Positive ageing is a multi-faceted concept. As outlined in the previous section, it includes a broad range of factors related to the person and their social and environmental context, both contemporaneously and throughout the life course. In recent years, there had been considerable research carried out to identify evidence for the factors that are important for positive ageing.
In the UK, the ‘Growing Older’ research programme asked older people what they felt contributed to quality of life (Bowling & Gabriel, 2007; Bowling, 2006; Bowling et al., 2003; Gabriel & Bowling, 2004). These factors fall into a number of key life domains: individual issues such as health, income and ability; environmental issues about accommodation and mobility; and psychological and social issues such as social networks and support. In particular, older people highlighted seven areas of importance:
Keeping active and healthy;
Comfortable and secure homes;
Having enough money to meet basic needs, to participate in society, to enjoy life and to retain one’s independence and control over life;
Getting out and about;
Friendships and the opportunity for learning and leisure; and
Access to good, relevant information.
These factors were important not just in themselves, but because of what they provided: freedom, autonomy, enjoyment in life, social attachment and relationships, social roles and security. These identified areas correspond with the areas identified by an extensive consultation process carried out as part of the WHO Global Age-Friendly Cities project. The eight areas covered by the project are: respect and social inclusion, civic participation and employment, housing, community support and health services, communication and information, outdoor spaces and buildings, transportation and social participation.
Recent research from The Irish Longitudinal Study of Ageing (TILDA) confirmed that older adults’ subjective quality of life is determined by multiple factors related to social participation, physical health and function, mental health and socioeconomic status (Layte, Sexton, & Savva, 2013). Mental health indicators appeared to be the strongest predictor of quality of life, followed by social participation, physical function, with socioeconomic status emerging as the least important predictor. The individual indicators that had the greatest independent effect on quality of life included: depression, anxiety, worry, stress, self-rated physical health, chronic pain, physical activity, loneliness, social activity, marital status and relationship quality with partner, relatives and friends.
It can be difficult to distinguish factors that are part of wellbeing, and factors that influence it. For example, good physical health and social relationships are both part of wellbeing, but also have an influence on a person’s happiness and satisfaction with life. In fact, there are likely to be influences in both directions, as happiness also leads to improved physical health and social relationships. Similarly, better physical health may help a person to achieve a higher income, and vice versa. For this reason, when measuring positive ageing, it is essential to include multiple measures of life domains, all of which are likely to influence each other in complex ways.
The following section will review the current evidence for the importance of a number of key life domains for healthy and positive ageing: Social and community relations, Employment and education, Disease and disability, Health behaviours, End-of-life care, Income and Financial Security, Home, Age-Friendly Environments, Safety, Ageism and Attitudes to Ageing and Subjective Wellbeing.
It is important to note that these domains are not exhaustive, and there are many factors not dealt with here that are important for wellbeing. The purpose of this section is to provide a broad overview of the evidence linking various domains of participation, health and security to important wellbeing outcomes. The complexity of positive ageing outcomes can make it difficult to precisely identify how policy can impact of influence positive ageing. Each section therefore concludes with a small number of examples of how policy can impact outcomes in the specific life domain.