Research in Gerontological Nursing

Instrument Development 

The Development and Testing of an Instrument to Measure Successful Aging

Meredith Troutman, PhD, PMHCNS-BC; Mary A. Nies, PhD, RN, FAAN, FAAHB; Sara Small, MSN; Amanda Bates, MSN


This article reports the development and testing of the Successful Aging Inventory (SAI). Two hundred participants completed two versions of the SAI, a Likert format and dichotomous format. To test the validity of the SAI, participants also completed the Life Satisfaction Inventory-A, Purpose in Life Test, Mastery Scale, and the Center for Epidemiologic Studies Depression Scale. Both versions of the SAI had acceptable psychometric properties. Principal components analysis resulted in five factors for the Likert version, accounting for 62.19% of the variance. The SAI shows promise as a measure of successful aging and also has the potential to be a useful method of tracking older adults’ overall progress and improvements in response to health promotion strategies. The next step is to evaluate its sensitivity and appropriateness for use with ethnic and racial minority older adults, and those with more varied health status.


This article reports the development and testing of the Successful Aging Inventory (SAI). Two hundred participants completed two versions of the SAI, a Likert format and dichotomous format. To test the validity of the SAI, participants also completed the Life Satisfaction Inventory-A, Purpose in Life Test, Mastery Scale, and the Center for Epidemiologic Studies Depression Scale. Both versions of the SAI had acceptable psychometric properties. Principal components analysis resulted in five factors for the Likert version, accounting for 62.19% of the variance. The SAI shows promise as a measure of successful aging and also has the potential to be a useful method of tracking older adults’ overall progress and improvements in response to health promotion strategies. The next step is to evaluate its sensitivity and appropriateness for use with ethnic and racial minority older adults, and those with more varied health status.

Over the past 15 years, successful aging has been defined in research in a variety of ways: as having an acceptable level of health and adaptation to the aging process (Bryant, Corbett, & Kutner, 2001); maintaining low risk of disease and disease-related disability, high mental and physical function, and active engagement with life (Rowe & Kahn, 1998); having greater life satisfaction and purpose in life (Fisher, 1995; Palmore, 1995; Tornstam, 1994); and experiencing a spiritual and existential quest and personal growth in wisdom and spirituality (Wong, 2000). Researchers have also measured the phenomenon with different instruments. While there is overlap, distinctions across many of the conceptual definitions are often based on where the emphasis lies (e.g., health versus sustained independence). The purpose of this article is to present an initial attempt to develop a tool, the Successful Aging Inventory (SAI), that measures successful aging based on a theoretical definition, that includes multiple dimensions of successful aging, and does not exclude individuals from being considered successful agers based on physical limitations alone.


There is variation in conceptual definitions of successful aging, although many overlap (Table 1). A clear link is not always evident between the instruments that have been used to measure successful aging and theoretical constructs. No singular tool multidimensionally assesses successful aging with consideration of the older adult’s perception, although an abundance of literature substantiates the complexity of successful aging (e.g., Bowling & Dieppe, 2005; Boyle, Barnes, Buchman, & Bennett, 2009; Duay & Bryan, 2006; Ford et al., 2000; Hsu, 2005; Inui, 2003; Matsubayashi, Ishine, Wada, & Okumiya, 2006; Phelan, Anderson, LaCroix, & Larson, 2004; Ryff, 1982; Varshney, 2007). Depp and Jeste (2009) noted the clear evidence of the indistinctness surrounding the meaning of successful aging; their literature search of studies that included an operationalized definition of successful aging identified 28 studies with 29 different definitions.

Variation and Similarity in Conceptual Definitions for Successful Aging

Table 1: Variation and Similarity in Conceptual Definitions for Successful Aging

Various studies have looked at different factors in successful aging, including socioeconomic class, health and well-being, lifestyle, spirituality, and interpersonal relationships. However, administering multiple instruments to assess each such variable is problematic because older adults fatigue easily and may have sensory impairments that pose challenges to completing lengthy paperwork. Further, assessing successful aging via a battery of instruments may only be feasible for the healthiest of older adults and not those most in need of assessment and intervention—people who are not aging well. Instruments frequently used to measure successful aging are lengthy, require a literacy level above that of some older adults, and have confusing formats. In addition, few instruments have been designed specifically to measure responses from older adults themselves (Burnside, Preski, & Hertz, 1998).

The literature on successful aging suggests that assessing older adults’ perspectives on their aging (Glass, 2003; Phelan & Larson, 2002) and taking into consideration multiple health domains is important to understand the phenomenon (Table 1). Thus, there is a need for instruments specifically designed for older adults. In response to these issues, the first author (M.T.) developed an instrument intended to capture successful aging from the perspective of older adults (only two of the 28 studies reviewed by Depp and Jeste, 2009, assessed self-rated successful aging), while considering various dimensions shown to be vital to successful aging: functional performance (Depp & Jeste, 2009), personality (Depp & Jeste, 2009), spirituality (Sadler & Biggs, 2006; Wong, 2000), gerotranscendence (Tornstam, 1994, 1997), and life satisfaction and purpose in life (Depp & Jeste, 2009; Wong, 2000). The instrument was derived within the context of a mid-range theory of successful aging.

Conceptual Framework

The conceptual definition of successful aging resulted from a concept analysis (Flood, 2002) that used Walker and Avant’s (1995) framework. Nursing and non-nursing literature (e.g., medicine, psychology, sociology) was extensively reviewed to construct the conceptual definition and identify key attributes and empirical referents. Successful aging is defined as an individual’s perception of favorable adaptation to the cumulative physiological and functional alterations associated with the passage of time, while experiencing spiritual connectedness and a sense of meaning and purpose in life (Flood, 2002).

Subsequently, the first author (formerly Flood, 2006) developed a mid-range theory of successful aging. The theory was derived directly from an extensive and ongoing review of nursing, medical, gerontological, psychological, and sociological research and theoretical literature that occurred over a 5-year period and included classic works (e.g., Rowe & Kahn, 1998) from further back. Major findings from the literature were synthesized and organized according to their key characteristics. Five areas of focus in the literature that were linked with “successful” or “healthy” aging or “well-being” of older adults were identified: physical status and mobility, mental/personality characteristics, spirituality, gerotranscendence, and purposefulness/life satisfaction. These areas were named accordingly and comprised major dimensions of the theory.

The major dimensions of the theory of successful aging, derived from the literature, are thus named functional performance mechanisms, intrapsychic factors, spirituality, gerotranscendence, and purposefulness/life satisfaction. The central assumption is that adaptation is essential for successful aging, and effective use of coping mechanisms allows one to age successfully. Coping mechanisms that facilitate successful aging are control processes in one of four dimensions (Flood, 2002):

  • Functional performance mechanisms (use of conscious awareness and choice as an adaptive response to cumulative physiological and physical losses due to aging).
  • Intrapsychic factors (enduring character features that enhance the ability to adapt to change and problem solve).
  • Spirituality (personal views and behaviors expressing relatedness to something greater than oneself).
  • Gerotranscendence (a shift in metaperspective, from a materialistic and rationalistic perspective to a more mature and existential one) (Tornstam, 1994).

Effective use of these coping mechanisms, which are interrelated, increases the likelihood of aging successfully. This theory is similar to Baltes and Baltes’ (1990) selection, optimization, and compensation model, which focuses on understanding the personal cognitive strategies older people themselves use to age successfully (Sadler & Biggs, 2006). Research has demonstrated support for the conceptualization of successful aging in the theory of successful aging (Cozort, 2008; Flood, 2006; Flood & Scharer, 2006; McCarthy, 2009).

The first author compiled a list of instruments that had been used to measure successful aging (or healthy aging or well-being) in the previous studies and identified areas that had not been addressed (e.g., “A relationship with God or some higher power is important to me.”) but had been described in the literature as relevant to successful aging. These instruments were carefully reviewed by the authors. Questions that appeared repeatedly and for which there was recurring literature support in relation to successful aging were noted. For example, “I am overall satisfied with my life right now” is indicative of life satisfaction, which has been frequently linked with successful aging (Baltes & Mayer, 1999; Barrett & Murk, 2009; Fisher, 1995; Meeks & Murrell, 2001; Neugarten, Havighurst, & Tobin, 1961; Palmore, 1995; Vaillant & Mukamal, 2001). “I often think of my loved ones who have passed away and feel close to them” demonstrates gerotranscendence, which is hypothesized as a precursor to successful aging (Tornstam, 2005) and is associated with life satisfaction (Ahmadi Lewin, 2000; Cozort, 2008; Tornstam, 2005).

The first author developed a set of questions that captured the five major areas of focus. The process of constructing SAI items involved several iterations; statements were written, revised, and some were deleted. Twenty final items were derived from the theory and literature on which it was based and then formatted as brief statements (Table 2). SAI item derivation was also influenced by the first author’s previous research experiences, in which older adult participants often offered their opinions on “what should be on this test” as they completed instruments such as the Life Satisfaction Inventory-A (LSI-A). Several senior nurse researchers reviewed the items for content validity, and, to assess face validity, participants in this study were asked to provide any comments or suggestions about whether or not the SAI seemed to capture what they understood successful aging to be. Both groups indicated that either type of validity appeared to be present.

SAI Item Content And Theoretical Dimensions Represented

Table 2: SAI Item Content And Theoretical Dimensions Represented

The SAI items attempted to capture each of the dimensions of the successful aging theory. Some items contain overlapping concepts from the dimensions. For example, “I have been able to cope with the changes that have occurred to my body as I have aged” is indicative of coping (intrapsychic factors) and age-related physical changes (functional performance mechanisms).

Both a dichotomous (yes/no) and Likert-format (hardly ever/strongly disagree, sometimes/somewhat disagree, about half the time/neither agree nor disagree, most of the time/somewhat agree, almost always/strongly agree) versions were constructed. Both versions were formatted to be reader friendly for older adults: A large font was used, content was placed in a table with clearly defined borders, and item boxes were shaded to help differentiate the various items. Reading levels were evaluated for both versions; the dichotomous version had a 5.8 grade reading level, and the Likert version had a 5.9 grade reading level.

Description and Scoring of Instrument

Both versions of the SAI were composed of 20 brief, positively worded statements expressing single ideas or behaviors suggestive of successful aging. Respondents were asked to indicate the extent to which they agreed with a statement or that the statement applied to them. Dichotomous items were scored 0 and 1, with higher scores representing affirmative responses. The range of possible scores was 0 to 20. Items from the Likert version were scored 0 to 4, with higher scores corresponding to more frequent/stronger positive responses. Thus, total scores could range from 0 to 80.



Two hundred community-dwelling older adults participated in a study designed to determine the psychometric properties of the SAI. Institutional Review Board approval was obtained prior to beginning the study. Informed consent was obtained prior to participation. Participants were recruited from local senior centers, health fairs, neighborhoods, and assisted living facilities. They were required to be 65 and older, able to speak English, and free of cognitive impairment.

The animal fluency test (Benton, Hamsher, & Sivan, 1994) was administered to check cognitive status before the older adults completed any questionnaires. In this test, individuals are asked to identify all of the animals they can in 60 seconds. Fewer than 12 animals is highly suggestive of cognitive impairment, and 12 to 15 animals may be indicative of mild cognitive impairment. The animal fluency test discriminates individuals with dementia from those without dementia with similar degrees of sensitivity and specificity as the Mini-Mental State Examination (Kilada et al., 2005). This kind of naming task is associated with executive, linguistic, and semantic components (Lezak, Howieson, & Loring, 2004). The intent was to screen for participants who would be able to understand the battery of instruments, while being as inclusive as possible. After screening, no participants were excluded on the basis of cognitive impairment.


Demographic information was collected, and then the SAI, LSI-A, Purpose in Life (PIL) test, Mastery Scale (MS), and Center for Epidemiologic Studies Depression Scale (CES-D) were administered. Members of the research team read the forms to anyone requiring reading assistance. Each participant was provided a $5 food coupon or $5 cash as a token of appreciation for completing the questionnaires.


Cronbach’s alpha coefficient is an important measure of the internal consistency reliability of a psychometric instrument and is considered an unbiased estimator. McCarthy (2009) observed a Cronbach’s alpha coefficient of 0.82 when she administered the SAI in a sample of 112 residents of a continuing care retirement community. Cozort (2008) reported a Cronbach’s alpha coefficient of 0.91 when the SAI was administered to 123 residents of an independent living facility.


The researchers provided participants the opportunity to write in any comments about whether the SAI seemed to adequately capture the essence of successful aging. Participants were also encouraged to offer any verbal comments. Participants generally believed the instrument assessed what made sense to them as successful aging. None identified any SAI items that did not make sense or seemed out of place. Therefore, face validity was deemed adequate.

Life satisfaction has been identified as an indicator of successful aging (Barrett & Murk, 2006; Fisher, 1995; Havighurst, 1961). Satisfaction with one’s life has been the most commonly proposed definition of successful aging and is also the most commonly investigated (Bowling & Dieppe, 2005). Purpose in life has also been recognized as a main constituent of successful aging (Bowling & Dieppe, 2005; Boyle et al., 2009; Fisher, 1995; Reichstadt, Depp, Palinkas, Folsom, & Jeste, 2007). Therefore, measures of these constructs were selected for the purpose of assessing validity. Although a number of other constructs are relevant to successful aging (e.g., functional ability, social support), these two were chosen because they are subjective assessments and not reliant on physical abilities or social/material resources. The intent was to produce a more inclusive measure of successful aging and avoid the notion of some benchmark being necessary to age successfully. Therefore, the LSI-A (Neugarten et al., 1961) and PIL test (Crumbaugh & Maholick, 1969) were used to assess convergent validity.

The range of possible scores on the LSI-A is 0 to 20; higher scores reflect greater life satisfaction. Sample items are “As I look back on my life, I am fairly well satisfied,” and “I’ve gotten pretty much what I expected out of life.” LSI-A content validity is supported by items based on repeated interviews with people ages 50 to 90 about life patterns, attitudes, daily activities, values, social interactions, and other concerns (American Thoracic Society, 1999). The LSI-A has interrater reliability of 0.78 (Neugarten et al., 1961). Studies using the LSI-A with older adults have produced statistically sound and theoretically meaningful results (Chokkanathan & Lee, 2006; Xavier et al., 2002). Construct validity is evidenced by correlations with the Life Satisfaction Rating Scale (American Thoracic Society, 1999).

The PIL is a 20-item, 7-point Likert scale that measures the degree to which a person experiences a sense of meaning and purpose in life (Crumbaugh, 1968). Items include “In life I have very clear goals and aims” and “My personal existence is very purposeful and meaningful.” The range of possible scores is 0 to 120, and higher scores indicate greater purposefulness. The PIL has been used with older adults (Ebersole & DePaola, 1987, 1989; Gerwood, LeBlanc, & Piazza, 1998). Crumbaugh (1968) reported a Pearson’s r of 0.995 between two forms of the PIL test when administered to the same sample and found support for construct validity.

The MS (Pearlin & Schooler, 1978 ) is a 7-item Likert format scale that measures personal control. This instrument was administered to assess for correlations with SAI scores based on one proposition of the theory of successful aging (Flood, 2006)—that high levels of personal control contribute to successful aging. Items include “I have little control over the things that happen to me” and “I can do just about anything I really set my mind to do.” MS items are answered on a 4-point scale (strongly agree, agree, disagree, strongly disagree). The range of possible scores is 7 to 28. The scale has been shown to exhibit reasonable internal reliability (Seeman, 1991) and good construct validity (Pearlin, Lieberman, Menaghan, & Mullan, 1981).

The CES-D (Radloff, 1977) was used to assess discriminant validity. On the basis of the theory of successful aging, one would not be expected to have depressive symptoms if one is effectively using intrapsychic factors (e.g., creativity, low levels of negative affectivity, personal control) as coping mechanisms. Therefore, a negative correlation would be expected between the CES-D and SAI. The CES-D is a 20-item Likert scale composed of statements such as “I was bothered by things that don’t usually bother me” and “I did not feel like eating, my appetite was poor.” Participants respond according to how often they have felt this way during the past week, from rarely or none of the time to most or all of the time. Internal reliability is demonstrated by Cronbach’s alpha coefficients of 0.87 to 0.89 (Radloff, 1977). Correlations with the Hamilton Rating Scale for Depression and the Raskin Depression Rating Scale were good after 4 weeks of treatment (r = 0.69 and r = 0.75; Radloff, 1977). The CES-D has been used with older adult samples (Pennix, Deeg, van Eijk, Beekman, & Guralnik, 2000; Pennix et al., 1998).



The study sample was composed primarily of White women (Table 3). Ages ranged from 52 to 100 (one participant wrote in her age as 52 after being screened), with a mean age of 75.01 (SD = 8.24 years). Educational attainment ranged from second grade to 5 years of post-secondary education, with a mean educational level of 12.87 years (SD = 2.82). (In keeping with the idea of inclusiveness, participants were not screened for educational level prior to giving informed consent. Therefore, some people who did not have the SAI reading level participated.) Nineteen percent of participants (n = 38) had less than a high school education, while 29% (n = 58) had completed high school, and 48% (n = 96) had 1 or more years of college education. Just under half of the participants (n = 91, 45.5%) were married, 34.5% (n = 69) were widowed, 13% (n = 26) were divorced, 5% (n = 10) were single, 1.5% (n = 3) did not report, and 0.5% (n = 1) had a significant other/companion. Most participants (n = 133, 66.5%) reported an income that allowed them to live comfortably, although 20.5% (n = 41) believed they could barely get by; 9.5% (n = 19) lived in some luxury, and 3.5% (n = 7) provided no response.

Characteristics of the Sample (N = 200)

Table 3: Characteristics of the Sample (N = 200)

Participants were asked whether they had various chronic conditions common in older adults; Table 4 reflects the frequencies of these conditions. Thirty-four participants (17%) were free of any chronic health condition. The modal number of health conditions was 1, occurring in 39% (n = 78) of participants. One quarter (n = 51) of the sample had two concurrent medical conditions, 7.5% (n = 15) had three, and 6% (n = 12) reported four concurrent medical conditions, while the remainder (n = 10, 5%) had five or more.

Health Conditions of the Sample (N = 200)

Table 4: Health Conditions of the Sample (N = 200)

Most participants (n = 116, 58%) rated their health as good. Twelve percent (n = 24) said their health was excellent, and the remainder rated their health as either fair (n = 48, 24%) or poor (n = 9, 4.5%). The majority of the sample (n = 127, 63.5%) reported exercising regularly.

Scale Description

Descriptive statistics were calculated for both versions of the SAI, and each version was examined for variability. Survey packets were mixed so that participants randomly received either the Likert or dichotomous version of the SAI. No statistically significant differences were found in SAI scores for participants with less than a sixth-grade education and those with educational levels of sixth grade or higher. One hundred six participants completed the Likert-format SAI (one participant did not fully complete it). Their scores ranged from 23 to 80, with a mean of 65.26 (SD = 10.49), a median of 67, and a mode of 74. The SAI scores were negatively skewed. Ninety-three participants completed the dichotomous-format SAI. These scores ranged from 14 to 20, with a mean score of 18.33 (SD = 1.68) and both a median and mode of 19. Scores for the dichotomous version were also negatively skewed.

Scale Reliability

For the Likert-format SAI, the Cronbach’s alpha coefficient was 0.86. For the dichotomous version, the Kuder-Richardson coefficient was 0.67. Thus, participant responses on the Likert SAI demonstrated more internal consistency. Many of the participants were individuals who sporadically attended the senior center or participated in the monthly senior lunch meetings. For this reason, the research team could not be assured of their ability to collect follow-up data on all (or a majority of) participants at a 2- or 4-week time point. Thus, test-retest reliability was not assessed.

Scale Dimensionality

Factor analysis was conducted to determine what structure existed for the Likert-format SAI items, since this version of the instrument had more desirable reliability and validity. Principal components analysis for the Likert version was conducted using a varimax rotation. Three criteria suggested by Mertler and Vannatta (2005) were used to determine the appropriate number of components to retain: eigenvalue, variance, and scree plot. These criteria indicated that five components should be retained. The five components accounted for 62.19% of the variance.

Some researchers use factor matrix loading cut-off points as low as 0.35, while others use cut-off points as high as 0.55 (Munro & Page, 1993). In this case, scale items were determined as belonging to one of the five components on the basis of a factor loading cut-off point of 0.4. The percentages of variance explained by each component were as follows:

  • Intrapsychic and functional performance coping mechanisms (Items 1 through 9): 32.29%.
  • Existential being (Items 16 through 20): 10.52%.
  • Introspective gerotranscendence (Items 12 through 14): 7.04%.
  • Spirituality (Items 11 and 15): 6.35%.
  • Retrospective gerotranscendence (Item 10): 5.99%.

The items intended to represent the constructs in the theory of successful aging did not load cleanly onto factors according to theory constructs (functional performance mechanisms, intrapsychic factors, spirituality, gerotranscendence, purpose in life/life satisfaction), as was anticipated (See Table 2 for listing of dimensions from which each item was derived).

Scale Validity

To assess convergent and discriminant validity, Pearson correlations were calculated to examine the relationships between scores on the two SAI versions and the LSI-A, PIL, MS, and CES-D. Mean scores on these instruments were as follows: LSI-A, 13.72 (SD = 4.73); PIL, 84.32 (SD = 14.64); MS, 19.22 (SD = 2.67); and CES-D, 10.02 (SD = 7.81). Positive correlations between the SAI and the LSI-A, the SAI and the PIL, and the SAI and the MS were expected. For the Likert-format SAI, no significant correlation was found with the LSI-A (Table 5). However, significant correlations were found with the PIL, MS, and the CES-D. Interestingly, for the dichotomous SAI, a significant, albeit slight correlation was found with the LSI-A (p < 0.012, r = 0.263), and a significant correlation also existed with the PIL (p < 0.000, r = 0.361).

Correlation Matrix for SAI and Study Variables

Table 5: Correlation Matrix for SAI and Study Variables

Convergent validity inferences for the Likert SAI can be made from the moderate correlations with the PIL and MS; discriminant validity was demonstrated by significant negative correlations with the CES-D. Convergent validity for the dichotomous SAI can be inferred from correlations with the LSI-A and PIL, although these were less strong than those of the Likert-format version.


The sample was composed primarily of White women whose education was comparable to other older Americans, 76% of whom have at least a high school diploma (Federal Interagency Forum on Aging-Related Statistics, 2008). The sample’s self-reported health was also comparable to that of White older Americans, 76% of whom report good to excellent health (Federal Interagency Forum on Aging-Related Statistics, 2008). The sample reported a slightly lower frequency of cardiovascular disease than national means for older adults—52% and 54% for men and women, respectively—and lower frequencies of arthritis than national standards for this age group (43% and 54% for men and women) (Federal Interagency Forum on Aging-Related Statistics, 2008). Likewise, fewer had cancer, stroke, and depression (Federal Interagency Forum on Aging-Related Statistics, 2008). However, the sample had a higher frequency of diabetes than older adults nationwide (19% and 17% for men and women) (Federal Interagency Forum on Aging-Related Statistics, 2008). Thus, the sample was in somewhat better health than older adults nationwide; however, they were both community dwelling and ambulatory, so these findings might be expected. Marital status findings suggest the sample may have had less social support than the average older adult; nationally, 60% to 78% of older adults in the 65-74, 75-84, and 85 and older age ranges are married (Federal Interagency Forum on Aging-Related Statistics, 2008), while only 45% of participants in this study were married.

The sample tended to score above the scale norms for the LSI-A, 12.5 (Neugarten et al., 1961); less than those for the PIL, 106.3 to 113.16 (Crumbaugh & Maholick, 1969; Krawczynski & Olszewski, 2000); and higher than some reported for the MS, 12.0 to 12.6 (Graff et al., 2007), 12.8 to 14.3 (Bohlmeijer, Valenkamp, Westerhof, Smit, & Cuijpers, 2005), but less than others, 21.8 (Jang, Haley, Small, & Mortimer, 2002). The sample generally had little depressive symptomology, with a mean CES-D score of 10.02 (scores ranging from 0 to 15 indicate absence of depression; Radloff, 1977). They tended to score on the upper end for either version of the SAI. This finding is interesting, since, on average, they did not score on the upper end of the possible range of LSI-A and PIL scores.

The SAI, and in particular the Likert version, shows promise as a single instrument measuring successful aging. There were few instances of omitted or double-marked responses in this study. No participants reported or demonstrated difficulty completing either version of the SAI, and several commented that they found the scale easy to understand and complete.

The SAI captures vital constructs of successful aging that the LSI-A and PIL do not, although it does contain three items that address meaning, purpose, and life satisfaction. Like many of the samples that have been used in research on successful aging, this sample was primarily White, educated, and financially stable. Their mean scores on life satisfaction, purpose in life, mastery, and depressive symptoms were within expected ranges, based on the norms for these scales.


We recognize that the process used for item generation—a comprehensive review of the successful aging literature and synthesis of key themes, from which a somewhat narrowly delineated set of items was derived and then subject to approval by content experts and senior researchers for face and content validity—is a deviation from the traditional method of generating a large pool of items that exceeds the desired amount. Initially, the number of items written should be two to four times the desired amount (Marsh & Yeung, 1997). However, another statistical rule of thumb says that in the beginning stages of test construction, one needs 5 research participants per item on the test (Schutz, as cited by Giacobbi, n.d.); we did adhere to this tenet.

Our intent was to develop an instrument derived from the theory of successful aging (Flood, 2006), as a means of measuring successful aging, according to this conceptualization of it. We constructed a reasonable number of items that could feasibly be administered to older adults, along with a selection of other instruments comprising the test battery. We sought to develop a psychometrically sound instrument that could be tested without burdening participants. Nonetheless, the authors acknowledge the nonstandard method of item selection as a potential limitation.

Therefore, one implication is the need for research to refine the SAI and make revisions, as indicated. Indeed, the first author’s research currently underway involves collection of focus group data from older adults describing their understanding of successful aging. These findings will be used to further inform the theory of successful aging and identify the need to include or eliminate additional items from the SAI.

Although the questionnaire format is an accepted approach for gathering information, it cannot fully capture the wide range of individuals’ thoughts, feelings, and ideas. It is possible the SAI does not include some aspects of successful aging considered important by older adults. Similarly, it is possible that some elements of successful aging were “missed”; despite the intention to construct items that convey a single idea, some SAI items (e.g., “I think of my loved ones who have passed away and feel close to them”) might need to be reworded, as participants could think of deceased loved ones but not feel close to them. Rewriting this item to more clearly communicate the intended idea (e.g., “When I think of loved ones who have passed away, I feel close to them”), might evoke more affirmative responses.

Conclusion and Implications

On the basis of initial testing, the Likert-format SAI appears suitable for measuring successful aging; it captures intrapsychic and functional performance, existential, spiritual, and gerotranscendental elements of the phenomenon. This study was a beginning step in the development of an instrument to measure a theoretically derived definition of successful aging, which accounts for multiple dimensions of the aging process from the older adult’s perspective. While the SAI seems promising as a measure of successful aging, further work remains.

Additional research to assess validity and reliability of the SAI will allow researchers greater confidence in using it. Focus groups could help obtain a deeper understanding of older adults’ perceptions of what successful aging is and to assess for face validity of the SAI. Future research will include administering the SAI to more diverse samples. In light of the increasing diversity in the United States (Bomar & Glenn, 2004; Wilmoth & Longino, 2006), it is essential that the instrument’s utility be evaluated in varied ethnic and racial groups. For example, a study of the SAI’s psychometric properties with Black older adults has been conducted (Troutman, Nies, & Mavellia, 2011).

Similarly, it would be beneficial to assess use of the instrument with older adults who have depression, to more fully assess discriminant validity. It will be particularly important to be able to evaluate successful aging in those who are likely to have barriers to well-being in old age and who may be less likely to age successfully. Thus, administering the SAI to older adults with greater levels of functional and physical limitations (e.g., those who require skilled nursing care in nursing homes), fewer economic resources, and less educational attainment would be valuable, as variation would be expected in these subpopulations. Validity of the SAI could also be better understood if the SAI were measured concurrently with instruments that measure functional status and social support, variables that have been associated with successful aging (Gow, Pattie, Whiteman, Whalley, & Dreary, 2007; Nusselder & Peeters, 2006; Rowe & Kahn, 1998; Willcox, Willcox, Shimajiri, Kurechi, & Suzuki, 2007).

Administration of the SAI in a different setting, such as a senior center where older adults regularly attend, would afford the opportunity to determine test-retest reliability. It is vital to gain insight into this form of reliability, as the long-term goal of this research is to implement interventions aimed at promoting successful aging in vulnerable older adults.

Identification of those who are not aging successfully can provide a foundation for developing strategies to help such individuals more effectively adapt to age-related physiological, cognitive, emotional, and functional changes, as well as experience spiritual connectedness and a sense of meaning and purpose in life during older adulthood. Intervention studies could ultimately strengthen nurses’ ability to facilitate successful aging through health promotion strategies.


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Variation and Similarity in Conceptual Definitions for Successful Aging

Study Definitions
Fisher (1995)a Being involved in addressing current problems of identity and development, and doing so in light of anticipated future situations, as implicated on the basis of past experience. Successful agers continue to grow and learn as they use past experiences to cope with the present and set goals for future development.
Rowe and Kahn (1998) Lower risk of disease/disability, greater mental and physical function, active engagement with life.
Guse and Masesar (1999)a Being friendly, having a sense of humor, being interested in/willing to help others, adapting to changes, never giving up or letting things get one down, and enjoying oneself as much as one possibly can.
Ford et al. (2000) Sustained independence during the 2-year period of observation.
Knight and Riccardelli (2003)a Health, activity, personal growth, happiness/contentment, independence, relationships, appreciation/value of life, and longevity.
Tate, Lah, and Cuddy (2003)a Health, satisfying lifestyle, keeping active, having a positive attitude, family, independence, keeping active mentally and spirituality, accepting aging, moderation, diet, keeping active socially, having goals, financial security, having interests, being useful, contentment, and humor.
Uotinen, Suutma, and Ruoppila (2003)a “Loosely based” (p. 173) on Rowe and Kahn’s criteria: no illness or injury presenting problems in daily life, no health problems imposing limitations on hobbies, self-rated cognitive functioning better than satisfactory, good age-comparative functional capacity, and no signs of depression.
Wagnild (2003) Enjoyment of health and vigor of the mind, body, and spirit into middle age and beyond.
Hsu (2005) Absence of disease and physical problems, normal cognition, and good social support.
Litwin (2005) The ability to remain integrated within social life, if it is adult’s wish to do so, while maintaining the maximum functional capacity possible.
Li et al. (2006) Cognitive function, activities of daily living, mood status, and no disability.
Matsubayashi, Ishine, Wada, and Okumiya (2006) White participants identified physical health/functioning, mental health, and social health as key attributes of successful aging. Japanese participants reported physical health/functioning, mental health, social health, and learning new things as key features.
Ko, Berg, Butner, Uchino, and Smith (2007) Rowe and Kahn’s criteria for successful aging.
Brown, McGuire, and Voelkl (2008)a Health, engagement in serious leisure activities, activity involvement, personal growth, close personal relationships.
McLaughlin, Connell, Heeringa, Li, and Roberts (2010) Having no major disability, no activity of daily living disability, no more than one difficulty with seven measures of physical functioning, obtaining a median or higher score on tests of cognitive functioning, and being “actively engaged.”

SAI Item Content And Theoretical Dimensions Represented

Item Theoretical Dimension
1. I manage to do the things that I need to do to take care of my home and to take care of myself (eating, bathing, and dressing). Functional performance mechanisms
2. I have been able to cope with the changes that have occurred to my body as I have aged. Functional performance mechanisms, Intrapsychic factors
3. I look forward to the future. Intrapsychic factors
4. I feel able to deal with my own aging. Intrapsychic factors
5. I feel able to cope with life events. Intrapsychic factors
6. I can come up with solutions to problems. Intrapsychic factors
7. I am good at thinking of new ways to solve problems. Intrapsychic factors
8. I enjoy doing creative new things or making things. Intrapsychic factors
9. I am in a positive, pleasant mood. Intrapsychic factors
10. I think of my loved ones who have passed away and feel close to them. Gerotranscendence
11. I spend time in prayer or doing some kind of religious activity. Spirituality
12. As I have aged, the way I think of the world has changed. Gerotranscendence
13. I would rather have a few close friends than many casual ones. Gerotranscendence
14. Sometimes there can be two right answers to a problem or situation. Gerotranscendence
15. A relationship with God or some higher power is important to me. Spirituality
16. I feel interest in/concern for the next generation. Gerotranscendence
17. My life is meaningful. Gerotranscendence, Purposefulness/life satisfaction
18. I am overall satisfied with my life right now. Gerotranscendence, Purposefulness/life satisfaction
19. I feel that I serve a purpose in this world. Gerotranscendence, Purposefulness/life satisfaction
20. Being the age that I am now is as good or better than I thought it would be. Gerotranscendence

Characteristics of the Sample (N = 200)

Variable n(%)
  White 179 (89.5)
  Black 15 (7.5)
  Hispanic 3 (1.5)
  Other 2 (1)
  Missing 1 (0.5)
  Women 133 (66.5)
  Men 67 (33.5)

Health Conditions of the Sample (N = 200)

Health Condition n(%)
Arthritis/orthopedic condition 73 (36.5)
Cardiovascular disease 67 (33.5)
Diabetes 42 (21)
Cancer 22 (11)
Respiratory condition 22 (11)
Depression 21 (10.5)
Anxiety 18 (9)
Stroke 10 (5)

Correlation Matrix for SAI and Study Variables

Measure SAI Score LSI-A Score PIL Score MS Score CES-D Score
SAI score
  Pearson correlation 1 0.112 0.512** 0.395** –0.338**
  p Value 0.253 0.000 0.000 0.001
  n 106 106 95 95 87
LSI-A score
  Pearson correlation 0.112 1 0.437** 0.228** –0.404**
  p Value 0.253 0.000 0.002 0.000
  n 106 197 185 184 148
PIL score
  Pearson correlation 0.512** 0.437** 1 0.470** –0.338**
  p Value 0.000 0.000 0.000 0.000
  n 95 185 188 187 150
MS score
  Pearson correlation 0.395** 0.228** 0.470** 1 –0.346**
  p Value 0.000 0.002 0.000 0.000
  n 95 184 187 187 150
CES-D score
  Pearson correlation –0.338** –0.404** –0.338** –0.346** 1
  p Value 0.001 0.000 0.000 0.000
  n 87 148 150 150 150

Dr. Troutman is Assistant Professor and Gerontology Faculty Affiliate, School of Nursing, Dr. Nies is Carol Grotnes Belk Endowed Chair in Nursing & Professor and Adjunct Professor, Department of Public Health Sciences, College of Health and Human Services, University of North Carolina (UNC) at Charlotte, and Ms. Small and Ms. Bates are in private practice, Charlotte, North Carolina.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity. This project was made possible through funding from a UNC Charlotte Junior Faculty Research Grant.

Address correspondence to Meredith Troutman, PhD, PMHCNS-BC, Assistant Professor and Gerontology Faculty Affiliate, CHHS 444B, School of Nursing, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223; e-mail:

Received: January 14, 2010
Accepted: July 01, 2010
Posted Online: January 21, 2011


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