Applying Concepts of Successful Aging to Whole Person Health

More than one in six adults in the United States are age 65 or older, and this population is rapidly growing. The share of the world’s population age 60 and older will double from one billion in 2020 to two billion by 2050. Adults are living longer than they did a century ago due to advances in public health and medicine.

How should we think about health in older age? Health is not the mere absence of disease but a state of physical, mental, and social well-being. The World Health Organization has promoted a holistic definition of health for 80 years, but this definition has been given new life with the whole person health movement. It’s important to consider aging within whole person health practices to help patients achieve successful aging.

The concept of successful aging focuses on a person’s ability to maintain physical and mental function, engage with their communities, and feel satisfied in each stage of life. There is no single definition by which to measure successful aging. But we can assess objective aspects of aging (i.e., the ability to do routine activities) as well as subjective experiences.

A 2006 review of 28 studies found that one in three older adults could be classified as aging successfully. That means, most older adults could be living more optimally. A more updated review is needed as life expectancy in the U.S. has declined in recent years and the definition of successful aging may have changed over the last two decades. Whole health practices offer a comprehensive approach to understanding successful aging.

To help all populations achieve better health outcomes, the goal of successful aging should thus be considered throughout the lifespan.

Whole person health seeks to empower individuals and communities to improve their health in biological, behavioral, social, and environmental areas. Some health care systems like the U.S. Department of Veterans Affairs (VA) have developed initiatives to reorient care around patients’ goals. VA Whole Health coaches help veterans explore their values, develop personal health plans, and make progress in achieving health goals. The coaches use motivational interviewing, positive psychology, and other evidence-based practices to support health behavior change.

In a recent commentary for the journal Medical Care, we make the case that successful aging can be implemented through the VA’s Whole Health initiative. What if coaches asked patients how they see aging as part of their health, and what parts of successful aging they might like to achieve? Coaches could then direct patients to appropriate resources and support health behavior changes to achieve successful aging goals.

It’s important to consider age in the context of life experience. Some populations experience functional decline at younger ages due to their exposure to trauma, poverty, and other adversities. For instance, homeless individuals have been found to develop geriatric conditions at earlier ages than housed adults. To help all populations achieve better health outcomes, the goal of successful aging should thus be considered throughout the lifespan.

With the confirmation of Robert F. Kennedy as the Secretary of the U.S. Department of Health and Human Services, there may be new opportunities for making progress in these directions. In particular, Secretary Kennedy has expressed his interest in health prevention and alternative, holistic approaches to health.

The VA has already demonstrated ways to help its patient population with successful aging and whole health. A new VA initiative brings together permanent supportive housing and geriatric services to help formerly homeless veterans age in place. Select VA facilities hired interdisciplinary clinical teams to provide medical care and other assistance (e.g., housekeeping, food preparation, transportation, financial planning) in multi-unit housing buildings for formerly homeless veterans.

While the VA offers geriatric programs, some homeless veterans have difficulty accessing these essential services. Under this new initiative, clinical teams will travel to housing sites to bring nursing, occupational therapy, and social work services to where formerly homeless veterans live. 

We are partnering with the VA Homeless Programs Office to determine if the new program works. We plan to measure successful aging for veterans who reside in buildings with enhanced services, compared to veterans who reside in buildings that lack enhanced services. This work is forthcoming. We hope, in the near future, our findings can be incorporated as a resource for whole health coaches in the VA and shared with other communities looking for evidence on how to serve aging homeless populations.