REVIEW

published: 09 April 2021

doi: 10.3389/fmed.2021.517226

Fostering Well-Being in the Elderly:

Translating Theories on Positive
Aging to Practical Approaches
Liora Bar-Tur*
MA Program in Gerontological Clinical Psychology, Faculty of Social & Community Sciences, Ruppin Academic Center,
Hadera, Israel

This article overviews positive aging concepts and strategies to enhance well-being in
the elderly and then presents a translation of theories on positive aging to practical
approaches for Positive Aging. Drawing upon positive psychology and positive aging
research and tools, this program is designed to help older adults improve their well-being
by acquiring skills and strategies to cope with present and future challenges. The Mental
Fitness Program for Positive Aging (MFPPA) can enhance seniors’ quality of life by
increasing their vital involvement and active engagement in life. This model is most
appropriate for community dwelling individuals. It can easily be conducted in wide range
of adult education programs in community centers, sheltered homes, and primary care
clinics. It can also be conducted through online psychoeducational training.
Keywords: mental health, well—being, positive psychology, successful aging, positive health
Edited by:
Hein van Hout,
Amsterdam University Medical
Center, Netherlands INTRODUCTION
Reviewed by:
The world is facing a demographic revolution; life expectancy has risen by more than two
Lisa Robinson,
Newcastle upon Tyne Hospitals NHS
decades since 1950 and the population has grown considerably. According to the World Health
Foundation Trust, United Kingdom Organization (1), the number of people over 60 in almost every country is growing faster than any
Celia Pereira Caldas, other age group. This reflects a combination of influences including increased longevity, declining
Rio de Janeiro State University, Brazil fertility, and the aging of the “baby boom” generation. These increases in longevity and the quality
*Correspondence: of life of older adults constitute a challenge to mental health professionals working to help the
Liora Bar-Tur growing older population not only to live longer and healthier but also better and happier. How to
liora.bartur@gmail.com age successfully and embrace well-being is the focus of much concern.
Traditionally, at least in Western societies, the elderly were viewed as “irrelevant” and a financial
Specialty section: drain on society. Recent studies have shown that many older adults are relatively healthy, active, and
This article was submitted to independent, and have many more resources for aging successfully and maintaining high levels of
Geriatric Medicine,
well-being. A growing number of older adults are resilient, socially engaged, and involved in their
a section of the journal
families and communities (2–5).
Frontiers in Medicine
Growing old in the twenty-first century is still a challenge and entails high risk, especially for
Received: 30 April 2020
the “old-old” and the “oldest-old.” Thus, aging successfully depends to a large extent on coping
Accepted: 08 February 2021
effectively with age-related life events.
Published: 09 April 2021
This article describes strategies and an intervention to enhance older adults’ positive functioning
Citation:
and well-being (6, 7) based on theories of positive aging and positive psychology research and
Bar-Tur L (2021) Fostering Well-Being
in the Elderly: Translating Theories on
interventions. Positive psychology, in theory and practice, centers on the notions of well-being
Positive Aging to Practical and optimal functioning. Research on positive aging deals with the comparative psychological
Approaches. Front. Med. 8:517226. well-being of older adults (8), their mental and physical health, concepts associated with aging
doi: 10.3389/fmed.2021.517226 successfully (9–12), and how psychological well-being can contribute to better health (13–15).

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Bar-Tur Mental Fitness Kit for Positive Aging

Rather than emphasizing dysfunction and psychopathology, the The MIDUS findings documented that multiple psychosocial
emphasis is on ways to flourish and increase functioning. Positive factors such as purpose in life, social relationships, mastery, and
psychology studies have put forward techniques to deal more prosocial behaviors such as volunteering predict better self-rated
effectively with key transitions over the course of the lifespan health, less disability, healthier profiles of biological risk, greater
(14–17). In this sense, research on positive psychology and its well-being, and better cognitive function in aging adults, even in
principles can be harnessed to support positive aging. the context of disability and chronic illness (26). Other findings
Many active seniors do volunteer work or have part-time suggest that resilience in the face of age-related challenges may
jobs where they can still contribute to family and community involve not only a better quality of life but also a reduced risk of
welfare (5). However, although the elderly continues to make a future disability and death.
contribution to their society, there are still extensive disparities Growing neuroscientific evidence linking psychological well-
in the way people experience aging and its many physical and being to physical health, and biological regulation shows that
cognitive impairments (6, 18). This makes it imperative to better qualities such as purposeful engagement, self-realization and
understand what constitutes successful aging and in particular growth, and enlightened self-regard influence how long and
how the lens of positive psychology can support and foster mental how well people live. Some studies have linked illnesses and
and physical health. disabilities to different aspects of well-being. Epidemiological
studies have documented the protective influence of well-being
(especially purpose in life) in reducing later life ill-health and
POSITIVE AGING: A CHALLENGE FOR cognitive impairment (25). Even positive emotional experiences
OLDER ADULTS’ MENTAL HEALTH such as enjoyment can help reduce anxiety and thereby indirectly
decrease cortisol production (26). Epidemiological studies have
Positive aging is a multidimensional concept that combines suggested that the degree of purpose in life predicts reduced risk
various characteristics of aging well such as optimal, successful, for numerous diseases (Alzheimer’s disease, stroke, myocardial
productive, and healthy aging. Positive aging consists of five infarction), and a proliferation of studies have begun to probe the
independent factors: health, cognition, activity, affect, and underlying biological mechanisms of neuroendocrine regulation,
physical fitness. It is described in practice by a broad set of inflammatory processes, gene expression, glycemic control, and
biopsychosocial factors and is assessed through both objective cardiovascular risk on aging. Many more studies have linked
and subjective indicators. The basic notion is that at any age, phenomenological indicators of well-being to reduced amygdala
including the old and very old, people are to some extent in activation in response to negative stimuli, sustained activity in the
charge of and responsible for their own quality of life (2). They ventral striatum and dorsolateral cortex when viewing positive
can enjoy positive well-being and experience “successful aging.” stimuli, and increased insular cortex volume [for more details see
Various models of successful aging (8, 9, 19–21) have explored the Ryff (25)].
components and dimensions of well-being and positive function All these analyses in the fields of phenomenology, biology,
in older adults. genetics, and neuroscience contribute to accounting for adaptive
Ryff ’s integrated model (originally called “successful aging” human functioning (20, 25). Positive aging studies have found
and later psychological well-being), was first presented by Ryff that older adults can optimize their aging experience (20, 25, 27).
(19) and Ryff and Essex (22) and later by Ryff and Singer They can maintain and implement preventive health behaviors,
(8, 23) and Ryff (20). It incorporates lifespan developmental act on resources available to them to cope with age-related
theories, clinical theories of personal growth, and mental health decline, and increase their well-being (7, 28). Thus, the focus
perspectives. It comprises six dimensions of positive functioning: should be on wellness, not illness in psychological research and
self-acceptance, positive relations with others, autonomy, in interventions for the older population.
environmental mastery, purpose in life, and personal growth.
Research has revealed that these dimensions of well-being and
healthy mental functioning are shaped by socio-demographic INTERVENTIONS
characteristics (e.g., age, gender, socio-demographic status,
ethnicity, and culture), as well as by individual experiences, The broad scope of studies on psychological well-being and
including both unexpected life stresses and planned, normative its complex links to mind-body and socio-cultural factors have
transitions (22–25). Hedonic well-being generally shows gains fostered important new directions in applications and education.
with age; that is, older adults tend to show increments in Interventions to enhance and improve older adults’ well-being
positive affect and decrements in negative affect, at least until are on the rise. These advances have been accompanied by
very old age. In contrast, eudemonic well-being, reflecting a preventive interventions outside the clinic (25, 29, 30).
sense of purpose, is more inclined to reflect decrements in the Numerous intervention studies with older adults in the
later years, especially in terms of assessment of purpose in life community, clinics, and in nursing homes have reported
and personal growth (8). In-depth measures across multiple noticeable improvements in their psychological well-being (30–
domains as well as longitudinal follow-ups have been conducted 36), subjective happiness (36–39), and life satisfaction (30,
since Ryff (19) first introduced the successful aging model. 40, 41). These changes in well-being are accompanied by
One of the most prominent studies is MIDUS (Midlife in the improvements in the quality of sleep (30, 33), better working
US, www.midus.wisc.edu). memory (32), decreased anxiety (36), higher levels of overall

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Bar-Tur Mental Fitness Kit for Positive Aging

mindfulness (42), and improvements in self-reported feelings who suffer from depression remain undetected in primary care.
of depression and depressive symptoms (30, 34–36, 38, 39, 42). Studies show that somatization is one of the most important
Although these well-being interventions suggest that the older single problems associated with this missed diagnosis (47). The
population’s quality of life can be improved, studies with more risk of suicide among older men is the highest mostly as a result of
rigorous designs and extended follow-up measurements are chronic physical illnesses and disability (48). Research has shown,
needed to consolidate these positive findings. however, that 20% of these individuals had consulted a physician
The major purpose of this wide range of interventions is to that same day, and 40% in the same week that they committed
reach as many older adults as possible, especially those who suicide (49, 50). Medical staff are often “gate- keepers” who meet
avoid seeking psychological support because of their negative older adults who may be at risk for psychological and social
beliefs and attitudes toward psychotherapy or mental health problems. Awareness of the inseparable relationships between
professionals. Older adults should be provided with the necessary physical and mental health can lead to comprehensive assessment
support to maintain a good balance between their decreased of the older person’s positive health. This is necessary if we wish
physical ability and increased transcendence, which can be to prevent and detect mental health issues as well as to enhance
significantly enhanced by tapping personal, environmental, and optimal well-being of older adults.
social resources. This equilibrium includes physical and mental
health at the micro level (personal), social well-being, and Promoting Positive Health
spirituality/transcendence (process) at the meso level, while The objective of positive health programs is to encourage seniors
living in a favorable and appropriate environment (43). Many to be more cognizant of their own resources and their strong
older adults constitute a resourceful group that can contribute health points to cultivate their rich physical, cognitive, and
actively to society, realize their own potential, cope with normal social qualities. These programs should be conducted as wellness
stressors of life, and contribute to their community productively programs offered by primary care clinics or health clubs in
and fruitfully. They implement what is called proactive coping, the community that are designed to encourage better health
which is defined as “an effort to build up general resources through changes in diet, cutting down on cigarettes and alcohol,
that facilitate promotion toward challenging goals and personal getting more exercise, and learning ways to manage stress and
growth” [(44), p. 349]. increase relaxation. Taking these steps toward maintaining a
The challenge facing professionals working with older adults healthier lifestyle can reduce the impact of disease (51). These
is to convey information about positive aging and suggest guidelines may also have a positive effect on cognitive decline
strategies to increase well-being by teaching new skills for positive and mood swings. Healthcare professionals may be engaged in
functioning. This can be achieved by recruiting and training staff the implementation of these interventions and reach out to older
members in health centers, primary care, sheltered homes, and adults in their community to encourage them to join health
other community centers and services for older adults who can promotion programs and engage in interventions that enhance
help incorporate strategies and tools for optimal functioning in positive aging. Primary care clinics can also offer a wide range
their organizations and communities. of preventive interventions such as fall prevention and disability
interventions for the frail and elderly (52, 53).

STRATEGIES TO ENHANCE POSITIVE Promoting Optimal Aging

AGING A systematic review and analysis of the effectiveness of 69
psychosocial interventions to promote the mental health of
Comprehensive Assessment of the Older older adults (54) revealed that skill training interventions with
Person’s Positive Health in Primary Care educational and/or behavioral components had a significant
Services and Mental Health Clinics effect on positive mental health outcomes. Promoting optimal
Many medical professionals, and specialists in particular, tend aging can be achieved by implementing special training
to overlook the constitutive unity of the person as a whole programs for older adults in the community including in leisure
in the context of this individual’s physical, social, and mental clubs, country clubs, retirement villages, sheltered homes, and
surroundings. Any comprehensive evaluation in mental health homes for the aged. They can also be conducted through
clinics, hospitals, and primary care should include an in-depth online psychoeducational training. These training programs
examination of the person’s life, beyond his or her cognitive can include, for example, the ABC model (Activating events-
and physical condition. This means including information as to adversities, Beliefs-Consequences) of optimal aging, which is
the person’s social, cultural, historical, and spiritual background grounded in the notions of unconditional self-acceptance and
to assess the individual’s positive health. This information can the frustrations linked to the inevitable consequences of aging
be obtained prior to the consultation by the secretarial staff, (55). Alternatively, the six “keys” for positive functioning can
interns, or students and should be transmitted to the doctor. give the elderly more meaning and purpose (8, 13, 20) where
This is particularly true for depression, which constitutes the seniors are encouraged to acquire a more positive attitude toward
most common emotional disorder in older adults. Milder forms one’s own self and the past including improving interactions with
of depression such as dysthymia are known to affect 20–30% significant others. Seniors can work on their autonomy, learn to
of all older adults (45). Nevertheless, older people are rarely have a voice, and reinforce their capabilities to make decisions
offered psychological interventions (46). Many older patients affecting their lives. Mastering one’s environment by being able to

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Bar-Tur Mental Fitness Kit for Positive Aging

handle daily life and create surroundings adapted to one’s needs The telephone and video substitutes for in-person meetings
is another key. One way of having renewed purpose in life is to pose an enormous challenge but also an opportunity to reach out
reassess the present and the past, or engaging in social activities. to many older adults who otherwise would not receive emotional
Senior volunteers, for example, were found to be happier, calmer, support. A support system could be established, for example, by
more content, more fulfilled, and more vital (56). Older adults initiating substantive online conversations to ascertain that their
who are able to capitalize on these five keys are more likely to emotional and mental needs are being met and to encourage
experience the sixth key of personal growth and are more open to them to ask for help, and to share. This would contribute to
experiences and capable of greater further development. reducing the loneliness and isolation that accompany long-term
lockdowns. Studies have shown that writing down three good
things or blessings every day, as well as engaging in gratitude and
Positive Assessment of the Older Person’s savoring techniques, can contribute to positive states and reduce
Strengths and Reserve Capacities feelings of depression related to ill-being, negative thoughts, and
Practitioners and therapists working with older clients should loss of a sense of meaning (70–72).
move away from the traditional medical assessment model.
Instead of focusing on the older person’s weaknesses (a frail Changing Professionals’ Attitude Toward
body, depressive moods, or weak community relationships), Positive Aging in Medical Staff, Old-Age
professionals should assess and activate clients’ strengths
and reserve capacities, and the strengths of the key primary
Home Staff, and Other Professionals
environment (family, friends, close associates, etc.) and Working With the Older Population
secondary groups (large-scale organizations, communities, Positive psychology programs are likely to have more impact
cultural groups, etc.) to reach personal goals and prevent when those running them are themselves positive and healthy.
predictable problems (57, 58). Thus, rather than asking “What is This includes a better understanding of the aging process in the
wrong?” (the typical question asked when visiting the physician), medical profession, which may still see aging as purely negative
mental health professionals should aim to determine “What (69, 73, 74). There should be a concerted effort to expand the
is good about me? What is still working? What is my reserve basket of psychological health services offered to the elderly,
capacity?” (6, 59). Positive assessments can be combined with the which would alleviate the strain on the health system through
physical assessments and should be given to the older person as prevention, detection, and rapid responses (75).
part of the overall positive health assessment.
Enhancing a Sense of Community and
Connectedness
Positive Psychology Interventions to Cope Fostering dialogue and a sense of community can help seniors
With Loneliness and Depression increase their social and emotional support, find ways to preserve
Loneliness is a significant risk factor in the emergence of mental and enrich family, friends, and community ties, and take
and physical health problems (60). When meaningful social advantage of neighborhood, community, and social activities
connections are perceived as severed or unavailable, loneliness to cope with anxiety and feelings of isolation. One major step
can have deleterious effects on cognition and behavior (61). involves proactive interactions to contact seniors without a
Interventions in healthy older adults such as physical or dietary strong social network by providing regular ways to “check in”
changes and enhancing social and cognitive engagement can help by including them in social events and structured activities for
diminish the impact of loneliness on the aging process and the older adults, as well as psychoeducation and support. Internet
emergence of psychiatric disorders (62). skills are a plus. Seniors can be taught to search for content of
Older people with depressive disorders can receive additional interest to their age group, read local newspapers, get medical
cognitive behavioral therapy, which is an effective treatment information, find out about events likely to appeal to them,
for depression and anxiety (46, 63, 64). In a systematic and ways to socialize through emails, WhatsApp, Facebook, etc.
review (65) examining the utility of 34 loneliness alleviation Studies have shown that being computer savvy reduces isolation
interventions among older persons, the findings suggested that and reinforces a sense of autonomy (76).
loneliness can be reduced by using educational interventions Overall, positive psychology interventions can be applied in
focused on social network maintenance and enhancement. health settings, but they should also be conducted in settings
These interventions can be implemented directly in face-to- already designed for positive interactions, such as senior citizens’
face meetings, group psychoeducation encounters, or through clubs and retirement communities. Modern media, including
tele-help online interventions. Today, mental health clinics are radio, TV, and the internet, are important ways to connect
rapidly converting from face-to-face modes of care to virtual ones and reach out to the elderly. By teaching seniors fundamental
as a result of the COVID-19 pandemic. Since the beginning of techniques that can lead to greater optimism, enhanced positive
the pandemic, many older adults have opted to stay at home thinking, and ways to define objectives that lead to higher
and avoid attending adult day centers and other community involvement and meaningful participation in the community,
programs. This underscores the importance of establishing a older adults can benefit from an improved quality of life.
system of remote mental care, comparable to what is being Systematic reviews of interventions designed to enhance the well-
implemented for physical healthcare (66–69). being of older adults indicate that group-based interventions and

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Bar-Tur Mental Fitness Kit for Positive Aging

interventions including social components have a very positive in life? Do I present myself in a positive or negative light?
effect on participants’ mental health (54). This suggests that Do I emphasize my achievements or my shortcomings?
group-based interventions should be prioritized. Do I dwell on the past and my losses or emphasize
the positive aspects of the present?” By analyzing the
“business cards,” the group and facilitator can learn a
THE MENTAL FITNESS PROGRAM FOR great deal about the participants’ well-being.
POSITIVE AGING The facilitator then helps the participants highlight
their positive experiences and strengths and to shift from
The Mental Fitness Program for Positive Aging is designed thinking about what they can no longer do to what they
as a psychological journey with 12 stations, each addressing a can achieve in the present. Participants are asked to
different topic. The program can be applied in a group setting examine their reserve capacities.
or individually through personal coaching or counseling. The Phase 3 The Mental Fitness Program encourages senior citizens
program includes a “personal map, compass, sail and oars” to to examine their rich pasts as well. Reviewing past
help senior citizens plan how they want to live their lives in experiences and applying understanding and acceptance
the near future and what they wish to experience along the to disappointments and failures allows the participants
way (55). These combined tools provide participants with a way to “draw” a road map of their talents and skills and
of developing positive attitudes toward aging by encouraging the domains in which self-efficacy has been cultivated.
them to review their past accomplishments and their current The focus of the discussion is on achievements and
personal resources and strengths. Various positive psychology accomplishments in life rather than dwelling on negative
strategies are introduced in each session, such as exploring experiences, which are nevertheless recognized. Each
personal strengths and practicing new ways to use them, learning person is given a picture of a boat sailing in the ocean.
how to invest in significant relationships, visualizing one’s best The guiding questions are: “Where do I come from
self, keeping a gratitude diary or a list of good things occurring and where do I want to sail to in the near future?”
during the day, seeking out activities that create flow, practicing Participants should provide a short description of their
mindfulness and acts of kindness, or accessing stories from their past experiences with a focus on significant events and
own lives to hone their sense of hope (6, 17, 77). Homework milestones in which they can evaluate their strengths
assignments for practicing these strategies are included together and personal resources. When discussing negative or
with other assignments relevant to each session’s topic and traumatic experiences, participants should reflect on
assignments that are addressed to maintaining healthy lifestyle. how those were overcome and what capabilities and
internal strengths helped them cope and adapt.
Phase 1 The journey begins with an introductory lecture by Maintaining positive self-esteem is often associated
the group facilitator, who reviews the core and the with the quality of interpersonal relations; thus,
latest studies in positive psychology and positive aging. the first three sessions also focus on mapping and
Then, attendees decide whether they want to continue assessing relations with meaningful others such as
as participants. Registering for the group can be viewed family members, friends, colleagues, or others. Positive
both as a proactive step toward change and an indicator self-esteem also relates to the senses of autonomy,
of willingness and commitment to attend most of the environmental mastery, self-realization, and personal
sessions and execute the homework assignments. growth, with the latter serving to enhance the pursuit
Phase 2 The second phase addresses the issue of identity and the of life’s goals. Senior citizens who were fully engaged in
aging self. The focal task is to increase self-acceptance work or social roles, as well as widows and widowers who
and positive self-image. Participants are guided in posing were assuming the role of care-giver, may need guidance
the following questions to themselves: “Who am I?” and in finding suitable alternative contexts for gaining a sense
“Who am I at this particular phase of my life?” Each of control and purpose in their lives.
participant is asked to write a personal introduction card In gaining a sense of direction and a realistic view
in the form of several bullet points, by way of response to of identity and self-image, the participants are enabled
the above questions. to discuss their priorities, and personal and independent
The purpose of this exercise is to discuss individual decisions, before planning and setting goals to maintain
identity and activities toward reinforcing self-acceptance or increase their well-being. The program teaches the
and positive self-esteem. Discussion questions are: participants to identify positive, realistic goals and to
“What does it mean to you to be 70+ years old? How do use the adaptive mechanisms of selection, optimization,
you feel as someone who is retired? What is your role as a and compensation (SOC) (9) to promote continued
grandmother or grandfather?” and others. By discussing maximization of their chosen activities in life, especially
this “business card” the third ager can evaluate his or her as they grow older and their resources decline (78).
life satisfaction, mental and emotional engagements in Phase 4 In this phase participants focus on their purpose in life
life, and personal attitudes. The bulleted identity points through the process of goal attainment. Setting clear,
written on the card raise important reflective questions realistic, measurable, and significant goals and managing
such as “What are my roles and meaningful engagements time and learning how to spend time effectively become

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increasingly important elements as people age and find conduct the program. The instructions for the mental fitness
they have more free time and fewer commitments to program are clear, and social work or psychology students can
family, work, and other obligations (79). also be recruited to lead the group sessions.
Thereafter, participants identify and increase Limitations: The mental fitness program is one of many
their health-promoting behaviors, to cope with the interventions suggested to enhance the well-being of older adults.
adversities encountered in growing old. Since unrealistic Its advantage is that it is a comprehensive program of positive
expectations, beliefs, and attitudes regarding old age health combining the physical, cognitive, social, and emotional
affect well-being and impede goal attainment, they learn aspects of positive aging. The limitations of this model have
to identify and replace irrational beliefs and attitudes to do with the fact that it is most appropriate for community-
with rational, more realistic ones (28). Assisted by the dwelling individuals with a high level of functioning as compared
group, the participants individually and collectively seek to individuals who have experienced cognitive decline. Another
and create emotional and social support. Participants are limitation is that to date, the model suggested has not been
encouraged to form a social network using the internet methodologically evaluated. An evaluation of this model should
or phone communication, which is activated between be performed and should be tested methodologically. The
the meetings for staying in touch, receiving support, and decision as to the type, frequency, and length of any strategy is,
sharing experiences, thoughts, and feelings experienced however, not easy to estimate. It depends on the institutions, and
during the week. the older adults’ current capacity, vulnerability, and subsequent
adherence to the intervention (52, 62).
The Mental Fitness Program can also be an effective intervention Systemic reviews of interventions designed to enhance
tool to assess senior citizens’ main areas of personal difficulty. the well-being of older adults indicate that group-based
It helps ascertain which components to positive well-being interventions and interventions including social elements
would benefit from enhancement, such as low self-esteem, have a very positive effect on participants’ mental health
unsatisfying relations with others, lack of emotional or social (54). This suggests that group-based interventions such
support, or difficulties in making decisions and taking the as the Mental Fitness Model for Positive Aging can be
steps to fulfill personal needs. It may also indicate the effectively prioritized.
phase in life where changes and losses require that personal We hope that the Mental Fitness Program will be evaluated
goals be revised to promote emotional and psychological shortly and will be approved as an effective intervention in
engagement and gratification. For seniors who suffer from promoting positive well-being of older adults.
emotional problems or mental disorders, positive psychology
interventions can be integrated into general treatment, such
as positive psychotherapy, CBT-REBT, or IPT (Interpersonal SUMMARY
Psychotherapy) for depression (28, 80). These interventions
can be successful for helping professionals who are themselves The demographic revolution constitutes a real challenge for
optimistic and in good health in facilitating seniors. However, society, but in particular for the older population and their
many professionals still need to overcome their own ageist helping professionals. The challenge for older adults is to
attitudes and phobias if they are to effectively assist what will maintain and, if possible, to increase their personal resources so
be an increasingly larger proportion of their clientele (73, 74, as not to overwhelm societal resources with their needs. Thus,
81). Professionals should also encourage clients to maintain older adults should bear some responsibility for making sure
a healthy lifestyle and are encouraged to engage in strategic that they maintain their health, maintain a healthy lifestyle, and
advocacy for extended medical insurance for mental health are engaged in their families and communities. The challenge
services, mainly in the areas of prevention, screening, and for helping professionals is to shift away from traditional
early intervention. stereotypes and ageism and suggest interventions that focus
Implementation: This model is most appropriate for on wellness and older adults’ reserve capacities rather than on
community-dwelling individuals with a high level of functioning. illness, patients, and symptoms. Interventions should incorporate
It can easily be conducted in a wide range of adult education practicing positive aging and well-being strategies to increase
programs in group settings, in community centers and health autonomy, environmental mastery, and purpose in life, as well
clubs. Seniors can be recruited through seniors’ communities as a healthy lifestyle. A prime point of intervention is to identify
online (Facebook). It can be offered to members of health- the resources and facilitate the social network cooperation that
care insurance companies as part of programs suggested to will keep older adults socially and physically active and involved
promote health aging. It can also be implemented online as is in their communities. It can be achieved together with the
currently the case via Zoom. The Mental Fitness Program has medical, physical, and mental health services given in health
been applied in Israel in community centers, sheltered homes, centers and primary care. Interventions should be adjusted
and retirement programs and has proved to be very effective, as to individual older adults’ level of functioning, special needs,
shown by the excellent feedback provided by the participants. and motivation.
Mental health professionals were recruited to lead the group Although findings indicate that the majority of the older
sessions after attending a full-day training course on how to population has a resourceful interpersonal milieu, varied social

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Bar-Tur Mental Fitness Kit for Positive Aging

networks, and positive well-being (82–84), there is also the great extent on social and cultural contexts. Therefore, it is
risk of future disability and limitations in mobility, which can imperative to develop educational programs and interventions
increase loneliness and reduce well-being. Increased loneliness in the community to promote strategies for positive functioning
and reduction in physical and mental health was also found and well-being. The challenge to present and future societies is
in many older adults during the COVID-19 pandemic. It is to provide older persons with opportunities for self-realization,
recommended to recruit and train medical staff in health centers continued personal growth, and social engagements.
and primary care to incorporate strategies and tools for optimal
functioning into their medical treatment approach. Crucially, AUTHOR CONTRIBUTIONS
the foundations for positive aging are laid down early in life
by adopting a healthy lifestyle. It is important to develop The author confirms being the sole contributor of this work and
healthy habits throughout the life cycle, which depends to a has approved it for publication.

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82. Litwin H, Shiovitz-Ezra S. Social network type and subjective well-being Conflict of Interest: The author declares that the research was conducted in the
in a national sample of older Americans. Gerontologist. (2011) 51:379– absence of any commercial or financial relationships that could be construed as a
88. doi: 10.1093/geront/gnq094 potential conflict of interest.
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the Oldest Old. New York, NY: Cambridge University Press Copyright © 2021 Bar-Tur. This is an open-access article distributed under the terms
(2011). doi: 10.1017/CBO9780511920974 of the Creative Commons Attribution License (CC BY). The use, distribution or
84. Jopp DS, Boerner K, Cimarolli V, Hicks S, Mirpuri S, Paggi S, et al. reproduction in other forums is permitted, provided the original author(s) and the
Challenges Experienced at Age 100: Findings from the Fordham Centenarian copyright owner(s) are credited and that the original publication in this journal
Study. J Aging Soc Policy. (2016) 28:187–207. doi: 10.1080/08959420.2016.11 is cited, in accordance with accepted academic practice. No use, distribution or
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