Is optimism related to healthy aging?

Reference: Kim, E. S., James, P., Zevon, E. S., Trudel-Fitzgerald, C., Kubzansky, L. D., & Grodstein, F. (2019). Optimism and healthy aging in women and men. American Journal of Epidemiology, 188(6), 1084–1091.

In Western society, aging is often portrayed in a negative light [1]. For this reason, as we age many develop a negative self-perception, which can be detrimental to one’s health [2, 3]. In contrast, a positive self-perception on aging may have the opposite effect. Recent research suggests that a positive affect may lead to healthier behaviors [4, 5, 6] and healthier biological functioning [7, 8, 9]. These are exciting findings because one’s self-perception is modifiable, to an extent, and therefore this might be a tangible way to prolong longevity. Further, with the ever-growing aging population, there is a great need to identify ways to improve cognitive and physical health. 

Optimism and Healthy Aging

Optimism, for example, is a sense of general positivity that someone has about themselves and their life. Thus, an optimistic person more often than not has a positive self-perception and positive affect. The relationship between healthy aging and optimism has begun to receive some attention in the literature. Specifically, optimism has been associated with a reduced risk of age-related diseases and mortality in elderly populations [10, 11, 12, 13]. However, the question remains whether optimism has an effect on cognitive health or physical health in older adults. Researchers Eric Kim and colleagues decided to close this gap and investigate how optimism may affect both cognitive and physical aging.  

Current Study

The main goal of the study by Kim and colleagues was to examine whether being an optimist affected men and women’s cognitive and physical health across time. Participants were recruited from a nationally representative sample from the United States [14] and were surveyed every two years for 6 to 8 years. The study included 5,698 participants 50 years or older that had good cognitive and physical functioning without any major chronic diseases.

Optimism was measured at baseline (i.e., at the start of the study) using the Life Orientation Test-Revised [15]. Based on responses to this test, participants were split into four quartiles: (1) most optimistic; (2) sometimes optimistic; (3) rarely optimistic; (4) least optimistic.

Healthy aging was measured using Rowe and Kahn’s model of successful aging [16] at baseline and follow-up. A participant was considered healthy if they reported having a low probability of disease (e.g., if the participant had not acquired a disease), performed well on a telephone cognitive assessment (e.g., immediate and delayed word memory recall task), and had less than four physical health limitations (e.g., limited ability to carry 10 pounds). 

The authors modeled the data to calculate associations between baseline optimism and maintaining healthy aging over 6 to 8 years while adjusting for the following factors: (1) age; (2) sociodemographic factors (i.e., sex, race, marital status, educational attainment, and total wealth); (3) health behaviors such as smoking, alcohol intake, physical activity, and body mass index; and (4) self-reported levels of depression.  

Main Findings

Regardless of optimism scores at baseline, 49% of all participants maintained characteristics of healthy aging (e.g., had not acquired a disease after baseline, performed similar or better on the cognitive assessment compared to baseline, and had less than four physical health limitations).  

All in all, there was a small positive relationship between optimism and healthy physical and cognitive aging. That is, in the top optimistic quartile only a quarter of the older adults (24%) had a greater chance of maintaining good health 6 to 8 years later when controlling for age and sociodemographic factors (see Figure 1). 

However, when controlling for age, sociodemographic factors,and “unhealthy” lifestyle factors (e.g., smoking or low physical activity levels), there was a small decrease in the percentage of participants in the top optimistic quartile that maintained healthy aging (see Figure 1). These findings suggest that prolonged longevity might be more related to overall good health and functioning than optimism alone. 

When comparing men and women, the effect of optimism at baseline on healthy aging was slightly greater in men, though not significantly so.

Meanwhile, those that were pessimists at baseline were less likely to maintain healthy aging at follow-up whereby there was a 10% reduced likelihood of maintaining healthy aging. This suggests that having a negative affect is related to poorer cognitive and physical health in the future. 

Associations between baseline optimism and maintaining healthy aging over 6 – 8 years. The y-axis is the hazard ratio – a hazard ratio of 1 suggests that there was no effect of baseline optimism on healthy aging whereas a hazard ratio of more than 1 suggests that there was a positive effect of optimism on healthy aging; an increased likelihood of maintaining healthy aging. The x-axis demonstrates each of the 4 optimism quartiles: Quartile 1 = least optimistic; Quartile 2 = rarely optimistic; Quartile 3 = sometimes optimistic; Quartile 4 = most optimistic. Model 1 is the effect of optimism on healthy aging when controlling for age, sociodemographic factors, and depression; Model 2 is the effect of optimism on healthy aging when controlling for age, sociodemographic factors, depression, and health behaviors.

Limitations 

However, some limitations need to be addressed. First, it should be noted that participants in the top optimism quartile were more educated, had a lower prevalence of smoking, and lower rates of depression compared to those in the bottom optimism quartile. Because of this, participants in the top optimistic quartile may have had an advantage over participants in the bottom optimistic quartile based on factors other than optimism, thus influencing the results. Second, small declines in cognitive and physical health are inevitable with age [17] therefore not observing a large positive relationship between optimism at baseline and healthy aging may have been caused by participants experiencing a natural decline in cognitive and physical health over the course of the study rather than a decrease in health because of low optimism levels. 

What does this all mean? 

Older adults who generally have a positive outlook may be more likely to remain cognitively and physically healthy compared to those who have a more negative outlook. Although the relationship between optimism and healthy aging was not clear-cut, the relationship between pessimistic people and aging seems clearer: being pessimistic is associated with a reduction in future cognitive and physical health. But if we look at these results optimistically (pun intended), they do provide some inspiration for the future because positive affect, including traits such as optimism, can be learned. That is, pessimists can change not only their negative affect but perhaps prolong their healthy cognitive and physical functioning. One way in which positive affect can be acquired is by changing daily goals and activities [18]. For example,check out this Forbes article for 16 Ways to Boost Your Optimism.

Where to go from here? 

As a society, we can change our perspectives on aging. If we begin to view aging as a positive process, perhaps older adults can remain healthy for longer. When aging is perceived as a positive process we will hopefully observe an increase in the population’s general positive self and world perception. Aging is inevitable but also beautiful – we should all be a bit more optimistic about the aging process!

Additional References

1.      Vasil, L., & Wass, H. (1993). Portrayal of the elderly in the media: A literature review and implications for educational gerontologists. Educational Gerontology, 19(1), 71–85. https://doi.org/10.1080/0360127930190107

2.      Levy, B. R., Slade, M. D., & Kasl, S. V. (2002). Longitudinal benefit of positive self-perceptions of aging on functional health. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57(5), P409–P417. https://doi.org/10.1093/geronb/57.5.P409

3.      Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83(2), 261–270. https://doi.org/10.1037/0022-3514.83.2.261

4.      Hingle, M. D., Wertheim, B. C., Tindle, H. A., Tinker, L., Seguin, R. A., Rosal, M. C., & Thomson, C. A. (2014). Optimism and diet quality in the women’s health initiative. Journal of the Academy of Nutrition and Dietetics, 114(7), 1036–1045. https://doi.org/10.1016/j.jand.2013.12.018

5.      Huffman, J. C., Beale, E. E., Celano, C. M., Beach, S. R., Belcher, A. M., Moore, S. V., Suarez, L., Motiwala, S. R., Gandhi, P. U., Gaggin, H. K., & Januzzi, J. L. (2016). Effects of optimism and gratitude on physical activity, biomarkers, and readmissions after an acute coronary syndrome: The gratitude research in acute coronary events study. Circulation: Cardiovascular Quality and Outcomes, 9(1), 55–63. https://doi.org/10.1161/CIRCOUTCOMES.115.002184

6.      Boehm, J. K., Chen, Y., Koga, H., Mathur, M. B., Vie, L. L., & Kubzansky, L. D. (2018). Is optimism associated with healthier cardiovascular-related behavior?: Meta-analyses of 3 health behaviors. Circulation Research, 122(8), 1119–1134. https://doi.org/10.1161/CIRCRESAHA.117.310828

7.      Boehm, J. K., Williams, D. R., Rimm, E. B., Ryff, C., & Kubzansky, L. D. (2013b). Relation between optimism and lipids in midlife. The American Journal of Cardiology, 111(10), 1425–1431. https://doi.org/10.1016/j.amjcard.2013.01.292

8.      Segerstrom, S. C., & Sephton, S. E. (2010). Optimistic expectancies and cell-mediated immunity: The role of positive affect. Psychological Science, 21(3), 448–455. https://doi.org/10.1177/0956797610362061

9.      Boehm, J. K., Williams, D. R., Rimm, E. B., Ryff, C., & Kubzansky, L. D. (2013a). Association between optimism and serum antioxidants in the midlife in the United States study. Psychosomatic Medicine, 75(1), 2–10. https://doi.org/10.1097/PSY.0b013e31827c08a9

10.  Tindle, H. A., Chang, Y.-F., Kuller, L. H., Manson, J. E., Robinson, J. G., Rosal, M. C., Siegle, G. J., & Matthews, K. A. (2009). Optimism, cynical hostility, and incident coronary heart disease and mortality in the women’s health initiative. Circulation, 120(8), 656–662. https://doi.org/10.1161/CIRCULATIONAHA.108.827642

11.  Giltay, E. J., Geleijnse, J. M., Zitman, F. G., Hoekstra, T., & Schouten, E. G. (2004). Dispositional Optimism and All-Cause and Cardiovascular Mortality in a Prospective Cohort of Elderly Dutch Men and Women. Archives of General Psychiatry, 61(11), 1126. https://doi.org/10.1001/archpsyc.61.11.1126

12.  Giltay, E. J., Kamphuis, M. H., Kalmijn, S., Zitman, F. G., & Kromhout, D. (2006). Dispositional optimism and the risk of cardiovascular death: The Zutphen elderly study. Archives of Internal Medicine, 166(4), 431. https://doi.org/10.1001/archinte.166.4.431

13.  Kim, E. S., Hagan, K. A., Grodstein, F., DeMeo, D. L., De Vivo, I., & Kubzansky, L. D. (2017). Optimism and cause-specific mortality: A prospective cohort study. American Journal of Epidemiology, 185(1), 21–29. https://doi.org/10.1093/aje/kww182

14.  Institution for Social Research, University of Michigan. (2006 – 2014). The Health and Retirement Study. https://hrs.isr.umich.edu

15.  Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67(6), 1063–1078. https://doi.org/10.1037/0022-3514.67.6.1063

16.  Rowe, J. W., & Kahn, R. L. (1997). Successful aging. The Gerontologist, 37(4), 433–440. https://doi.org/10.1093/geront/37.4.433

17.  Chalise, H. M. (2019). Aging: Basic Concept. Am J Biomed Sci & Res, 1(1).

18.  Sheldon, K. M., & Lyubomirsky, S. (2007). Is it possible to become happier? (And if so, how?): Is It Possible to Become Happier. Social and Personality Psychology Compass, 1(1), 129–145. https://doi.org/10.1111/j.1751-9004.2007.00002.x