Biological, Social-Environmental, And Psychological

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

Biological, Social-Environmental, and PsychologicalDialecticism: An Integrated Model of Aging

Dean D. Von Dras and Herman T. BlumenthalAging and Development Program ,

., • . Department of Psychology. • .. Washington University, St. Louis >

Noting social-environmental and psychological factors as moderators of biological systems, adialecticism involving these forces is proposed to account for physical changes and declinesthroughout adulthood. A sampling of research indicating psychosocial and social-cognitiveconstructs, lifestyle, and contextual elements to influence rates of morbidity and mortality ispresented, and how these factors may advance the aging clock is discussed. A contextuallygrounded model of older adults' health behavior decision making is also introduced, and severalareas where social psychologists may become active in research that illuminates processes ofsuccessful aging are described.

To be bom and to die are common to all animals, butthere are specifically diverse ways in which these phe-nomena occur. (Aristotle, trans. 1984)

The questions of how people mature and why people grow oldhave been the focus of theory and scientific investigation sincethe time of Aristotle. Modem theories of human aging have pos-ited causative neurobiologica! processes that produce changesin behavior, cognition, and psychophysical function with in-creasing age (cf Bondareff, 1985; Botwinick, 1984; Salthouse,1991). The homeostatic concept of aging posits that aging ispart of a physiologic ontogenedc program or "master plan" reg-ulated by the neuroendocrine system (Timiras, 1978). With ad-vancing age this system, designed to maintain a balance be-tween opposing biological mechanisms, progressively wanes,thereby creating imbalances expressed as manifestations of ag-ing. Dilman (1981) demonstrated that over time there is a pro-grammed progressive elevation in the hypothalamic set point toincoming endocrine signals so that a higher level ofthe incom-ing hormones is required to activate the hypothalamus. He alsoshowed that the imbalances deriving from such phenomena cangive rise to obesity, prediabetes, atherosclerosis, cancer,immunosuppression, menopause, and osteoporosis. The extentto wbich behaviors may play a role in tbe foregoing is depend-

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

ent on cerebral influences on the hypotbalamus. Stein-Behrensand S^x)Isky (1992) addressed this aspect ofthe problem instudies focusing on the relation between physical and cognitivestress and aging, under the guise of stress as an accelerator ofnormal aging and aging as a time of impaired ability to copewith stress. Their particular focus is on the changes during stresson the hypotbalamic-pituitary-adrenocortical axis that result ina hypersecretion ofthe adrenal steroid homiones. They attributethe same spectrum of disorders as Dilman to the hypersecretionof adrenal homiones. In addition, they note that thehippocampal neurotis are a prime target of tbese bomiones andthat there is a positive correlation of adrenal bypersecretion inAlzheimer's disease and affective disorders.

Although it is evident that biopatbological changes intbe brain result in impairment of various behaviors, tbe ex-treme of which is manifested in dementia, tbe evidence thatis emerging in the disciplines of neuroendocrinology andpsychoneuroimmunology is that social and cognitive eventsnot associated witb identifiable brain cbanges, at least bypresently available techniques, can initiate biologicalchanges. In tbe context of aging then, we are on the bomsof a dilemma: Biological changes in the brain associatedwith aging may be responsible for tbe emergence of psy-chological and behavioral change, but tbere is also the pos-sibility tbat social-environmental and psychological factorsmay initiate biological changes. Assxmiing such a tautol-ogy, it is expected tbat there should be correspondent rela-tions between social, psychological, and biologicalsystems. In this article we suggest such relations and advo-

2 0 0 VON DRAS AND BLUMENTHAL

cate that social psycbologists play important roles in under-standing adult developmental processes and in delineatingprocesses of successful aging.

BIOLOGICAL DETERMINISM VERSUSA BIOLOGICAL,

SOCIAL-ENVIRONMENTAL,AND PSYCHOLOGICAL DIALECTICISM

A traditional and widely held view of adult maturationalprocesses is that human aging is a progressive and irrevers-ible process determined by one's genetic predisposition thatculminates in death (Jones, 1959). This has led to a perspec-tive of biological determinism from which various pro-cesses of adult development and aging have been viewed,and which has proposed that changes in bebavior acrossadulthood reflect age-related changes in the biology of thebrain and its many subsystems (Bondareff, 1985). Whenconsidering adaptive person-environment transactions,however, this purely biological orientation appears too re-strictive to account for the wide range of individual varia-tion in pattems of biological and psychological growth,maintenance, and change across the life course (Birren &Cunningham, 1985).

There is, however, a different biological perspective thatmay provide greater flexibility than the foregoing traditionalview. Martin (1997) argued that although there are geneticprograms that specify fetal development, postnatal growth,and sexual maturity, there is no genetic program that speci-fies senescence—only one that specifies maximum life span.Biological aging changes are caused by random events suchas by-products of normal oxygen metabolism and the inacti-vation of protein by glucose metabolism, so-called advancedglycosylation end products (AGE products). There are alsodefense systems acquired in the course of evolution that, inaccord with Darwin's (1859/1975) principle serve to maxi-mize reproductive capacity ofthe species, which for humansis the age period between about 15 and 30 years. Al^er aboutage 30, these defense systems progressively wane becausethey are subject to the same random events tbat directly causeaging changes. Blumenthal (1997) demonstrated that thisconcept of causes and defenses also applies to aging of thebrain.

Indeed, Darwin's (1859/1975) principle of evolution sug-gests an interaction between genetic and environmental fac-tors. Thus, to hypothesize biological processes as the solecausal mechanism of human aging would be incomplete. Amore accurate hypothesis, one reflective of and in accordwith Darwin's theory, is that of a bio-psycho-social dialecti-cism. From such an integrated perspective, the causal pro-cesses of adult development and aging are not reducible tobiological, nor to social factors alone (see Bengston, Bur-gess, & Parrott, 1997, for a brief review of social theories ofaging). Elather, biological, social-environmental, and psy-chological forces operate diaiectically, the viability of tbe bi-

ological being a necessary platform for life but influenced toa large extent by the impact the other two bave on basichomeostatic and adaptative processes. Thus recognizing thiscollectivity, the processes of human aging are seen not to beunder rigid genetic control, but rather subject to socioculturaland environmental influences, free choice, and adaptation(Birren & Cunningham, 1985). Further, noting the influencepsychological processes exert on underlying biological sys-tems (Kiecolt-Glaser & Glaser, 1986; Maier, Watkins, &Fleshner, 1994; Vogt, 1992), tbe constructs of primary andsecondary aging (i.e., change as a function of biological sys-tem exhaustion, insult, or wear and tear) are suggested not tobe orthogonal but rather related processes occurring simulta-neously along a continuous time-life dimension (Von Dras& Blumenthai, 1992), where changes in the person's func-tional abilities, capacities, and potentials across the lifecourse reflect the collective effects of biological, so-cial-environmental, and psychological factors (seeBlumenthal, 1983, for a more in-depth discussion of ag-ing-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, andsocial-environmental conditions interactively influence dis-ease processes and rates of mortality. A model of aging thatintegrates these forces is shown in Figure 1. What is impor-tant to note about the integrated model of aging representedin Figure 1 is that all factors causally impact the aging controlmechanisms or "aging clock" located in the brain. Thus, asdescribed by Eisdorfer and Wilkie (1977) and by Everitt(1983), within the brain, neurons of higher brain centers as-sociated with the regulation of biological aging activate thehypothalamus and pyramidal and extrapyramidal systems,which in turn mediate neuroendocrine and autonomic ner-vous systems' activity and the metabolism of skeletal mus-cles. Subsequent release of peripheral neurotransmitters andhormones by glandular systems (e.g., pituitary, adrenal, thy-roid, thymus) is suggested to regulate the course of tissue ag-ing and target organ's (e.g., heart, kidney, pancreas) homeo-stasis, with deficient or excessive levels of circulatinghormones (e.g., corticosteroids, catecholamines) leading to adisruption of homeostatic processes and peripheral organdamage, thereby accelerating the rate of aging. Regardingpotential 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 adrenalsteroid hormone glucocorticoid hydrocortisone has been in-dicated to cause dendrite atrophy and eventual cell loss ofhippocampal neurons, resulting in impairment of learningand 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 201

Time/Life CadtiniiaiD

FIGURE 1 An integrated model of aging.

1 r

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 de-clines and losses of various sorts (e.g., in cognitive ability,functional capacity, size of social network), as well as ratesof mortality and morbidity as indexes to gauge what nor-mally occurs as one ages (Rowe & Kahn, 1987). Recog-nizing individual differences in the rates of change over thelife course, however, recent tbeory and research has been di-rected at tbe study, explanation, and attainment of successfulaging (Baltes, 1997; Rowe & Kahn, 1987, 1998; Schulz &Heckhausen, 1996); positing that with the appropriate regu-lation of factors such as nutrition, lifestyle, and environment,the individual may live to the end ofthe maximal human lifespan of roughly 120 years (Shock, 1977), enjoying continuedand above-average functioning in many different life do-mains (e.g., cognitive ability, physical health, social activ-ity). Thus conceptually, one defmition of successful aging isthat of a prolongation or maintenance of youthful abilitiesand extended healthfulness at levels above the average ofone's cohort or the performance standards of previous gener-ations.' Following this definition, a very optimistic and lib-

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

eral example of a 70-year-old person's successful agingwould be a depiction of an individual who, along with thewisdom attained via life's experiences, possesses relativelysimilar levels of cognitive ability, physical vitality andhealthfulness, and involvement in career, community, andsocial activities enjoyed during young adulthood or midlife.

An implicit assumption of the integrated model of agingin Figure 1 is that tbere are very gradual and normally occur-ring changes and reductions in various organ systems' func-tioning over time. For the purposes of recognizing individualvariability in this process of change, slow and very slow ratesof decrement and change may be respectively construed asnormal and successful aging, whereas a high rate of decre-ment and change in systems' functioning and viability woulddenote an acceleration of aging. Correspondingly then, rely-ing on the rates of morbidity and mortality as dependent vari-ables, and genetic predispositions, psychological andsocial-environmental factors as quasi-independent variables,this integrated model becomes a method by which to assessthe interactive influences of biological, social, and psycho-logical factors on rates of change across the life continuum.In the following sections, social-environmental and psycho-logical factors suggested to influence rates of morbidity andmortality, and how these factors may advance the agingclock are discussed.

Lifestyle Influences i

With an individual's transcending development from youngadulthood to midlife, and then onto later adulthood, there isgenerally an increase in risk for disease and a decline inhealth and functionality (Jackson, 1999). Since 1980, theleading causes of death among older adults in the UnitedStates have respectively been diseases of the heart, cancers,and cerebrovascular disease. These diseases account for70% of all deaths in those 65 years of age and older, and areprojected to remain the major causes of death in olderadults through the year 2020 (Jackson, 1999). Yet despitethe increased probability of poor health in later life, it is im-portant to note that the occurrence and course of manylate-life diseases often stem from lifestyle habits initiated atearly points in the person's development (e.g., cigarettesmokers who begin smoking in their late teen years andcontinue to do so throughout the adult years are likely tomanifest symptoms of heart and lung disease in midlife).Indeed, unhealthy lifestyles have been recognized to influ-ence 50% of all-cause mortality in the United States (Mi-chael, 1982). Thus, lifestyle modifications such as losingweight, limiting alcohol intake, stopping smoking, mcreas-ing aerobic activity, maintaining key nutrients and minerals,and reducing intake of sodium and fats have beenwell-noted prescriptions to help prevent common lateradulthood diseases such as arthritis, hypertension,noninsulin-dependent diabetes, osteoporosis, heart disease.


and atherosclerosis (Wilcox & King, 1999). For example, alifestyle intervention to slow or stop coronary atherosclero-sis, which consisted of a low-fat vegetarian diet, aerobic ex-ercise, stress management training, smoking cessation, andgroup psychosocial support, indicated a reduction in arterystenosis and fewer cardiac events in participants able tomaintain comprehensive changes in diet and lifestyle,whereas control-group participants showed an increase inartery stenosis and twice as many cardiac events (Omish etal., 1998). Less intensive lifestyle interventions have alsoshown beneficial effects (e.g., Dunn et al., 1999). For in-stance, an intervention for obese women that consisted of alow-fat diet and increased everyday lifestyle activity (e.g.,walking instead of driving short distances, taking stairs in-stead ofthe elevator), was found just as effective as diet andstructured aerobic exercise in lowering weight, systolicblood pressure, serum lipids, and lipoprotein levels(Andersen et al., 1999). Thus, because later life may be per-ceived as a time that includes declines in physical function-ing and bealthfulness, a more optimistic outlook is affordedby the easy to apply, prescriptive lifestyle changes that pre-vent illness, allow more years of healthy living, and extendlongevity. Further, it is important to note that the influenceof lifestyles on health and disease processes across the lifecourse provides key evidence arguing against a rigid bio-logical control of aging, and in support of the integratedmodel. Moreover, it logically follows that lifestyle modifi-cations that lower risk for disease and mortality may alsoslow or prevent an acceleration of aging.

Psychosocial Moderators

Additional support for an integrated model of aging comesfrom research fields suggesting interrelations betweenpsychosocial factors and biophysiological homeostasis. Oneof the most noted areas is psychoneuroimmunology(Kiecolt-Glaser & Glaser, 1986; Maier et al., 1994), wherepsychosocial factors (e.g., anxiety, bereavement, emotions oflove, work stress) have been suggested to dynamically influ-ence the production of circulating hormones, neuropeptides,and blood cells that servea specialized role in the immune sys-tem's defense against invading agents. With theconsequencesbeing both positive (i.e., high perceived supportiveness of so-cial relationships being suggested to promote the ability to re-sist infection and occurrence of illness; e.g., Cohen, 1991; Co-hen, Doyle, Skoner, Rabin, & Gwaltney, 1997;Kiecolt-Glaser, Fisher, et al., 1987) and negative (i.e., highpsychological stress suggested to deplete and weaken the im-mune 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). Forexample, caregivers of patients with Alzheimer's diseasewere 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 ofthe chronic stress they endured, whereas heightened immunesystem functioning has been observed in individuals who re-ported the stress-buffering effects of strong feelings of socialbelongingness (Kennedy, Kiecolt-Glaser, & Glaser, 1990).Correspondingly, research exploring how neuroendocrinefunction may be associated with aspects of one's social envi-ronment indicated lower levels of urinary catecholamines andcortisol in older men who reported higher frequencies of re-ceiving emotional support (e.g., feeling loved) and instrumen-tal support (e.g., receiving help with daily tasks), and who hadmore children, relatives, and friends in their social network(Seeman, Berkman, Blazer, & Rowe, 1994), again suggestinga reduction in stress response occurs via positive aspects ofone's interpersonal relationships. Overall, psychosocial fac-tors (e.g., perceived stress, aspects of social support) havebeen indicated to influence blood flow, body temperature, lev-els of circulating hormones, and immune function (Maier etal., 1994). In relation to the integrated model, psychosocialforces are suggested to affect higher centers ofthe central ner-vous system that in turn influence homeostatic processes ofthe hypothalamus, neuroendocrine system, and autonomicnervous system, all which are components ofthe brain's agingclock. Consequently then, changes in systems' homeostaticprocesses due to psychosocial factors, which result in in-creases in risk of disease and mortality, may connote an ad-vancement or acceleration ofthe aging clock.

Research in diabetes and cancer further suggestspsychosocial variables as causal antecedents ofbiophysiological response and rate of change across the lifecourse. For example, coping style, personality constellation,psychopathological predispositions, and social support haveall been found to significantly affect the diabetic's glucosecontrol (AGE protein production), as well as the occurrenceand 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 animportant 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 involvingthese variables and cancer has been a controversial one (cfGrossarth-Maticek & Eysenck, 1991; Kiecolt-Glaser &Chee, 1991; Zonderman, Costa, & McCrae, 1989). For ex-ample, in a 20-year follow-up study, psychological depres-sion was positively associated with incidence and mortalityfrom cancer after controlling for demographic, health, andlifestyle factors (Persky, Kempthome-Rawson, & Shekelle,1987). Thus overall, psychosocial factors are again indicatedto impact on brain centers that control homeostatic mecha-nisms and autonomic nervous system activity in a way that

INTEGRATED MODEL OF AGING 2 0 3

diminishes immune response and increases risk of diseaseand mortality, potentially speeding up the aging clock.

Other evidence linking personality characteristics, copingstyle, and aspects of interpersonal relationships withbiophysiological processes and longevity is foimd in cardio-vascular 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 havebeen significantly associated with greater risk of coronaryheart disease as well as other health problems (e.g.. Barefoot,Dahlstrom, & Williams, 1983; Barefoot et al., 1991; Haneyet al., 1996; Matthews, 1982; Siegler, Peterson, Barefoot, &Williams, 1992; Siltanen, 1984; Williams & Barefoot, 1988;Williams et al., 1980). Regarding coping style, the tendencyto trust others, be tolerant, easygoing, and relaxed was foundto predict survival in a sample of older men and women aftercontrolling for demographic, health, and lifestyle factors(Barefoot etal., 1987). Social support has also been shown inseveral 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 dis-ease who reported not having a close personal confidant weremore than three times as likely to die within a 5-year periodthan were other patients with coronary artery disease (Wil-liams et al., 1992). A similar increase in mortality has alsobeen observed in cardiac patients who perceive low socialsupport (Gorkin et al., 1993). In sum, personality characteris-tics, coping style, and interpersonal relationships are all sug-gested to moderate biological systems that are componentsofthe aging clock (i.e., higher centers ofthe central nervoussystem, hypothalamus, neuroendocrine system, and auto-nomic nervous system). Thus, it again follows thatpsychosocial factors that increase the probability for diseaseand mortality may also accelerate aging.

Social-Cognitive Moderators

Social-cognitive mechanisms and processes have also beenindicated to moderate biological systems, influence rates ofmorbidity and mortality, and thus moderate aging. For exam-ple, research involving older adults in a simulated drivingchallenge reported level of self-esteem to be negatively asso-ciated with peak elevations in cortisol response (Seeman etal., 1995). In fact, participants with low self-esteem werefound to have a nearly sixfold increase in cortisol response(Seeman et al., 1995), suggesting facets of self-concept maymediate hypothalamic-pituitary-adrenal system functioning,and resultantly the mechanisms and timing of the agingclock. Other research, examining the subjective appraisal ofhealth made by older adults in poor objective health, reportedthat older adults who were optimistic about their health weresignificantly less likely to die than were those less optimisticin their appraisal (Borawski, Kinney, & Kahana, 1996). Fur-

thermore, when optimism is measured as a dispositional per-sonality variable it is associated with a faster rate of recoveryfrom coronary artery bypass surgery and retum to normal lifeactivities (Scheier et al., 1989). Thus, whether regarded as abias in attribution and appraisal processes or as an underlyingcharacter trait, optimism is suggested to mediate biologicalprocesses and influence the individual's health and contin-ued viability. A comparable relation has been observed be-tween psychological control and health (e.g., Rodin, 1986;Rodin & Timko, 1992). For example, older adults who re-ported little functional impairment and high perceived con-trol were less likely to be hospitalized and had a lower risk ofmortality than were their same-aged peers who also reportedlittle functional impairment but low-perceived control(Menec & Chipperfield, 1997). Other research, assessingweek-to-week variability on measures of perceived control,reported that individuals who were less variable over 25 as-sessment sessions had a signiflcantly higher probability ofsurvival 5 years later (Eizenman, Nesselroad, Featherman, &Rowe, 1997), again linking control with health and contin-ued viability. In general, "health-related cognitions and be-haviors, symptom labels, and physiological processes appearto mediate the control-health relationship" (Rodin & Timko,1992, p. 196). Analogously then, social-cognitive constructssuch as self-concept, optimism, and control may mediatehigher order cerebral mechanisms that in turn regulate thehomeostasis and timing of lower order components (e.g., thehypothalamus, amygdala, neuroendocrine system, auto-nomic nervous system), hence influencing the aging clockand rates of change.

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

Being a member of a particular environmental, so-cial-cultural, or psychiatric illness cohort may also moder-ate one's aging. For example, a greater than expected mor-tality rate among U.S. service men interred by the Japaneseduring World War II and among people in tbe Netherlandsduring 1945 was observed as a result of the psychologicalstress and environmental hardship these populations en-dured during time of war (Jones, 1959). Further, member-ship in a particular socioeconomic cohort has been sug-gested to influence health behaviors (e.g., smoking,physical activity, alcohol consumption), psychologicalcharacteristics (e.g., depression, hostility), and rates of mor-bidity and mortality (Adler et al., 1994; Lantz et al., 1998),with lower socioeconomic status being associated with in-creased morbidity and mortality. In a like manner, member-ship in a particular ethnic cohort has also been suggested toaffect health behavior and rates of morbidity and mortality(cf Flack et al., 1995; Johnson et al., 1995; Myers,Kagawa-Singer, Kumanyika, Lex, & Markides, 1995; Yeeet al., 1995), with ethnic minority status in the United States

204 VON DRAS AND BLUMENTHAL

being associated with greater economic impoverishment,riskier behavior, and increased rates of morbidity and mor-tality. Other research has suggested that psychiatric illnessinfluences rates of morbidity and mortality. For example.World War II inductees who were medically dischargeddue to neurosis were found to have a 20% higher all-causemortality rate than that of controls (Keehn, Goldberg, &Beebe, 1974). In a prospective study, the all-cause mortalityrate of psychiatric outpatients was reported to be nearlytwice that expected in their general population counterparts,with greater rates of mortality found in patients diagnosedwith antisocial personality and schizophrenia (Martin,Cloninger, Guze, & Clayton, 1985). Further, although thedirection of causal flow between depression and physicalfunction is unclear (e.g., depression may produce a declinein physical function, or decline in physical function maycause depressive symptomology), it is noted that depressivesymptoms 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 prospectivestudy, depressed older adults were found to be at signifi-cantly higher risk of physical decline in timed walking,standing balance, and rising from and sitting down in achair, suggesting depression to be a significant predictor oflater functional decline, disability, and death (Pherminx etal., 1998). Overall, various contextual elements (e.g., envi-ronmental, socioeconomic, social-cultural, psychological)are suggested to impact on biological systems that are com-ponents ofthe aging clock (i.e., cerebral cortex, hypothala-mus, endocrine system, autonomic nervous system), in-creasing risk of disability, disease, and mortality, therebyadvancing or accelerating aging.

A NEW DIRECTION FOR AGINGRESEARCH

The influence of social and psychological factors on rates ofmorbidity and mortality suggests the necessity of an inte-grated model of aging that accounts for the collective influ-ence of biological, social-environmental, and psychologicalforces on adult development and aging processes. As notedby Botwinick (1984), however.

Through the years scientists have tried to understand aging byformulating theories ... (but) despite all our models and allour theories, we really do not know very much about whypeople and animals age or why major organ systems decline,(pp.4-5)

Yet, just as there has been a burgeoning of interest in un-derstanding the processes of self-awareness and psychologi-cal influences on neurobiological events (e.g., Churchland,1986; Creutzfeldt, Eccles, Szentagothai, & Gulyas, 1987;

Popper & Eccles, 1977; Searle, 1995), so too is there agrowing interest in understanding the effects of social andenvironmental factors on aging processes (Vogt, 1992).

To this effect then, it is further recognized that social psy-chologists, by conducting both basic and applied research,play important roles in understanding aging processes and indelineating processes of successful aging. Indeed, social psy-chological research is necessary to illuminate paths to optimalexperiences and outcomes in later life. Thus, operatively, inaccord with a national agenda for research on aging (Lonergan& Kravens, 1991), social psychologists may make importantcontributions by conducting research that contributes to a ba-sic understanding about the processes of aging, addressesproblems of later life disability and functional impairment,provides interventions that would assist in lowering rates ofmorbidity and mortality among the elderly, and increasesknowledge of behavioral and social factors that help olderadults maintain social relationships, physical health, and psy-chological well-being, Given that noncollege-age adults rep-resent a very small proportion of individuals on which modelsof social behavior are built (Sears, 1987), a first step in this en-deavor is to recognize that adult human experience involves usall (i.e., young, midtife, old, and very old adults), and to enrollage-representative individuals as participants in research. It isalso impK>rtant to be aware that within a society where func-tional utilitarianism and youthfulness are esteemed, preju-diced attitudes toward older adults are often found in itsfolklore, institutions, media representations, and social ste-reotypes (Blank, 1979; Butler. 1969, 1980; Slotterback &Saamio, 1996; Whitboume & Hulicka, 1990). Therefore, aseducators, it behooves us to include information about midUfeand later adulthood in class lectures and discussions toheighten social awareness ofthe temporal aspect of adult lifeand periods of development beyond the college years, therebypromoting knowledge about the vast individual differences incontinued development and maturity, and refuting negativestereotypes and myths of midlife and later adulthood (seeBlank, 1979, for a discussion of ways to supplement socialpsychology teaching resources). In this regard it is also impor-tant to espouse successful aging in its broadest, mosthealth-promoting terms, as an individual needs-oriented goalof optimal health, adaptive functioning, and well-being, thatincludes making positive adjustment to frailties and disabili-ties, and attaining a sense of meaning and purpose in one'slater years despite changes in functionality, social roles, ca-reers, 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 thatwill explain behavior throughout adulthood. As an illustra-tion of such an endeavor, an analogue of Rakowski's (1984)model of older adults' health behavior decision making ispresented in Figure 2. This modified model suggests recipro-cal and dynamic association between social pereeptions,mental representations, memory, and evaluative processes


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FIGURE 2 Contextuatly grounded model of older adults' healthbehavior decision making.

that influence decision making and behavior. Further, themodified model also recognizes the pervading influence ofcontextual factors on thought and behavior (cf Blank, 1989;Bruner, 1990; Shweder, 1991). Tbus, congruent withRevenson's (1990, 1994) ecological/contextual framework,a key assumption of this model is that each person operateswithin many interdependent and overlapping contexts: an in-terpersonal context, a sociocultural context, a situationa!context, and a temporal context. For example, followingRevenson's (1994) characterization, the style of supportfamily members (the interpersonal context) provide to an in-dividual making changes in diet and lifestyle to prevent heartdisease may reflect "rugged-individualist" attitudes that bol-ster self-esteem and competence, but only for older men (thesociocultural context), and only during an initial transitionalperiod when decisions are made and actions first taken (tbetemporal context) following a physician's advice that dietaryand lifestyle changes are required (the situational context).This model is especially noteworthy in that it suggests sev-eral areas where social psychologists may become active inresearch that explores adult development and illuminatesprocesses of successful aging.

For example, research exploring social percep-tual-cognitive processes (components of Stages I, II, and IIIof the model in Figure 2) as well as contextual factors (theground surrounding and influencing all of the deci-

sion-making model's components) is one area important inilluminating processes of successful aging. Indeed, Giles andCondor (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 ... notonly to the extent ofthe lifespan but to the very quality of it"(p. 60). Within the decision-making model, both interper-sonal communications and intrapersonal cues are forces thatactivate mental representations and prompt one to plan ac-tions and carryout behaviors. Indeed, interpersonal commu-nications are essential in conveying social norms, attitudes,and coping information (Hafner & Welz, 1989), and in shap-ing health behaviors (cf Lewis, Rook, & Schwarzer, 1994).Thus adaptively, people with close interpersonal relation-ships are more likely to engage in positive health behaviors,eating healthfully, exercising, not smoking, and taking actionto prevent disease such as having a regular checkup and con-ducting self-exams (cf Antonucci & Akiyama, 1993; Schone& Weinick, 1998; Umberson, 1987, 1992). Intrapersonalcues also operate as causal factors that activate cognitionsand prompt behaviors. For example in a communit>' surveyof interest in a peer-led successful aging course, respondentswho expressed the greatest interest in participating were alsoindividuals most likely to benefit from the positive socialcontact and assistance afforded by the successful agingcourse, that is, older adults reporting low psychosocialwell-being and self-efficacy and greater physical limitations(Kocken & Voorham, 1998). Further elucidation of interper-sonal communications and intrapersonal cues that influencedecision making and lead to healthy and adaptive aging areimportant areas for future research.

Attitudes are causally linked to later choices and behav-iors in the decision-making model of Figure 2, and thus rep-resent another key area in illuminating processes ofsuccessful aging. For example, research exploring olderadults' use of informal and formal social assistance reporteda person's utilization of assistance to be positively associatedwith their expectations of care from family members and atti-tudes about using formal services (Noelker et al., 1998). Sim-ilarly, older adults' positive attitudes toward exercise werefound to predict greater adherence to home-based exerciseprograms (Jette et al., 1998). Other research has suggestedthat the susceptibility for attitude change varies at tiifferentpoints along the life continuum, with younger and olderadults being more susceptible to attitude change than adultsat midlife (Visser & Krosnick, 1998). Thus, one potentialarea for future research would be attitude change interven-tions to promote successful aging (e.g., changing attitudes tohelp individuals adopt new lifestyle habits to prevent illness).As prescriptively suggested by Visser and Krosnick (1998,Table 6), social psychological research that explores suscep-tibility to attitude change mechanisms such as decreasing im-portance or obsolescence of attitudes, changes in memoryretrieval processes and cognitive resources, decreasing cer-


tainty of attitudes, clianges in roles and social networks, andchanges in meaning associated with attitude objects overtime 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 contex-tual factors are causally linked to later behavior and actions.Thus, research that investigates social stereotypes "tbat castolder adults as inflexible, unwilling or unable to cbange atti-tudes, behavior or lifestyles" (Ory & Cox, 1994, p. 95) wouldalso contribute to illuminating processes of successful aging.For example, stereotyping of older adults as ignorant, resis-tant to change, and responsible for their own plight, alongwith the contextual influences of geography {e.g., neighbor-hood location, distance to centers) and other social character-istics (e.g., problems of family structure and economics,racism, reluctance to use services) were common themes de-scribed by expert social service providers as barriers to olderadults' nutritional well-being (Arcury, Quandt, Bell, Mc-Donald, & Vitolins, 1998). Allied research, investigating op-timistic bias, age stereotypes, and perceptions of age-relatedillnesses reported that participants were less optimistic intheir judgments of risk when they believed the medical con-dition was related to aging (Madey & Gomez, 2000). Further,middle-aged adults were found to be unrealistically pessi-mistic for acquiring common age-related diseases (i.e., cata-racts, vision and hearing loss), suggesting that persons'perceived optimism or pessimism about their ability to stayhealthy varies at different points across the life course(Madey & Gomez, 2000). One conclusion suggested by thisstudy is that as a result of age-illness stereotypes, people mayoverlook environmental or lifestyle factors that may contrib-ute to poor health, thus delaying lifestyle modifications thatwould help them live more healthfully and age more success-fully (Madey & Gomez, 2000). Other investigations (e.g.,Barta Kvitek, Shaver, Blood, & Shepard, 1986; James &Haley, 1995) have suggested that age-illness stereotypesmay also influence the care provided by health practitioners.Thus research tbat exposes age-disease stereotypes and bi-ases in health attitudes is an important first step in correctingthese biases and in helping older adults realize lifestylechanges that beneficially foster health and well-being.

A greater understanding of otber social-cognitive pro-cesses and contextual influences (e.g., interpersonal, tempo-ral, situational, sociocultural) is essential in illuminatinglater life development and successful aging. For example.Levy and Langer (1994) reported older adults from cultureswhere elderly persons are viewed positively (i.e., Chinese,American deaf) bad better memory test performance than didolder adults from a culture where elderly persons are viewednegatively (i.e., American), suggesting that long-held cul-tural beliefs about aging may become self-fulfil ling prophe-cies that influence the degree of later life memory loss.Similarly, social schemas, important self-motives, and mem-ory processes have been suggested to influence later life cop-ing and behavior. For example, an investigation by Wong

and Watt (1991) indicated older adults have a wide array ofreminiscences, and that reminiscences tbat were integrative(i.e., personal memories where the main function is toachieve a sense of self-worth, coherence, and reconciliationover one's life) and instrumental (i.e., personal memories ofpast plans, goals, overcoming of challenges, and drawingfrom past experiences to solve present problems) were re-lated to better mental and physical health. An expanded un-derstanding of age-associated changes in attributionalprocesses is also needed. For example, in comparison toyoung adults, older adults were found to make more attribu-tions that suggest a character-by-situation interaction in vi-gnettes that involved relationship situations, and moredispositional attributions of the main character in vignettesthat resulted in negative outcomes (Blancbard-Fieids, 1994).Moreover, tbe activation and use of different attributionalschemas have been suggested to vary throughout adulthood.For instance, attributions elicited by a vignette involving ayoung couple's career and relationship concems that endswith the couple breaking up indicated that the scheina "mar-riage is more important than career" (p. S141) linearly in-creased in frequency of expression from young (30%) to lateradulthood (82%), whereas the schema "tbe marriage was al-ready in trouble" (p. S141) showed a U-shaped function withmidlife adults (45%) expressing this more frequently thanyoung (25%) or older (25%) adults (Blanchard-Fields,1996). Extensively, this research suggests age variation insocial-cognitive processes that consequenfly shape and di-rect behavior. Therefore, further exploration of tbe strengthand relevance of schemas elicited by different situations,self-motives, and cultural beliefs would be key in under-standing when older adults engage in complex in-depth rea-soning or when they rely on automatic or heuristic processes(Blanchard-Fields, 1996), thus illuminating social-cognitiveprocesses that may influence healthfulness, adaptation, andoptimal person-environment transactions in later life.

As noted by the feedback loops in the decision-makingmodel of Figure 2, dynamic self-appraisal and social com-parison are important causal mechanisms that influence laterchoices and actions. Therefore researcb focused on mutableaspects of self, social comparison processes, and adaptivebehaviors is also necessary to better understand processes ofsuccessful aging. For example, previous theory and researchhave described changes in aspects of self throughout adult-hood, noting an unfolding of negative and positive possibleselves (cf Cross & Markus, 1991; Markus & Herzog, 1991),and self-appraised changes in dispositional traits from earlyto later life (Fleeson & Heckhausen, 1997). Relatedly, under-lying self processes (e.g., need for esteem, control, safety)have been suggested to influence one's selection of perfor-mance domains, setting of goal standards, and behavioralstrategies 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

INTEGRATED MODEL OF AGING 207

comparisons have been suggested to be protective of themental health and well-being of older adults in poor health(cf Ryff, 1999). Thus in general, adaptive shifts inself-deflnition, compensatory behavioral strategies, andself-enhancing social comparisons have all been implicatedas correlates of health and adaptation in later life (cf. Ryff,1999). Therefore, continued research in these areas, withspecial consideration given to contextual influences, wouldfurther contribute to our understanding of adaptive processesand transitions throughout the adult years.

Research that combines different aspects of decision mak-ing (i.e., cognitive, psychological, social, statistical) is alsoneeded to understand processes of successful aging. Al-though there has been little investigation integrating thesevarious aspects, different pieces of research may be fltted to-gether to begin to form a larger mosaic. For example, re-search focusing on cognitive mechanisms has indicated thatolder adults spend more time considering less information(Johnson, 1993), suggesting age-related changes in deci-sion-making processes due to slowing of information pro-cessing or reduction in cognitive resources. Other researchfocusing on decisions about finances, legal problems, and re-tirement issues has suggested that domains and contexts maydifferentially moderate older adults' decision-making effi-cacy. For example, older adults were found to be overconfi-dent in assessing tbe efficacy of their solutions when asked tomake decisions conceming legal problems and finances(Devolder, 1993). Conversely, when asked to make deci-sions regarding financial planning and retirement issues,older adults were found to be underconfident in their deci-sion-making appraisals (Hershey & Wilson, 1997). Investi-gations focusing on psychological processes that moderatechoice have suggested that with advancing age there isgreater 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, re-search exploring self-appraisal motivation reported olderadults low in self-efRcacy and high in uncertainty about theirintellectual ability status were more likely to select intellec-tual performance domains where they had previously re-ceived tow-uncertainty feedback (Von Dras, 1996). Thisresearch hints that self-appraisal behaviors that lead to suc-cessful aging (e.g., self-exam to prevent disease,self-monitoring to maintain diabetic control) may be moder-ated by how self-assessment feedback is perceived and inter-preted as well as a variety of personal characteristics (e.g.,self-efficacy perceptions, uncertainty orientation,self-enhancing and self-protective motives). Of paramountconcern from a social perspective is that family members andintimate companions are often involved in helping olderadults 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 be-havior within the interpersonal context are needed to eluci-

date individual and family members' decision-making pro-cesses, and illuminate ways older adults may "enhance andmaintain their competence, self-esteem, and autonomy untilthe end of life" (Motenko & Greenberg, 1995, p. 388). As il-lustrated in Figure 2, a variety of cognitive, psychological,and social factors influence decision making. Thus researchendeavors in this area should be integrative, and especiallyattentive to the interdependent relationships between percep-tion, experience, thought, and behavior, keeping in mind thatthe older adult's power and control over life and deci-sion-making ability is related to health (Beckingham & Watt,1995), and that "chronic disease and disability pose the great-est threats to successful aging" (Rose, 1991, p. 87).

Other forces also influence one's decisions and choices inlater life, and subsequently successful aging. Indeed, in laterlife the individual's choices and behaviors may reflect an un-folding of intrapsychic developmental processes (e.g.,Erikson, Erikson, & Kivnick, 1989;Gutmann, 1987;Kivnick& Jemstedt, 1996), as well as the affects of the many socialinteractions and role models one has been exposed to acrossthe life course (Hendricks, 1992). For instance, one theoreti-cal perspective suggests that across adulthood there is a pro-cess of fluctuations that defines the posturing of one's "selfto its inner and outer worlds, and alludes that this process ofintrapsychic development and self-definition influences de-cisions and behaviors throughout the adult years (Gould,1972). Another perspective posits that we live in a sjinbolicworld, and suggests that the successful aging "me" is a resultof a "self negotiated and acquired via one's social interac-tions (cf Hendricks, 1992). In accordance with this latter so-cial constructionist perspective, Kastenbaum (1994)suggested three possible models of the successfully agingman: the saint, the son of a bitch, and the sage. Althoughthese representations fall short of describing the entire rangeof later life experiences and capacities, they allude to the pro-cesses of social leaming by which successful aging personasand styles of behavior may be acquired by older adults(Kastenbaum, 1994; Kivnick & Jemstedt, 1996). In a relatedway, interpersonal support processes have also been identi-fled as factors that impact on the person's wellness andhealth as they mature and grow old (e.g., Lewis et al., 1994).For example, perceptions of social support have been posi-tively associated with attitudes toward health goals, motiva-tion to comply with social norms, control beliefs, andperceived success in attaining healthful outcomes (Von Dras& Madey, 1997), suggesting that successful aging may befaciltated by the perception as well as real positive function-ing of supportive relationships. Other research has suggestedthat marital couples' poor mental and physical health maylessen the assistance and care older spouses provide to oneanother (Von Dras, Siegler, Barefoot, Williams, & Mark,1999), thus impeding successful aging. In general, theoryand research that explores the self-deflning influences ofintrapsychic processes and social interactions, along with theeffects ofbehavioral modeling and interpersonal support on


successful aging processes, would extend these areas of re-search and provide basic information for developing inter-ventions to assist the individual in maintaining health andwell-being in later life.

CONCLUSION

Biological, social-environmental, and psychological factorsoperate dialecticaiiy, influencing processes of adult develop-ment and aging. Successful aging refers to individual trajec-tories of experience, adaptation, and optimal outcomes, andincludes various social psychological processes such asself-perception, attitude change, stereotyping, and socialcomparison that influence later life well-being and health.Both the integrated model of aging (Figure !) and the deci-sion-making model of older adults' health behaviors (Figure2) provide contextually oriented frameworks that suggestmany areas for future social psychology research. Notingthat older adults are more heterogeneous than any other seg-ment of the population (Burback-Weiss, 1988), muchthought should be given to how successful aging may be-come a social construct that discriminates against individualswho are not able to meet self-initiated goals, or are belowtheir cohort's mean for healthfulness, vitality, functionality,and social involvement (Sullivan & Fisher, 1994). Thus, it isimportant to characterize successful aging in a way so that itinciudes making positive adjustment to frailties and disabili-ties, and in attaining a sense of meaning and purposethroughout one's life. A primary concern of future research isto understand older adults' lifestyle practices, and "whysome individuals choose not to adopt beneficial health be-haviors" (Schone & Weinick, 1998, p. 625). Future researchis also needed that will illuminate social psychological pro-cesses and mechanisms that mediate decision-making activi-ties and behavior, and thereby provide a "link between healthbehaviors and morbidity and mortality in the elderly"(Schone & Weinick, 1998, p. 626). Recognizing the dialecti-cism between biological, social-environmental, and psycho-logical factors, and their interactive influence on processes ofadult development and aging, one is reminded that "actionand thought cannot be understood or explained without refer-ence to relationships with goals, intentions, and meaning onthe one hand, and contexts, situations, and history on theother" (Blank, 1989, p. 227). Thus, future research ap-proaches, while avoiding nihilistic empirical premises,should recognize the interplay between contexts, processes,and mechanisms, and how these forces shape each person'sidentity, transcendent experience, and maturation across thelife course. Noting the languid nature of many past and pres-ent adult deveiopment and aging research paradigms (seeRyff, 1989, and Kivnick & Jemstedt, 1996, for related dis-cussions)—largely oriented on behaviorist principles; con-structs such as achievement, competency, and control; and

negative-biases in expectation to demonstrate age-relateddecrement—it is appropriate to herald Blank's (1989) earherdeclaration:

Explication of processes of change and stability and of in-volvement in active negotiation of everything from successand failure to emotional intimacy to one's self are urgentlyneeded to revitalize areas as diverse as attributions, physicalenvironment relationships, social and self-identity, and inter-personal relations, (p. 236)

Thus, the immediate charge put forth to social psycholo-gists is to note tbe many influences on human experienceacross the life course and become active in the descriptionand explanation of successful aging processes both as re-searchers and as educators—with the highest hope being anenhancement 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 ofWisconsin-Green Bay.

Very special thanks to Scott Madey and Susan Robin-son-Wheeler for their insightful comments on earlier ver-sions of this article.

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