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Living Longer Requires Making Lots of Small Changes

A positive attitude towards getting older can extend your life, and its quality.

Key points

  • New research on positive aging suggests that there are many different factors that work together to produce a healthy old age.
  • Small incremental changes in our lives can help us live 4 to 7 years longer, and maintain our cognitive functioning for more than a decade.
  • Positive aging needs more than just a healthy attitude towards getting older. It also needs access to the resources necessary to maintain health.

Maybe it is something about creeping up on 60 that is making me take note of the ever-growing research on healthy aging. And there is lots to consider, especially when it comes to the impact a positive attitude and healthy lifestyle have on our longevity. That was one of the key findings from a lifetime of work by Dr. Dilip V. Jeste, an acclaimed psychogeriatician who just retired this past July from his post at the University of California San Diego School of Medicine. Jeste’s work is among the body of work that has most intrigued me, especially because it suggests that having a positive attitude towards aging can be the equivalent to never having smoked. In other words, it predicts living years longer than the cranky curmudgeon who does nothing but complain about every ache and pain, no matter how privileged their life really is.

Ideas like this are supported by a newly published study by Pei-Lun Kuo and colleagues at the National Institute on Aging (NIA) that used data from the Baltimore Longitudinal Study of Aging to estimate how many extra years of life we can expect from different aspects of healthy living. The results are dramatic, and cause for hope if one wants their senior years to be long and productive. To understand the research, first, consider that there are four broad areas of life affected by aging. One, body composition includes things like your body mass index and waist circumference. The second aspect of aging is energetics which refers to how much energy you use and its availability, typically measured by oxygen consumption and cardiorespiratory fitness. Third, we need to consider our homeostatic mechanisms like inflammation and blood pressure. And finally, we have to look for signs of neurodegeneration and neuroplasticity, if your brain is healthy with all parts working well or if you're losing grey matter and connections between neurons.

Combined, the quality of each of these four aspects of our lives create phenotypes which are broad categories that describe us in very general terms. We can add up our scores on each aspect of our aging process and predict which of over 30 phenotypes we are likely to be. The real magic here is that if we improve our overall score on the four dimensions of aging, moving ourselves at least one standard deviation towards better health, there is a huge potential payoff. The researchers at the NIA estimate that any change for the better (even a relatively small change across multiple factors) can predict the equivalent of 4-7 years of additional chronological age and physical functioning (one can expect to live longer) and a shocking 7-13 years of additional cognitive functioning (even if our body declines, our minds are likely to remain alert). Those are profound changes, but they do implicate many different aspects of our lives.

And that, unfortunately, is something that is often overlooked. We tend to over-simplify the secrets to the fountain of youth. We focus on a few narrow life lessons, learned from people living in “blue zones” (parts of the globe like Loma Linda, California and Nicoya, Costa Rica that have an unusually high number of people over the age of 100). The research on positive aging, however, like much of the research on resilience across the lifespan, suggests that we need to think about the way multiple physiological, social and even institutional and environmental systems all work hand in glove to create the right conditions for optimal development.

After all, maintaining a positive attitude towards aging requires more than mental calisthenics to remain positive, or simplistic recipes for long life like avoiding red meat. A good deal of our resilience during our senior years comes down to having the many different resources we need to trigger positive thoughts and the environments around us to support healthy habits related to being meaningfully active and sociable. To put this simply, it is easier to be optimistic about the near future when our housing is secure, we have access to medical care and in-home supports, we can eat well without bankrupting ourselves, and our ties with our community remain strong. None of these is going to on its own make us live longer. Put them together, though, and that could change our overall score on a healthy aging scale. Suddenly, the future looks much brighter.


Kuo, PL., Schrack, J.A., Levine, M.E. et al. Longitudinal phenotypic aging metrics in the Baltimore Longitudinal Study of Aging. Nat Aging 2, 635–643 (2022).

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