Increased Mortality Risk in Older Adults With Persistently Low or Declining Feelings of Usefulness to Others

Abstract

Objectives-To determine if persistently low or declining feelings of usefulness to others in later life predicts increased mortality hazard in older adults.Methods-Data on change in perceptions of usefulness, health, behavioral and psychosocial covariate factors, and mortality originate from the MacArthur Study of Successful Aging, a prospective study of 1,189 older adults (age 70-79 years).Results-Older adults with persistently low feelings of usefulness or who experienced a decline to low feelings of usefulness over the first 3-years of the study experienced a greater hazard of mortality (sociodemographic adjusted HR = 1.75 (95% CI = 1.22 to 2.51)) over a subsequent 9-year followup as compared to older adults with persistently high feelings of usefulness.Discussion-Older adults with persistently low perceived usefulness or feelings of usefulness that decline to a low level may be a vulnerable group with increased risk for poor health outcomes in later life.Keywords older adults; perceived usefulness; perceptions of aging; mortality Engagement in social and productive activities, especially those which contribute to the wellbeing of others and society, are often cited indicators of healthy or successful aging in later life (Fischer, 1995;Moody, 2001;Rowe & Kahn, 1998). The desire to contribute to others, be productive, and feel useful have also been cited as important motives for volunteerism and social activity in older adulthood Okun, 1994). Such activity may, in turn, benefit older adults' mental and physical well-being. A sizable body of research indicates that greater engagement in social and productive activity is linked to better functioning and health and greater longevity in later life (e.g., Glass, de Leon, Marottoli, & Berkman, 1999;Mendes de Leon, Glass, & Berkman, 2003;Menec, 2003;Musick, Herzog, & House, 1999).A handful of studies have also shown that what older adults think about their social value and usefulness may be as important as their actual activity in terms of an impact on health. Such work has focused on whether perceptions of social usefulness are linked with disability and mortality outcomes in later life. Studies of rural-dwelling French (age 60 years and older) and Japanese (aged 65 years and older) elders have shown that compared to older adults who frequently felt useful to others, those with low feelings of social usefulness were more likely Corresponding Author: Tara L. Gruenewald, tgruenewald@mednet.ucla.edu. to experience increases in physical disability and impairments in the ability to perform activities of daily living (ADLs) and more likely to die over follow-up periods of four to six years (Grand, Grosclaude, Bocquet, Pous, & Albarede, 1988;Okamoto & Tanaka, 2004). Similarly, not feeling needed by others predicted greater risk of institutionalization and mortality in a study of older Finnish adults (those age 75, 80, and 85 years;Pitkala, Laakkonen, Strandberg, & Tilvis, 2004)). These findings were recently replicated in a sample of older Americans; compared to el...

Caregiving and Perceived Generativity: A Positive and Protective Aspect of Providing Care?

“…For example, higher self-perceptions of generativity are associated with lower mortality and lower risk of the development of disability in older adults (Gruenewald, Liao, & Seeman, 2012). Studies also indicate that adults with higher self-perceptions of generativity and usefulness demonstrate better psychosocial well-being, including lower levels of depressive symptomology, greater feelings of self-efficacy and mastery, as well as greater social connectedness and integration (Grand, Grosclaude, Bocquet, Pous, & Albarede, 1988; Gruenewald, Karlamangla, Greendale, Singer, & Seeman, 2007, 2009; McAdams et al, 1993). …”

Self-perceived uselessness and associated factors among older adults in China

“…Self-perceived uselessness, or its opposite, usefulness, is a major component of self-perceived aging: for example, it is one of five items of the Attitude Toward Own Aging subscale of the Philadelphia Geriatrics Center Morale Scale [3]. The feeling of uselessness shapes older adults’ thoughts and behaviors [1–12], which in turn influences psychological and physiological well-being [1, 2, 13]. …”

“…Empirical studies in both China and Western societies have consistently reported that self-perceived uselessness, a negative self-perception of aging, is a robust predictor of high mortality risk [2, 3, 5, 11, 13–18] and a wide range of poor health indicators such as functional impairment, disability [1–3, 10, 19, 20], chronic conditions [21, 22], lower rates of recovery from illness [23], poorer cognitive and mental health function [20, 24–26], and lower rates of good self-rated health and life satisfaction [20, 27–30]. Studies further indicate that older adults who have higher levels of self-reported uselessness tend to have lower levels of social engagement, physical activity, self-efficacy and self-esteem as well as higher levels of depression [1–4].…”

“…From a psychological perspective, self-perceived uselessness could diminish beliefs about self-control and self-efficacy that could lead to low resilience capacity and depression, thus preventing psychological well-being [1, 2]. Self-perceived usefulness, by contrast, could lead to a positive appraisal of one’s capacity to deal with adversity or difficulties in daily life [2].…”

“…From a psychological perspective, self-perceived uselessness could diminish beliefs about self-control and self-efficacy that could lead to low resilience capacity and depression, thus preventing psychological well-being [1, 2]. Self-perceived usefulness, by contrast, could lead to a positive appraisal of one’s capacity to deal with adversity or difficulties in daily life [2]. From a physiological perspective, self-perceived uselessness could lead to neuroendocrine and neurohumoral changes, immune alterations, autonomic and cardiovascular dysregulation or central neurotransmitter system dysfunction because of cardiovascular stress [37, 38].…”