The prediction of subjective wellness among the old-old: Implications for the "fourth-age" conception

Dov Shmotkin, Amit Shrira, Nitza Eyal, Tzvia Blumstein, Aviva Shorek

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objectives. As the "fourth-age" conception suggests that the adaptability of psychosocial capabilities is disrupted at old-old age due to failures in maintaining balanced functions, this study examines the predictability of subjective wellness outcomes by factual dysfunction markers of health among old-old people across 12 years. Method. Participants were self-respondents in a 3-wave survey that sampled the older (age 75-94) Jewish population in Israel. Wave 1 (N = 1,369, mean age = 83.5) preceded Wave 2 (N = 687, mean age = 85.4) by 4 years and Wave 3 (N = 164, mean age = 91.6) by 12 years. Results. The dysfunction markers (comorbidity, medication consumption, doctor's visits, and difficulties in activities of daily living [ADL]) predicted subjective wellness by relating to an increase in depressive symptoms, as well as to a decrease in life evaluation and self-rated health, beyond adjustment for sociodemographics. However, in most cases, an interaction finding indicated that dysfunction markers were weaker predictors of age-related change in subjective wellness among older participants. Discussion. At old-old age, the results point to reduced predictability of subjective wellness by factual dysfunction. This finding supports the fourth-age model. Still, researchers should consider an alternative interpretation, by which increasing independence between factual and subjective indicators is protective, rather than debilitating, among old-old people.

Original languageEnglish
Pages (from-to)719-729
Number of pages11
JournalJournals of Gerontology - Series B Psychological Sciences and Social Sciences
Issue number5
StatePublished - Sep 2014

Bibliographical note

Funding Information:
Funding The first two waves of the CALAS were funded by grants from the U.S. National Institute on Aging (R01-5885-03 and R01-5885-06) and conducted by the Department of Clinical Epidemiology at the Chaim Sheba Medical Center. The third wave of data collection and continued work were conducted by the Herczeg Institute on Aging at Tel Aviv University, supported by the Israel Academy of Science (1041–541), the Israel National Institute for Health Policy (R/17/2001), and a donation from Ellern Foundation. The presently reported study was also supported by the Basic Research Fund at Tel Aviv University.


  • Aging
  • Dysfunction markers
  • Fourth age
  • Old-old
  • Subjective wellness


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