucose control (AGE protein production), as well as the occurrence and course of diabetes-related diseases (e.g., Barglow, Hatcher, Edidin, & Sloan-Rossiter, 1984; Bradley, 1979; Fisher, Delameter, Bertelson, & Kirkley, 1982; Geringer, Perimuter, Stem, & Nathan, 1988; Lustman. Griffith, Ciouse, & Cryer, 1986; Surwit & Feinglos, 1984). Psychosocial constructs have also been suggested to play an important role in tbe development and course of cancer (e.g., Anderson, Kiecolt-Glaser, & Glaser, 1994; Fox, 1978; Selye, 1979), albeit the direction of the causal relation involving these variables and cancer has been a controversial one (cf Grossarth-Maticek & Eysenck, 1991; Kiecolt-Glaser & Chee, 1991; Zonderman, Costa, & McCrae, 1989). For example, in a 20-year follow-up study, psychological depression was positively associated with incidence and mortality from cancer after controlling for demographic, health, and lifestyle factors (Persky, Kempthome-Rawson, & Shekelle, 1987). Thus overall, psychosocial factors are again indicated to impact on brain centers that control homeostatic mechanisms and autonomic nervous system activity in a way that

INTEGRATED MODEL OF AGING

diminishes immune response and increases risk of disease and mortality, potentially speeding up the aging clock. Other evidence linking personality characteristics, coping style, and aspects of interpersonal relationships with biophysiological processes and longevity is foimd in cardiovascular disease (e.g., Berkman, Vaccarino, & Seemen, 1993; Cohen, 1991; Costa, Zonderman, & McCrae, 1991; Siegler et al., 1990; Siegman & Smith, 1994). For example, measures of hostility and the Type A behavior pattem have been significantly associated with greater risk of coronary heart disease as well as other health problems (e.g.. Barefoot, Dahlstrom, & Williams, 1983; Barefoot et al., 1991; Haney et al., 1996; Matthews, 1982; Siegler, Peterson, Barefoot, & Williams, 1992; Siltanen, 1984; Williams & Barefoot, 1988; Williams et al., 1980). Regarding coping style, the tendency to trust others, be tolerant, easygoing, and relaxed was found to predict survival in a sample of older men and women after controlling for demographic, health, and lifestyle factors (Barefoot etal., 1987). Social support has also been shown in several studies to predict morbidity and mortality (e.g., Berkman et al., 1993; Blazer, 1982; Broadhead et al., 1983). For example, unmarried patients with coronary artery disease who reported not having a close personal confidant were more than three times as likely to die within a 5-year period than were other patients with coronary artery disease (Williams et al., 1992). A similar increase in mortality has also been observed in cardiac patients who perceive low social support (Gorkin et al., 1993). In sum, personality characteristics, coping style, and interpersonal relationships are all suggested to moderate biological systems that are components ofthe aging clock (i.e., higher centers ofthe central nervous system, hypothalamus, neuroendocrine system, and autonomic nervous system). Thus, it again follows that psychosocial factors that increase the probability for disease and mortality may also accelerate aging.

Social-Cognitive Moderators Social-cognitive mechanisms and processes have also been indicated to moderate biological systems, influence rates of morbidity and mortality, and thus moderate aging. For example, research involving older adults in a simulated driving challenge reported level of self-esteem to be negatively associated with peak elevations in cortisol response (Seeman et al., 1995). In fact, participants with low self-esteem were found to have a nearly sixfold increase in cortisol response (Seeman et al., 1995), suggesting facets of self-concept may mediate hypothalamic-pituitary-adrenal system functioning, and resultantly the mechanisms and timing of the aging clock. Other research, examining the subjective appraisal of health made by older adults in poor objective health, reported that older adults who were optimistic about their health were significantly less likely to die than were those less optimistic in their appraisal (Borawski, Kinney, & Kahana, 1996). Fur-

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thermore, when optimism is measured as a dispositional personality variable it is associated with a faster rate of recovery from coronary artery bypass surgery and retum to normal life activities (Scheier et al., 1989). Thus, whether regarded as a bias in attribution and appraisal processes or as an underlying character trait, optimism is suggested to mediate biological processes and influence the individual's health and continued viability. A comparable relation has been observed between psychological control and health (e.g., Rodin, 1986; Rodin & Timko, 1992). For example, older adults who reported little functional impairment and high perceived control were less likely to be hospitalized and had a lower risk of mortality than were their same-aged peers who also reported little functional impairment but low-perceived control (Menec & Chipperfield, 1997). Other research, assessing week-to-week variability on measures of perceived control, reported that individuals who were less variable over 25 assessment sessions had a signiflcantly higher probability of survival 5 years later (Eizenman, Nesselroad, Featherman, & Rowe, 1997), again linking control with health and continued viability. In general, "health-related cognitions and behaviors, symptom labels, and physiological processes appear to mediate the control-health relationship" (Rodin & Timko, 1992, p. 196). Analogously then, social-cognitive constructs such as self-concept, optimism, and control may mediate higher order cerebral mechanisms that in turn regulate the homeostasis and timing of lower order components (e.g., the hypothalamus, amygdala, neuroendocrine system, autonomic nervous system), hence influencing the aging clock and rates of change.

Contextual Moderators: Environmental, Social-Cultural, Psychiatric Illness Cohorts

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Being a member of a particular environmental, social-cultural, or psychiatric illness cohort may also moderate one's aging. For example, a greater than expected mortality rate among U.S. service men interred by the Japanese during World War II and among people in tbe Netherlands during 1945 was observed as a result of the psychological stress and environmental hardship these populations endured during time of war (Jones, 1959). Further, membership in a particular socioeconomic cohort has been suggested to influence health behaviors (e.g., smoking, physical activity, alcohol consumption), psychological characteristics (e.g., depression, hostility), and rates of morbidity and mortality (Adler et al., 1994; Lantz et al., 1998), with lower socioeconomic status being associated with increased morbidity and mortality. In a like manner, membership in a particular ethnic cohort has also been suggested to affect health behavior and rates of morbidity and mortality (cf Flack et al., 1995; Johnson et al., 1995; Myers, Kagawa-Singer, Kumanyika, Lex, & Markides, 1995; Yee et al., 1995), with ethnic minority status in the United States

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being associated with greater economic impoverishment, riskier behavior, and increased rates of morbidity and mortality. Other research has suggested that psychiatric illness influences rates of morbidity and mortality. For example. World War II inductees who were medically discharged due to neurosis were found to have a 20% higher all-cause mortality rate than that of controls (Keehn, Goldberg, & Beebe, 1974). In a prospective study, the all-cause mortality rate of psychiatric outpatients was reported to be nearly twice that expected in their general population counterparts, with greater rates of mortality found in patients diagnosed with antisocial personality and schizophrenia (Martin, Cloninger, Guze, & Clayton, 1985). Further, although the direction of causal flow between depression and physical function is unclear (e.g., depression may produce a decline in physical function, or decline in physical function may cause depressive symptomology), it is noted that depressive symptoms are associated with greater physical disability (Wells et al., 1989), increased morbidity (Beekman et al., 1995). and higher utilization of health services (Johnson, Weissman, & Klerman, 1992). Moreover, in a prospective study, depressed older adults were found to be at significantly higher risk of physical decline in timed walking, standing balance, and rising from and sitting down in a chair, suggesting depression to be a significant predictor of later functional decline, disability, and death (Pherminx et al., 1998). Overall, various contextual elements (e.g., environmental, socioeconomic, social-cultural, psychological) are suggested to impact on biological systems that are components ofthe aging clock (i.e., cerebral cortex, hypothalamus, endocrine system, autonomic nervous system), increasing risk of disability, disease, and mortality, thereby advancing or accelerating aging.

A NEW DIRECTION FOR AGING RESEARCH The influence of social and psychological factors on rates of morbidity and mortality suggests the necessity of an integrated model of aging that accounts for the collective influence of biological, social-environmental, and psychological forces on adult development and aging processes. As noted by Botwinick (1984), however. Through the years scientists have tried to understand aging by formulating theories ... (but) despite all our models and all our theories, we really do not know very much about why people and animals age or why major organ systems decline, (pp.4-5) Yet, just as there has been a burgeoning of interest in understanding the processes of self-awareness and psychological influences on neurobiological events (e.g., Churchland, 1986; Creutzfeldt, Eccles, Szentagothai, & Gulyas, 1987;

Popper & Eccles, 1977; Searle, 1995), so too is there a growing interest in understanding the effects of social and environmental factors on aging processes (Vogt, 1992). To this effect then, it is further recognized that social psychologists, by conducting both basic and applied research, play important roles in understanding aging processes and in delineating processes of successful aging. Indeed, social psychological research is necessary to illuminate paths to optimal experiences and outcomes in later life. Thus, operatively, in accord with a national agenda for research on aging (Lonergan & Kravens, 1991), social psychologists may make important contributions by conducting research that contributes to a basic understanding about the processes of aging, addresses problems of later life disability and functional impairment, provides interventions that would assist in lowering rates of morbidity and mortality among the elderly, and increases knowledge of behavioral and social factors that help older adults maintain social relationships, physical health, and psychological well-being, Given that noncollege-age adults represent a very small proportion of individuals on which models of social behavior are built (Sears, 1987), a first step in this endeavor is to recognize that adult human experience involves us all (i.e., young, midtife, old, and very old adults), and to enroll age-representative individuals as participants in research. It is also impK>rtant to be aware that within a society where functional utilitarianism and youthfulness are esteemed, prejudiced attitudes toward older adults are often found in its folklore, institutions, media representations, and social stereotypes (Blank, 1979; Butler. 1969, 1980; Slotterback & Saamio, 1996; Whitboume & Hulicka, 1990). Therefore, as educators, it behooves us to include information about midUfe and later adulthood in class lectures and discussions to heighten social awareness ofthe temporal aspect of adult life and periods of development beyond the college years, thereby promoting knowledge about the vast individual differences in continued development and maturity, and refuting negative stereotypes and myths of midlife and later adulthood (see Blank, 1979, for a discussion of ways to supplement social psychology teaching resources). In this regard it is also important to espouse successful aging in its broadest, most health-promoting terms, as an individual needs-oriented goal of optimal health, adaptive functioning, and well-being, that includes making positive adjustment to frailties and disabilities, and attaining a sense of meaning and purpose in one's later years despite changes in functionality, social roles, careers, and self-autonomy (Bowling, 1993; Coleman, 1992; Kivnick & Jemstedt, 1996; Motenko & Greenberg, 1995; Ryff, 1989; Sullivan & Fisher. 1994). A second step is to build and apply innovative models that will explain behavior throughout adulthood. As an illustration of such an endeavor, an analogue of Rakowski's (1984) model of older adults' health behavior decision making is presented in Figure 2. This modified model suggests reciprocal and dynamic association between social pereeptions, mental representations, memory, and evaluative processes

INTEGRATED MODEL OF AGING

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that influence decision making and behavior. Further, the modified model also recognizes the pervading influence of contextual factors on thought and behavior (cf Blank, 1989; Bruner, 1990; Shweder, 1991). Tbus, congruent with Revenson's (1990, 1994) ecological/contextual framework, a key assumption of this model is that each person operates within many interdependent and overlapping contexts: an interpersonal context, a sociocultural context, a situationa! context, and a temporal context. For example, following Revenson's (1994) characterization, the style of support family members (the interpersonal context) provide to an individual making changes in diet and lifestyle to prevent heart disease may reflect "rugged-individualist" attitudes that bolster self-esteem and competence, but only for older men (the sociocultural context), and only during an initial transitional period when decisions are made and actions first taken (tbe temporal context) following a physician's advice that dietary and lifestyle changes are required (the situational context). This model is especially noteworthy in that it suggests several areas where social psychologists may become active in research that explores adult development and illuminates processes of successful aging. For example, research exploring social perceptual-cognitive processes (components of Stages I, II, and III of the model in Figure 2) as well as contextual factors (the ground surrounding and influencing all of the deci-

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sion-making model's components) is one area important in illuminating processes of successful aging. Indeed, Giles and Condor (1988), noting the constant changes in technology, society, and aging one experiences across tbe life course, suggested that "How people represent, understand, attribute, and respond to these constant changes can contribute ... not only to the extent ofthe lifespan but to the very quality of it" (p. 60). Within the decision-making model, both interpersonal communications and intrapersonal cues are forces that activate mental representations and prompt one to plan actions and carryout behaviors. Indeed, interpersonal communications are essential in conveying social norms, attitudes, and coping information (Hafner & Welz, 1989), and in shaping health behaviors (cf Lewis, Rook, & Schwarzer, 1994). Thus adaptively, people with close interpersonal relationships are more likely to engage in positive health behaviors, eating healthfully, exercising, not smoking, and taking action to prevent disease such as having a regular checkup and conducting self-exams (cf Antonucci & Akiyama, 1993; Schone & Weinick, 1998; Umberson, 1987, 1992). Intrapersonal cues also operate as causal factors that activate cognitions and prompt behaviors. For example in a communit>' survey of interest in a peer-led successful aging course, respondents who expressed the greatest interest in participating were also individuals most likely to benefit from the positive social contact and assistance afforded by the successful aging course, that is, older adults reporting low psychosocial well-being and self-efficacy and greater physical limitations (Kocken & Voorham, 1998). Further elucidation of interpersonal communications and intrapersonal cues that influence decision making and lead to healthy and adaptive aging are important areas for future research. Attitudes are causally linked to later choices and behaviors in the decision-making model of Figure 2, and thus represent another key area in illuminating processes of successful aging. For example, research exploring older adults' use of informal and formal social assistance reported a person's utilization of assistance to be positively associated with their expectations of care from family members and attitudes about using formal services (Noelker et al., 1998). Similarly, older adults' positive attitudes toward exercise were found to predict greater adherence to home-based exercise programs (Jette et al., 1998). Other research has suggested that the susceptibility for attitude change varies at tiifferent points along the life continuum, with younger and older adults being more susceptible to attitude change than adults at midlife (Visser & Krosnick, 1998). Thus, one potential area for future research would be attitude change interventions to promote successful aging (e.g., changing attitudes to help individuals adopt new lifestyle habits to prevent illness). As prescriptively suggested by Visser and Krosnick (1998, Table 6), social psychological research that explores susceptibility to attitude change mechanisms such as decreasing importance or obsolescence of attitudes, changes in memory retrieval processes and cognitive resources, decreasing cer-

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tainty of attitudes, clianges in roles and social networks, and changes in meaning associated with attitude objects over time would be an important next step in this area. As suggested in tbe decision-making model of Figure 2, social stereotypes along with social-environmental contextual factors are causally linked to later behavior and actions. Thus, research that investigates social stereotypes "tbat cast older adults as inflexible, unwilling or unable to cbange attitudes, behavior or lifestyles" (Ory & Cox, 1994, p. 95) would also contribute to illuminating processes of successful aging. For example, stereotyping of older adults as ignorant, resistant to change, and responsible for their own plight, along with the contextual influences of geography {e.g., neighborhood location, distance to centers) and other social characteristics (e.g., problems of family structure and economics, racism, reluctance to use services) were common themes described by expert social service providers as barriers to older adults' nutritional well-being (Arcury, Quandt, Bell, McDonald, & Vitolins, 1998). Allied research, investigating optimistic bias, age stereotypes, and perceptions of age-related illnesses reported that participants were less optimistic in their judgments of risk when they believed the medical condition was related to aging (Madey & Gomez, 2000). Further, middle-aged adults were found to be unrealistically pessimistic for acquiring common age-related diseases (i.e., cataracts, vision and hearing loss), suggesting that persons' perceived optimism or pessimism about their ability to stay healthy varies at different points across the life course (Madey & Gomez, 2000). One conclusion suggested by this study is that as a result of age-illness stereotypes, people may overlook environmental or lifestyle factors that may contribute to poor health, thus delaying lifestyle modifications that would help them live more healthfully and age more successfully (Madey & Gomez, 2000). Other investigations (e.g., Barta Kvitek, Shaver, Blood, & Shepard, 1986; James & Haley, 1995) have suggested that age-illness stereotypes may also influence the care provided by health practitioners. Thus research tbat exposes age-disease stereotypes and biases in health attitudes is an important first step in correcting these biases and in helping older adults realize lifestyle changes that beneficially foster health and well-being. A greater understanding of otber social-cognitive processes and contextual influences (e.g., interpersonal, temporal, situational, sociocultural) is essential in illuminating later life development and successful aging. For example. Levy and Langer (1994) reported older adults from cultures where elderly persons are viewed positively (i.e., Chinese, American deaf) bad better memory test performance than did older adults from a culture where elderly persons are viewed negatively (i.e., American), suggesting that long-held cultural beliefs about aging may become self-fulfil ling prophecies that influence the degree of later life memory loss. Similarly, social schemas, important self-motives, and memory processes have been suggested to influence later life coping and behavior. For example, an investigation by Wong

and Watt (1991) indicated older adults have a wide array of reminiscences, and that reminiscences tbat were integrative (i.e., personal memories where the main function is to achieve a sense of self-worth, coherence, and reconciliation over one's life) and instrumental (i.e., personal memories of past plans, goals, overcoming of challenges, and drawing from past experiences to solve present problems) were related to better mental and physical health. An expanded understanding of age-associated changes in attributional processes is also needed. For example, in comparison to young adults, older adults were found to make more attributions that suggest a character-by-situation interaction in vignettes that involved relationship situations, and more dispositional attributions of the main character in vignettes that resulted in negative outcomes (Blancbard-Fieids, 1994). Moreover, tbe activation and use of different attributional schemas have been suggested to vary throughout adulthood. For instance, attributions elicited by a vignette involving a young couple's career and relationship concems that ends with the couple breaking up indicated that the scheina "marriage is more important than career" (p. S141) linearly increased in frequency of expression from young (30%) to later adulthood (82%), whereas the schema "tbe marriage was already in trouble" (p. S141) showed a U-shaped function with midlife adults (45%) expressing this more frequently than young (25%) or older (25%) adults (Blanchard-Fields, 1996). Extensively, this research suggests age variation in social-cognitive processes that consequenfly shape and direct behavior. Therefore, further exploration of tbe strength and relevance of schemas elicited by different situations, self-motives, and cultural beliefs would be key in understanding when older adults engage in complex in-depth reasoning or when they rely on automatic or heuristic processes (Blanchard-Fields, 1996), thus illuminating social-cognitive processes that may influence healthfulness, adaptation, and optimal person-environment transactions in later life. As noted by the feedback loops in the decision-making model of Figure 2, dynamic self-appraisal and social comparison are important causal mechanisms that influence later choices and actions. Therefore researcb focused on mutable aspects of self, social comparison processes, and adaptive behaviors is also necessary to better understand processes of successful aging. For example, previous theory and research have described changes in aspects of self throughout adulthood, noting an unfolding of negative and positive possible selves (cf Cross & Markus, 1991; Markus & Herzog, 1991), and self-appraised changes in dispositional traits from early to later life (Fleeson & Heckhausen, 1997). Relatedly, underlying self processes (e.g., need for esteem, control, safety) have been suggested to influence one's selection of performance domains, setting of goal standards, and behavioral strategies that allow optimization of performance outcomes (Bakes & Baltes, 1990; Baltes, Smith, & Staudinger, 1992; Brandtstadter & Rothermund, 1994; Lawton & Nahemow, 1973). In social comparison research, positive self-other

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comparisons have been suggested to be protective of the mental health and well-being of older adults in poor health (cf Ryff, 1999). Thus in general, adaptive shifts in self-deflnition, compensatory behavioral strategies, and self-enhancing social comparisons have all been implicated as correlates of health and adaptation in later life (cf. Ryff, 1999). Therefore, continued research in these areas, with special consideration given to contextual influences, would further contribute to our understanding of adaptive processes and transitions throughout the adult years. Research that combines different aspects of decision making (i.e., cognitive, psychological, social, statistical) is also needed to understand processes of successful aging. Although there has been little investigation integrating these various aspects, different pieces of research may beflttedtogether to begin to form a larger mosaic. For example, research focusing on cognitive mechanisms has indicated that older adults spend more time considering less information (Johnson, 1993), suggesting age-related changes in decision-making processes due to slowing of information processing or reduction in cognitive resources. Other research focusing on decisions about finances, legal problems, and retirement issues has suggested that domains and contexts may differentially moderate older adults' decision-making efficacy. For example, older adults were found to be overconfident in assessing tbe efficacy of their solutions when asked to make decisions conceming legal problems and finances (Devolder, 1993). Conversely, when asked to make decisions regarding financial planning and retirement issues, older adults were found to be underconfident in their decision-making appraisals (Hershey & Wilson, 1997). Investigations focusing on psychological processes that moderate choice have suggested that with advancing age there is greater cautiousness (e.g., Botwinick, 1984, pp. 177-181) and less impulsivity (e.g., Green, Meyerson, Lichtman, Rosen, & Fry, !996) in decision making. In a related area, research exploring self-appraisal motivation reported older adults low in self-efRcacy and high in uncertainty about their intellectual ability status were more likely to select intellectual performance domains where they had previously received tow-uncertainty feedback (Von Dras, 1996). This research hints that self-appraisal behaviors that lead to successful aging (e.g., self-exam to prevent disease, self-monitoring to maintain diabetic control) may be moderated by how self-assessment feedback is perceived and interpreted as well as a variety of personal characteristics (e.g., self-efficacy perceptions, uncertainty orientation, self-enhancing and self-protective motives). Of paramount concern from a social perspective is that family members and intimate companions are often involved in helping older adults make a variety of life and medical care decisions (e.g., Glasser, Prohaska, & Roska, 1992; Hansson & Remondet, 1987; Motenko & Greenberg, 1995; Smyer, 1993; Wilber & Reynolds, 1995). Tbus methodologies that investigate behavior within the interpersonal context are needed to eluci-

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date individual and family members' decision-making processes, and illuminate ways older adults may "enhance and maintain their competence, self-esteem, and autonomy until the end of life" (Motenko & Greenberg, 1995, p. 388). As illustrated in Figure 2, a variety of cognitive, psychological, and social factors influence decision making. Thus research endeavors in this area should be integrative, and especially attentive to the interdependent relationships between perception, experience, thought, and behavior, keeping in mind that the older adult's power and control over life and decision-making ability is related to health (Beckingham & Watt, 1995), and that "chronic disease and disability pose the greatest threats to successful aging" (Rose, 1991, p. 87). Other forces also influence one's decisions and choices in later life, and subsequently successful aging. Indeed, in later life the individual's choices and behaviors may reflect an unfolding of intrapsychic developmental processes (e.g., Erikson, Erikson, & Kivnick, 1989;Gutmann, 1987;Kivnick & Jemstedt, 1996), as well as the affects of the many social interactions and role models one has been exposed to across the life course (Hendricks, 1992). For instance, one theoretical perspective suggests that across adulthood there is a process of fluctuations that defines the posturing of one's "self to its inner and outer worlds, and alludes that this process of intrapsychic development and self-definition influences decisions and behaviors throughout the adult years (Gould, 1972). Another perspective posits that we live in a sjinbolic world, and suggests that the successful aging "me" is a result of a "self negotiated and acquired via one's social interactions (cf Hendricks, 1992). In accordance with this latter social constructionist perspective, Kastenbaum (1994) suggested three possible models of the successfully aging man: the saint, the son of a bitch, and the sage. Although these representations fall short of describing the entire range of later life experiences and capacities, they allude to the processes of social leaming by which successful aging personas and styles of behavior may be acquired by older adults (Kastenbaum, 1994; Kivnick & Jemstedt, 1996). In a related way, interpersonal support processes have also been identifled as factors that impact on the person's wellness and health as they mature and grow old (e.g., Lewis et al., 1994). For example, perceptions of social support have been positively associated with attitudes toward health goals, motivation to comply with social norms, control beliefs, and perceived success in attaining healthful outcomes (Von Dras & Madey, 1997), suggesting that successful aging may be faciltated by the perception as well as real positive functioning of supportive relationships. Other research has suggested that marital couples' poor mental and physical health may lessen the assistance and care older spouses provide to one another (Von Dras, Siegler, Barefoot, Williams, & Mark, 1999), thus impeding successful aging. In general, theory and research that explores the self-deflning influences of intrapsychic processes and social interactions, along with the effects ofbehavioral modeling and interpersonal support on

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successful aging processes, would extend these areas of research and provide basic information for developing interventions to assist the individual in maintaining health and well-being in later life.

CONCLUSION Biological, social-environmental, and psychological factors operate dialecticaiiy, influencing processes of adult development and aging. Successful aging refers to individual trajectories of experience, adaptation, and optimal outcomes, and includes various social psychological processes such as self-perception, attitude change, stereotyping, and social comparison that influence later life well-being and health. Both the integrated model of aging (Figure !) and the decision-making model of older adults' health behaviors (Figure 2) provide contextually oriented frameworks that suggest many areas for future social psychology research. Noting that older adults are more heterogeneous than any other segment of the population (Burback-Weiss, 1988), much thought should be given to how successful aging may become a social construct that discriminates against individuals who are not able to meet self-initiated goals, or are below their cohort's mean for healthfulness, vitality, functionality, and social involvement (Sullivan & Fisher, 1994). Thus, it is important to characterize successful aging in a way so that it inciudes making positive adjustment to frailties and disabilities, and in attaining a sense of meaning and purpose throughout one's life. A primary concern of future research is to understand older adults' lifestyle practices, and "why some individuals choose not to adopt beneficial health behaviors" (Schone & Weinick, 1998, p. 625). Future research is also needed that will illuminate social psychological processes and mechanisms that mediate decision-making activities and behavior, and thereby provide a "link between health behaviors and morbidity and mortality in the elderly" (Schone & Weinick, 1998, p. 626). Recognizing the dialecticism between biological, social-environmental, and psychological factors, and their interactive influence on processes of adult development and aging, one is reminded that "action and thought cannot be understood or explained without reference to relationships with goals, intentions, and meaning on the one hand, and contexts, situations, and history on the other" (Blank, 1989, p. 227). Thus, future research approaches, while avoiding nihilistic empirical premises, should recognize the interplay between contexts, processes, and mechanisms, and how these forces shape each person's identity, transcendent experience, and maturation across the life course. Noting the languid nature of many past and present adult deveiopment and aging research paradigms (see Ryff, 1989, and Kivnick & Jemstedt, 1996, for related discussions)—largely oriented on behaviorist principles; constructs such as achievement, competency, and control; and

negative-biases in expectation to demonstrate age-related decrement—it is appropriate to herald Blank's (1989) earher declaration: Explication of processes of change and stability and of involvement in active negotiation of everything from success and failure to emotional intimacy to one's self are urgently needed to revitalize areas as diverse as attributions, physical environment relationships, social and self-identity, and interpersonal relations, (p. 236) Thus, the immediate charge put forth to social psychologists is to note tbe many influences on human experience across the life course and become active in the description and explanation of successful aging processes both as researchers and as educators—with the highest hope being an enhancement of each individual's continued development, unique experience, well-being, and health in later life.

ACKNOWLEDGMENT Dean D. Von Dras is now at the University of Wisconsin-Green Bay. Very special thanks to Scott Madey and Susan Robinson-Wheeler for their insightful comments on earlier versions of this article.

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