Whether it is cause or effect is unclear, but high morale seems to go along with a longer life, according to a new Scandinavian study.
Among people 85 years and older, those who felt optimistic about life and had something to look forward to lived five years longer on average than their more pessimistic counterparts.
"As patients get older, their whole physical and social world gets smaller and I think that leads to fewer things they are looking forward to," said Dr. Sei Lee, a geriatrician and researcher at the University of California, San Francisco, who was not involved in the study.
"Hopefully it's empowering to patients to say, as we grow older, there may be less control over our bodies and selves, but we still have control over our outlook and that actually may have a profound effect on our mortality," Lee told Reuters Health.
Among adults in Sweden and Finland who participated in the study, all at least 85 years old, those who were most pessimistic had nearly twice the risk of dying in the next five years, compared to those who were the most optimistic. That was true even after researchers accounted for age, health and other factors.
Dr. John Niklasson, a consulting geriatrician at Umeå University in Sweden and lead author of the study online March 15 in Age and Ageing said he was intrigued by the morale difference he had seen in elderly patients and wondered if boosting their spirits might prolong their lives.
"One day a few years ago I did medical rounds and I met an old lady, who told me, 'Doc, I don't have any reason to live,'" Niklasson told Reuters Health in an email. "She didn't say this as part of a suicidal depression, more like a dry statement," he explained.
"A bit later the same morning, I met another woman of just about the same age, with about the same amount of disease and other burdens . . . she said, 'I don't have time to stay in the hospital, I have to go home today, I have so much to do.'"
Niklasson and coauthors defined high morale as "future-oriented optimism regarding the problems and opportunities associated with living and ageing" and used a morale scale designed for the elderly to find out if such an outlook might promote survival.
Previous research has found that people with higher morale feel better. But the authors wanted to test the theory on the very old.
They followed 646 people with an average age of 89, who lived in Northern Sweden and Western Finland, 30 per cent in nursing homes. In 2000 to 2002, and again in 2005 to 2007, the participants answered 17 questions by phone or in person about their levels of agitation, loneliness and dissatisfaction with aging. The researchers also analysed data from population registries to track illnesses and deaths.
In the first round of interviews, 302 people showed high morale, 203 fell into the moderate morale category and 141 showed low morale.
The elderly participants with high morale tended to be slightly younger than those who were more pessimistic and to use fewer medications. They were also less likely to live in an institution or alone, or to be socially isolated or malnourished than those with low or moderate morale.
The people with high morale were also more functional, had fewer diseases and had better vision than their pessimistic counterparts.
At the five-year follow-up, 56 per cent of the high morale group was still alive, compared to 32 per cent of the low morale group and 39 per cent of the moderate morale group. Those with higher morale were more likely to survive even after researchers accounted for age, gender, impaired vision and hearing, daily functioning and other health factors.
The researchers acknowledge that one quarter of the seniors eligible to participate in the study did not respond to questionnaires, and many of them were sicker, with a high proportion of dementia, than the study group. So the results may not generalize to all elderly people.
The study also did not measure personality traits, which are among many factors that might affect morale as one ages.
Still, the results imply that "if low and moderate levels of morale could be improved by appropriate intervention, it would not only improve well-being but it might also increase survival," Niklasson and colleagues conclude.
"It seems to me that getting your basic needs met is not enough," Niklasson told Reuters Health in an email. "So to boost morale, other things are probably important as well: having someone to talk to, having a partner, eating good food and drink, doing things you enjoy doing and symptom relief from diseases.
"My theory here is simply that if you lead a life you want to live, you would want to continue to live it," Niklasson said.
Lee said he was also struck by how many people in the study were depressed (62 per cent), noting that the mood disorder is very common in older adults but often hard to detect.
"Depression just has to be very high on our list of underlying things that might be going on in (older) adults," said Lee.