Positive aging expectations linked to better cognitive perception

Getting 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 may influence how they perceive their cognitive abilities, according to a new study from researchers in the Penn State College of Nursing.

The team found that people who had more positive expectations of aging tended to report less frequent 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 journal Aging & Mental Health.

"Aging expectations are malleable and influence an individual's perceptions of their cognitive functioning," said Nikki Hill, associate professor in the Ross and Carol Nese College of Nursing at Penn State, who is first author on the paper.

Modifying older adults' aging expectations could support healthier cognitive aging through increased awareness and accurate assumptions about the aging process."

Nikki Hill, Associate Professor, Ross and Carol Nese College of Nursing, Penn State

Previous research has found that expectations about aging, such as whether a person expects to maintain high levels of activity or if they expect everything to go downhill, are associated with health. Those with more negative aging expectations tend to experience worse outcomes, such as more rapid physical and cognitive decline, while positive perceptions of aging are linked to behaviors that promote health and wellbeing like 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's noticed that when people describe their experiences, they often include stereotypical and stigmatized beliefs about aging and cognitive decline. It led Hill to wonder how people's expectations about the aging process may influence how they interpret cognitive changes they may experience -; a relationship that few studies have examined.

"Do people's perceptions of what they expect aging to be in the future, in terms of physical health, mental health, cognitive health, affect the way that they perceive their cognitive performance?" Hill said. "If it does, then that gives us more clues about how to interpret people's reports of cognitive changes and, potentially, how to intervene earlier to support people to maximize their aging outcomes."

For example, people who are worried about perceived declines in their cognitive function -; even if their cognitive health is normal -; are at higher risk for developing a cognitive impairment in the future, Hill explained. She said that with conditions like Alzheimer's disease and related dementias, there's a slow, gradual decline in cognitive function over decades and people often experience subtle symptoms before clinical tests identify an impairment in cognition.

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

The survey asked about their expectations about physical health, mental health and cognitive function in relation to aging. They were asked to rate statements -; for example, "every year that people age, their energy levels go down a little more" -; on a four-point scale from "definitely true" to "definitely false." To assess their perceptions of their own cognition, participants were asked about their cognitive abilities over the last seven days. They were also asked about their ability to perform certain tasks today compared to 10 years ago to assess whether they believed their cognitive abilities had declined.

The team found that people who had more positive expectations of aging tended to rate their cognitive function better and report less perceived decline in their cognitive abilities, both in the last week or over the last 10 years. On the other hand, more negative expectations of aging were linked to more negative perceptions of their current cognitive performance and whether they perceived cognitive decline.

The researchers also found that there wasn't much difference between participants' expectations of their physical, mental or cognitive health and how they perceived their cognition. People with positive aging expectations 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 ground aging expectations more in what is true and less stigmatized, then maybe we can help people clarify what they're experiencing in terms of cognitive changes, which will support our ability to respond to individual needs for maximizing cognitive health," Hill said.

Hill said that the team plans to conduct more research to understand this complex relationship such as how do beliefs about aging influence whether older adults report the cognitive change they're experiencing and how healthcare providers engage patients in conversations about cognitive health.

Other authors on the paper include Renata Komalasari, postdoctoral scholar in the Ross and Carol Nese College of Nursing at Penn State; Sakshi Bhargava and Emily Bratlee-Whitaker from 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.

Funding from the Tressa Nese and Helen Diskevich Center of Geriatric Nursing Excellence in the Ross and Carol Nese College of Nursing at Penn State supported this work.