As discussed in numerous articles it is hard to refute that there is a rapidly growing older population in all countries, and that many citizens even those in highly developed countries technologically speaking may not be aging ‘successfully’ ‘well’, or optimally, either measured subjectively or objectively or both [24]. While aging may be inevitable, a sizeable number of emergent findings show non biological factors do influence aging processes, longevity potential, and outcome.

Recent findings by Fang et al. [25] for example describe four distinct subtypes of psychological features that tended to impact the emotional well-being among Chinese older adults in a non uniform manner. This group showed aging adults studied could be divided into four distinct subtypes of psychological well-being. The ‘unhappy’ subtype appeared to be most prevalent. Associated expressions of uselessness feelings were also found impactful as far as the processes of psychological health were concerned. Other study participants showed less emotion or emotional blunting, while others said they were satisfied and positive and possibly more resilient than those who perceived themselves as useless and who appeared more discontented and negative. Smoking status, drinking status, and social support were significantly associated with the transition between subtypes, while physical health was significantly correlated with the initial subtype membership.

Other current data suggest that aging processes are not stable and that the lower life expectancy rates found in some countries between 2019-2021 appeared to stem largely from a host of behavioral or modifiable social factors. In this regard, the authors advocated that government policies that improve population health and aim to build resilience to future shocks, such as COVID-19, as well as healthy lifestyles, in general, will be helpful here in all likelihood. Such policies might include reducing population exposures to major upstream risks for cardiovascular diseases and cancers, such as harmful diets and low physical activity levels, while tackling the commercial determinants of poor health, and ensuring access to affordable health services [26]. Other data imply a strong need for interventions that improve social engagement [27], and foster the socioeconomic status of citizens throughout the lifespan, especially as regards age related cognitive health issues [28], Clearly though, this set of strategies while laudable must not be carried out in isolation or disengaged from personal responsibility where this is relevant in our view.

Alternately, even in the event policies as listed above are implemented, aging adult’s health may be adversely impacted by trauma, and non-political forms of adversity among other factors and that increase stress, and engender negative belief patterns and others [29].  Other data show aging as a temporal state when viewed positively is generally found to be life affirming, and one that can mitigate a cascade of multiple adverse health situations or syndromes. Indeed, one recent study found that those older adults said to embody a state of successful aging rather than unsuccessful aging showed lower rates of depression and anxiety symptoms that are often highly impairing and associated with low life quality and a broad negative and fearful outlook of the future [30]. On the other hand, among life supporting variables are environmental enrichment, safety, a belief in plasticity, security, and dignity that should not be overlooked by providers who seek to advance and foster a state of what has been termed successful or graceful aging if the clients desire this opportunity [24,31,32]. This view presupposes there may be modifiable features of activity and thoughts and behaviors, as well as ‘some degree of cognitive and biological reserve’ as capacities that can be mobilized to enhance healthy longevity and life expectancy and a state not fraught with adverse features alone [24].

According to Fiske et al. [11], it may be possible to foster emotional resilience through education and other cultural offerings and beliefs and that may impact longevity and serve as protective factors. In addition, various forms of behavioral therapy, cognitive-behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are potentially effective if used to enhance older adults’ wellbeing. Preventive interventions for older individuals with chronic illnesses, along with targeted behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review also appear valuable and have received support.

Kohl et al. [33] has shown the implementation of a novel clinical psycho-educational offering developed to encourage engagement in activities associated with successful aging that targets sleep, socialization, physical, and cognitive activity through myth-busting, developing SMART goals and tracking behavioral change appears to yield favorable results, and can engender more positive self-appraisals with when subject to encouragement. However, rather than expecting a single mode of therapy to apply uniformly to all, Tse et al. [34] caution us to focus on the role of intrinsic factors or personal micro level factors that can impact aging processes and perceptions differentially and significantly and must be accounted for and duly acknowledged.

Self-efficacy perceptions and morale promotion also appears to have a bearing on the ability to manage stress associated with aging [5] as does an individual's sense of their personal ability to self-monitor their behaviors in the face of adverse health exposures [35], plus the acceptance of those irreversible changes that accompany aging [9]. In addition, being receptive to new learning experiences, adjusting to changes, and embracing life to its fullest extent are of high import. The adoption of a positive outlook and affirmative thoughts that help maintain a positive self-image [9], and staying socially active may help the older adult thrive rather than deteriorate [7].

In the interim, to prevent associated increases in disease associated disability, and tremendous economic costs, researchers have begun to outline possible modes of attaining some of the aforementioned attributes including a graceful, successful dignified aging state and healthy longevity. Here, depression, a serious albeit common mood disorder associated with persistent feelings of sadness and loss of interest and pleasure in daily activities may warrant special attention, especially among those with chronic illnesses, mobility losses, those that live alone, and/or have been exposed to one or more adverse life events and losses.  This is because all engender significant adverse aging impacts in their own right [35]. Alternately, an absence of depression may have the effect of heightening favorable and success oriented aging perceptions [37].

Small et al. [38] found a short-term healthy lifestyle program combining mental and physical exercise, stress reduction, and a healthy diet did indeed have significant effects on cognitive function and brain metabolism and that appeared to heighten the cognitive efficiency of a brain region involved in working memory. Kohl et al. [33] found a psycho educational oriented health program imparted to aging veterans visibly induced improvements in life satisfaction, emotional well-being, and energy levels post-intervention. Linear regression results found higher life satisfaction was associated with lower depressive symptoms, higher emotional well-being, and higher self-efficacy.

Selected strategies that might be harnessed to advance maximal wellbeing in later life might depend on what factors are most salient and cost effective as well as far reaching, and might include efforts directed towards fostering cognitive engagement, physical exercise/activity opportunities [39,40], access to a healthy diet, moderate alcohol usage [41], avoidance of smoking, regular cancer screening, reminiscence therapy [42] and socially favorable interactions and opportunities [41]. Bone mineral supplements, stations to reduce cholesterol and heart disease, amyloidal clearance to reduce the risk of Alzheimer’s disease are some additional strategies advocated to date. Additionally, tailored dietary practices along with anti-inflammatory dietary diversity could possibly help by reducing mortality risk and promoting longevity in older adults, especially those with inflammatory diseases, malnutrition, low muscle mass indicators [43] and those who want to work, but are forced to retire [44].

Ho et al. [45] found people who participated in volunteer or charity work and recreational activities were more likely to achieve successful aging than their counterparts who did not engage in these activities. Hence, subject to further study, policies and interventions that encourage older adults to participate in volunteer or charity work and recreational activities may support the achievement of successful aging in later life, as well as helping mitigate depressive feelings.

In sum, people worldwide are clearly living longer, but not necessarily optimally in many cases. Indeed, today in 2025 most adults can expect to live well into their sixties and beyond and every country in the world is experiencing growth in both the size and the proportion of older persons in the population, although chronic diseases and depression and many other possibly modifiable health issues such as incurring a falls injury may mar or limit the attainment of a truly healthy longevity of high quality.

Multiple modifiable factors that range from physical to economic and educational factors, not just genetics, appear to impact the aging process positively or negatively. Indeed, since, many older adults may not age optimally in many spheres the ability to alter this presently and in the future appears a valid goal, when weighed or weighted against the costs of failing to improve and ensure all aging adults can attain a high state of wellbeing and dignity in their later years. These costs include social and human costs as well as healthcare costs that are incalculable and will continue to be staggering in our view in the face of a lack of insightful strategic planning and policies and substantive budget allocations and social marketing of healthy options and positive aging images. This applies even more so and especially to the face of the number of persons aged 80 years or older that is expected to triple between 2020 and 2050 to reach 426 million and is now found in low- and middle-income countries to a greater degree than high income countries and at a time of diminishing resources, global warming issues, air pollution, poverty, wage and educational gaps, political upheavals, mass migrations, and a wide spread obesity epidemic. Indeed, by 2050, two-thirds of the world’s population over 60 years will live in low- and middle-income countries where resources and health opportunities are already quite limited and restrictive [WHO].

Yet, while some countries have set national health goals to improve aging outcomes and life quality in the future, and differing concepts of how to minimize age associated health declines and improve the potential for graceful aging are being generated [46], no model of practice has emerged. In addition, very little research in this regard prevails compared with other more ‘mainstream’ health topics. Many schools of health professions do not focus on the older population and its needs, and provider pathways are limited and potentially less attractive than tracks such as cardiovascular disease tracks.

However, it appears advancements in this regard are being made and can make a difference and will be helpful especially if they protect against modifiable life negating situations and beliefs and misconceptions about aging in a comprehensive and unified manner.