Can a positive view of aging lead to better cognitive performance?

Growing older brings certain expectations, from gray hair and wrinkles to more bouts of forgetfulness. While these beliefs may seem harmless, whether a person views these changes in a positive or negative light can affect how they perceive their cognitive abilities, according to a new study from researchers at Penn State College of Nursing.

The team found that people who had more positive expectations about aging were less likely to report cognitive problems, such as difficulty concentrating or keeping track of what they were doing. They were also less likely to report that their cognitive performance had declined over time.

The findings were published in the news Aging and mental health.

“Aging expectations are malleable and influence an individual’s perception of their cognitive functioning,” said Nikki Hill, associate professor at the Ross and Carol Nese College of Nursing at Penn State, who is the paper’s first author. “Adjusting aging expectations of older adults could support healthier cognitive aging through increased awareness and accurate assumptions about the aging process.”

Previous research has shown that expectations about aging, such as whether a person expects to maintain a high activity level or expect everything to go downhill, is linked to health. Those with more negative expectations about aging tend to experience worse outcomes, such as faster physical and cognitive decline, while positive perceptions of aging are linked to behaviors that promote health and well-being, such as exercise.

Hill is interested in understanding how older adults experience cognitive changes and how that influences outcomes related to aging. In her work, she said she has noticed that when people describe their experiences, they often include stereotypical and stigmatized views about aging and cognitive decline. It led Hill to wonder how people’s expectations about the aging process might influence how they interpret the cognitive changes they may experience—a relationship that few studies have explored.

“Do people’s perceptions of what they expect aging to be like in the future, in terms of physical health, mental health, cognitive health, affect the way they perceive their cognitive performance?” said Hill. “If so, that will give us more clues about how to interpret people’s reports of cognitive changes and, potentially, how we can intervene earlier to support people in maximizing their aging outcomes.”

For example, people who worry about perceived declines in their cognitive function — even if their cognitive health is normal — are at greater risk of developing cognitive impairment in the future, Hill explained. She said that in conditions such as Alzheimer’s disease and related dementias, there is a slow, gradual decline in cognitive function over decades and that people often experience subtle symptoms before clinical tests reveal a disturbance in cognition .

The research team conducted an online survey of individuals aged 65 and older in the United States who lived independently and did not report any diagnosis of dementia or other cognitive disorders. A total of 581 people completed the survey; 51% of respondents were female and 74% were non-Hispanic white.

The survey asked about their expectations about physical health, mental health and cognitive functioning in relation to aging. They were asked to rate statements (for example, “Every year that people get older, their energy levels drop a little more”) on a four-point scale from “absolutely true” to “absolutely false.” To assess their perception of their own cognition, participants were asked about their cognitive skills over the past seven days. They were also asked about their ability to perform certain tasks today, compared to a decade ago, to assess whether they thought their cognitive skills had declined.

The team found that people with more positive expectations about aging tended to rate their cognitive function better and report less perceived decline in their cognitive skills, both in the past week and in the past decade. On the other hand, more negative expectations about aging were linked to more negative perceptions of their current cognitive performance and whether they were experiencing cognitive decline.

The researchers also found that there was not much difference between participants’ expectations about their physical, mental or cognitive health and how they perceived their cognition. People with positive expectations about aging in any of the three domains were more likely to rate their cognition higher, while people with negative expectations rated their cognition lower.

“If we can intervene in a way to make expectations of aging more based on what is true and less stigmatized, then we may be able to help people articulate what they are experiencing in terms of cognitive changes, which will support our ability to respond to individual needs to maximize cognitive health,” Hill said.

Hill said the team plans to conduct more research to understand this complex relationship, such as how beliefs about aging influence whether older adults report the cognitive change they experience and how health care providers engage patients in conversations about cognitive health.

Other authors on the paper include Renata Komalasari, postdoctoral researcher at the Ross and Carol Nese College of Nursing at Penn State; Sakshi Bhargava and Emily Bratlee-Whitaker of RTI Health Solutions; Justin Do, Sidney Kimmel Medical College, Thomas Jefferson University; Monique Brown, associate professor, Arnold School of Public Health, University of South Carolina; Rachel Wu, associate professor of psychology, University of California, Riverside; and Jacqueline Mogle, associate professor of psychology, Clemson University.