Elderly? Put On a Happy Face!

A positive affect — the hallmark of overall well-being — is associated with improved health and success in many areas of life. Now, it may also predict survival.

Positive affect is a psychological state of experiencing joy, happiness, excitement, enthusiasm, and contentment. In contrast, a negative affect is characterized by anxiety, depression, and hostility. Many studies have revealed an association between a positive affect and good health status, including improved immune system function, a lower risk of the common cold, and less morbidity and disability from chronic diseases.

A new investigation, published in the American Journal of Epidemiology, reports that positive affect also predicts overall survival in the elderly. And, the more positive the affect, the longer the survival. The authors evaluated more than 4400 subjects aged 61 years or older and followed them for an average of more than 7 years. The subjects completed exams and surveys of their overall health status, mental health, socioeconomic status, and lifestyle habits. After adjustment for all other variables, positive affect was positively associated with survival in people younger than 80 years old. In subjects older than 80 years, positive affect did not significantly predict survival.

How positive affect influences survival is not completely clear, but it could be due to both indirect and direct causes. In general, people with a positive affect engage in better health behavior than those without a positive affect. As evidenced in other studies, a higher positive affect predicts participation in sports or physical activity, moderation in eating and drinking habits, and increased self-awareness and perception of illness. Also, people with a positive affect tend to be more self-confident, which leads to better health-related decisions. Direct effects of a positive affect include lower cortisol levels, improved cardiovascular recovery from stress, and reduced inflammation, all of which predict improved morbidity and mortality.

In older elderly people, positive affect and overall life satisfaction is strongly correlated to health status. This may explain why the oldest group of subjects in the current study did not experience increased survival with a positive affect. The association tended toward a positive relationship, but was not statistically significant. A larger sample size or controlling other factors that contribute to overall well-being may clarify this association.

Still, some studies have reported that affect does not change as people age. That is, a young, positive person grows into an older, positive person. And, a young, negative person becomes an older, negative person. What does the current study tell us, then? If there is really little we can do about changing our outlook, why wait until people are elderly to predict survival? Is a positive affect at age 25 related to improved survival? To date, no data can prove this, since the follow-up period of this study would be, literally, a lifetime.

While the results are not consistent across the ages evaluated in the study, and there are plenty of unanswered cause-and-effect questions, the results do provide incentive for elderly people to look on the bright side of life. Likewise, clinicians and caregivers should monitor the attitudes and outlooks of the elderly, as they might predict future health outcomes. We might not be able to alter one’s affect, but we might be able to offset its health consequences.

References

Fredman L, Hawkes WG, Black S, Bertrand RM, & Magaziner J (2006). Elderly patients with hip fracture with positive affect have better functional recovery over 2 years. Journal of the American Geriatrics Society, 54 (7), 1074-81 PMID: 16866678

Kim BS, Bae JN, & Cho MJ (2010). Depressive symptoms in elderly adults with hypotension: different associations with positive and negative affect. Journal of affective disorders, 127 (1-3), 359-64 PMID: 20619901

Krijthe BP, Walter S, Newson RS, Hofman A, Hunink MG, & Tiemeier H (2011). Is Positive Affect Associated With Survival? A Population-based Study of Elderly Persons. American journal of epidemiology, 173 (11), 1298-307 PMID: 21454828

Ostir GV, Markides KS, Black SA, & Goodwin JS (2000). Emotional well-being predicts subsequent functional independence and survival. Journal of the American Geriatrics Society, 48 (5), 473-8 PMID: 10811538

Park-Lee E, Fredman L, Hochberg M, & Faulkner K (2009). Positive affect and incidence of frailty in elderly women caregivers and noncaregivers: results of Caregiver-Study of Osteoporotic Fractures. Journal of the American Geriatrics Society, 57 (4), 627-33 PMID: 19392954