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Trajectories of positive aging: observations from the women's health initiative study

  • Oleg Zaslavsky (a1), Barbara B. Cochrane (a2) (a3), Nancy Fugate Woods (a2), Andrea Z. LaCroix (a3), Jingmin Liu (a3), Jerald R. Herting (a4), Joseph S. Goveas (a5), Karen C. Johnson (a6), Lewis H. Kuller (a7), Lisa W. Martin (a8), Yvonne L. Michael (a9), Jennifer G. Robinson (a10), Marcia Stefanick (a11) and Lesley F. Tinker (a3)...



The purpose of this study was to describe the longitudinal trajectories and bidirectional relationships of the physical-social and emotional functioning (EF) dimensions of positive aging and to identify their baseline characteristics.


Women age 65 and older who enrolled in one or more Women's Health Initiative clinical trials (WHI CTs) and who had positive aging indicators measured at baseline and years 1, 3, 6, and 9 were included in these analyses (N = 2281). Analytic strategies included latent class growth modeling to identify longitudinal trajectories and multinomial logistic regression to examine the effects of baseline predictors on these trajectories.


A five-trajectory model was chosen to best represent the data. For Physical-Social Functioning (PSF), trajectory groups included Low Maintainer (8.3%), Mid-Low Improver (10.4%), Medium Decliner (10.7%), Mid-High Maintainer (31.2%), and High Maintainer (39.4%); for EF, trajectories included Low Maintainer (3%), Mid-Low Improver (9%), Medium Decliner (7.7%), Mid-High Maintainer (22.8%), and High Maintainer (57.5%). Cross-classification of the groups of trajectories demonstrated that the impact of a high and stable EF on PSF might be greater than the reverse. Low depression symptoms, low pain, and high social support were the most consistent predictors of high EF trajectories.


Aging women are heterogeneous in terms of positive aging indicators for up to 9 years of follow-up. Interventions aimed at promoting sustainable EF might have diffused effects on other domains of healthy aging.


Corresponding author

Correspondence should be addressed to: Oleg Zaslavsky, PhD, Department of Nursing, Faculty of Health Sciences and Social Welfare, University of Haifa, Haifa 31905 Israel. Phone: +972-48288749; Fax: +972-48288017. Email:


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Anderson, G. L. et al. (2003). Implementation of the Women's Health Initiative study design. Annals of Epidemiology, 13 (9S), S5S17. doi:10.1016/S1047-2797(03)00043-7.
Berkman, L. F. and Syme, S. L. (1979). Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109, 186204.
Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R. and Pamuk, E. (2010) Socioeconomic disparities in health in the United States: what the patterns tell us. American Journal of Public Health, 100 (1S), S186–S196. doi:10.2105/AJPH.2009.166082.
Burnam, M. A., Wells, K. B., Leake, B. and Landsverk, J. (1988). Development of a brief screening instrument for detecting depressive disorders. Medical Care, 26, 775789. doi:10.1097/00005650-198808000-00004.
Depp, C. and Jeste, D. (2006). Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. American Journal of Geriatric Psychiatry, 14, 620. doi:10.1097/01.JGP.0000192501.03069.bc.
Ferro, M. A., Avison, W. R., Campbell, M. K. and Speechley, K. N. (2011). Prevalence and trajectories of depressive symptoms in mothers of children with newly diagnosed epilepsy. Epilepsia, 52, 326336. doi:10.1111/j.1528-1167.2010.02899.x.
Fried, L. P. et al. (2001). Frailty in older adults: evidence for a phenotype. Journal of Gerontology. Series A, Biological Sciences and Medical Sciences, 56, M146–M156. doi:10.1093/gerona/56.3.M146.
Gill, T. M., Gahbauer, E. A., Han, L. and Allore, H. G. (2010). Trajectories of disability in the last year of life. New England Journal of Medicine, 362, 11731180. doi:10.1056/NEJMoa0909087.
Hays, J. et al. (2003). The Women's Health Initiative recruitment methods and results. Annals of Epidemiology, 13 (9S), S18–S77. doi:10.1016/S1047-2797(03)00042-5.
Jones, B. L., Nagin, D. S. and Roeder, K. A. (2001). A SAS procedure based on mixture models for estimating developmental trajectories. Sociological Methods & Research, 29, 374393. doi:10.1177/0049124101029003005.
Kaplan, M. S., Huguet, N., Orpana, H., Feeny, D., McFarland, B. H. and Ross, N. (2008). Prevalence and factors associated with thriving in older adulthood: a 10-year population-based study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 3A, 10971104. doi:10.1093/gerona/63.10.1097.
Kurland, B. F., Gill, T. M., Patrick, D. L., Larson, E. B. and Phelan, E. A. (2006). Longitudinal change in positive affect in community-dwelling older persons. Journal of the American Geriatrics Society, 54, 18461853. doi:10.1111/j.1532-5415.2006.00970.x.
Lenze, E. J. et al. (2001). The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. American Journal of Geriatric Psychiatry, 9, 113135.
Levine, D. W. et al. (2003). Reliability and validity of the Women's Health Initiative Insomnia Rating Scale. Psychological Assessment, 15, 137148. doi:10.1037/1040-3590.15.2.137.
Matthews, K. A. et al. (1997). Women's health initiative. Why now? What is it? What's new? The American Psychologist, 52, 101116. doi:10.1037/0003-066X.52.2.101.
Mehta, K. M. et al. (2007). Anxiety symptoms and decline in physical function over 5 years in the health, aging and body composition study. Journal of the American Geriatrics Society, 55, 265270. doi:10.1111/j.1532-5415.2007.01041.x.
Minicuci, N., Marzari, C., Maggi, S., Noale, M., Senesi, A. and Grepaldi, G. (2005). Predictors of transitions in vitality: the Italian longitudinal study on aging. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 60, 566573. doi:10.1093/gerona/60.5.566.
Nagin, D. S. (2005). Group-Based Modeling of Development. Cambridge, MA: Harvard University Press
Nagin, D.S. and Odgers, C. L. (2010). Group-based trajectory modeling in clinical research. Annual Review of Clinical Psychology, 6, 109138. doi:10.1146/annurev.clinpsy.121208.131413.
Phelan, E. A., Anderson, L. A., LaCroix, A. Z. and Larson, E. B. (2004). Older adults’ views of “successful aging”—how do they compare with researchers’ definitions? Journal of American Geriatric Society, 52, 211216.
Rowe, J. and Kahn, R. (1997). Successful aging. Gerontologist, 37, 433440. doi:10.1093/geront/37.4.433.
Scheier, M. F. and Carver, C. S. (1985). Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219247. doi:10.1037/0278-6133.4.3.219.
Sherbourne, C. D. and Stewart, A. L. (1991). The MOS social support survey. Social Science & Medicine, 32, 705714. doi:10.1016/0277-9536(91)90150-B.
Strawbridge, W. J., Cohen, R. D., Shema, S. J. and Kaplan, G. A. (1996). Successful aging: predictors and associated activities. American Journal of Epidemiology, 144, 135141. doi:10.1093/oxfordjournals.aje.a008900.
Strawbridge, W., Wallhagen, M. and Cohen, R. (2002). Successful aging and well-being: self-rated compared with Rowe and Kahn. Gerontologist, 42, 727733. doi:10.1093/geront/42.6.727.
Wang, L., van Belle, G., Kukull, W. B. and Larson, E. B. (2002). Predictors of functional change: a longitudinal study of nondemented people aged 65 and older. Journal of American Geriatric Society, 50, 15251534. doi:10.1046/j.1532-5415.2002.50408.x.
Ware, J. E. Jr. and Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): 1. Conceptual framework and item selection. Medical Care, 30, 473483. doi:10.1097/00005650-199206000-00002.
Woods, N. F. et al. (2012). Toward a positive aging phenotype for older women: observations from the women's health initiative. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 67, 11911196. doi:10.1093/gerona/gls117.
Zaslavsky, O., Cochrane, B. B., Herting, J. R., Thompson, H. J., Woods, N. F. and Lacroix, A. (2014). Application of person-centered analytic methodology in longitudinal research: exemplars from the Women's Health Initiative clinical trial data. Research in Nursing and Health, 37, 5364. doi:10.1002/nur.21575.


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