Live longer if have strong life purpose – JAMA May 2019

Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years

JAMA Network Open. 2019;2(5):e194270. doi:10.1001/jamanetworkopen.2019.4270
Aliya Alimujiang, MPH; Ashley Wiensch, MPH; Jonathan Boss, MS; Nancy L. Fleischer, PhD, MPH; Alison M. Mondul, PhD, MPH; Karen McLean, MD, PhD; Bhramar Mukherjee, PhD; Celeste Leigh Pearce, PhD, MPH

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IMPORTANCE A growing body of literature suggests that having a strong sense of purpose in life
leads to improvements in both physical and mental health and enhances overall quality of life. There
are interventions available to influence life purpose; thus, understanding the association of life
purpose with mortality is critical.

OBJECTIVE To evaluate whether an association exists between life purpose and all-cause or cause specific
mortality among older adults in the United States.

DESIGN, SETTING, AND PARTICIPANTS The Health and Retirement Study (HRS) is a national
cohort study of US adults older than 50 years. Adults between the ages of 51 to 61 were enrolled in
the HRS, and their spouses or partners were enrolled regardless of age. Initially, individuals born
between 1931 and 1941 were enrolled starting in 1992, but subsequent cohort enrichment was carried
out. The present prospective cohort study sample was drawn from 8419 HRS participants who were
older than 50 years and who had filled out a psychological questionnaire during the HRS 2006
interview period. Of these, 1142 nonresponders with incomplete life purpose data, 163 respondents
with missing sample weights, 81 participants lost to follow-up, 1 participant with an incorrect survival
time, and 47 participants with missing information on covariates were excluded. The final sample for
analysis was 6985 individuals. Data analyses were conducted between June 5, 2018, and April
22, 2019.

EXPOSURES Purpose in life was assessed for the 2006 interview period with a 7-item questionnaire
from the modified Ryff and Keyes Scales of Psychological Well-being evaluation using a Likert scale
ranging from 1 to 6, with higher scores indicating greater purpose in life; for all-cause and causespecific mortality analyses,
5 categories of life purpose scores were used (1.00-2.99, 3.00-3.99, 4.00-4.99, 5.00-5.99, and 6.00).

MAIN OUTCOMES AND MEASURES All-cause and cause-specific mortality were assessed between
2006 and 2010. Weighted Cox proportional hazards models were used to evaluate life purpose and mortality.

RESULTS Of 6985 individuals included in the analysis, 4016 (57.5%) were women, the mean (SD)
age of all participants was 68.6 (9.8) years, and the mean (SD) survival time for decedents was 31.21
(15.42) months (range, 1.00-71.00 months). Life purpose was significantly associated with all-cause
mortality in the HRS (hazard ratio, 2.43; 95% CI, 1.57-3.75, comparing those in the lowest life purpose
category with those in the highest life purpose category). Some significant cause-specific mortality
associations with life purpose were also observed (heart, circulatory, and blood conditions: hazard
ratio, 2.66; 95% CI, 1.62-4.38).

CONCLUSIONS AND RELEVANCE This study’s results indicated that stronger purpose in life was
associated with decreased mortality. Purposeful living may have health benefits. Future research
should focus on evaluating the association of life purpose interventions with health outcomes,
including mortality. In addition, understanding potential biological mechanisms through which life
purpose may influence health outcomes would be valuable.