The active aging personal strategies of older adults in Europe: a systematic review protocol of qualitative evidence
Authors: Klugar Miloslav , Klugarova Jitka , Ĉáp Juraj , Mareĉková Jana , Roberson Donald N. , Sirkka Andrew , Kelnarova Zuzana 
Published: December 2014

Review question/objective

The objectives of this review are to identify the personal strategies related to active aging among older adults in Europe.

Background

There is a consensus that the aging population is beginning to impact many facets of our life. Not only do they have more medical problems1, they have the potential to "drain" the focus of the medical community, as well as national budgets with their accompanying medical bills.2 They are also among the least physically active of all age groups3 and many state they simply do not know about physical activity.4

Personal strategy is a process to make change starting with personal research that includes an understanding of one's life stages, the forces that drive one's life and plausible events for the current life stage.5 Personal strategy requires a readiness to define a vision of a person's future, and to create a plan to achieve that vision.6 Personal strategy is a proactive process that assists a person to review or reset a long-term goal in life in order to renew motivation, eliminate harmful or unhealthy habits and to invest in the quality of life.7 Personal strategies related to active aging will help us to better understand and identify how older adults in Europe prepare themselves for the natural process of aging and what are their personal approaches to active aging.

Literature on active aging, successful aging and healthy aging clearly indicates a problem with the definition of these terms.8 The terms "active aging", "successful aging" and "healthy aging" are often used in research articles with similar semantic context and meanings. The qualitative articles in this field are mainly focused on the clarification of these concepts from the respondents' perception. In the following part we expose main findings from qualitative studies founded in preliminary search to show necessity of qualitative synthesis in this area.

Based on face-to-face interviews, Bowling9 identified perceptions of active aging. The most common perceptions of active aging are or were having/maintaining physical health and functioning, leisure and social activities, mental functioning and activity, and social relationships and contacts. Within these main categories, the most commonly mentioned subthemes of active aging include exercising the body in order to maintain health and functioning, attending clubs and social participation, and exercising the mind to retain mental activity by doing crosswords, puzzles and similar mental activities.9 Gilbert, Hagerty, and Taggert10 based on a phenomenological approach examined lived experiences of the elderly on facilitators and barriers to healthy aging. The following facilitators of successful aging were revealed: taking care of oneself (such as eating a healthy diet), participating in regular exercise, socializing with others, meeting spiritual needs and availing themselves of medical interventions, positive attitude and meaningful activity. The barriers to successful aging include: giving up and giving in, aging process, and environmental limitations.

Craciun, Zaharia, Radu & Rusan11 focused their research on middle-aged adults (aged 50-60 years) who are facing the transition to the third age, and the successful aging representations and strategies they employ in order to reduce the discrepancy between realistic and ideal aging. Interviews and thematic analysis was used as research methods. In the first part of the findings they identified widely successful aging strategies based on different positive factors such as healthy and balanced lifestyle, positive cognitive functioning, meaningful and quality relationships (as well as having a significant other), strength in overcoming life obstacles, contentment, calmness and peace, enjoying pleasurable activities, making good use of the spare time and intellectual activities, a beautiful life. Obstacles towards successful aging were primarily related to health, stress, social isolation, and financial limitation. The second part of the findings shows coping strategies toward successful aging as a cognitive, behavioral, social, and meaning, such as faith, hope, or the meaning of life. Their findings lend support to the social constructivist representation of aging. In this case, aging is not defined only by biological changes or changes in daily life activities, but by the social structures and representations which shape individual perceptions and behaviors.

Gabrielle, Jackson & Mannix12 used a feminist perspective in the study of the health and aging concerns and self-care strategies of older female registered nurses (aged 40-60 years) currently working in direct caregiving roles in acute public hospitals and community facilities. A thematic analysis was used in this research, and two major themes were identified. The first theme of aches and pains of aging includes the impact of neglecting oneself, physical changes, living with pain, and tiredness. The second theme related to evolving lifestyles including exercise, nutrition, and adapting.

Robinson, Demetre & Corney13 conducted interviews with individuals who had retired between two and 10 years ago with the aim of exploring the variability of retirement experiences. Interviews were subject to a multilevel thematic qualitative analysis. Four meta-themes were established: positive continuity and challenge, liberation and release, loss and gain and restriction, regret and decline. The themes encompass co-occurring pre-retirement antecedents, post-retirement experiences, relationship factors and retirement guidance attitudes/experiences.

Drawing on a series of biographical interviews with people aged 60-96 years focusing on future hopes and concerns Clarke and Warren14 explore active aging in the broader context of older people's lives. The findings show that fears of the future, limited resources, decline and dependency can exist alongside the desire to live longer and the positive, anticipation of forthcoming events and strong intergenerational relations. "Living for now" and "taking a day at a time" are common strategies for dealing with the unpredictability of later life. Similarly, planning for death, such as writing (living) wills and making funeral arrangements, may be positive and proactive responses to beliefs and concerns about dying. "Active aging" therefore needs to offer choices for life to be lived at all stages while recognizing that much of the focus for older people is on ordinary needs, deeds and relationships.

Hewitt, Howie, & Feldman15 examined, using a retrospective narrative study with semi-structured interviews, the factors influencing four older peoples' decision to plan for the activities during retirement. A narrative analysis led to the development of categories and subsequent themes to reveal the participants' experiences of these issues. These three themes are environmental influences, the planning process and retirement experiences, and the outcome of planning. Overall, retirement activities that were continued or initiated led to a positive experience even when these planned activities were temporarily interrupted or altered.

The findings from these articles draw attention to the dynamic social aspect of aging perceptions and the great potential of intervening before retirement. Interventions should target and support a changing of negative aging representations, promote social engagement, increase social support, develop effective coping strategies, promote health behaviors as well as an active lifestyle.11

We have chosen a qualitative synthesis in order to understand more about the healthy and active lifestyle of older adults. Several primary qualitative studies were found in the preliminary search; however, there is no previous qualitative synthesis in this field.