Happy older people do live longer
June May-Ling Lee is Research Associate at the Centre for Ageing Research and Education (CARE; @CAREDukeNUS) at the Duke-NUS Medical School, Singapore (@dukenus). Rahul Malhotra is Assistant Professor in Health Services and Systems Research and Head of Research at CARE at the Duke-NUS Medical School, Singapore. Here they describe findings from their recent paper in Age and Ageing, co-authored with colleagues from CARE and the Singapore Ministry of Health, presenting the association between happiness and all-cause mortality among older individuals in Singapore.
There is a growing interest in the pursuit of happiness to improve health of older people. Happiness or positive emotion has been linked with a range of better health outcomes. However, the evidence of the effect of happiness on living longer is inconclusive.
Many studies do initially observe a greater extent of happiness to be associated with a lower likelihood of dying, but this link disappears once differences in demographic, lifestyle and health factors between those less and more happy are accounted for. And, studies do not often account for differences in social factors, such as loneliness and social networks. Further, studies linking happiness with a longer life pertain mostly to individuals in Western countries, and do not speak exclusively to older people. Thus, it is imperative and timely to ask the following questions:
Is the health benefit of happiness, in terms of a longer life, observed among older people in an Asian country?
Is this benefit independent of demographic, lifestyle, health and psychosocial factors?
In a recent paper in Age and Ageing, we utilized data from a nationally-representative survey (Panel on Health and Ageing among Singaporean Elderly [PHASE]) to look at the association between happiness, assessed in the year 2009, and subsequent likelihood of dying due to any cause, until 31 December 2015, among individuals aged 60 years and older in Singapore, a Southeast Asian nation.
Happiness was assessed by asking the survey participants how often in the past week they experienced the following: ‘I felt happy’, ‘I enjoyed life’ and ‘I felt hope about the future’. Their responses were considered in two distinct ways:
(1) a ‘happiness score’ (sum of scores on the three items; range: 0 to 6; higher value indicating a greater extent of happiness), and
(2) a ‘binary happiness variable’ (happy [happiness score=6] / unhappy [happiness score≤5]).
We accounted for a wide range of demographic (e.g. age; educational status), lifestyle (e.g. smoking; sleep duration), health (e.g. body mass index; activity limitations) and social (e.g. loneliness; social networks) factors in our analysis.
We found that every increase of one point on the happiness score lowered the chance of dying due to any cause among older Singaporeans by an additional nine percent. And, the likelihood of dying due to any cause was 19% lower for happy, versus unhappy, older people.
Our findings suggest that happiness may increase the life expectancy of older adults, beyond lifestyle, health and social factors. And, even incremental increases in happiness may be beneficial for older people ‒ thus, individual-level activities, as well as governmental policies and programs that maintain or improve happiness or psychological well-being, may contribute to a longer life among older people.
Waves 1, 2 and 3 of the Panel on Health and Ageing among Singaporean Elderly (PHASE) have been funded or supported by the following sources: Ministry of Social and Family Development, Singapore; Singapore Ministry of Health’s National Medical Research Council under its Singapore Translational Research Investigator Award “Establishing a Practical and Theoretical Foundation for Comprehensive and Integrated Community, Policy and Academic Efforts to Improve Dementia Care in Singapore” (NMRC-STAR-0005-2009), and its Clinician Scientist – Individual Research Grant - New Investigator Grant “Singapore Assessment for Frailty in Elderly-Building upon the Panel on Health and Aging of Singaporean Elderly” (NMRC-CNIG-1124-2014); and Duke-NUS Geriatric Research Fund. The views and opinions expressed herein are solely the authors’ responsibility and do not represent the endorsement and views of the funding sources.