The mean age of the participants was 55 years (range of 32 to 70 years old), and 92% identified their race/ethnicity as white (not Hispanic origin). Half of the participants were nurses and slightly more than half (58%) were involved in community services agency. All participants were female. A total of 42% had a higher than baccalaureate degree of education (Table 1).
Three core categories were identified from the transcripts: (1) characteristics of healthy aging; (2) healthy aging attainment/achievement; and (3) programs and activities for healthy aging. Figure 1 includes these core categories and their themes, depicting the conceptual dimensions of healthy aging and their relationships as identified from the perspective of community practitioners. Characteristics of healthy aging included three distinct themes: person-specific components, social components, and spiritual components. Healthy aging attainment was characterized by two distinct themes: facilitators and barriers. Two distinct themes related to programs and activities were promoting fitness and promoting wellness. Each of the core categories and associated themes is discussed in detail below.
Meaning of Healthy Aging
Community-based practitioners defined healthy aging in terms of meeting the basic needs of older individuals (e.g., nutritional, housing, medical) and making sure they have access to resources. Focus group participants emphasized, “resources are a broader term than just financial resources that includes personal resources, physical wellness to be able to live independently and be socially connected.” Additionally, participants indicated that the meaning of healthy aging would differ depending on the individual characteristics of an older adult. One participant commented:
“So, for people with reasonable funds … I would think healthy aging is more staying active, making sure that you’re doing what you want to do that brings value to you to the extent that you want to do that, you live where you want to.”
Some participants reflected on healthy aging as older adults being able to do things that are meaningful to them and maintain meaningful relationships within their community, family, and religious groups. They further added exploring new experiences, discovering new things, and finding new avenues of expression and joy.
Characteristics of Healthy Aging
The various characteristics of healthy aging derived included: (1) person-specific components at the individual level, (2) social components that encompass interactions with one’s community, and (3) spiritual components that incorporated more transcendent perspectives on growing older.
Participants discussed various person-specific components including: (1) physiological – being free of disease-specific symptoms; (2) basic needs – being able to manage self-care independently and free of disabilities that hamper mobility; (3) psycho-emotional – subjective well-being through hedonic, eudaemonic, and evaluative approaches; and (4) cognitive – being proactive and having conscious control over one’s life.
“I mean…at the early stage, people don't necessarily need a caregiver. It's about that, being able to be proactive and about having the positive attitude is critical in maintaining quality of life for that period of one to five years.”
Most focus group participants identified social components as key to healthy aging, with available and accessible opportunities for socialization. The social components were classified by the older adults’ type of involvement, either creating or contributing to their community (e.g., engaging in community services).
“I would agree with the basic needs, and I’d add the social component, which is key, I think, to healthy aging … I mean it’s one thing to live independently, but if you’re not connected to others, whether it be for fun or for support with daily activities of living, I just think that’s a key component.”
Participants believed the spiritual component to be another key factor that determines whether a person is aging healthily. They viewed older people as having more time than younger adults and able to look at things with a more spiritual and positive perspective.
“Healthy aging to me is exploring new experiences and finding new avenues of expression and joy. There’s a lot of people that are now trying to change the negative image of aging and focus on more positive aspects of aging. I think that the spiritual piece is a part of that.”
Healthy Aging Attainment
The likelihood of healthy aging attainment depends on various factors. These practitioners identified those factors in terms of facilitators and barriers towards healthy aging, which were related to care recipients and care providers. The following are some of the facilitators and barriers that were commonly associated with the attainment of healthy aging:
Facilitators of Healthy Aging
Care recipient. Equipping older adults with resources was identified as a facilitator that gives them hope to potentially meet their goals. As one participant said, “There are resources for adaptation that will make the elderly live more successfully and keep them independent for a longer period of time.” Acceptance of aging was another key facilitator for older adults to make lifestyle decisions that take into account accepting their physical and social situation. Further, increasing their access to economic autonomy, enhancing social exposure, and making them empowered to make their own choices in life were identified as facilitators of healthy aging by the practitioners.
Care provider. Developing a trusting relationship with health care providers and having program sustainability were considered important facilitators. Participants indicated that many opportunities to support aging lie in technology as well as the built environment. These professionals also advocated for fewer procedures at health care encounters, more age-sensitive health practices across settings, and sustainability.
“I mean I’ve heard of some opportunities where some grants, like breast cancer awareness and stuff, and churches have been able to take advantage and apply for grants and receive funding, but then it comes, and it goes, and that's it. So, if there was something that could be … more stable, sustainable, and that's getting people where they are…. I think there's a lot of room for growth … sustainable funding is the key.”
Barriers to Healthy Aging
Care recipient. The presence of disability, “aging-unfriendly” communities, and lack of access and awareness of resources makes it difficult for older adults to benefit from available services. In addition, increasing health care costs and the cost of supportive housing aggravate the restraints to achieving healthy aging.
“More and more hospitals are being seen as cost centers, and your relative or you don’t want anybody to be in the ED or in the hospital because that just costs so much more than any other care…”
Furthermore, social isolation was identified as an emerging issue and more highly prevalent among older adults. Many elders were described as having a reduced social network and interactions, leading to a higher level of isolation, immobility, and lower well-being.
“You'd see these giant apartment buildings just full of people and you think, oh, they're surrounded by people. They're surrounded by people, but they're completely alone and they can't get out for reasons we've been talking about … And there's nowhere for them to walk to if they did.”
Care provider. Underfunded resources and the temporary nature of some programs due to lack of sustainability were viewed as major issues that are affecting the health care system and programs that support older populations. Healthcare services provided to older populations were also identified to be reactive healthcare – reacting to adverse conditions or symptoms and mainly treatment-focused as opposed to patient-centered, a practice described as deeply embedded in the healthcare system.
Programs and Activities for Healthy Aging
Participants indicated that as people age, some of them start experiencing limitations in activities and cognition. Senior centers were identified as providing a wide variety of services that help older adults meet their daily living needs. Two themes emerged related to programs and activities used to promote healthy aging: (1) promoting fitness, and (2) promoting wellness.
Participants discussed programs that promote fitness through services involving meaningful physical activity -- not necessarily “exercise” but whatever keeps older individuals engaged. These professionals emphasized, in particular, the importance of group activity classes and fall prevention programs.
Participants also discussed mental stimulation activities, self-management programs, and stress management programs to promote wellness, emphasizing mental wellness as a necessary component.
“I think the mental health side really complicates things because so many people live with depression or anxiety … tendencies that they have lifelong and compensated well for. And then when they lose that ability to compensate, things can really spiral quickly.”