Temporal Discounting Is Associated with an Increased Risk of Mortality among Community-Based Older Persons without Dementia

Abstract

BackgroundTemporal discounting is an important determinant of many health and financial outcomes, but we are not aware of studies that have examined the association of temporal discounting with mortality.MethodsParticipants were 406 older persons without dementia from the Rush Memory and Aging Project, a longitudinal cohort study of aging. Temporal discounting was measured using standard preference elicitation questions. Individual discount rates were estimated using a well-established hyperbolic function and used to predict the risk of mortality during up to 5 years of follow-up.ResultsThe mean estimate of discounting was 0.45 (SD = 0.33, range: 0.08–0.90), with higher scores indicating a greater propensity to prefer smaller immediate rewards over larger but delayed ones. During up to 5 years of follow-up (mean = 3.6 years), 62 (15% of 406) persons died. In a proportional hazards model adjusted for age, sex, and education, temporal discounting was associated with an increased risk of mortality (HR = 1.103, 95% CI 1.024, 1.190, p = 0.010). Thus, a person with the highest discount rate (score = 0.90) was about twice more likely to die over the study period compared to a person with the lowest discount rate (score = 0.08). Further, the association of discounting with mortality persisted after adjustment for the level of global cognitive function, the burden of vascular risk factors and diseases, and an indicator of psychological well being (i.e., purpose in life).ConclusionTemporal discounting is associated with an increased risk of mortality in old age after accounting for global cognitive function and indicators of physical and mental health.

Discrepancies between cognition and decision making in older adults

“…An example of an item is “Would you prefer $1000 in cash right now or $3000 in a year?” All immediate rewards were $1000 and delayed rewards ranged in value from $1200 to $3000. Our group has shown that temporal discounting is associated with cognition [42] and increased mortality among older adults [43]. Risk aversion (gamma) was assessed with a series of 10 coin toss questions “Would you prefer $15 for sure, OR a coin toss in which you will get $ (an amount greater than $15) if you flip heads or nothing if you flip tails?” [44].…”

Age‐related differences in delay discounting: Immediate reward, reward magnitude, and social influence

“…Yet, even with this lifetime of experience in making decisions about delayed rewards, the social influence effects demonstrate that malleability in delay discounting exists even into older adulthood. The ability to impact levels of delay discounting in older adults holds promise because individual differences in delay discounting are associated with a number of consequential behaviors and outcomes in older adulthood, including exercise rates (Tate, Tsai, Landes, Rettiganti, & Lefler, 2015); cognitive decline and mortality (Boyle, Yu, Gamble, & Bennett, 2013;James, Boyle, Yu, Han, & Bennett, 2015); and suicide ideation and attempts (Dombrovski et al, 2011).…”

White matter correlates of temporal discounting in older adults

“…Older adults are at higher risk for poorer decision-making due to age-associated brain changes, and in old age, temporal discounting can have profound financial and health consequences, resulting in decreased wellbeing and independence. We previously demonstrated that temporal discounting is associated with poorer cognitive function (Boyle et al 2012), cognitive decline (James et al 2015), and mortality (Boyle et al 2013). To date, however, the neural underpinnings of temporal discounting in old age remain unclear.…”