Behavioural Science Section/Review

Gerontology 2003;49:123–135
DOI: 10.1159/000067946

New Frontiers in the Future of Aging:

From Successful Aging of the Young Old
to the Dilemmas of the Fourth Age
Paul B. Baltes Jacqui Smith
Max Planck Institute for Human Development, Berlin, Germany

Key Words ty (e.g., loss of identity, psychological autonomy and a

Successful aging W Young old W Oldest old W Fourth age W sense of control). Investigation of the fourth age is a new
Berlin Aging Study W Aging mind and challenging interdisciplinary research territory. Fu-
ture study and discussion should focus on the critical
question of whether the continuing major investments
Abstract into extending the life span into the fourth age actually
We review research findings on the oldest old that dem- reduce the opportunities of an increasing number of peo-
onstrate that the fourth age entails a level of biocultural ple to live and die in dignity.
incompleteness, vulnerability and unpredictability that is Copyright © 2003 S. Karger AG, Basel

distinct from the positive views of the third age (young

old). The oldest old are at the limits of their functional
capacity and science and social policy are constrained in During the last decades, gerontological science, social
terms of intervention. New theoretical and practical en- policy and cultural-medical-economic advances have
deavors are required to deal with the challenges of formed a powerful political coalition that resulted in
increased numbers of the oldest old and the associated major increases in longevity and the quality of human
prevalence of frailty and forms of psychological mortali- aging, especially for the young old (third age). These
advances have contributed to a spirit of scientific and
social policy optimism. However, new scientific evidence
about the oldest old gathered in recent years indicates that
This article is based on a Plenary Lecture prepared for the Valencia
some general recommendations that presently predomi-
Forum, Valencia, Spain, April 1–4, 2002. The Valencia Forum was
sponsored by the International Association of Gerontology in sup- nate in the politics of aging may be based on inappro-
port of the Second United Nations World Assembly on Aging. It also priate assumptions. Specifically, theoretical arguments
summarizes the content of two invited lectures by the first author. [1–5] and empirical findings [6, 7] suggest that the process
The first was given as part of the Matilda Riley Lecture Series of the of optimization of the fourth age is inherently more diffi-
National Institute on Aging (October 2001), the second as part of the
cult than that of the young old (or third age). Increasingly,
George Maddox Lecture Series at Duke University (March 2002).
The authors acknowledge Matilda Riley and George Maddox not the scientific news about prospects of survival into very
only for their distinguished contributions to gerontology but also for old age is shifting from a focus on aspects of gain to
their extraordinary visions on the future of an aging society. aspects of loss. As gerontologists plan the future of

© 2003 S. Karger AG, Basel Paul B. Baltes

ABC 0304–324X/03/0492–0123$19.50/0 Max Planck Institute for Human Development
Fax + 41 61 306 12 34 Lentzeallee 94
E-Mail karger@karger.ch Accessible online at: D–14195 Berlin (Germany)
www.karger.com www.karger.com/ger Tel. +49 30 824 06 255, Fax +49 30 824 99 39, E-Mail sekbaltes@mpib-berlin.mpg.de
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research and practice towards optimal aging [8], we pro- ties, including the amount of resources available to care
pose that they need to recognize the two faces of human for the elderly. In other words, there may be some danger
aging: the gains and losses. This review summarizes our inherent in pushing an exclusive old-age focus. Such a
arguments and provides supportive research. focus potentially limits the resources necessary for im-
The two faces of human aging are captured elegantly in proving the state of earlier phases of life, namely child-
the following vignettes. The first is a story about the hood and adolescence. These early life phases lay the
world-famous cellist Pablo Casals who, as an 80-year-old, foundations for subsequent life span development and for
was asked by a young student why he continued to prac- future resources necessary to support old age. Perhaps the
tice so hard. ‘Why?’, Casals answered. ‘This is simple. time has come to think about the younger ages in order to
Because I want to get better!’ This story illustrates a gain serve old age.
perspective on old age: in particular, the idea that old age For gerontologists, highlighting the need for a modula-
has much latent potential which awaits activation through tion of gerontological policy is not an easy emotional task
a better material, medical, social and psychological cul- because the effort involves critical reflection and is not
ture of old age. fully consistent with the dominant geropolitical move-
The second story, an ancient Greek saga, is helpful in ment. However, it is our belief that in the long run, geron-
highlighting the risks associated with sheer extensions of tology and the older population will benefit most if their
the life span. The saga is about Eos, the Greek goddess of respective agendas are part of an overarching frame, one
the dawn, who fell in love with the mortal earthling that considers policy implications for all stages of life and
Tithonos, the prince of Troy. True to her own immortali- for society as a whole.
ty, Eos wanted to go on living with and loving him forev-
er. In this spirit, the goddess begged the master of all
Greek gods, Zeus, to make her lover immortal. Zeus The Third versus Fourth Age Distinction:
granted Eos this wish and bestowed eternal life on Titho- Some History and Definitions
nos. Not included in the gift of Zeus, however, was anoth-
er condition that Greek gods enjoy, namely eternal youth Several authors have asserted that in order to under-
and vitality. Despite immortality, Tithonos aged like a stand the future scenario of an aging population, it is use-
human: he became frailer and frailer and although his ful to distinguish between a third and a fourth age [1, 2, 6,
body remained alive, his mind died. With much pain in 12–15]. The third versus fourth age script is a further elab-
her heart, Eos decided to move her former lover into a oration of the young old versus old old distinction intro-
separate chamber where, according to the Greek saga, he duced by Neugarten [14] and the historian Laslett [13].
continued to live mindlessly. Laslett and Neugarten were key instigators of the basic
Two important issues are highlighted in the ambiva- idea of multiple ages of old age and, in particular, high-
lent spirit of this Greek saga. First, pushing the limits of lighted the uniqueness of a third age. The third versus
aging and its health-related support structures further into fourth age script also has some similarity to distinctions
advanced old age may actually decrease rather than between normal, pathological, successful and optimal
increase the state of human dignity for many older per- aging [16–18] and the associated notion that very old age
sons [9–11]. In this context, we argue that the extraordina- is characterized by much pathology.
ry needs and vulnerabilities of the fourth age potentially What specifically is meant by the distinction between
require some reorientation of aging policy. One critical the third and the fourth age? To begin, it should be
question is whether the continuing major investments emphasized that, like most phenomena in human evolu-
into extending the life span into the fourth age actually tion and science, the idea of the third and fourth age itself
reduce the opportunities of an increasing number of peo- is undergoing changes and strictly speaking is not tied to a
ple to live and die in dignity. specific age range. As phenotypic expressions, the third
The second issue addresses the idea that a social policy and fourth age are dynamic and moving targets and are
of aging needs to be placed into the larger frame of the themselves subject to evolution and variation. Examina-
common societal good and the life course as a whole. Con- tion of the differences in population aging between devel-
tinuing to define gerontological policy as a call for more oped and developing countries makes this point of histori-
and better societal resource allocation on behalf of the cal-cultural contingency. In today’s developing countries,
older population may decrease the overall economic, the period of old age begins and ends at younger chrono-
physical, social and psychological health of future socie- logical ages than is the case in developed countries.

124 Gerontology 2003;49:123–135 Baltes/Smith

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 In general, there are two ways to define the third and Table 1. Recent news from gerontology
fourth age. The first is population-based, the second is
The good news: the third age (young old)
person-based. Both modes of definition, in our view, are
Increase in life expectancy: more older people live longer
necessary to capture the essence of the distinction and to Substantial latent potential for better fitness (physical, mental)
direct interpretations and research inquiries to directions in old age
that highlight the discontinuity and qualitative differ- Successive cohorts (generations) show gains in physical and mental
ences between the ‘ages’ of old age. fitness
Evidence of cognitive-emotional reserves of the aging mind
More and more people who age successfully
Population-Based Definition High levels of emotional and personal well-being (self-plasticity)
First, regarding the demographic population-based Effective strategies to master the gains and losses of late life
way of defining the third and fourth age: The transition The not-so-good or bad news: the fourth age (oldest old)
between the third and the fourth age can be thought of as Sizeable losses in cognitive potential and ability to learn
being the chronological age at which 50% of the birth Increase in chronic stress syndrome
cohort are no longer alive. Having such a criterion Sizeable prevalence of dementia (about 50% in 90-year-olds)
increases the likelihood that people beyond that cutoff age High levels of frailty, dysfunctionality and multimorbidity
Dying at older ages: with human dignity?
are indeed subject to aging processes. This definition
would put the transition from the third to the fourth age in Prospects for the 21st century: the era of chronic incompleteness of
mind and body?
developed countries at around 75–80 years of age [4, 19,
20]. In developing countries, the current age range for the
third and fourth age is clearly much lower.
A more differentiated, but still demography-based def-
inition is to further delimit the 50% criterion by excluding
from the calculation those people who died at younger and dying. However, many normal changes of aging are
ages. Thus, we could speak of the transition from the third not directly related to mortality. The concept of the fourth
to the fourth age as the age at which 50% of the people age espoused here includes such aging changes. Morbidity
who attained age 50 or 60 have died subsequently. For and mortality are two related but conceptually indepen-
developed countries, this definitional strategy would put dent constructs.
the beginning of the fourth age closer to 80–85 years. It is The distinction between the third and fourth age is also
this latter definition of the fourth age, as beginning on one that is characterized by a focus either on a predomi-
average at 85 or so, that we currently use when presenting nantly positive versus negative view of the future poten-
empirical evidence based on data from developed coun- tial to sustain and improve life quality during the period
tries. of old age. The background to these two viewpoints is
reviewed in the next sections.
Person-Based Definition
The second mode of differentiating between the third
and the fourth age is an individualized one. Theoretically, The Scientific Good News: The Third Age
the aim of this approach is to estimate the maximum life
span of a given individual rather than the average of the Predominantly to prevent a misunderstanding of our
population. Based on present-day evidence, for instance, central message, we begin with the positive news about
and excluding specific illnesses that prevent a longer life aging. In our view, this information was generated pri-
to begin with, such an individual maximum life span is marily from research with persons and groups which
thought to vary between 80 and 120 years. In this view, represent the third age, the young old (refer to table 1).
individual transitions to the fourth age could begin at The prevailing optimism among many gerontologists is
rather different ages, for instance, around 60 for some or based on this news.
around 90 for others [21–27].
There are scientific precursors to the person-based def- Increases in Life Expectancy: More Older People Live
initional approach of a third-fourth age distinction as Longer
well. For example, the distinction can be seen as a corre- One of the first pieces of good news is the continual rise
late of Kleemeier’s [28] and Riegel and Riegel’s [29] con- of life expectancy rates in developed countries [4, 19, 20,
cept of terminal decline associated with processes of death 30–33]. What is new is that these projections now include

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80- and 90-year-olds and even centenarians. Although doubt, a good policy of aging requires attention to such
there is still no conclusive evidence that the maximum life factors as the social roles allocated to older adults and the
span has increased beyond 120 years, it is clear that 70-, general availability of intelligent-support systems includ-
80-, 90- and 100-year-olds will live longer than those age ing computers, better housing, access to health care and
groups have in the past. better transportation.
Vaupel [31], for instance, shows that current octoge-
narians in the developed world have a mean additional Longitudinal Evidence on Cognitive Reserves of the
life expectancy of almost 8 years, 4 years longer than 80- Aging Mind
year-olds could have hoped to live some 30 years ago. Perhaps the best evidence of the positive potential of
Centenarians also live longer after they have reached 100. the aging mind comes from longitudinal and intervention
Currently, as suggested by Vaupel, there is an annual studies in which individuals are exposed to extensive
increase of 8% in the number of centenarians in devel- practice, better health conditions or favorable life condi-
oped countries. In part, this especially rapid increase of tions associated with work and leisure. From such re-
centenarians is due to the fact that, to begin with, there are search we know, for instance, that in developed countries
more people reaching the oldest ages. The increase is also most people maintain their level of everyday intelligence
intrinsic to the improved environmental and social-tech- or mental achievement until around age 70 [37].
nological life conditions of the oldest old. Moreover, the aging mind has a sizeable potential for
new learning [47–49]. This is especially true if areas such
Successive Cohorts or Generations Show Gains in as language and professional expertise are considered,
Physical and Mental Fitness where mental activities involve products of culture and
Additional positive findings about the expressions of experience rather than products of basic brain fitness [50,
aging originate from cohort-comparative work on physi- 51] and where everyday activities such as those associated
cal functioning and mental health status. Some recent with work, education and leisure collaborate and are apt
research on cognitive plasticity, originally from the Göte- to generate or maintain various forms of expertise [52–
borg studies in Sweden [34, 35] and now from the Swedish 56]. In some instances, culture- and practice-nurtured
Twin Study [36] and Schaie’s Seattle Longitudinal Study functions can be maintained into the late 80s as was
[37] as well as our own work [38–43], shows that today’s shown in the Berlin Aging Study (BASE) for the case of
70-year-olds are comparable to 65-year-olds who lived 30 language-based competence [57]. This longitudinal find-
years ago. This suggests that in the past 30 years or so, ing of stability of one major cognitive function into the
same-aged older people in developed countries have age range of the late 80s is most impressive.
gained approximately 5 ‘good’ years of life [44]. There is
also some initial evidence from national surveys in the Expert Knowledge Systems: Emotional Intelligence
USA [27, 45, 46] that on the whole today’s over-65-year- and Wisdom
old North Americans have fewer physical disabilities There is more evidence on positive facets of the mind
(e.g., affecting competence in everyday functioning) than of older persons in the third age. Older adults are at the
earlier cohorts of the same age range. top of all age groups in such categories as emotional intel-
When explaining these findings, it is important to ligence and wisdom [58–61].
remember that this progress in life expectancy and overall Emotional intelligence represents the ability to both
physical and mental fitness is not the result of genetic understand the causes of emotions (e.g., hate, love or fear)
improvement, but of contemporary social and cultural and to develop strategies to avoid emotional conflict situ-
forces. In concert, better material environments, more ations or to modulate their negative correlates and conse-
advanced medical practice, the improved economic situa- quences. Older people’s high levels of functioning or even
tion of older persons, more effective educational and improvements in emotional intelligence are especially
media systems, increased psychological resources such as evident when it comes to difficult life problems between
reading, writing and computer literacy, and many other people [59–64].
related factors allow older persons to approach their own Wisdom is the prototypical example of the potential
maximum life span in healthier and more vital condi- that old age holds in store [65]. It represents an ideal com-
tions. When the physical body declines in old age, the bination of mindfulness and virtue. We have been con-
environmental systems supporting the aging of the mind ducting research on this topic for more than a decade and
and the body become especially important [47]. Without define wisdom as an expertise in matters of the conduct,

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Fig. 1. BASE data. With age, the discrepan-
cy between subjective health assessments
and the objective status increases [74].

meaning and interpretation of life [58, 64, 66–69]. In our beings are masters of internal adaptations and reconstruc-
work, older adults are among the best performers in wis- tions. When people have to deal with an illness, they com-
dom tasks. Such findings lend support to the notion that pare themselves with others who have similar or even
older adults have specialized forms of knowledge and worse illnesses. The power of plasticity of the self and the
skills that can be brought to the task of creating a society ability to transform beliefs amount to some of the best
with a strong sense of intergenerational connectivity and insurance policies for well-being in old age one can have.
coproduction. However, we need to be aware of the fact that such find-
ings about the adaptive power of the self also make clear
Regulatory Adaptive (Pragmatic) Capacity on the why self-report data on well-being are not the best indica-
Subjective Level: Self-Plasticity tors of actual life quality in old age. People report positive
Equally optimistic findings concerning the potential of well-being even though their objective life circumstances
the aging mind come from research on personal (psycho- are negative.
logical) adjustment to changed conditions of life, includ- Taken together, this kind of news is what makes some
ing losses in health. Such research is conducted to under- of us into so-called ‘happy gerontologists’ to quote an Ital-
stand the mechanisms that people use to nurture their ian philosopher, Bobbio [75]. Furthermore, this news is
sense of well-being and life satisfaction and to maintain a rightfully at the forefront of political action agendas like
positive sense of control and optimism [59–61, 70–73]. that of the second World UN Assembly on Aging [76]. We
In the BASE [6], for instance, researchers demon- emphasize once again, however, that this evidence has
strated the remarkable ability people have to regulate the been accumulated primarily in developed countries for
subjective impact of health-related losses [74] (see fig. 1). the period from age 60 to 80. The good news about aging
The older people get, the greater is the discrepancy is the news of the third age.
between subjective evaluations of their health and the
objective medical status. The result: Subjective estimates
of health do not differ with age. Of course, this does not The Not-So-Good Scientific News:
mean that objective health does not decline. The finding The Fourth Age
illustrates the psychological capacity of individuals to
transform reality. This capacity appears to remain intact One question that follows from the news that people
during old age, whereas the health of the body itself are living longer is whether the exciting findings on the
declines. plasticity and adaptivity of the young old can be general-
In the spirit of this remarkable self-plasticity of older ized to the oldest old (fourth age). Several major projects
persons, research has demonstrated that most human are now underway, for example in the USA, China and

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Fig. 2. Dementia prevalence increases with
age. a Canadian data [102]. b BASE data
[84].

Europe, to explore the characteristics of the oldest old and [80, 81]. At the ages above 85, and this did not include
to address this question [1, 12, 15, 20, 27, 36, 77]. persons diagnosed with dementia, many individuals were
Research on the different ‘ages’ of old age is one of the not able to acquire this memory technique. Moreover,
new frontier topics of gerontological research. there were practically no instances where perfect solutions
Based on this recent work distinguishing between were attained, including the test conditions where a high
‘ages’ of old age, the positivity of the news about human performance was possible in principle. Even in the
aging begins to crumble (refer to lower half of table 1). ‘healthy’ oldest old, new learning was severely impaired.
Findings from the BASE [6] serve as an illustration.
Despite their optimistic reports on young old age, BASE The Self Is at Its Limits of Functioning in the Fourth
researchers have also uncovered some of the dilemmas Age
and dysfunctionality of very old age. In contrast to the BASE data on measures of subjective functioning in
young old, data on 90- and 100-year-olds clearly show the area of self, personality and emotionality also yielded
many of the negative consequences of living longer into evidence on losses of functioning in the oldest old [7, 72,
the fourth age. Living longer seems to be a major risk fac- 82, 83]. In particular, for aspects of emotion and well-
tor for human dignity [9–11]. BASE findings on the being associated with no decline in the young old (e.g., life
marked decreases in physical and mental health in the satisfaction, positive affect, aging satisfaction, loneliness),
fourth age (outlined below) are all the more significant as losses in the oldest old become prominent especially when
they apply to subgroups who are behaviorally and biologi- multiple indicators were considered.
cally positively selected and represent those few who sur-
vived into very old age and were able and willing to con- Dementia Prevalence in the Fourth Age
tinue as study participants [78]. Thus, if anything, our The perhaps best-known indicator for a sizeable nega-
observations underestimate the actual plight of the oldest tive shift in the mental health status of the oldest old is the
old. dramatic increase in the prevalence of dementia (see fig. 2
[102]). Findings of the BASE confirmed this trend. Al-
Sizeable Losses in Cognitive Potential and Ability to most half of the 90-year-olds suffered from some form of
Learn dementia [84].
The first piece of evidence for a major loss in the Dementia is a condition characterized by a gradual loss
mind’s potential of the oldest old comes from cognitive of many of the fundamental qualities of Homo sapiens:
training research with participants of BASE. Singer et al. intentionality, autonomy, independent forms of living,
[79], for instance, conducted an extensive memory train- personal identity, social connectedness, to name just a
ing study. The memory training program used had been few. Note that these qualities are fundamental to defining
shown in the past to be rather effective with the young old human dignity and the opportunity of individuals to exer-

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Fig. 3. BASE data. Age (a) and gender (b)
are risk factors for belonging to groups
with poor and very poor functional status.
Groups’ profiles were classified by a joint
consideration of 23 physical, mental health,
psychosocial and social indicators [2, 85].

cise their human rights in an agentic manner. Effective [85]. Our impression is that the years gained in very old
treatment of dementias is extremely limited. Indeed, be- age often approximate levels of functioning that may jus-
cause of the complexity of biogenetic-cultural causation, tify their designation as ‘bad’ years. Irrespective of the
it will be difficult to find an effective medical solution in validity of such a label, there is little doubt that the fourth
the near future, except for some dementias with well- age tests the boundaries of human adaptability. When the
defined genetic etiologies. It may be a sad commentary, fourth age is considered, then living a long life has its
but dying before reaching the oldest ages is currently the costs, medically, psychologically, socially and economi-
only way to avoid succumbing to Alzheimer-type demen- cally.
tia! Here, it is useful to ask whether these findings are in
opposition to research, for instance by Manton [27] and
Wholistic-Systemic Indicators (Profiles of Crimmins [86], which presents the more optimistic mes-
Functioning) in the Fourth Age sage that the average level of vitality and health is increas-
The most comprehensive picture of the fourth age is ing over cohorts so that today’s older North Americans
obtained when analyses are conducted in which a large have fewer physical impairments than their parents’ gen-
number of physical, medical, psychological and social erations. There is no contradiction. Both facts can be true
indicators are considered together [12]. Such an approach at the same time. Historical cohort or generational im-
permits looking at the person as a whole. This potential of provements in physical and mental fitness, however, are
a systemic-wholistic analysis is perhaps the greatest typically much smaller than the general aging effects that
strength of the BASE because this study, more than any are central to the present report. Comparatively speaking,
other, is based on many sessions of intensive observation the effect of old age is the dominant one, and in current
including medical, psychiatric and psychological assess- times it outweighs by far the magnitude of historical
ments as well as social, life history and economic informa- cohort improvements in health.
tion.
When taking such a wholistic, multivariate and profile Living and Dying in the Fourth Age
view, sizeable aging losses are revealed as individuals Human dignity and human rights become especially
reach the oldest ages. Figure 3 summarizes the BASE find- critical when conditions of testing the limits prevail such
ings. The probability of classification as a group charac- as is often true in the case of living and dying in the fourth
terized by many chronic life strains (i.e., multidysfunc- age (see table 2). One research question is whether the pro-
tionality and multimorbidity) was almost 5 times higher cess of death and dying differs by age. In other words,
for the oldest old than for the young old [7, 82]. This what is the behavioral-mental status of individuals who
increase in dysfunctionality afflicts especially women die at 80, 90 or 100 years of age?

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Table 2. Living and dying in the fourth age (findings of BASE) Bobbio’s [75] ‘happy gerontologists’ are not ready to
accept these conclusions. For instance, they will say that
Behavioral observations
this more negative evidence about the fourth age is a tran-
Chronic life strains accumulate in the fourth age: 80% experience
losses in 3–6 areas (multimorbidity), e.g. vision, hearing, sitional phenomenon. They argue that, in the long run,
strength, functional capacity (IADL-ADL), illness, cognition research and better social policies will produce more posi-
Increased systemic breakdown in psychological adaptivity tive results. Scientists ought to be careful with predictions.
Increased losses in the positive side of life (happiness, social Keeping the uncertainty of prognostications in mind, in
contacts)
the following, we present our own assessment.
Profile of functioning 2 years prior to death is increasingly negative
from age 85 to 100+
Losses in cognitive functions
Losses in identity (greater loneliness and psychological Meta-Theoretical Propositions about the
dependence) Biocultural Architecture of the Fourth Age
Social context
The oldest old are mostly female What about theoretical considerations concerning the
The majority of women are widowed and live alone fourth age and its associated dysfunctionality? Baltes and
(if not institutionalized)
The majority are hospitalized at some time in the last years of life
colleagues [2, 48, 88] outlined an ensemble of meta-theo-
The majority die alone in a hospital or institution retical propositions that offer an interpretative frame-
work for empirical findings that the fourth age is highly
vulnerable and change-resistant. In essence, the proposal
is that the biocultural architectural plan of ontogeny is
incomplete for the oldest ages. Moreover, the biologically
prefabricated ‘house of life’ has little of the beautiful
The age-comparative results on living and dying from incompleteness that many appreciate in Schubert’s unfin-
the BASE give rise to the conclusion that the years prior to ished symphony. Instead, the life course architecture
death are more dysfunctional in older ages especially reflects a frustrating incompleteness that becomes the
where the aging mind is concerned [87]. When looking at more evident in its radical implications at the oldest
many indicators from the cognitive and self-related do- ages.
mains of psychological functioning, it is the oldest dying Figure 4 summarizes the three principles addressed in
persons who have the lowest profile 2 years prior to death. the meta-framework contributing to the incompleteness
Most likely this increase in dysfunctionality with age of the biocultural architecture of the life course and their
represents the superimposition of terminal-change trajec- implications for the fourth age [2]. First, figure 4a refers to
tories associated with the process of dying onto normal biologically based age functions and reflects the fact that
aging trajectories. evolutionary selection pressure has operated primarily
In general, it appears that the overall desirable profile during the first half of life to ensure reproductive fitness
of findings for the third age shifts to being less desirable in and effective parenting behavior [21, 25, 26, 89]. As a
the fourth age. In the fourth age, BASE data suggest that consequence, compared to younger ages, the orchestra-
all behavioral systems change concomitantly toward a tion of the human genome in older age groups is more
more and more negative profile. Few functions remain likely to be characterized by deleterious genetic expres-
robust and resilient to negative change. The rate of nega- sions and interactions. Much of this decrease in genetic
tive change is larger if aging is superimposed by pathol- reliability follows from random-event processes rather
ogy. than a genetic plan of aging [90]. The essence of the story
Such data provide grounds for reflection. Increasingly, is as follows: because evolution operated primarily on the
philosophers, social scientists and citizens alike ask the first half of the life span, ‘evolutionary biology was not a
question of whether survival into the oldest ages is desir- good friend of old age’.
able to begin with, especially given evidence that many of Figure 4b deals with the biology-culture interactions. It
the oldest old live their lives in a condition where a strong suggests that, across the life span, it takes more and more
expression of human rights and human dignity – as culture-based resources and practice to exploit the biolog-
expressed in a sense of psychological control and personal ical potential that is inherent in the human genome. The
identity – is increasingly infringed (see below). argument for an age-related increase in the need for cul-
ture has two main parts. First, for human development to

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Fig. 4. Schematic representation of three
principles (a–c) governing the dynamics be-
tween biology and culture that lead to an
aging-associated increase in the incomplete-
ness of the biocultural architecture of the life
course [2].

have reached higher levels of functioning, there had to be Mastering the New Challenges and Daunting
a conjoint increase in the richness and dissemination of Dilemmas of the Fourth Age
culture and its opportunities for practice [88, 91]. The
material, mental, social and technological aspects of cul- In many ways, the argument about the fourth age pre-
ture, for instance, were the primary motor for the sharp sented above gives rise to melancholy rather than opti-
increase in longevity during the 20th century, not a mism. In our concluding section, we would like to modu-
change in the evolution-based genome. Second, there is an late such an impression of full-fledged pessimism. Human
age-related increase in the need for culture because of the aging has latent potentials that still need to be uncovered,
fact summarized in figure 4a. Aging is associated with a and science as well as social policy are powerful sources
decrease in biological potential and efficiency of the for positive change [92].
organism. Such a loss requires an increase in the suppor-
tive and compensatory role of culture-based resources Genetic Medicine and Technology
including their use and practice. Contemporary science is becoming an era of the life-
Third, and as shown in figure 4c, Baltes [2] argued that and biosciences. Not surprisingly, therefore, when it
the efficacy of culture to compensate for biological decline comes to innovations in the optimization of human aging
decreases in very old age. This is primarily due to the age- one frequently mentioned factor is the contribution of
related loss in biological potential and increasing loss in ‘new genetics’ [93, 94]. While in the past the human
learning potential. There is less improvement for the same genome changed over thousands of years, modern science
input. The intervention result becomes smaller and suggests new strategies of genetic corrections that can be
smaller. implemented within a shorter time frame. Certainly,
This triangulated, conceptual script of age-associated there is some hope in this line of inquiry [25]. However,
changes in the biocultural architecture of the life course we venture to add two perspectives on possible limita-
should be kept in mind when it comes to speculations tions.
about the future of aging in a population where more and The first is the inherent incompleteness of the overall
more individuals reach advanced old age. Of course, the biogenetic architecture of the life course summarized
script characterizes a dynamic and evolving framework above [2]. This meta-theoretical framework suggests that
and new science may change the constellation. Neverthe- it would require changing the whole system of biological
less, the direction of the age-related change remains one functioning. The second perspective on limits of genetic
of growing incompleteness and vulnerability, and less intervention technology is the argument that most expres-
chance for modifiability and optimization. sions of morbidity and diseases involve biogenetic multi-
causality. Many genes are involved in the process of aging,
and many lie dormant and might become operative when
genetic interventions take place. Admittedly, some dis-

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Table 3. A theory of adaptive development: selective optimization psychological strategies of life management. In the follow-
with compensation (SOC) [16] ing, we summarize one theory of effective life manage-
ment that Margret Baltes, Paul Baltes and colleagues [2,
Selection: elective and loss-based
Concerns directionality of development including selection of 16, 97–99] have articulated and tested during the last
alternative outcomes and goal structures decade. It is the theory of selective optimization with
Optimization
compensation.
Concerns means for achieving desired outcomes (attaining higher As shown in table 3, the theory of selective optimiza-
levels of functioning) tion with compensation proceeds from the assumption
Compensation that the life course consists of a changing script regarding
Concerns activation or acquisition of new means for counteracting the means and goals of life. These changes in means and
loss/decline in means that threatens the maintenance of a given goals require systematic changes in the allocation of
level of functioning resources. Overall, the primary investment of resources in
SOC behaviors are universal processes of optimal development early life is into processes of gain (growth). With increas-
SOC behaviors are relativistic in that their phenotype depends on ing age, more and more resources are invested into main-
person- and context-specific features tenance and repair.
SOC is a developmental construct. Its peak expression is in
adulthood. In old age, elective selection and compensation
Our favorite example of the psychological meaning of
become more important selective optimization with compensation comes from
several interviews with the 80-year-old pianist Rubin-
stein. When Rubinstein was asked how he continued to be
such an excellent concert pianist, he named three reasons.
He played fewer pieces, but practiced them more often,
eases are more single-gene-based and there is hope that and he used contrasts in tempo to simulate faster playing
such diseases might be rectified with genetic therapy. than he in the meantime could master. Rubinstein re-
However, we are impressed with the arguments advanced duced his repertoire (i.e., selection). This gave him the
by many biomedical researchers [95, 96] that the com- opportunity to practice each piece more (i.e., optimiza-
plexity of the genetic action involved in human aging is tion). And finally, he used contrasts in speed to hide his
too great and person-specific to permit quick and univer- loss in mechanical finger speed, a case of compensation.
sal solutions. Rubinstein described a classic example of what psy-
Despite much uncertainty about the general promise of chology has shown is a key strategy of effective aging. Peo-
genetic intervention technology, this technology is argu- ple who select, optimize and compensate are among those
ably the perhaps most important avenue toward complet- who feel better and more agentic. The art of life in old age
ing the biocultural architecture of the life course, and one consists of the creative search for a new, usually smaller
that might redesign the human genome such that it comes territory that is cared for with similar intensity as in the
closer to the unfinished symphony of Schubert. There- past. The same is true for cultures. Cultures who offer old-
fore, regarding the future of the fourth age, societies and er persons ways of selecting, optimizing and compensat-
policy makers should take an explicit position on the need ing are the cultures which assist best in maximizing the
for massive increases in support of modern biomedical gains of older age.
technology including of course its behavioral-health com- Using this image of the smaller territory brings us to a
ponents [23]. What is essential, however, is that these further concrete example from life that we owe to Bert
efforts are placed into the larger frame of biocultural Brim [100]. His father grew to be very old, 103 years to be
orchestration rather than simple genetic determinism [88, exact. As a younger old person he was fully engaged in
94]. running his farm, including the surrounding hills. As a 75-
year-old, he was somewhat impaired in his mobility.
Successful Aging through Selection, Optimization and Thus, he concentrated on his garden. As a 90-year-old, he
Compensation could hardly walk and his hearing and sight were im-
Aside from the yet untested promise of genetic inter- paired. At that time, his houseplants received special care.
vention technology, there are other strategies of managing Later he focused on the flowers on the window ledge near
the journey of aging into the oldest ages. In addition to his chair in the living room. The window became a center
social policy and aging-friendly support structures as well of his goal striving and subjective well-being. In the writ-
as preventive and corrective health policies, these include ings of the great Greek epic writer Hesiod there is a saying

132 Gerontology 2003;49:123–135 Baltes/Smith

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that fits perfectly with this strategy of successful aging: Furthermore, the chances for human dignity may actually
‘Half can be more than a whole.’ be reduced in the fourth age if social policy is predomi-
nantly directed towards promoting longer lives beyond
the third age. Healthy and successful aging has its age lim-
Conclusions and Outlook its.
To deal effectively with the problems of the fourth age
To conclude, we return to the idea that old age has two that arise from a continuation of the aging of the popula-
faces and, in this context, suggest directions for future tion, new levels of scientific, medical and social resources
research and policy. On the one hand, there is much scien- are required together with efforts aimed at modulation. In
tific evidence to suggest that older persons can be more addition, societies will have to ponder carefully how to
effective and productive members of a well-functioning consider the question of both human rights and human
society than the current culture of old age permits. One responsibilities and how to allocate resources to the differ-
major quest, therefore, is to invest scientific and policy ent subgroups that constitute society as a whole [101]. A
efforts in a broad range of areas that contribute to a better vital society requires age fairness in resource allocation:
culture of old age. optimizing the state of the future aging population re-
On the other hand, we submit that recent evidence quires well-functioning and productive younger age
about the fourth age, the oldest old, mandates close atten- groups so that societal resources continue to be available
tion. Specifically, we propose that one byproduct of the to support old age. Age fairness in resource allocation is a
recent addition of years to people’s lives is the new and particular dilemma in developing countries where long-
daunting challenge of living and dying in the fourth age range planning requires prioritized investment of scarce
(oldest old). There is now increasing evidence to show that resources into children, youth and young adulthood.
the fourth age is not a simple continuation of the third In our view, most elderly citizens are aware of this
age. Among the oldest old, there is a high prevalence of dilemma, and most are also prepared to invest in the
dysfunction and reduced potential for enhancement of young. In this spirit, we hope that gerontologists will join
function. in a new commitment to strengthen the earlier ages of the
Aside from physical dysfunction, the accelerated in- life course. ‘Old for young’ is a motto that could become a
crease in psychological mortality during the fourth age is part of the aging enterprise so that a proper balance of
of special significance. It threatens some of the most pre- perspectives and age fairness can be achieved. If this mot-
cious features of the human mind such as intentionality, to is adopted, perhaps societies will proceed more careful-
personal identity and psychological control over one’s ly and be watchful for the negative consequences of push-
future as well as the chance to live and die with dignity. ing biological aging or sheer longevity to its limits.

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