Elsevier

The Lancet

Volume 385, Issue 9968, 14–20 February 2015, Pages 640-648
The Lancet

Series
Subjective wellbeing, health, and ageing

https://doi.org/10.1016/S0140-6736(13)61489-0Get rights and content

Summary

Subjective wellbeing and health are closely linked to age. Three aspects of subjective wellbeing can be distinguished—evaluative wellbeing (or life satisfaction), hedonic wellbeing (feelings of happiness, sadness, anger, stress, and pain), and eudemonic wellbeing (sense of purpose and meaning in life). We review recent advances in the specialty of psychological wellbeing, and present new analyses about the pattern of wellbeing across ages and the association between wellbeing and survival at older ages. The Gallup World Poll, a continuing survey in more than 160 countries, shows a U-shaped relation between evaluative wellbeing and age in high-income, English speaking countries, with the lowest levels of wellbeing in ages 45–54 years. But this pattern is not universal. For example, respondents from the former Soviet Union and eastern Europe show a large progressive reduction in wellbeing with age, respondents from Latin America also shows decreased wellbeing with age, whereas wellbeing in sub-Saharan Africa shows little change with age. The relation between physical health and subjective wellbeing is bidirectional. Older people with illnesses such as coronary heart disease, arthritis, and chronic lung disease show both increased levels of depressed mood and impaired hedonic and eudemonic wellbeing. Wellbeing might also have a protective role in health maintenance. In an analysis of the English Longitudinal Study of Ageing, we identify that eudemonic wellbeing is associated with increased survival; 29·3% of people in the lowest wellbeing quartile died during the average follow-up period of 8·5 years compared with 9·3% of those in the highest quartile. Associations were independent of age, sex, demographic factors, and baseline mental and physical health. We conclude that the wellbeing of elderly people is an important objective for both economic and health policy. Present psychological and economic theories do not adequately account for the variations in patterns of wellbeing with age across different parts of the world. The apparent association between wellbeing and survival is consistent with a protective role of high wellbeing, but alternative explanations cannot be ruled out at this stage.

Introduction

People's self-reports of their subjective wellbeing are becoming a focus of intense debate in public policy and economics, and improvement of the wellbeing of the population is emerging as a key societal aspiration. The Report by the Commission on the Measurement of Economic Performance and Social Progress1 initiated by the French Government and chaired by Joseph Stiglitz argued that present measures of economic performance such as gross domestic product are insufficient as indicators of the progress of society, and that self-reported wellbeing should also be taken into account. In the UK, the Office for National Statistics is driving a national debate about the measurement of wellbeing,2 and in the USA, the Gallup-Healthways Wellbeing Index Poll interviews 1000 adults every day about wellbeing, and similar initiatives are taking place in other countries.3

Subjective wellbeing and health are closely related, and the link could become increasingly important at older ages, if only because the prevalence of chronic illness increases with advancing age. As life expectancy increases and treatments for life-threatening disease become more effective, the issue of maintaining wellbeing at advanced ages is growing in importance. Studies of older people show that assessments of quality of life are affected by the person's state of health,4 but the frequent finding that average self-reported life evaluation in the population increases with age suggests that subjective wellbeing is affected by many factors other than health. These factors include material conditions, social and family relationships, and social roles and activities—factors that also change with age. Research suggests that subjective wellbeing might even be a protective factor for health, reducing the risk of chronic physical illness and promoting longevity. Some researchers5 have argued that subjective wellbeing should be addressed as a measurement of health evaluation and be considered in health-care resource allocation. This Series paper summarises the present evidence linking subjective wellbeing with health in an ageing population.

Key messages

  • Major advances in the measurement and interpretation of subjective wellbeing have been made

  • Three measures—life evaluation, hedonic experience, and meaningfulness—represent different aspects of life experience and have distinct associated factors

  • In high-income English-speaking countries, life evaluation dips in middle age, and rises in old age, but this U-shape pattern does not hold in three other regions (countries of the former Soviet Union and eastern Europe, sub-Saharan Africa, and Latin America and the Caribbean) where life evaluation decreases with age

  • Outside high-income English-speaking countries, worry, lack of happiness, and physical pain rise with age, whereas anger and stress decrease

  • In the former Soviet Union and eastern European countries, elderly people are particularly disadvantaged relative to young people, in terms of lower life evaluation and high levels of worry, low happiness, and physical pain

  • A two-way relation between physical health and subjective wellbeing exists; poor health leads to reduced subjective wellbeing, while high wellbeing can reduce physical health impairments

  • Evidence shows that subjective wellbeing is associated with longer survival

Section snippets

Measurement of subjective wellbeing

Within the construct of subjective wellbeing, at least three different approaches capture a different aspect—life evaluation, hedonic wellbeing, and eudemonic wellbeing (panel).6 Life evaluation refers to peoples' thoughts about the quality or goodness of their lives, their overall life satisfaction, or sometimes how happy they are generally with their lives. Measurement uses such questions as the Cantril ladder,7 wherein individuals are asked to place themselves on an 11-step ladder with worst

Wellbeing in older people

What is the association between wellbeing and age? The best information available is from large-scale international surveys that have asked about life evaluation, although more recent surveys have also included measurement of hedonic and eudemonic wellbeing. One recent study14 examined assessments of life evaluation (broadly defined “happiness” with life or life satisfaction) in several European, American, Asian, and Latin American cross-sectional surveys during several periods, and replicated

Subjective wellbeing as a determinant of physical health at older ages

The notion that impaired subjective wellbeing is associated with increased risk of physical illness is not new; established research has linked depression and life stress with premature mortality, coronary heart disease, diabetes, disability, and other chronic disorders.24 What is new is the possibility that positive subjective wellbeing is a protective factor for health.25 Prospective epidemiological studies26 suggest that positive life evaluations and hedonic states such as happiness predict

Physical illness as a determinant of impaired subjective wellbeing

Clinical and community studies24 show that a wide range of medical disorders are associated with increased levels of depression, and with illnesses that are prevalent at older ages. Many individuals show increases in depressive symptoms after diagnoses of diabetes, coronary heart disease, stroke, some cancers, and chronic kidney disease.40, 41, 42 Collaborative care that focuses both on mental health and physical illness has beneficial effects.43 Ill health is also associated with reduced

Conclusions

Research into subjective wellbeing and health at older ages is at an early stage. Nevertheless, the wellbeing of elderly people is important, and evidence suggests that positive hedonic states, life evaluation, and eudemonic wellbeing are relevant to health and quality of life as people age. Health-care systems should be concerned not only with illness and disability, but also with supporting methods to improve positive psychological states. Contemplation of large scale clinical trials to

Search strategy and selection criteria

We searched PubMed and Web of Science with the terms “happiness”, “positive wellbeing”, “life satisfaction”, “aging”, “health”, and “mortality”. Our search included articles published in English between Jan 1, 2000, and March 31, 2012. We identified additional reports from the reference lists of selected articles. Some important older publications are cited either directly or indirectly through review articles.

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