A recent study published in Geriatrics debunks the assumption that an older chronological age results in an inevitable and universal decline in health. The researchers reported that a significant number of older adults who participated in the study experienced an improvement in cognitive and/or physical functioning [1].
Challenging the status quo
Older age is known as a time of decline in both physical and cognitive health. Surveys have found that the vast majority of the general population, as well as health professionals, wrongly believe that everyone will develop dementia or that, as they age, their cognitive abilities will decline [2]. Even the tools used by the World Health Organization (WHO) to measure later-life cognitive and physical health only show whether there is or isn’t a decline, without the option for improvement [3].
Beyond not considering improvement as a possible outcome, there is also another reason the health improvements at older ages are not widely reported: researchers most often use average values to represent trajectories, and people who experienced improvements, if they are in the minority, do not show up in the results. “What’s striking is that these gains disappear when you only look at averages,” said lead author Becca R. Levy, a professor of social and behavioral sciences at the Yale School of Public Health (YSPH). “If you average everyone together, you see decline. But when you look at individual trajectories, you uncover a very different story.” Additionally, if some individuals show visible improvements, they are often viewed as exceptions rather than as part of a broader pattern [2].
The overall results perpetuates the idea that chronological aging leads to inevitable decline. However, this study challenges that assumption and presents evidence that improvement is possible, even at an older age.
Beyond extraordinary people
To give examples in support of the possibility of late-age improved performance, the authors start their paper with examples of people who achieved their biggest life achievements in later life, such as Diana Nyad, who, despite earlier failed attempts, at the ripe age of 64, set a world record in the 110-mile swim from Cuba to Florida.
Such anecdotes may lead to a conclusion that only very special, gifted individuals can improve with age. Therefore, these researchers analyzed data from a nationally representative Health and Retirement Study (HRS) of participants aged 65 and older to investigate whether improvement is possible even for the average person and “whether positive age beliefs predicted this potential improvement”.
In this study, physical health was assessed in almost 5,000 participants using walking speed, and global performance measures of cognitive health were collected in over 11,000 participants using a test that covers a broad range of cognitive domains, including short-term memory, delayed recall, and mathematical skills. The measures were taken at the beginning of the study and during follow-ups up to 12 years.
The power of belief
When the researchers in this study analyzed the study participants as a single homogeneous group, they observed, on average, declines in cognitive function and walking speed. However, upon closer, more granular examination, the researchers reported that, when analyzing a smaller subset of participants (those who had measurements of both walking speed and cognition), over 45% showed improved levels of cognitive and/or physical functioning beyond baseline, with many showing improvement in both domains. When analyzed separately, almost 32% of participants improved their cognition, and 28% improved their walking speed. A similar pattern of results was seen even with more stringent criteria.
Improvement in cognitive and physical health was predicted by the study participants’ positive age-related beliefs, even after adjusting for various factors and when more stringent criteria were applied to the analysis. Positive age beliefs associated with improvements were observed not only in participants who had some deficits at the beginning of the study (and were recovering from them) but also among people who had normal levels of functioning and improved beyond those levels.
In line with these results are the results of a previous study from this group that showed an association between negative age-related beliefs and biomarkers of Alzheimer’s disease, such as plaque and tangle accumulation, as well as lower hippocampal volume [4]. However, future studies should examine whether such an association exists between positive age-related beliefs and biomarkers of improved brain functioning, such as neurogenesis.
These results also agree with the stereotype embodiment theory (SET). According to this theory, the internalization of beliefs about old age begins at a young age and comes from various environmental sources. Those beliefs, when an individual becomes older, not only apply to others but also to oneself and can be used to predict better or worse cognitive and physical health [5].
Contradicting common views
The results of this study “contradict a dominant belief about aging held by scientists, health care professionals, and the lay public that it is a time of inevitable and universal decline in functioning.” This study provides additional evidence in support of previous studies that show a similar pattern, all suggesting that geroscience studies should go beyond investigating the speed of decline and also consider the possibility of improvements [6-8].
“Many people equate aging with an inevitable and continuous loss of physical and cognitive abilities,” said Levy. “What we found is that improvement in later life is not rare, it’s common, and it should be included in our understanding of the aging process.”
“Our findings suggest there is often a reserve capacity for improvement in later life,” she said. “And because age beliefs are modifiable, this opens the door to interventions at both the individual and societal level.”
Literature
[1] Levy, B. R., & Slade, M. D. (2026). Aging Redefined: Cognitive and Physical Improvement with Positive Age Beliefs. Geriatrics, 11(2), 28.
[2] Mehegan, L., & Rainville, C. (2023). ADULTS’ UNDERSTANDING OF COGNITIVE DECLINE, DEMENTIA, AND ALZHEIMER’S DISEASE. Innovation in Aging, 7(Suppl 1), 130.
[3] World Health Organization. (2004). Integrated Care for Older People (ICOPE): Guidance for Person-Assessment and Pathways in Primary Care; World Health Organization: Geneva, Switzerland
[4] Levy, B. R., Ferrucci, L., Zonderman, A. B., Slade, M. D., Troncoso, J., & Resnick, S. M. (2016). A culture-brain link: Negative age stereotypes predict Alzheimer’s disease biomarkers. Psychology and aging, 31(1), 82–88.
[5] Levy B. (2009). Stereotype Embodiment: A Psychosocial Approach to Aging. Current directions in psychological science, 18(6), 332–336.
[6] Levy, B. R., Pilver, C., Chung, P. H., & Slade, M. D. (2014). Subliminal Strengthening: Improving Older Individuals’ Physical Function Over Time With an Implicit-Age-Stereotype Intervention: Improving Older Individuals’ Physical Function Over Time With an Implicit-Age-Stereotype Intervention. Psychological Science, 25(12), 2127-2135.
[7] Meisner B. A. (2012). A meta-analysis of positive and negative age stereotype priming effects on behavior among older adults. The journals of gerontology. Series B, Psychological sciences and social sciences, 67(1), 13–17.
[8] Westerhof, G. J., Nehrkorn-Bailey, A. M., Tseng, H.-Y., Brothers, A., Siebert, J. S., Wurm, S., Wahl, H.-W., & Diehl, M. (2023). Longitudinal effects of subjective aging on health and longevity: An updated meta-analysis. Psychology and Aging, 38(3), 147–166.
View the article at lifespan.io
