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Concordance and discordance in successful aging measures and mortality

aging mainly referred to absence of diseases and disability, maintenance of adequate cog-
nitive and physical function, and ability to engage in social activities (Rowe and Kahn,
1997). This definition focused on physical, physiological, or cognitive functions, usually
known as the biomedical model or objective successful aging (OSA). More and more re-
searchers today, however, define successful aging as a biopsychosocial model that empha-
sizes components of psychological characteristics and resources, such as life satisfaction
and well-being, capacity for personal development, mastery/growth, positive adaptation,
social networks and support, integration and participation, or cultural components (Bowl-
ing and Dieppe 2005; Cosco, Prino, Perales et al., 2014; Rowe and Kahn, 2015). The new
biopsychosocial version of successful aging includes not only objective components (i.e.,
OSA) but also subjective components (or called subjective successful aging, SSA) (Rowe
and Kahn, 2015). Indeed, there is a consensus among the researchers that successful aging
should be a multidimensional concept from both objective and subjective measures (Blaz-
er, 2006; Bowling and Iliffe, 2006; Depp, Glatt, and Jeste, 2007; Feng, Son, and Zeng,
2015; Jeste, Savla, Thompson et al., 2013; Lewis, 2011, Phelan, Anderson, Lacroix et al.,
2004; Rowe and Kahn, 2015; Young, Fan, Parrish et al., 2009).
Regardless of whether they are from the respondents’ perspective or from the research-
ers’ perspective, different definitions and metrics of successful aging could produce pro-
found heterogeneity in the outcome of successful aging (Cosco, Prino, Perales et al., 2014).
For instance, Strawbridge, Wallhagen, and Cohen (2002) reported that half of the older
adults aged 65–99 rated themselves as aging successfully, whereas slightly more than
one-third of the older adults evaluated themselves as aging unsuccessfully even though
they met Rowe and Kahn’s criteria. Bowling and Dieppe (2005) showed that when older
adults were asked to provide their own definitions of successful aging, they put relatively
greater emphasis on social integration and well-being compared to other components in
the biomedical model. Montross, Depp, Daly et al. (2006) reported that 92% of a sample
of 205 older community-dwelling people considered themselves to be aging successfully,
even though a large majority of them either suffered from some chronic conditions or had
some physical limitations. Von Faber and colleagues (2001) showed that the oldest-old
(aged 85 or older) in the Netherlands typically viewed psychological well-being as the
core component of successful aging. One study from the U.S. found that Japa-
nese-American older adults were more likely to consider having a longevity gene as an
important component to successful aging than their Caucasian counterparts, who were
more likely to rate remaining in control over one’s own decisions as important (Matsu-
bayashi, Ishine, Wada et al., 2006). A meta-analysis based on twenty-seven major indi-
vidual empirical studies on successful aging showed that the proportion of older adults
considered to be aging successfully ranged from 0.4% to 95.0%, depending on the defini-
tion used (Depp and Jeste, 2006); another meta-analysis based on more than one hundred
studies revealed a similar finding (Cosco, Prino, Perales et al., 2014). All of these findings
indicate great inconsistencies and variations in successful aging measurements.
With few exceptions (Cernin, Lysack, and Lichtenberg, 2011; Pruchno, Wilson-Gend-
erson, Rose et al., 2010), most studies have not looked into the subtypes of successful ag-
ing jointly classified by OSA and SSA. So far we have not found studies investigating how
concordance or discordance between OSA and SSA is associated with mortality among
older adults. This study aims to examine how concordance and discordance between SSA
and OSA are associated with subsequent mortality among older adults from a large na-
tionwide longitudinal survey in China. Developing subtypes of successful aging in terms
of concordance and discordance between SSA and OSA and understanding their associa-
tions with subsequent mortality could help researchers better understand the differentials
in meanings of successful aging defined objectively or subjectively, improve the ability of

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