Are you only as old as you feel? Attitudes about aging linked to cognitive health, study finds

It’s often said that age is just a number. A new study from researchers at Penn State College of Nursing suggests that it might also be a state of mind.

The study, headed by Nikki Hill, an associate professor at the university, involved an online survey of 581 people aged 65 to 90, equally split between men and women, married and single, and from a variety of educational backgrounds. All were English-speaking, had no self-reported diagnosis of dementia or other cognitive impairment, and were living independently at the time.

They found that more positive expectations regarding physical health, mental health and cognitive function in aging were associated with higher ratings of current subjective cognition, as well as lower subjective cognitive decline (SCD).

“Aging expectations are malleable and influence an individual’s perceptions of their cognitive functioning,” Hill wrote in the report, which was published in the journal Aging and Mental Health. “Modifying older adults’ aging expectations could support healthier cognitive aging through increased awareness and accurate assumptions about the aging process.”

Subjects’ views were measured with the 12-item Expectations Regarding Aging scale, which presents statements about physical health, mental health and cognitive function. Participants rank these statements from “definitely true” to “definitely false.”

Statements include: I expect that as I get older I will become more forgetful; It’s an accepted part of aging to have trouble remembering names; Forgetfulness is a natural occurrence just from growing old; It is impossible to escape the mental slowness that happens with aging.

Then, participants’ current subjective cognition was measured with the eight-item PROMIS Cognitive Abilities scale, with statements rated from “not at all” to “very much.” These include: My mind has been as sharp as usual; I have been able to think clearly without extra effort; I have been able to remember things as easily as usual without extra effort.

Finally, SCD was measured with questions from the Everyday Cognition Scale. Participants were asked: “Please rate your ability to perform certain everyday tasks now, as compared to your ability to do these same tasks 10 years ago,” in response to statements such as “remembering where I have placed objects,” with options ranging from “better or no change” to “consistently much worse.”

People who had more positive expectations of aging tended to rate their cognitive function better and report less perceived decline in their cognitive abilities, both in the last week and over the last 10 years. Conversely, those with more negative expectations of aging also had more negative perceptions of their current cognitive performance and whether they perceived cognitive decline.

“We found that older adults’ expectations regarding physical health, mental health, and cognitive function in aging were associated with both aspects of subjective cognition examined: perceptions of current cognitive performance as well as perceived cognitive decline (i.e., SCD),” Hill wrote.

She also noted earlier studies on similar topics, which suggest a reason for this outcome. “When people are more confident in their ability to cope with aging-related changes and expect to have better outcomes, they engage in behaviours that ultimately reinforce these expectations,” she said.

“Alternatively, individuals who attribute declines in physical, mental, or cognitive health to ‘normal aging’ (i.e., hold more negative aging stereotypes) may consequently have more negative aging expectations, engage in activities that align with these expectations, and ultimately experience poorer outcomes.”

She added: “It is important to note that the links between expectations regarding aging and aging-related outcomes are complex and develop over a lifetime of experience. Although most research to date has focused on the effect of expectations on health outcomes, evidence also demonstrates that aging expectations can change over time and be influenced by experiences of health and well-being.”

Speaking to the website Scitechdaily, Hill suggested her research could be useful in helping people as they age, regardless of decline.

“Do people’s perceptions of what they expect aging to be in the future … affect the way that they perceive their cognitive performance?” she said. “If it does, then that gives us more clues about how to interpret people’s reports of cognitive changes and, potentially, how to intervene earlier to support people to maximize their aging outcomes.”

“Older adults’ expectations regarding the aging process may influence how they perceive cognitive changes they experience,” Hill wrote , “whether these are viewed through a lens of age- or dementia-related stigma or negative aging stereotypes, and ultimately, whether and how they choose to report their experiences with memory or other cognitive problems. This holds important implications for efforts to improve earlier identification of cognitive decline since this often relies on patients disclosing symptoms.”

Hill plans to do more research into how beliefs about aging influence whether older adults report the cognitive changes they’re experiencing, and how healthcare providers engage patients in conversations about cognitive health.

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