I read with great interest Cheng's guest editorial “Defining successful aging: the need to distinguish pathways from outcomes.” The landscape of successful aging literature is littered with pathway – and outcome-oriented conceptualizations, making this differentiation an important issue to address. Further to the notion highlighted by Cheng is the usage (and confounding) of items surrounding successful aging. A recent review of the operational definitions of successful aging highlights the continued heterogeneity of successful aging operationalizations, identifying over 100 unique definitions of successful aging (Cosco et al., 2014). Perhaps as a by-product of this pervasive definitional heterogeneity, there is an equally pervasive conceptual overlap of the constituent components of successful aging. Depending on the definition of successful aging used (and possibly the availability of variables in a dataset and theoretical background of the researcher), the same item may be used as a predictor, component, or outcome of successful aging. While Cheng (rightfully) advocates for the inclusion of psychosocial components into definitions of successful aging, these items are particularly prone to this conceptual confusion. Take, for example, an item specifically identified by Cheng: life satisfaction. Successful aging was originally posited as inextricably linked to life satisfaction; however, subsequently, life satisfaction has been identified as a predictor (Roos and Havens, 1991), indicator (Leonard, 1981), and component (Pruchno et al., 2010) of successful aging. Further, several qualitative studies have been conducted with laypersons specifically differentiating between successful aging and life satisfaction, e.g. Fisher (1995). As Cheng illuminates and these examples highlight, the language of successful aging is rife with conceptual confusion – an inhibitive force in the advancement of the field – that must be addressed.

The use of antipsychotics for the management of behavioral and psychiatric symptoms of dementia (BPSD) remains highly controversial. These drugs are well known to be associated with increased mortality from cerebrovascular events, as well as with falls, cognitive impairment, and other serious side effects. In 2009, a UK target was set to reduce their use in dementia patients by two-thirds over a three-year period (Banerjee, 2009).