Aging Is Associated With Better Mental Health

Fran Lowry

August 25, 2016

Like good wine and cheese, one's mental health improves with age, new research suggests.

In a study of more than 1000 adults, people in their senior years were found to be happier and more content with their lives than those in their 20s and 30s, despite their physical ailments.

The study was published in the August issue of the Journal of Clinical Psychiatry.

"Most people think that old age is all doom and gloom and that everything goes down, that physical health declines and the brain deteriorates and the people are depressed," senior author Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences and director of the Center on Healthy Aging at the University of California, San Diego, told Medscape Medical News.

"In reality, that is not the case. It does not apply to everybody, and in our study of aging adults, their improved sense of psychological well-being was linear and substantial. Participants reported that they felt better about themselves and their lives year upon year, decade after decade," Dr Jeste said.

Dr Dilip Jeste

Dr Jeste and his group examined trends in physical, cognitive, and mental health over the adult lifespan from cross-sectional data obtained from 1546 individuals aged 21 to 99 years living in San Diego County, California.

The sample was selected using random digit dialing for the Successful Aging Evaluation (SAGE) study, a structured multicohort investigation that included structured telephone interviews and in-home surveys of community-based adults without a known diagnosis of dementia.

"Most studies of aging advertise that they are going to do a study, and so people volunteer to take part. But that becomes a biased sample, because the participants volunteer because they are doing better. We wanted to avoid that, and so we did our sampling using the same method as the Gallup poll," Dr Jeste explained.

"This was a cross-sectional study, so we examined all of our subjects at one point in time. We asked them how they were feeling on a particular day, so this was a snapshot in time," he added.

The mean age of the participants was 66 years (standard deviation [SD] = 21), and 51% were men. Most (60%) of the sample had a Bachelor's degree, 20% completed 12 years or less of education, and 21% had a postgraduate education.

Most of the sample identified themselves as non-Latino Caucasian, 14% as Hispanic/Latino, 7% Asian-American, 1% African American, and 2% as other ethnic or racial backgrounds.

The analyses showed that although physical and cognitive function worsened with age, mental health steadily improved.

Mental health scores on the Happiness Subscale significantly improved with age (P < .001), as did scores on the reverse-coded Anxiety Scale (P < .001) and the Depression Scale (P < .001).

In addition, both the SF-36 mental health composite and the reverse-coded Perceived Stress Scale scores demonstrated inverted U-shaped effects, indicating that mental health distress peaks in younger adults and declines with age.

Overall, our findings support the existence of a paradox in which aging is associated with better mental health despite loss of physical and cognitive function. Dr Dilip Jeste

"Overall, our findings support the existence of a 'paradox' in which aging is associated with better mental health despite loss of physical and cognitive function," Dr Jeste said.

"In all of the things we looked at, their level of well-being, happiness, satisfaction with life, and also depression, anxiety, and perceived stress, in all six of these things, there was an improvement in mental health. It was the people in their 20s and 30s who had the most stress and the highest level of depressive and anxiety symptoms," he said.

"We see that the 20s and 30s are a period when you have lots of choices, but also worries about making the right decisions and fears of making the wrong decisions. But as you get older, you can look back and say, hey, I did okay. I think that stresses on younger people are much greater today than they were years ago. Their lives are much more stressful now," Dr Jeste said.

Older people also tend to become wiser with age, he noted.

"They learn not to sweat the little things, and a lot of previously big things become little. Also, a number of studies have shown that older individuals tend to be more skilled at emotional regulation and complex social decision-making. They also experience and retain fewer negative emotions and memories," he said.

Misconceptions About Aging

"I think one of the misconceptions that people have is that normal aging is associated with disability, loneliness, social isolation, and functional and cognitive decline," said Brent P. Forester, MD, director of the Geriatric Mood Disorders Program at McLean Hospital, Belmont, Massachusetts, when asked by Medscape Medical News to comment on the study.

"What this and other studies have shown is that there is a fair amount of resilience and wisdom in older adults, and those two key characteristics are highlighted in this study. These allow older adults to handle adversity better and function well despite perhaps having disabilities that would be impairing to others without those characteristics," Dr Forester said.

"There is a common bias about aging, which we call ageism, where people project their own feelings about what it might be like to be old or what they have experienced in their own families, where the older adults did not do well," he said.

Ageism then creates a mindset against trying to identify or treat problems, such as depression, that are highly treatable in older people, Dr Forester said.

"When we see depression in older adults, it's usually in the context of medical problems. The more medical comorbidity the person has, the more likely they are to have depression. It's partly a psychological reaction to being physically sick, but more than that, it's probably a biological relationship between their medical problems and what's going on in their brain that is causing them to feel this way," he said.

"By addressing some of the treatable mental health issues that do occur with aging, including depression and anxiety, we may not only be able to improve mood and functioning related to depression, we may also have a beneficial effect on physical outcomes," Dr Forester said.

The study was supported by the National Institute of Mental Health and the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego. Dr Jeste and Dr Forester report no relevant financial relationships.

J Clin Psychiatry. 2016;77:e1019-e1025. Abstract


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