Feeling Old vs Being Old: Associations Between Self-perceived Age and Mortality

Self-perceived age reflects appraisals of health, physical limitations, and well-being in later life.¹ Older people typically feel younger than their chronologic age, and it is thought that those who feel younger than their actual age have reduced mortality.^2,3 We sought to confirm this relationship in a large representative population sample, and to understand the role of existing health problems, poor physical function, depression, sociodemographic factors, social isolation, impaired cognitive function, and health behaviors in explaining the association.

This study was approved by the National Research Ethics Service, and all participants provided written consent. We analyzed data from the second wave (2004-2005) of the English Longitudinal Study of Ageing.⁴ Self-perceived age was measured by asking respondents, “How old do you feel you are?” All-cause mortality and deaths from cancer and cardiovascular disease up to March 2013 were recorded. We divided participants into those whose self-perceived age was close to their chronologic age (1 year older to 2 years younger), those who felt more than 1 year older than their chronologic age, and those who felt 3 or more years younger than their actual age (similar results emerged when the difference between self-perceived and actual age was modeled as a continuous variable). Cox proportional hazards regression models were used to test associations between self-perceived age and mortality, adjusting for different sets of covariates.

The sample consisted of 6489 individuals 52 years and older. Mean (SD) actual age was 65.8 (9.3) years, while the mean self-perceived age was 56.8 (13.3) years. Most respondents (69.6%) felt 3 or more years younger than their actual age, with 25.6% having a self-perceived age close to their chronologic age and 4.8% who felt more than 1 year older than their chronologic age.

The crude mortality rate during the mean follow-up period of 99 months was 14.3% in participants who felt younger, 18.5% in those who felt about their actual age, and 24.6% in those who felt older (Table 1). Adjustment for covariates had pronounced effects on the associations between self-perceived age and mortality. Nevertheless, when we combined the factors that were independently associated with mortality in models 1 through 8, feeling older than actual age remained a significant independent predictor of mortality (model 9: hazard ratio, 1.41; 95% CI, 1.10-1.82). Results were similar after excluding deaths occurring within 12 months of baseline (Table 2). Analyses of separate causes of death showed a strong relationship between self-perceived age and cardiovascular death, but no association between self-perceived age and cancer mortality (Table 2).

We found that self-perceived age predicted all-cause and cardiovascular mortality during the following 8 years. Although baseline health, physical disability, and health behavior accounted for some of the association, after adjusting for all covariates, there remained a 41% greater mortality hazard in people who felt older than their actual age compared with those who felt younger than their actual age. Our study used data from a large nationally representative survey and a simple measure of self-perceived age. We tested for reverse causality by excluding deaths within 12 months of baseline and found that the association was not due to participants in the terminal phases of their lives rating themselves as feeling older than their real age.

The mechanisms underlying these associations merit further investigation. Possibilities include a broader set of health behaviors than we measured (such as maintaining a healthy weight and adherence to medical advice), and greater resilience, sense of mastery, and will to live among those who feel younger than their age.⁵ Self-perceived age has the potential to change, so interventions may be possible.⁶ Individuals who feel older than their actual age could be targeted with health messages promoting positive health behaviors and attitudes toward aging.

Corresponding Author: Andrew Steptoe, DSc, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Pl, London WC1E 6BT, England (a.steptoe@ucl.ac.uk).

Published Online: December 15, 2014. doi:10.1001/jamainternmed.2014.6580.

Author Contributions: Dr Steptoe had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Steptoe.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Steptoe.

Obtained funding: Steptoe.

Study supervision: Steptoe.

Conflict of Interest Disclosures: None reported.

Funding/Support: The English Longitudinal Study of Ageing was developed by a team of researchers based at the University College London, National Centre for Social Research, and the Institute for Fiscal Studies. The data were collected by the National Centre for Social Research. The funding is provided by the National Institute on Aging in the United States and a consortium of UK government departments coordinated by the Office for National Statistics. The developers and funders of the English Longitudinal Study of Ageing and the UK Data Archive do not bear any responsibility for the analyses or interpretations presented here. Ms Rippon is supported by University College London and the International Longevity Centre UK, and Dr Steptoe holds the British Heart Foundation chair of psychology.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.