Botes, Riaan; Vermeulen, Karin; Buskens, Erik (2017). 'An integrative wellbeing model for the oldest old: The role of adaptation, capabilities and resources.' Paper presented at the annual conference of the HDCA, Cape Town 2017.



From the literature it is clear that the vast majority of people aged 65 and over has either one or several chronic diseases (Lee et al., 2009). Chronic diseases like arthritis, stroke and cardiovascular disease are the main culprits and are responsible for many health problems (Klijs et al., 2011).It is however important to understand that health is more than the absence of disease, but rather the achievement of a set of functionings important to the elderly patient (Anand, 2005;Grewal et al., 2006).

For the oldest old the reality of decline in health and non-health factors is evident (van & Perenboom, 2014). This however does not suggest that the oldest old individuals are not aging successfully.

There is substantial evidence that the oldest old elderly value aging and health differently than the younger (old) individuals(Romo et al., 2013). The capability approach might be especially suited to describe and value oldest old individuals life, since it allows the oldest old to identify factors relevant for successful aging.


We utilized multi-state life tables to assess the impact of specific disease on time the oldest old spent in a disabled state. Secondly, we investigated the oldest old capabilities by determining health state valuations of a capability and utility based questionnaire. Finally, we determined functionings by requesting the elderly to describe their own health using a capability and utility based questionnaire.


The first aspect, we propose in our model, is for the oldest old to accept that health affected by disease is a reality.

However certain diseases have a greater disabling impact than others. Secondly, it is essential for the oldest old to still be positive about their future wellbeing. They should therefor adapt to the “new” disease affected health state. Amidst the reality of potential disability, finding a sense of purpose and maintaining autonomy is critical (Nosraty et al., 2012).

The third concept in the model refers to capabilities. Being realistic about the future goals and aspirations and focusing on aspects that are still under one’s control is important (Reichstadt et al., 2010).

Since feeling capable and in control is to a large extent a psychological process, this in turn could increase certain aspects like optimism, which has shown to increase biological and functional parameters (Avvenuti et al., 2016)

The final component of the model is functionings. People have preferences for specific functionings that are determined by their own predilections and standards.

The availability or absence of resources might be a key issue to consider. Resources is central to the capability approach, but often not regarded as critical conversion elements to achieve personal health care, wellbeing and QoL goals (Mitra, 2006). Resources allow individuals to obtain certain disease affected functionings to ultimately cope and self-manage the challenges of the aging process.


i)Rather than focusing on physical health, oldest old policy should rather aim to assist the oldest old to adapt to their new disease affected health status ii) identifying realistic capabilities is essential to maintain self-efficacy and a positive outlook on future wellbeing.

iii) the oldest old should achieve personal functionings, with the resources available. For instance, using available resources to achieve attachment functioning (feelings of affection and support towards and from friends and family) will allow the elderly to cope with disability and self-manage wellbeing outcomes (Robitaille et al., 2014).

Resources can be anything from income, social status, social support, individual resilience and spiritual beliefs (Huber et al., 2011;Putrik et al., 2015).

Thus reaching for a certain level of resource achievement, which is a highly individualized practice, allows the elderly patient to cope and achieve wellbeing outcomes. Interventions aimed at allowing the oldest old to utilize available resources to adapt to new disease affected health states and aspire and reach realistic wellbeing goals could prove be a cost-effective strategy to enhance oldest old personal choice and control over health care decisions.

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