Longevity Increased by Positive Self-Perceptions of Aging

ATTITUDES AND SOCIAL COGNITION

Becca R. Levy and Martin D. Slade

Yale University

Suzanne R. Kunkel

Miami University

Stanislav V. Kasl

Yale University

This research found that older individuals with more positive self-perceptions of aging, measured up

to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. This

advantage remained after age, gender, socioeconomic status, loneliness, and functional health were

included as covariates. It was also found that this effect is partially mediated by will to live. The sample

consisted of 660 individuals aged 50 and older who participated in a community-based survey, the Ohio

Longitudinal Study of Aging and Retirement (OLSAR). By matching the OLSAR to mortality data

recently obtained from the National Death Index, the authors were able to conduct survival analyses. The

findings suggest that the self-perceptions of stigmatized groups can influence longevity.

There has been a proliferation of studies in the last 6 years

showing the effects of race and gender self-stereotypes on behav-

ior and function (e.g., Leyens, Desert, Croizet, & Darcis, 2000;

Steele & Aronson, 1995; Stone, Lynch, Sjomeling, & Darley,

1999). Most of these studies have explained their findings by

referring to stereotype threat (Wheeler & Petty, 2001). Essentially,

this theory states that members of stigmatized groups “experience

stereotype threat when they are in situations in which other people

may view them stereotypically in ways likely to increase perfor-

mance pressures” (Blasovich, Spencer, Quinn, & Steele, 2001, p.

225). According to the theory, “susceptibility to stereotype threat

lies not in the internalization of the stereotype, but in caring about

the domains to which it might prove to be a frustration” (Crocker,

Major, & Steele, 1998, p. 519).

Self-stereotypes of aging, or older individuals’ beliefs about old

people as a category, do not appear to fit into the stereotype-threat

framework. The underlying reason is that self-stereotypes of aging

seem to develop and operate through internalization. We believe

older individuals’ internalized age stereotypes contribute to the

formation of their self-perceptions of aging, which, in turn, can

have a physiological outcome. In this study, we partially address

this model by examining whether self-perceptions of aging influ-

ence survival.

Unlike race and gender stereotypes, which individuals encounter

while developing group self-identities, individuals acquire age

stereotypes several decades before becoming old. Thus, younger

individuals are likely to automatically accept age stereotypes with-

out questioning their validity (Nelson, 2002; Perdue & Gurtman,

1990). When individuals reach old age and the stereotypes become

self-relevant, they have already internalized these stereotypes

(Giles, Fox, & Smith, 1993; Levy & Langer, 1994).

Once individuals become older, they may lack the defenses of

other groups to ward off the impact of negative stereotypes on

self-perceptions. For example, African Americans are potentially

able to defend themselves against stereotype threat by disengaging

from the academic domain (Steele & Aronson, 1995). This with-

drawal is facilitated by the stipulation that stereotype threat arises

in specific situations, under specific conditions, when one is en-

gaging in specific tasks (e.g., Steele & Aronson, 1995).

An equivalent disengagement is less likely to be an option for

older individuals because the central themes of self-stereotypes of

aging are health and function or their absence, which promotes a

diffusiveness that transcends domains (Levy, Hausdorff, Hencke,

& Wei, 2000). The all-encompassing nature of self-stereotypes of

aging may not lend itself to disengagement for older individuals in

the same way as, for instance, academic stereotypes do for African

Becca R. Levy, Martin D. Slade, and Stanislav V. Kasl, Department of

Epidemiology and Public Health, Yale University; Suzanne R. Kunkel,

Scripps Gerontology Center, Miami University.

Martin D. Slade is now at the Department of Biostatistics, Harvard

University.

This research was generously supported by a fellowship from the

Brookdale Foundation and by a National Institute on Aging grant

(AG05727) to Becca R. Levy. We thank Heiner Maier for his helpful

comments.

Correspondence concerning this article should be addressed to Becca R.

Levy, Department of Epidemiology and Public Health, Yale University,

P.O. Box 208034, 60 College Street, New Haven, Connecticut 06520-

8034. E-mail: [email protected]

Journal of Personality and Social Psychology, 2002, Vol. 83, No. 2, 261–270

261

Americans or employment stereotypes do for women. The diffu-

siveness of age stereotypes can be seen in a series of laboratory

studies demonstrating that the same sets of positive and negative

primes, typified by wise versus senile, can lead to enhancement or

decline, respectively, in a wide array of cognitive and behavioral

outcomes, including memory performance, handwriting, self-

efficacy, mathematical performance, and views of other older

people (Levy, 1996; Levy et al., 2000).

The depth and breadth of self-stereotypes of aging may be

explained by their focus on cognitive and physical decline, which

conveys a sense of the ultimate outcome: death (Becker, 1980;

Levy et al., 1999–2000). This outcome does not facilitate com-

partmentalization into a domain: “The knowledge of the inevita-

bility of death is the underlying sense from which all other fears

are ultimately derived” (McCoy, Pyszczynski, Solomon, & Green-

berg, 2000, p. 37).

A second self-protective strategy practiced by other stigmatized

groups that may be less accessible for older individuals is egali-

tarian thinking. Controlled personal beliefs are capable of inhibit-

ing the earlier-developed negative stereotypes toward women and

African Americans by asserting later-acquired egalitarianism (De-

vine, 1989; Devine & Monteith, 1999). However, egalitarianism,

as promoted by the women’s, civil rights, and political correctness

movements, does not exist to the same degree in relation to age

stereotypes as it does for gender and race stereotypes (Levy &

Banaji, 2002). There is, then, a greater likelihood that younger

individuals will accept negative stereotypes about aging as true

and that this will continue to occur when the individuals become

older and the stereotypes become self-stereotypes. This acceptance

diminishes the prospect for defending self-perceptions against

negative age stereotypes.

There are two additional indications that aging self-stereotypes

are internalized. First, research suggests that self-stereotypes of

aging can operate without older individuals’ awareness. This is in

contrast to the noninternalization that characterizes stereotype

threat and is reflected in its reliance on awareness at critical stages:

recognition that a stereotype may be applied to oneself in a

particular situation and that one may then act in accordance with it

(e.g., Crocker et al., 1998).

The series of laboratory studies that achieved cognitive and

physical changes in older participants did so by flashing aging

stereotype primes on a screen at a speed that was below the

threshold of awareness (see Levy, 1996, for a more detailed

description of the procedure). In one of the studies, older individ-

uals who were first exposed to subliminal negative age stereotype

primes and then to cognitive challenges showed a significantly

heightened cardiovascular response, compared with those exposed

to subliminal positive age stereotypes and the same challenges. Yet

the two groups of older individuals did not differ in how stressful

they rated the challenges to be (Levy et al., 2000). There was, then,

unawareness not only of the stereotype primes but also of their

physiological impact.

Another study showed that the same subliminal priming of age

stereotypes can influence a behavior that is thought to operate

largely without awareness: handwriting (Allport & Vernon, 1933;

Wolff, 1948). A panel of judges who did not know the age and

priming group of the older participants described handwriting

samples from the negatively primed group as significantly deteri-

orated, compared with baseline, whereas those participants who

received positive primes were rated as significantly more accom-

plished (Levy, 2000).

A further indication that self-stereotypes of aging are internal-

ized is that older individuals tend to hold feelings toward their own

group that are as negative as the feelings held about it by those

outside their group—the young (Nosek, Banaji, & Greenwald,

2002). Similarly, older individuals are more likely to oppose

programs that benefit the aged than are younger individuals (Levy

& Shlesinger, 2001; Shlesinger & Kronebusch, 1994). This con-

trasts with the in-group preference of other stigmatized groups

(Levy & Banaji, 2002). For instance, Asians and African Ameri-

cans, in spite of acknowledging that they are perceived in negative

terms, tend to hold as positive views toward their respective groups

as Whites do toward their own group (Crocker et al., 1998).

Although the writings of the Symbolic Interactionists are re-

garded as inconsistent with stereotype-threat theory (Crocker et al.,

1998), these writings help to explain the process by which self-

stereotypes of aging are internalized and affect self-perceptions of

aging. These scholars, including Charles Horton Cooley and

George Herbert Mead, conceptualized the self as a product of

societal beliefs conveyed through social interaction (Cooley, 1902;

Mead, 1934). Such beliefs are likely to include both the positive

and the negative age stereotypes that exist in American culture

(Brewer, Dull, & Lui, 1981; Hummert, 1999) rather than only the

negative stereotypes that are addressed by stereotype threat (e.g.,

Steele & Aronson, 1995). Studies of older individuals have found

a correspondence between self-stereotypes and self-perceptions

(Imamoglu, Kueller, Imamoglu, & Kueller, 1993; Levy, 1999).

The preponderance of negative aging stereotypes in society does

not guarantee a preponderance of internalized negative aging ste-

reotypes, nor of eventual negative aging self-perceptions. Within

the elderly category, subgroups may have different exposures to

aging stereotypes. As an example, older Deaf individuals report

more positive attitudes toward aging than do older individuals who

are not hearing impaired (Levy & Langer, 1994). Older members

of the Deaf community tend to participate in intergenerational

activities, in which they are given equal or higher status, to a

greater extent than do older hearing individuals (Becker, 1980);

this type of intergenerational contact may be a source of insulation

from mainstream negative stereotypes.

Further, among those who are exposed to the same stereotypes

within the same subgroups, there is variability in what is internal-

ized. For instance, older role models can provide young individ-

uals with a countervailing force against negative stereotypes of

aging (Palmore, 1998). In addition, personality differences may

affect receptivity to stereotypes (Allport, 1954).

Link Between Self-Perception of Aging and Longevity

Most of the research on self-stereotypes and self-perceptions

referred to here has been confined to the laboratory, which un-

avoidably imposes limitations. There is no way of knowing

whether the stimuli and paradigms authentically represent how

self-stereotypes and self-perceptions operate in the real world and

over time. In the present research, we partially address these

limitations by examining, in the community, the impact of aging

self-perceptions on a long-term outcome: longevity.

The lengthening of the average American life span by 27 years

over the last century has provoked considerable research on the

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LEVY, SLADE, KUNKEL, AND KASL

determinants of longevity (e.g., Perls & Silver, 1999; Rogers,

Hummer, & Nam, 2000). Much of this research has focused on

genes (e.g., Pletcher, Houle, & Curtsinger, 1999; Rogina, Reenan,

Nilsen, & Helfand, 2000). Yet as much as 75% of longevity may

be due to nongenetic attributes, including psychological and be-

havioral factors (Vaupel et al., 1998). In addition, most of the

research on predictors of survival has focused on negative factors

(e.g., disease, injury, and cognitive decline; Stroebe, 2000). Rela-

tively few studies have examined positive factors, such as benefi-

cial beliefs, that might affect survival. The following study exam-

ines for the first time whether positive self-perceptions about one’s

aging influence survival, controlling for functional health and

other relevant factors.

We have located only one other study that considered the link

between views of aging and survival. In the Berlin Aging Study,

researchers examined the association between 17 indicators of

psychological functioning and mortality during 7 years in a sample

that was 70 years or older (Maier & Smith, 1999). The authors did

not expect views of aging to emerge as a significant predictor. Yet,

after systematically inspecting the variables, they found that one of

the best predictors of mortality was the Attitude Toward Own

Aging subscale of the Philadelphia Geriatric Center Morale Scale

(PGCMS; Lawton, 1975; Liang & Bollen, 1983), controlling for

age, socioeconomic status, life satisfaction, self-rated health, num-

ber of illnesses, and cognition. Partially because of the lack of a

functional health variable in their analyses, the authors concluded

that the negative beliefs about aging are “probably not the cause

for an increased mortality risk, but they may reflect potential

causes from other domains of functioning” (Maier & Smith, 1999,

p. 51). By contrast, our study, which includes functional health as

a covariate, is designed to explore the possibility that self-

perceptions of aging directly affect survival.

Overview

In the following two studies, we examine whether self-

perceptions of aging influence longevity and how this process

might occur. We conducted our analyses by matching data from

the Ohio Longitudinal Study of Aging and Retirement (OLSAR)

with data from the National Death Index (NDI).

The OLSAR serves our research aims because it (a) contains

items at baseline that measured self-perceptions of aging; (b)

allows us to chart the course of survival over a 22.6-year period;

threshold of aging, thus allowing us to explore the reach of aging

self-perceptions; and (d) contains survey waves, collected after

baseline, that allow us to examine a psychological mechanism by

which aging self-perceptions might influence longevity.

Study 1

In the first study, after controlling for relevant factors, we

examined the hypothesis that those with more positive aging

self-perceptions at baseline will live longer.

Method

Participants

In 1975, Robert Atchley and his colleagues at Miami University re-

cruited participants for the OLSAR in Oxford, Ohio. Because of the small

size of the town (a population of approximately 15,000), the investigators

were able to contact virtually all individuals who met the participation

criteria of being (a) cognitively intact, (b) age 50 or over by July 1, 1975,

and (c) a community resident. The investigators compiled the list of

potential participants by starting with the voter registration records and

then using a variety of other techniques, including a postcard census of all

mailing addresses in the community, a review of welfare rolls, and com-

munity informants. The efforts to recruit all eligible individuals in the town

maximized the heterogeneity of the sample characteristics as well as the

variability in beliefs about aging. The study team identified a total of 1,461

eligible individuals, of whom 1,157 participated.

We added two criteria for inclusion of participants in the analyses. They

had to (a) meet the vital-status protocol (included in the Measures section,

within the description of the survival variable) and (b) provide complete

data for the variables analyzed in the study. We excluded 139 participants

because they did not meet the vital-status protocol and another 358 par-

ticipants because they were missing data for at least one of the variables.

A total of 660 participants met these additional inclusion criteria.

The final cohort comprised 338 men and 322 women. Their age at

baseline ranged from 50 to 94 years (M ⫽ 63.00 years, SD ⫽ 9.23). Their

mean score on the Health Scale for the Aged (Rosow & Breslau, 1966)

was 4.84 (the items for this scale are listed under Covariates in the

Measures section). Scores on the Health Score for the Aged ranged from 0

to 6, with a higher score reflecting better health. The participants’ average

socioeconomic status, as measured by the Two-Factor Index of Social

Position (Hollingshead, 1965), was 32.49, which indicates that participants

tended to be middle class. Scores on this scale ranged from 11, indicating

the highest socioeconomic status, to 77, indicating the lowest socioeco-

nomic status.

The final cohort of 660 participants did not differ from the excluded

participants in age, socioeconomic status, or functional health. However,

the final cohort significantly differed by gender and race. In the total

sample of individuals recruited, 42.7% were male, as opposed to 51.2% in

the final cohort. Also, in the total sample of individuals recruited, 4.6%

were Black or “other,” whereas 2.5% described themselves as Black or

“other” in the final cohort.

Measures

Independent variable: Self-perceptions of aging. For our self-

perceptions of aging measure, we used the Attitudes Toward Own Aging

subscale that Liang and Bollen (1983) based on five items from the

PGCMS (Lawton, 1975). This subscale consists of the following items:

“Things keep getting worse as I get older,”“I have as much pep as I did

last year,”“As you get older, you are less useful,”“I am as happy now as

I was when I was younger,” and “As I get older, things are (better, worse,

or the same) as [sic] I thought they would be.”

Participants responded to the first four items with a “no,” scored as 0, or

“yes,” scored as 1. The first and third items were reverse scored to make

all the items measure a positive aging self-perception. As indicated, par-

ticipants responded to the fifth item by selecting either “better,”“worse,”

or “the same.” To make the fifth item comparable to the other four items,

we changed it to a dichotomous variable and combined “the same” re-

sponses with “worse” responses (in analyses presented in the Results

section, we verified that combining “the same” responses with “better”

responses did not change the impact of the independent variable on

survival). Participants received a total score ranging from 0 to 5, with a

higher score indicating a more positive aging self-perception.

Several researchers found that these five items loaded highly on a single

factor in different data sets (Liang & Bollen, 1983; Mancini, Shade, &

Quinn, 1995; McCulloch, 1991). We conducted a factor analysis to check

that the items also loaded on one factor in the OLSAR. Indeed, when we

conducted a factor analysis with all the PGCMS items, the five items

loaded on a single factor with all factor loadings greater than .40, thus

meeting the definition of meaningful loadings (Hatcher, 1994). These five

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LONGEVITY FROM POSITIVE SELF-PERCEPTIONS

PGCMS items had not previously been examined as a subscale in the

OLSAR.

Outcome: Survival. Our outcome variable is survival. This is the first

study to match the OLSAR with mortality data, which we obtained from

the NDI.

For the analyses, we used the number of days participants survived after

the baseline interview. The survival variable ranged from the baseline

survey in 1975 to January 1, 1998, the cut-off date for mortality data

available from the NDI. To determine whether and when participants had

died, we developed a vital-status protocol on the basis of information

provided by the NDI, which included possible matches of deceased indi-

viduals on three variables: first and last name; date of birth; and state in

which death occurred, as most of the cohort did not move out of Ohio

before death. To be considered dead, participants needed to match on all

three criteria (264, or 43%, of the participants coded as dead were in this

group) or match on two of the three criteria and have confirmation by an

obituary and/or an informant (355, or 57%, of the participants coded as

dead were in this group). If the OLSAR participants only matched the NDI

data by date of birth and state in which death occurred, to be considered

dead they also had to match on first name (some of the participants

changed their last name with marriage or divorce).

To be considered alive, participants were (a) confirmed to be living

through January 1, 1998, by the participants themselves; (b) confirmed to

be living through January 1, 1998, by an informant and had no matches

provided by the NDI (368, or 92%, of the participants coded as alive were

in either this group or the first group); or (c) had one match provided by the

NDI but also sent in a survey response after the NDI date of death (31, or

8%, of the participants coded as alive were in this group).

Covariates. The covariates for this study include the following mea-

sures assessed at baseline: age; gender; race, as categorized by either White

or Black or “other”; and socioeconomic status (Hollingshead, 1965), which

takes into account participants’ years of education and occupational status.

Baseline functional health was also included as a covariate. It was

assessed by Rosow and Breslau’s (1966) six-item Health Scale for the

Aged. Participants were asked,

Which of the following things are you physically able to do? (Place a

check by each of the things you can do): 1. heavy work around the

house (shoveling snow, washing walls, etc.); 2. work at a full time

job; 3. ordinary work around the house; 4. walk half a mile; 5. go out

to a movie, to church, to a meeting or to visit friends or relatives; 6.

walk up and down stairs.

Each check was scored as a 1. Thus, the scores ranged from 0 to 6, with

a lower score indicating lower functional health. We analyzed this measure

as an ordinal variable. Others have found that the Health Scale for the Aged

strongly correlates with observed physical performance measures (Alex-

ander et al., 2000).

In addition, we included two covariates that could be alternative expla-

nations for self-perceptions of aging influencing survival: self-rated health

and loneliness. There is considerable evidence that self-rated health influ-

ences survival (Idler & Kasl, 1992; Idler, Russell, & Davis, 2000). It has

been shown that loneliness predicts survival and tends to correlate with

another predictor of survival: depression (for which there was no OLSAR

measure; Cacioppo et al., 2000; Danner, Snowdon, & Friesen, 2001; Dill

& Anderson, 1999). By adding self-rated health and loneliness as covari-

ates, we tried to make sure that self-perceptions of aging is a new explan-

atory variable and not just another way to measure more established

variables.

We measured self-rated health by the item “Is your health improving,

declining or remaining about the same?” Loneliness was measured by the

PGCMS item “How much do you feel lonely?” with not much scored as 1

and a lot scored as 2 (Lawton, 1975).

Statistical Analyses

To examine whether more positive aging self-perceptions at baseline

lead to greater longevity after relevant factors are controlled for, we used

univariate and multivariate Cox proportional-hazards regression models.

The regression models used days since baseline interview as the time scale.

The analyses were conducted in stages. First, we conducted two Kaplan–

Meier survival curves: one with each value of the self-perception of aging

measure examined separately, and one with the participants dichotomized

into those below and those equal to or above the self-perception of aging

mean of 3.67 (see Figure 1).

Figure 1. Influence of positive self-perceptions of aging (PSPA) on survival. Arrow indicates median survival.

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LEVY, SLADE, KUNKEL, AND KASL

Next, we conducted several tests of the assumptions for proportional

hazards, such as visual inspection of log-log survival curves and inclusion

of a Self-Perception of Aging ⫻ Log (Time) interaction term in the model.

For all of these tests as well as all additional analyses reported, the

self-perceptions of aging measure was analyzed as a continuous variable.

These tests indicated that the assumptions for proportional hazards were

met by the data.

Then, after analyzing the self-perceptions of aging risk ratio using a

univariate Cox proportional-hazards regression model, we added the fol-

lowing potential covariates to our model: age at baseline, race, gender,

socioeconomic status, functional health, self-rated health, and loneliness.

Using a backward-elimination strategy, we reduced covariates to those

significant at .05. Before eliminating nonsignificant covariates, we checked

that their removal did not produce a meaningful change (greater than 1%)

in the self-perceptions of aging hazard ratio. The final multivariate model

therefore contained only those control variables that significantly predicted

survival and/or confounded the relationship between self-perceptions and

survival (see Table 1). Accordingly, race and self-rated health were

eliminated.

Results

The results support the hypothesis of Study 1: Those with more

positive aging self-perceptions at baseline live longer, after rele-

vant factors are controlled for.

In the initial analysis, before the covariates were added, those

with more positive self-perceptions of aging scores survived sig-

nificantly longer than did those with more negative self-

perceptions of aging scores. When we conducted a Kaplan–Meier

survival analysis with self-perceptions of aging as a dichotomous

variable, we found that the median survival of those in the more

positive self-perceptions of aging group was 7.6 years longer than

the median survival of those in the more negative aging self-

stereotype group (see Figure 1). That is, the median survival for

the more positive self-perceptions group was 22.6 years past

baseline, whereas the median survival for those in the more neg-

ative self-perceptions group was 15 years. Using the nonparamet-

ric log-rank test, we found that the two groups were significantly

different (p ⬍ .001). When we conducted a Cox proportional-

hazards regression model with self-perceptions of aging as a

continuous variable, each one-point increase in self-perceptions of

aging showed a consistent increase in survival.

The influence of sequentially adding covariates to the model on

the positive self-perceptions of aging survival risk ratio is pre-

sented in Table 1. The final survival model, with all the covariates

added, is presented in the extreme right column.

When the self-perceptions of aging score acted as a predictor,

the survival risk ratio remained significant after we sequentially

adjusted for covariates. The risk ratio of .87 (p ⬍ .001) suggests

that positive self-perceptions of aging reduce the risk of mortality.

For each change of one point in the positive self-perception of

aging measure, the risk of dying decreased by 13%. When we ran

the model with the PGCMS item “As I get older, things are (better,

worse, or the same) as [sic] I thought they would be” recalculated

so that “the same” was combined with “better” rather than with

“worse,” a similar result emerged: The risk ratio of positive self-

perceptions on survival became .89 (p ⬍ .004).

Ordered from greatest to least impact on survival, the variables

were in the following sequence: age, self-perceptions of aging,

gender, loneliness, functional health, and socioeconomic status.

We determined this by multiplying each variable’s coefficient by

the mean of the variable and then taking the absolute value.

Visual inspection of the data revealed that the trend of more

positive aging self-perceptions leading to greater longevity con-

sistently appeared when we repeated this analysis six times after

stratifying by age, gender, socioeconomic status, functional health,

and loneliness. That is, we divided the participants into two sets of

age groups (less than 60 years old or 60 years old and over, and

less than 70 years old or 70 years old and over), two gender

groups, two health groups (those below and those equal to or

greater than the functional health mean of 4.84), two socioeco-

nomic status groups (those below and those equal to or greater than

the socioeconomic status mean of 32.49), and groups of those who

reported they felt lonely and those who reported they did not. In all

the analyses, those with more positive self-perceptions of aging

outlived those with more negative self-perceptions of aging.

We were able to establish that the influence of self-perceptions

of aging on survival was a larger effect than the total PGCMS from

which the self-perceptions of aging measure’s items were taken.

We did this by conducting three additional survival analyses with

the PGCMS items. First, we modeled survival as a function of the

total PGCMS score, controlling for age, functional health, gender,

and socioeconomic status. The hazard ratio was .97 (p ⫽ .06; 95%

confidence interval [CI] ⫽ .94–1.00). The same analysis (see

Table 1), using the self-perceptions of aging measure, significantly

predicted survival ( p ⬍ .001). In addition, the sum of the PGCMS

items, excluding the five used for the self-perceptions of aging

measure, did not significantly predict survival when we controlled

for age, functional health, gender, and socioeconomic status (p ⫽

.38). Third, we found that self-perceptions of aging still signifi-

Table 1

Relationship Between Positive Self-Perceptions of Aging (PSPA) and Survival

Risk ratio

for

PSPA alone

Risk ratio for PSPA adjusted for:

Age Age, sex Age, sex, SES

Age, sex, SES,

functional health

Final model:

Age, sex, SES,

functional health,

loneliness

.78 .90 .88 .88 .90 .87

(0.74–0.83) (0.84–0.95) (0.83–0.94) (0.82–0.94) (0.84–0.97) (0.80–0.94)

p ⬍ .001 p ⬍ .001 p ⬍ .001 p ⬍ .001 p ⬍ .006 p ⬍ .001

Note. Confidence intervals appear in parentheses. SES ⫽ socioeconomic status.

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LONGEVITY FROM POSITIVE SELF-PERCEPTIONS

cantly predicted survival (hazards ratio ⫽ .88, p ⫽ .008; 95% CI ⫽

.81–.97) after we controlled for the sum of the PGCMS items,

excluding the five used for the self-perceptions of aging measure,

as well as age, functional health, gender, and socioeconomic

status.

Discussion

The findings from Study 1 suggest that self-perceptions of aging

have an impact on survival—when age, functional health, gender,

and socioeconomic status are controlled for—that is greater than

the impact of some other variables that have been previously

linked to survival, including gender, socioeconomic status, func-

tional health, and loneliness. A primary question that arises from

these findings is, By what mechanism do self-perceptions influ-

ence survival? In the following study, we explore whether will to

live acts as an intervening variable.

Study 2

Our finding in Study 1, that a social–psychological variable

directly influences survival, raises the question of whether an

additional psychological mechanism might act as a mediator. On

the basis of our prior research and the research of others, we

predicted that if self-perceptions of aging affect survival, the

underlying mechanism would be, in part, through will to live (Idler

& Kasl, 1992; Levy et al., 1999–2000; Phillips & Smith, 1990;

Sinard, 2001). We define will to live as a judgment that the

perceived benefits of one’s life outweigh the perceived hardships.

One of the reasons we predicted will to live may act as a

mediator between self-perceptions of aging and survival is that

among the views of aging that are internalized from a young age

are beliefs about the inverse relationship between the value and the

length of older persons’ lives. These beliefs are reinforced

throughout a lifetime, particularly in old age. A parody of one way

these messages may be transmitted to older individuals can be

found in a cartoon depicting a doctor telling an older patient, “It

appears that you’ll definitely outlive your usefulness” (Cullum,

2001).

In a previous study, we found that views of aging can affect

older individuals’ reported will to live. When we subliminally

exposed older individuals to negative stereotypes of aging, they

were significantly more likely to reject life-prolonging medical

treatment in hypothetical scenarios, whereas those in the positive

stereotype group were significantly more likely to accept life-

prolonging medical treatments (Levy et al., 1999–2000). As pre-

dicted, this effect did not appear in the young, for whom the age

stereotypes and the outcome of will to live were not as relevant.

This age stereotype effect occurred regardless of the financial or

familial burden associated with the hypothetical medical treat-

ments (Levy et al., 1999–2000). These findings suggest that the

positive stereotypes of aging primes tilted the will-to-live balance

toward the perceived benefits of life, whereas the negative stereo-

types tilted the balance toward the perceived hardships of life.

Although we did not measure self-perceptions of aging in the

previous study, the connection between age stereotypes and will to

live suggested to us that will to live might act as mediator between

aging self-perceptions and survival.

A number of studies have generated a pattern of findings that

suggest that will to live affects survival. Although the investigators

of these studies did not directly measure will to live, this concept

is often implied. One set of studies has demonstrated that the

timing of deaths is affected by holidays. Chinese American women

are more likely to die during the week after the Harvest Moon

Festival, a holiday in which they play a prominent role, rather than

during the week before it (Phillips & Smith, 1990). Jewish men are

more likely to die immediately after than right before Passover, an

8-day holiday in which they traditionally have greater psycholog-

ical and ritual involvement than do Jewish women, for whom no

such mortality effect emerged (Idler & Kasl, 1992; Phillips &

King, 1988). Among Christians, both men and women are more

likely to die in the month following Christmas and Easter than in

the month before these holidays (Idler & Kasl, 1992).

The relationship between significant holidays and survival is not

limited to specific ethnic or religious groups. For example, one

study found a sharp increase of deaths in the month after the

much-anticipated January 1, 2000 (Sinard, 2001). The author con-

cluded that because “a likely contributing factor was desire of

patients to live into the next century...these data suggest a role

for the patient’s state of mind in postponing his or her own

outcome” (Sinard, 2001, p. 1707).

These studies suggest that the anticipation of holidays and the

holidays themselves provide a perceived benefit that is transient

insofar as it ends when the holidays do; at that point, the perceived

hardships of life become more salient than the perceived benefits.

The outcome appears to reflect a shift from will to live to what

might be called will to die. Will to die occurs when the perceived

hardships of one’s life outweigh the perceived benefits. A study of

over 1.5 million Finnish married persons, aged 35 to 84, found that

mortality is higher than normal in the first 6 months after the death

of a spouse (Martickainen & Valkonenen, 1996). The authors

attributed the finding to “an overall weakening of a persons’ ability

to resist and cope with disease” (p. 1092).

The capacity to cope with a newly imposed perceived hardship

is perhaps due to the reservoir of preexisting perceived benefits

that carry over to the new challenge. A related phenomenon was

conceptualized by Ryff and Singer (1998) as the life of purpose, or

fulfilled life, that helps individuals cope with trauma.

We were able to examine whether will to live partially mediates

the relationship between self-perceptions of aging and survival

because the OLSAR included follow-up survey waves containing

variables that we believe measure our hypothetical mediator, will

to live.

Method

Although the analyses share with Study 1 the predictor variable (self-

perceptions of aging, measured at baseline) and the outcome variable

(survival), we added our predicted mediator, will to live.

Our will-to-live measure was developed from three items appearing in a

14-item semantic differential measure that was included in the 1977 wave

of follow-up data collection. The questions were prefaced with the follow-

ing statement: “Below is a list of adjectives that can be used to describe a

person’s life. For each line, check the one box that best describes what you

think about your life in retirement.” The responses consisted of paired

words on opposite ends of a 7-point scale. The three semantic differential

items we selected included the following pairs of adjectives: empty–full,

hopeless–hopeful, and worthless–worthy. These adjectives seemed to most

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LEVY, SLADE, KUNKEL, AND KASL

closely correspond to our earlier-stated definitions of will to die and will to

live, respectively. That is, when the perceived hardships of one’s life

outweigh the perceived benefits, we expect an outlook that is empty,

hopeless, and worthless, whereas when the perceived benefits of one’s life

outweigh the perceived hardships, we expect an outlook that is full,

hopeful, and worthy. These items loaded on a single factor, with loadings

greater than .86.

Results

As predicted by Study 2’s hypothesis, we found that will to live

partially mediated the relationship between positive self-

perceptions of aging and survival. The will-to-live variable ful-

filled the three criteria for a partial mediator (see Figure 2; Kenny,

Kashy, & Bolger, 1998). Complying with the first criterion, we

found that the initial variable, self-perceptions of aging, predicted

the outcome of survival,

␤

⫽ .2464, SE ⫽ .0291, p ⬍ .001. (This

is consistent with findings from Study 1.) Complying with the

second criterion, we found the initial variable, self-perceptions of

aging, correlated with the presumed mediator, will to live. That is,

when we regressed will to live on self-perceptions of aging, this

was significant (

␤

⫽ .6458, SE ⫽ .0937, p ⬍ .001). According to

the third criterion, we found that the presumed mediator, will to

live, affected the outcome, survival, even when we controlled for

the direct path between the initial variable, self-perceptions of

aging, and the outcome, survival (

␤

⫽ .0555, SE ⫽ .0266, p ⬍

.04). Even though the beta weight associated with the direct path

from self-perceptions of aging to survival was reduced with the

inclusion of the presumed mediator, will to live, in the model,

self-perceptions of aging still predicted survival in this final equa-

tion (

␤

⫽ .2058, SE ⫽ .0533, p ⬍ .001). Thus, it appears that will

to live acts as a partial mediator and does not completely mediate

the relationship between baseline self-perceptions of aging and

survival. In further support that will to live acts as a partial

mediator, according to Baron and Kenny’s (1986) modification of

the Sobel test, we found that the Z score associated with will to live

as a mediator was significant (Z ⫽ 1.97, p ⬍ .03).

To increase our confidence that will to live partially mediates

the relationship between self-perceptions of aging and survival, we

conducted an additional analysis with an alternative relationship

between the variables. We examined whether it is possible that

self-perceptions of aging mediate the relationship between will to

live and survival. To check this, we repeated the mediational

analysis, but with will to live (in 1975) as the predictor and

self-perceptions of aging (in 1977) as the mediator. We found that

self-perceptions of aging did not fit the definition of a mediator

(Kenny et al., 1998). Although the first criterion was fulfilled (will

to live measured in 1975 significantly predicted survival) and the

second criterion was fulfilled (will to live measured in 1975

significantly predicted self-perceptions of aging in 1977), the third

criterion was not met. That is, self-perceptions of aging measured

in 1977 did not significantly predict survival when we controlled

for the 1975 will to live.

Discussion

As predicted, we found that will to live partially mediated the

relationship between self-perceptions of aging and survival,

whereas self-perceptions of aging did not mediate the relationship

between will to live and survival.

Our findings from Study 2 suggest that positive self-perceptions

of aging lengthened survival both directly and indirectly. Even

with the indirect path added, the direct path between self-

perceptions of aging and survival remained fairly strong. This

indicates that although will to live is part of the process by which

self-perceptions of aging influence survival, other mediators are

probably involved. Another likely means is cardiovascular re-

sponse to stress, which earlier research has shown can be adversely

affected when elderly participants are exposed to negative stereo-

types of aging (Levy et al., 2000).

The semantic differential questions of the OLSAR, on which we

based our will-to-live measure, were framed in terms of retirement.

This raises the possibility that the participants were considering the

will-to-live items specifically in terms of retirement rather than in

terms of a broader perspective. The importance of retirement as a

rite of passage was suggested by Neugarten (1996), who described

the continuum of views toward it: At one end, “many people

describe retirement as a period characterized by monotony, bore-

dom and decline, a period marking time until death”; at the other

end, life in retirement provides “time to develop new interests and

with opportunities to extend not only one’s lifetime but also what

can be called one’s personal biography”(p. 223). To examine the

role played by retirement in response to the will-to-live measure,

we compared responses of those who reported they were em-

ployed, housewives, or retired. No differences emerged between

the responses of these groups, suggesting that this measure acts as

more than a proxy for retirement. In short, however salient retire-

ment may be, will to live appears to reflect thoughts that go beyond

the participants’ job status.

General Discussion

This study found that positive self-perceptions of aging mea-

sured up to 23 years earlier contributed to individuals living

longer. The advantage remained after we controlled for age, gen-

der, socioeconomic status, loneliness, and functional health. Self-

perceptions of aging had a greater impact on survival than did

gender, socioeconomic status, loneliness, and functional health in

this cohort. The robustness of our finding is further suggested by

our demonstration that those in the more positive self-perception

of aging group demonstrated better survival among men as well as

women, those with better as well as worse functional health, those

less than 60 years as well as 60 years and over, those less than 70

Figure 2. Will to live as a partial mediator between positive self-

perceptions of aging (PSPA) and survival. The number in parentheses

indicates the direct effect of PSPA on survival prior to inclusion of the

mediator in the regression equation. * p ⬍ .05. ** p ⬍ .001.

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LONGEVITY FROM POSITIVE SELF-PERCEPTIONS

years as well as 70 years and over, those with lower as well as

higher socioeconomic status, and those who reported experiencing

loneliness as well as those who did not.

The increased life span of 7.5 years in our study is considerable,

especially when we compare our findings with those of other

longevity studies. The effect of more positive self-perceptions of

aging on survival is greater than the physiological measures of low

systolic blood pressure and cholesterol, each of which is associated

with a longer life span of 4 years or less (Friedman et al., 1995).

The survival advantage of more positive self-perceptions of aging

is also greater than the independent contribution of lower body

mass index, no history of smoking, and a tendency to exercise;

each of these factors has been found to contribute between 1 and 3

years of added life (Fraser & Shavlik, 2001).

Our self-perceptions of aging measure provided a partial inven-

tory of the participants’ definition of their old age. Because we

assume that these definitions tend to evolve, in part, from the age

stereotypes internalized in childhood and beyond, they are unlikely

to be consciously evaluated (Levy & Banaji, 2002). Nevertheless,

self-perceptions of aging are likely to generate feelings of benefit

or hardship that we suggest are evaluated within the mediating

phase that constitutes the will to live. Hence, we found that the

more positive the self-perceptions of aging were, the greater was

the will to live, and this partially mediated the relationship between

self-perceptions of aging and survival.

Even though there are, as noted in the introduction, important

differences between the old and other targeted groups, our findings

demonstrate that the old cannot be considered in monolithic terms.

As an example, although the old may lack certain defenses against

internalizing negative stereotypes of aging, our data show that a

considerable number of individuals are able to successfully cope

with these stereotypes.

Additionally, although the theory of stereotype threat excludes

internalization and therefore sets it apart from self-stereotypes of

aging, this does not preclude the possibility that racism is inter-

nalized by its targets. Indeed, studies using a scale designed to

measure the internalized racism of African Americans have found

an association between this variable and a number of psycholog-

ical and behavioral outcomes (Taylor, Henderson, & Jackson,

1991; Williams & Williams-Morris, 2000). Also, an association

has been found among African Americans between accepting the

validity of racist stereotypes and chronic health problems (Wil-

liams & Chung, in press). For many chronic illnesses, African

Americans have a higher mortality rate than do Whites (Rogers et

al., 2000).

It is, therefore, possible to propose that a fundamental common-

ality may arise from the impact of stigmatization. Although further

exploration is needed, our study suggests that the process shared

by stigmatized groups may be found in the effect of self-

stereotypes on self-perceptions. To the extent that the process is

shared, there is a greater likelihood that the outcome will be as

well. Accordingly, our study carries two messages. The discour-

aging one is that negative self-perceptions can diminish life ex-

pectancy; the encouraging one is that positive self-perceptions can

prolong life expectancy.

There is clearly a need to ameliorate the discouraging message.

One approach would emphasize positive stereotypes of aging

among the young by such means as promoting positive intergen-

erational activities. Another approach would deemphasize negative

stereotypes of aging by, for instance, encouraging older individu-

als to monitor the correspondence between the ways they are

targeted by others and the ways they target themselves. An incen-

tive for engaging in this process of self-awareness might follow

from a recognition that stigmatization can carry with it the ultimate

penalty.

However, both these approaches are piecemeal measures. If a

previously unidentified virus was found to diminish life expect-

ancy by over 7 years, considerable effort would probably be

devoted to identifying the cause and implementing a remedy. In

the present case, one of the likely causes is known: societally

sanctioned denigration of the aged. A comprehensive remedy

requires that the denigrating views and actions directed at elderly

targets undergo delegitimization by the same society that has been

generating them.

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Received November 13, 2000

Revision received January 8, 2002

Accepted January 8, 2002 䡲

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