Skip to main content Accessibility help

Validation of an a priori, index model of successful aging in a population-based cohort study: the successful aging index

  • Theodore D. Cosco (a1), Blossom C. M. Stephan (a2) and Carol Brayne (a1)



Many definitions of successful aging (SA) exist in the absence of an established consensus definition. There are few examples of a priori application of SA models in real world contexts using external validation procedures. The current study aims to establish the predictive validity of an a priori, continuous model of SA with respect to service utilization.


Individuals (n = 740; 64.2% female) aged 65 years and over (mean 75.9; SD 6.2), randomly selected from general practitioner registries in five sites across the United Kingdom included in the second and third combined screen and assessment waves of the Medical Research Council Cognitive Function and Aging Study (MRC CFAS; a longitudinal population-based cohort study) comprised the baseline and two-year follow-up in the current study. A Successful Aging Index (SAI) was created using items identified by systematic reviews of operational definitions and lay perspectives of SA, capturing physiological and psychosocial components. Demographic data and SAI components were collected at baseline. Outcome measures, i.e. health service use, informal care use, and functional service, were captured at two years follow-up.


Logistic regression revealed significant relationships between the SAI and six of eight service use outcomes in models adjusted for age, sex, education, and socio-economic status. Analysis of the area under the receiver operating characteristic (ROC) curve demonstrated sufficient predictive capabilities for all models, (range 0.65–0.86).


The SAI demonstrated a strong association, and predictive accuracy, with respect to service use, providing preliminary support for the practical utility and usefulness of this measure.


Corresponding author

Correspondence should be addressed to: Theodore D. Cosco, Forvie Site, Robinson Way, Cambridge, CB20SR, UK. Phone: 07414983921. Email:


Hide All
Bowling, A. and Iliffe, S. (2006). Which model of successful ageing should be used? Baseline findings from a British longitudinal survey of ageing. Age and Ageing, 35, 607614.
Brayne, C. (2006). Incidence of dementia in England and Wales: the MRC cognitive function and ageing study. Alzheimer Disease and Associated Disorders, 20 (Suppl. 2), S47S51.
Cluett, C. et al. (2010). Polymorphisms in LMNA and near a SERPINA gene cluster are associated with cognitive function in older people. Neurobiology of Aging, 31, 15631568.
Cosco, T. D., Prina, A. M., Perales, J., Stephan, B. and Brayne, C. (2013). Lay perspectives of successful ageing: a systematic review and meta-ethnography. BMJ Open, 3, e002710.
Cosco, T. D., Prina, A. M., Perales, J., Stephan, B. and Brayne, C. (2014a). Operational definitions of successful aging: a systematic review. International Psychogeriatrics, 26, 373381.
Cosco, T. D., Prina, A. M., Perales, J., Stephan, B. and Brayne, C. (2014b). Whose “successful ageing”? Lay- and researcher-driven conceptualisations of ageing well. European Journal of Psychiatry, 28, 124130.
Cosco, T. D., Stephan, B. and Brayne, C. (2014c). (Unsuccessful) binary modeling of successful aging in the oldest-old adults: a call for continuum-based measures. Journal of the American Geriatrics Society, 62, 15971598.
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.
Drubbel, I., de Wit, N., Bleijenberg, N., Eijkemans, R., Schuurmans, M. and Numans, M. (2013). Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 68, 301308.
Folstein, M., Robins, L. and Helzer, J. (1983). The Mini-Mental State Examination. Archives of General Psychiatry, 40, 812.
Havighurst, R. (1961). Successful aging. The Gerontologist, 1, 813.
Jopp, D., Wozniak, D., Damarin, A., De Feo, M., Jung, S. and Jeswani, S. (2015). How could lay perspectives on successful aging complement scientific theory? Findings from a US and a German life-span sample. The Gerontologist, 55, 91106.
Katz, S., Downs, T. D., Cash, H. R. and Grotz, R. C. (1970). Progress in development of the index of ADL. The Gerontologist, 10, 2030.
Kehusmaa, S., Autti-Ramo, I., Helenius, H., Hinkka, K., Valaste, M. and Rissanen, P. (2012). Factors associated with the utilization and costs of health and social services in frail elderly patients. BMC Health Services Research, 12, 204.
Lawton, M. and Brody, E. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179186.
Pruchno, R., Wilson-Genderson, M. and Cartwright, F. (2010). A two-factor model of successful aging. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 65, 671679.
Rowe, J. and Kahn, R. (1987). Human aging: usual and successful. Science, 237, 143149.
Searle, S., Mitnitski, A., Gahbauer, E., Gill, T. M. and Rockwood, K. (2008). A standard procedure for creating a frailty index. BMC Geriatrics, 8, 24.
Townsend, E. and Ryan, B. (1991). Assessing independence in community living. Canadian Journal of Public Health, 82, 5257.
Xie, J., Brayne, C. and Matthews, F. E. (2008). Survival times in people with dementia: analysis from population based cohort study with 14 year follow-up. BMJ, 336, 258262.
Yip, A. G., Brayne, C., Easton, D. and Rubinsztein, D. C. (2002). Apolipoprotein E4 is only a weak predictor of dementia and cognitive decline in the general population. Journal of medical genetics, 39, 639643.
Young, Y., Fan, M. Y., Parrish, J. M. and Frick, K. D. (2009). Validation of a novel successful aging construct. Journal of the American Medical Directors Association, 10, 314322.


Type Description Title
Supplementary materials

Cosco supplementary material
Appendix 1

 Word (18 KB)
18 KB

Validation of an a priori, index model of successful aging in a population-based cohort study: the successful aging index

  • Theodore D. Cosco (a1), Blossom C. M. Stephan (a2) and Carol Brayne (a1)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed