As the population ages, the number of older people with frailty is expected to increase worldwide with consequent rising of expenditures for healthcare and long-term care. Effective methods for preventing or delaying the onset of frailty are urgently required. Frailty is a common and important geriatric condition characterized by age-associated declines in multiple physiological mechanisms, leading to increased vulnerability to stressors and higher risk for adverse health outcomes. Significant advancements have been made in the understanding of the frailty pathophysiological background. Chronic inflammation is likely a key mechanism contributing to frailty both directly as well as indirectly, by affecting a wide spectrum of systems (e.g., the musculoskeletal, endocrine, and hematologic systems). Given its multidimensional nature, preventing frailty requires a comprehensive approach. In this context, raising awareness about healthy lifestyle and improving health education are key interventions for the prevention of frailty. Every effort should be made by healthcare authorities in order to maximize efforts in this field, taking into account the need of balancing priorities, needs, and resources.

This chapter aims to explore emotions during the aging process, and the contribution of emotional regulation to successful aging. Wisdom and socio-emotional selectivity theories framed successful aging. Other theories, as positive psychology, happiness, and broaden-and-built theory, where also brought to disentangle successful aging. The development of cognition and emotion along the life span brings positivity and subjectivity into logic thinking. Learning appears as the main mechanism underlying this evolution. The older adults prioritize affective issues over logic ones. This happens, not because people cannot behave differently but because affect and cognition evolve, namely through learning, to a different adaptive way. Old people use a more affective and subjective approach to physical and social environment, which contributes to successful aging.

Aging is a complex process which occurs with various speeds in all vertebrate species. So far, most of the studies aiming at understanding of the mechanisms of human aging have involved animal models; recently it became evident that if we would like to better understand the aging in humans we should study it in humans. There are several theories to capture the process of aging, which have a common denominator of age-dependent loss of multiple bodily functions. However, it seems now very important to change this paradigm and to reconsider aging as a process of multidirectional dysregulation of many systems either intertwined or in parallel. The immune system is not an exception. The immune changes during aging are the consequence of the body immunological history reflecting continuous challenges by various antigenic aggressions. Both parts of the immune response are reacting but aging differentially. Thus, the sum of the immune changes reflects the continuous adaptations and remodelling either in increase or in decrease. Inflammaging and immunosenescence are the same but the two sides of the medal as one cannot exist without the other. The immune changes in connection with the neuroendocrine system importantly contribute to the health and disease associated with aging.

National Autonomous University of Mexico (FES Zaragoza, UNAM) has developed a Multidisciplinary Model of Community Gerontology for Community-Dwelling Older Adults with the aim of training the elderly in self-care, mutual-help and self-promotion related to preventing and controlling chronic diseases that have a high prevalence in old age linked to oxidative stress. The most important findings during the implementation of Model are the following: (i) elderly living in urban areas have higher oxidative stress than rural-elderly, linked at increased risk of deterioration cognitive; (ii) oxidative stress is a risk factor for osteoporosis in the elderly, and the consumption of vitamins C and E may be an adjuvant supplement for the prevention of osteoporosis; (iii) older people healthy without malnutrition, with a balanced diet and calorie restriction between 10 and 20%, showed a lower frequency and degree of DNA damage than people without caloric restriction, and consumption of vitamins C and E for prolonged periods does not prevent or decrease DNA damage; (iv) moderate physical exercise reduce oxidative stress and chronic inflammatory process associated with aging, in particular Tai Chi has higher antioxidant and anti-inflammatory effect than the walking.

The goal of this contribution is to review psychosocial intervention programs designed to promote successful aging. To this end, nineteen articles assessing the effectiveness of positive aging programs were identified. The objectives, contents, indicators, theoretical frameworks, methodologies and results of these programs are presented and discussed in this chapter.

The Rowe and Kahn model of successful aging has changed our view of aging from a deficit to resource model but attention is needed to assure that successful aging includes people of all types, histories, and resources; not only those rich uniquely privileged with regard to disease and disability, cognitive and physical functioning and engagement in life. We suggest an integration of the Convoy Model of Social Relations into the Successful Aging Model as a potentially useful approach for addressing these criticisms. We describe two field experiments originally designed to test the Successful Aging Model and demonstrate how social networks provide a unique pathway to successful aging that can be useful for all populations rather than a privileged minority. Results from the intervention among less advantaged populations indicate that improvement and ‘success’ can also be achieved among people who have experienced a life time of significantly greater challenges. Results support the suggestion that integrating the Convoy Model of Social Relations into the Successful Aging Model will help facilitate achieving this goal. We conclude with a call to recognize the potential of social relations to influence and create unique models of successful aging appropriate to individuals in varying and challenging circumstances.

Telomeres are specialised non-coding repetitive DNA-protein structures that form protective caps at the ends of eucaryotic chromosomes. They safeguard the chromosome ends, maintain genomic integrity and play a crucial role in replicative senescence, one of the main mechanisms of aging in cultured somatic cells. In epidemiological studies, short telomere length (TL) has been associated with increased risk of degenerative diseases and diminished survival. TL at birth, which is strongly determined genetically, and TL attrition during growth are seemingly the main explanation for inter-individual variation in TL across adults. This implies that the association between TL and adult-onset diseases largely reflects elements that have fashioned TL during early life.

Promoting physical activity is in many ways beneficial even in oldest-old, 90 years and older, but methods must be adjusted and individualized. Versatile exercise improving the cardiorespiratory fitness, muscle strength and mobility as well as balance is effective for maintaining functional capacity, especially among those already having impaired mobility and being frail. Physical exercise can slow down the progress of osteoporosis, and intense exercise may even improve bone density in an older person. The main focus of physical activity aiming at the prevention of falls and fractures is in training that improves balance and muscular strength in the lower extremities. Endurance exercise and strength training may also prevent cognitive decline. Mental and social aspects of physical activity in older people are also important.

Psychoneuroimmunology is the science that allows us to understand how several aspects of biology, psychology and sociology are interrelated and involved in achieving successful ageing and consequently healthy longevity. If the ageing process is a biological fact that affects practically all living beings, in social animals such as rats and mice, and especially in humans, social factors can also affect physiological responses, moreover, the psychological characteristics of an individual condition the functional state of the organism. In this context, we have recognize that the maintenance of an appropriate homeostasis, which is carried out through the homeostatic systems, namely the nervous, endocrine and immune systems, is the basis of good health. This healthy state is reached and maintained in different ways for each subject through his/her life and depends on their genes and environmental factors. This fact explains the different rates of ageing, i.e., the biological age, of each individual, and also explains why chronological age does not always coincide with biological age. Because of this the finding of markers of the rate of ageing is very relevant. The use of lifestyle strategies that improve biological age permits the reaching of successful ageing and healthy longevity. In the present chapter, after a brief exposition of the general characteristics of the communication between homeostatic systems, the field of psychoneuroimmunoendocrinology is introduced as the bridge into bio-psycho-social conditions dealing in this Section.

The present chapter will contribute to the body of research on associations between socio-economic resources, health and economic status, family intergenerational relations and between involvement with life and subjective well-being. It was achieved by analyzing data on these two dimensions of successful aging among European countries and Israel (based on SHARE data). The countries differ in their cultural and social contexts, particularly, family traditions and welfare development. As a substantial number of studies on the topic were conducted within one culture, it is imperative to continue and study these associations further in a wider comparative perspective. A most significant finding was the strong association between intergenerational family relations (including all its components) and successful aging (the two dimensions), even after controlling for background resources, including health and functioning, economic attributes and other variables. This means that predicting the decline of family relations was not proven in our research.

In the last 40 years there has been a significant change in the vision of aging: it is now understood and accepted that the elderly are the managers of their own physical and mental health, although some require the help of social and health agents to maintain their autonomy. The environment, fundamentally the social environment, is considered an important variable in the promotion of active aging, since it influences the cognitive maintenance of the elderly in very different ways. This chapter reviews the influence of environmental enrichment defined as those physical, sensory, affective and / or cognitive experiences that develop throughout life and contribute to optimize the physical, cognitive and / or emotional repertoires of a person, in the aging. It is revised the theoretical and methodological bases (lifespan theory, theory of disuse and cognitive plasticity construct) that support this line of research and the results of research carried out on lifelong environmental enrichment and environmental enrichment in old age. Regarding the first line: LIFELONG ENVIRONMENTAL ENRICHMENT. Epidemiological and longitudinal studies seem to show that maintaining an active lifestyle in old age - physical, mental and social - can protect against cognitive impairment. The educational level has an important role in protecting against age-related cognitive impairment, not only as a direct effect, but also because it can encourage greater cognitive activity in different areas of life. The effects of education are reinforced by all kinds of activities, including cultural and physical activities, which seem to play an important part in the cognitive maintenance of older people. Regarding the second line: ENVIRONMENTAL ENRICHMENT IN OLD AGE. The chapter reviews cognitive plasticity research and studies on cognitive training in old age, which generally show that the effects of cognitive training can improve the performance of the elderly in the trained areas with moderate effects, and that are detected by psychological tests or measures of objective skills, although they present some limitations that must be reviewed. Finally it is proposed a scheme that considers all the variables that can intervene in the transfer of training that could be considered to evaluate the effects of an intervention. This is posed to solve the need to verify the individual effect of each one to reach the proposed objective and, following a scheme of interventions based on the evidence, to design a formation that foments the environmental enrichment and is adjusted to the objective pursued and the characteristics of the elderly.

We argue in this chapter that environmental perspectives have the potential to enrich models of successful aging. Importantly, theories of successful aging have so far largely ignored the role of contextual influences; this is where this chapter steps in. Our reasoning is grounded in the field of environmental gerontology which strives to understand the relationship of aging individuals to their environments as well as its utilization and optimization to effectively support individuals/families with varying conditions, capabilities, and needs. First, we provide an overview of established models able to contribute to the understanding of how older adults have interchange with their environments. Doing so, we address traditional theories such as the competence-press model as well as more recent approaches such as Golant’s model of residential normalcy and the motivational theory of life-span development. Second, we elaborate on the connection between environmental gerontology reasoning and successful aging, for example by highlighting the critical role of environments for aging with disabilities. Third, we consider issues of interventions located at the environmental level and also address the challenges of implementation, hence to make sustainable changes in home and clinical environments in order to support successful aging.

In this chapter philosophical, psychological and research conceptions of spirituality and transcendence are reviewed as an essential part of human personality, self-understanding, and well-being and along the life cycling. Theoretical accounts on lifelong development suggest that spirituality and transcendence gain additional importance in old age, due to living into old age and facing its challenges, in the context of normative psycho-social crisis in adulthood, generativity and ego-integrity. As a source of meaning and purpose, spirituality and transcendence not only contribute to, but are also considered an essential part of, subjective well-being. Moreover, the impact of spirituality and transcendence on quality-of-life and successful ageing are reviewed is not only apparent from a comprehensive understanding of respective concepts. Empirical research provides considerable evidence that spirituality and transcendence substantially contribute to the perceived quality-of-life, establishing and maintaining resilience, coping with crisis and trauma, as well as to engagement in activities and interpersonal relationships.

Key points. There is currently too little hard evidence to propose a single diet in order to prevent cognitive decline. Dietary changes can influence cognition / cognitive decline, although long periods of adherence need to be taken into account before significant results can be seen. It is paramount to offer nutritional education already at an early age. Since the 'optimal diet' is not the same in each age group, dietary advice must be patient-tailored.

Psychological approaches to successful aging would be incomplete if they failed to incorporate human strengths such as altruism, morality, or a personality growth orientation, even if these characteristics are likely to be incompatible with a constant experience of positive affect, because they require the ability to tolerate and make use of mixed and negative experiences This chapter that it is worth the effort to strive for wisdom, even if wisdom should be considered an ideal that most individuals cannot even come close to. The way towards wisdom is demanding and, thus, it does not come as a surprise that only very few individuals, if any, score high on performance-based measures of wisdom-related knowledge. There also is no evidence for the idea that wisdom automatically comes with age or that wiser individuals are better adjusted as, for example, manifested in higher life satisfaction, better jobs and careers, or a more fulfilling social life. And yet, wisdom-related knowledge is an essential element of the good life; it fosters generativity and the common good and can give guidance in times of crises because it is grounded in deep insight into human nature and the life course. Wisdom suggests constructive ways of making sense of existential issues that may be threatening to many, but that need to be addressed in order to fully exploit what it means to be human; thus, wisdom could be considered as a constituent element of successful life.

The models of successful and/or active aging implicitly rely on the hypothesis of a strong biological limit to human longevity. This chapter explores this dimension of the models through three sections presenting the continuous increase in life expectancy, exploring the “rectangularization” of the survival curve and introducing the revolution of adult longevity. When we began to observe a decrease in mortality among the oldest old people, it was not understood that our species begun to change its longevity. The next three sections ask whether centenarians are a model of successful ageing, explore the variability of end-of-life trajectories and discuss the existence of a possible trade-off between longevity and functionality. It is clear that the majority of the centenarians do not meet the criteria for successful ageing. There is also a correlation between the age at death and the number of months spent with disability in the last year of life. These results suggest that the longer one lives, the more difficult it is to meet the criteria of successful ageing. Therefore, a more dynamic vision of successful ageing should be developed. Otherwise every advance in terms of longevity will be paid by an apparent decline in terms of successful ageing.