Successful aging is not a new concept among researchers and many of them have continued to study it to seek the most ideal definition and to identify any additional factors related to SA.Here, we aimed to determine the prevalence and associated factors of SA among public servants in the Klang Valley. As we had adapted the Rowe and Kahn’s model (1987), thuswe compared our findings with previous studies that applied a similar model. In terms of prevalence, some studies have shown that 10.1% of respondents aresuccessful agers[10], andthe prevalence may be up to 50% or more [11]. Meanwhile, the prevalence of SA in the present study was concordant with those studies and within that range, i.e. 37.5%. When comparing our findings with previous local studies, the prevalence of SA among the older people (aged 60-80 years) was much lower at 13.8%[12]. This demonstratesthe decreasing trend in the prevalence of SA as age increases. This is supported by a study that involved the younger age group population as the respondents. In that study, the prevalence of SA was 50.1% for those aged 50–54 years, 46.2% for those aged 55–59 years, 42.0% for those aged 60 years and above and only 37.2% for those aged 65 years and above [11]. The differences in the findings could be due to the difference in the theories or models used to study SA, differences between age groups or studied populations, as well as influences from the culture.
In agreement with previous studies, we found that younger age, non-obese, being physically active and good social support were the four significant predictors for SA.Having normal BMI, regular exercise and social support distinguished people who continued to age successfully 4 years later from those who did not have it[13].
Apart from gender and occupation, age was a predictor for SA in one biomedical model[(14)].Even though there was a large-scale review of SA among younger people, some studies produced the opposite findings. Despite experiencing late-life disability, some people still felt that they had aged successfully. This is because they tend to use adaptation and coping strategies to align their perception of SA with their experiences [15]. This is supported by a study that documented that older age was associated with lower likelihood of objectively- defined SA), but with a greater likelihood of self-ratedSA[16].
In the present study,non-obese respondents had 2.1 times higher odds of having SA, which is the highest odds ratio of all the predictors analysed. This association is consistent with that of a prior study [17].Obesity has a negative impact on health-related quality of life. Even a small amount of weight loss (5–10% of the initial weight) is beneficial for both young and old people to prevent the adverse effects of obesity [18]. Thus, optimizing body weight and dietary intake are proposed as nutritional strategies towards reducing the risk of age-related chronic diseases.
Previous studies have indicated that good social support is a significant predictor for SA [19].As predicted, our results revealed similar findings. Among the various possible predictors analysed, good social support was the second strongest predictor for SA. Good social support can be obtained from a spouse, family members, relatives, friends or neighbours. Higher levels of social support were beneficial for preventing depressive symptoms, thus maintaining or improving life satisfaction [20],which has a significantly positive impact on successful later years [21]. People who are able to visit their relatives and friends are more likely to be successful agers [22].
Similarlyto previous studies, being physically active was a significant predictor for SA in the present study. Physically active respondents are more likely to be rated as successful agers[23]. Being physically active continued to be an important significant determinant of self-perceived health into very late adulthood [24].This is very important for improving balance, mobility and for preserving independence[25].
Healthy lifestyles, including during midlife, have been proven to be associated with good overall health during aging.However, we could not determinethe associations between remaining socio-demographic and behaviour variables and SA in the present study. This is inconsistent with previous studies[26-27].A possible explanation for the discrepancy is that the majority of our respondents were female and it is not the norm for Malaysian women to smoke or drink alcohol due to socio-cultural environmentalinfluence [28].
We observed that the most difficult criteria of SA for our respondents to fulfil was ‘having no major chronic disease’, which put them into the non-successful agers category.Therefore, efforts should be taken to highlight the importance of preventing chronic diseases to everyone, even though studies had agreed on the possibility for chronic illness and SA to coexist within the same individual [29-30]. People should be clear that we are not saying this to criticise or stigmatize whomever does not meet the Rowe and Kahn’s definition of SAbut to emphasizethat every pre-retirement age group adult should have awareness and knowledge of their own health or medical status. Subsequently, action should be taken to improve it by having regular health screenings and practicing healthy lifestyles. Employers play a role in providing a healthy working environment and carrying out promotional activities on SA. Apart from the roles of health professionals, the goals towards higher prevalence of SA in the future can be achieved if everyone plays their part in improving their wellbeing.
Involving the pre-retirement population groupas respondents could yield better understanding of SA. Based on the findings of this study, more focused intervention can be implemented in this group.Meanwhile, the limitation of this study is that people with underlying medical problems who were already on long medical leave and who had retired early from government service had already been excluded from the outset at the sampling stage. Therefore, there is possibility of over or underestimate of the total percentage successful agers.