(June 2015) As older Americans live longer, researchers are exploring the connections between health and well-being in order to improve the overall quality of life in later years. This newsletter highlights recent research by National Institute on Aging-supported researchers and others who are examining
two aspects of well-being—how older people evaluate their
daily lives and how they experience their daily lives.
This line of research, known as subjective well-being,
goes beyond traditional measures of physical and cognitive
health to understand the emotional dimension of older
adults’ lives—whether people perceive their day-to-day
existence as positive (satisfying and enjoyable) or negative
(unsatisfying and distressing). By surveying subjective
well-being, researchers may be better able to identify
particularly vulnerable groups of older adults who are at
risk for poor health. An understanding of how health care
practices influence the well-being of older people could
help health professionals design improved treatment strategies.
Similarly, insight into the interaction between well-being
and daily activities could help health professionals
design interventions to promote the health and well-being
of older adults and their caregivers. Researchers are also
discussing whether national surveys should begin tracking
well-being as an indicator of social progress and a target
Defining and Measuring Well-Being
Well-being may be assessed objectively—by determining
whether an individual’s basic needs for food, shelter,
economic security, social relationships, and health care are
being met. In contrast, subjective well-being is a reflection
of how an older adult evaluates and experiences his or
her life. Most researchers have examined
two main aspects of subjective well-being:
- Life satisfaction or evaluative well-being refers to an
individual’s judgments about how satisfying his or her
life is over an extended period of time. Typical survey
questions ask respondents to generalize; for example,
“taking all things together, how satisfied are you with life
these days?” Survey participants usually rate their life
satisfaction on a “ladder” with 11 steps, the first rung
representing the “worst possible life for you” and the
top representing “the best possible life for you.” Some
studies also measure satisfaction with specific aspects of
life such as relationships, community, health, or work.
- Experienced well-being refers to an individual’s
moment-by-moment assessment of the emotional quality
of daily life—the frequency and intensity of feelings
of happiness, sadness, anger, stress, or pain that make
days pleasant or unpleasant. This relatively new measure
involves asking survey respondents “how do you feel at
this moment?” or asking them to recall their emotions at
specific times during the previous day.
Because these two measures capture different aspects of
well-being, using them together can provide a rich picture of
life satisfaction and quality. For example, Deaton and Stone
(2014) show that U.S. adults who live with children tend to
have slightly lower life satisfaction but more intense experienced
well-being (higher levels of both joy and stress) than
those who do not.
A third type of subjective well-being, known as “eudaimonic
well-being,” measures an individual’s sense that his or
her life has meaning and purpose. Although aspects of this
measure overlap with the other two, it is distinct in that it is
based on an understanding that people are motivated by factors
beyond their own personal happiness or satisfaction
(National Research Council 2013).
Patterns in Well-Being at Older Ages
In the United States, life satisfaction declines during
middle age (ages 45 to 54) and then rises again, reflecting a
U-shaped pattern, according to
Steptoe, Deaton, and Stone (2014). Yet, two measures of
negative well-being—reporting a lot of stress or anger the
previous day—decline throughout the life course. Worry
stays high until age 50, then drops, according to Steptoe and
his colleagues. These findings are based on their analysis of
data from the Gallup World Poll, an ongoing survey conducted
in more than 160 countries. Life satisfaction among
older people in other countries does not follow the same patterns.
“Economic theory can predict the dip in well-being in
middle age [in the United States],” they write. “This is the
period at which wage rates typically peak and is the best time
to work and earn the most, even at the expense of present
well-being, so as to have increased wealth and well-being
later in life.” The decline in anger, stress, and worry at older
ages is consistent with other findings related to the “socioemotional
selectivity theory.” This theory holds that as people
age they tend to make more careful choices, focusing
their time and energy on more emotionally meaningful experiences
and friendships, which buffer losses related to aging
and boost well-being (Carstensen, Fung, and Charles 2003,
cited in Steptoe, Deaton, and Stone 2014).
Health and Well-Being
Low levels of self-reported well-being are linked to a heightened
risk of disease. “Established research has linked depression
and life stress with premature mortality, coronary heart
disease, diabetes, disability, and other chronic disease,” write
Steptoe, Deaton, and Stone (2014). Not surprisingly, other
studies show that chronic diseases are linked to high levels of
unpleasant daily experiences. One study, which surveyed
11,500 individuals ages 50 and older, finds that stroke and
chronic lung disease take the biggest toll on experienced
well-being (Wikman, Wardle, and Steptoe 2011). Additionally,
the more chronic conditions people have, the
lower their experienced well-being.
Can a higher level of subjective well-being serve to prevent
illness and postpone death? Growing evidence suggests
that it might, report Steptoe, Deaton, and Stone. They
point to an analysis that reviewed 70 studies tracking a
combined total of 3,800 people (Chida and Steptoe 2008).
Among participants who began the studies in good health,
those with high levels of well-being (measures that included
experienced well-being and life satisfaction) were less likely
to die than those with low levels, the analysis finds. The
studies also show that higher levels of well-being are related
to lower death rates in patients with renal failure and
These studies show only correlations, not cause and effect,
so the specific role that subjective well-being plays in forestalling
death is unclear. But well-being measures could be
used to revise health care practices in areas that are less often
addressed, such as relieving emotional distress and maintaining
older adults’ sense of dignity, argue Steptoe, Deaton, and
Stone. Patients’ well-being could be assessed directly rather
than relying on reports from relatives
or caregivers, and treatment strategies
could be tailored to meet individuals’
Smith and colleagues (2014) find that
older adults report the highest levels of
experienced well-being and are happiest
while socializing, working or volunteering,
and exercising. How older people
feel while participating in specific
activities influences the choices they
make about spending their time and, in turn, their health.
For this 2009 study, the researchers examined reports
from 4,600 U.S. Health and Retirement Study (HRS) participants
who were ages 50 and older and averaged age 70.
Respondents identified the amount of time they spent
engaged in specific activities the previous day, the types of
feelings they experienced, and the intensity of those feelings.
The researchers found that participants spent an average
of 3.5 hours daily viewing television, an activity that some
people experienced positively and others experienced quite
negatively. Only one other activity—managing and spending
money—elicited higher levels of frustration and nervousness
than television viewing. “TV appears to contribute less to
overall positive well-being in older adults than other activities
that involve more social, cognitive, and physical engagement,”
they write. An “active and engaged lifestyle” (including
socializing, work or volunteering, and exercise) is linked
to higher levels of experienced well-being, they conclude.
But what about older people with disabilities whose
health presents obstacles to activities and participation?
A study by Freedman and colleagues (2011) finds that older
married adults with disabilities have lower levels of experienced
well-being and life satisfaction than their peers without
a disability. The lower activity and participation levels
of individuals with disabilities explain a portion of the
difference in evaluated well-being between the two groups.
Compared with their counterparts without disabilities,
respondents with a disability (of typical severity) labeled 71
fewer minutes per day as “pleasant.” The impact is comparable
to or larger than having a poor relationship with one’s
spouse, the researchers report.
While both groups experience fairly similar levels of frustration
and worry, older adults with a disability reported
feeling more physical pain and tiredness
and were more dissatisfied with
their health and memory ability than
their peers. The authors of this study
drew on time-use diaries completed
by 400 older married couples in the
nationally-representative 2009 Panel
Study of Income Dynamics (PSID).
Participants were asked to reflect on
the previous day and rate their experienced
well-being while carrying out
The researchers suggest that finding
ways to enable older people with
disabilities to be involved in physical activity and volunteering
could improve their well-being and satisfaction with
their lives. Additionally, they identify reducing pain and
exhaustion as “critical targets for improving late-life well-being”
of older adults who are disabled in some way.
Married Couples, Caregiving, and Well-Being
In the United States, unpaid family members provide the
vast majority of the care that allows older people to live in
their own homes. For an older married person living with
a disability, the spouse is usually central to care activities.
Researchers have debated whether a spouse’s well-being is
enhanced or eroded by caregiving. Some studies emphasize
the burden of providing care and the negative consequences
for well-being, while others emphasize the benefits of altruistic
A study by Freedman, Cornman, and Carr (2014) explores
experienced well-being and care of spouses. The authors find
that older women’s experienced well-being is lower when
engaged in routine housework relative to other activities. But
when those same chores are done for a husband with a disability,
a wife’s well-being is enhanced, suggesting beneficial
aspects of providing care. In contrast, husbands’ experienced
well-being does not fluctuate, whether they are participating
in care-related activities or household chores.
These findings are based on interviews with 400 older
married couples from the PSID. Caregiving tasks included
activities such as laundry, shopping, food preparation, cleaning,
and personal care for others.
The differences the researchers found between men and
women could reflect the nature of traditional divisions of
household labor: Women are more
likely to perform continual and daily
chores (cooking, house cleaning) while
men tend to carry out sporadic projects
such as repairs, the researchers note.
For women, chores may “be particularly
daunting as they experience their
own health declines,” they write.
Additional research could explore the
impact of housekeeping assistance on
the health and well-being of female caregivers; the findings
could inform the design of support programs for caregivers.
Using the same data set, Carr and colleagues (2014) demonstrate
that one of the strongest predictors of well-being
among older couples is marital quality: Older husbands and
wives who rate their marriages highly are not only more satisfied
with their lives but also experience more positive emotions
during the day. Their findings suggest that troubled
marriages take an emotional toll, whereas high-quality marriages
can buffer against late-life stressors, such as caregiving.
Well-Being Measures and Policymaking
Should the United States begin tracking national levels of
subjective well-being and focus policy on improved well-being
among older adults? Can measures of well-being be
used to gauge national progress, supplementing economic
indicators such as GDP? Steptoe, Deaton, and Stone (2014)
note that “the well-being of elderly people is an important
objective for both economic and health policy.” But Deaton
and Stone (2013) argue that subjective well-being measures
should be used cautiously to inform national policy, noting
that individuals’ responses are self-reported, making them
subject to personal interpretation and to the respondent’s
current focus of attention. A National Research Council
panel (National Research Council 2013) expressed skepticism
over the usefulness of measuring the average well-being
level of the entire population. In the panel’s view, these
measures are best used to pinpoint specific groups within
the population that may experience an unusual degree of
distress and to evaluate interventions to improve their lives.
Benjamin and colleagues (2012) argue that measures of
subjective well-being do not capture the full range of human
motivation and preferences. They find that people are willing
to trade personal well-being for other things they care
about—income, their family’s happiness, social status, or a
sense of control. The researchers gave 2,600 adults and university
students a series of 13 hypothetical
scenarios and asked them to evaluate
which of two options would make
them happier and to identify which
they would choose. While most people
chose the option that made them happier,
a sizable share reported that their
choice compromised their happiness.
The researchers conclude that people
have desires and objectives other than
happiness, which challenges the assumption that people tend
to make choices exclusively to maximize their happiness.
They emphasize that happiness measures alone are an insufficient
basis for evaluating government policies. Benjamin and
colleagues (2014b) find similar results in the choices medical
students made related to medical residency programs.
In related work, Benjamin and colleagues (2014a) describe
a broader set of well-being survey questions that include
more than 130 factors that shape individual well-being. In
addition to experiential well-being and life satisfaction, the
questions measure factors related to family well-being, personal
health, security, freedom, and other social and personal
values. They asked 4,600 U.S. respondents to state their
preference between pairs of aspects to capture the relative
strength of different factors. Using this set of measures, they
identified aspects of well-being that older people valued more
highly than younger people, including “being treated with
dignity and respect” and “having many options and possibilities
in life and the freedom to choose among them.” They
propose a method of combining the responses to this set of
questions to create a more comprehensive well-being index.
Horner (2014) shows how subjective well-being measures
might be used to inform a specific policy decision. Her
study, using data from the United States and 16 western
European countries, examines the impact of raising the
retirement age. She finds that retirees’ subjective well-being
improves when retirement occurs and then declines a few
years later. The boost that retirement provides takes place
in the same way whether individuals retire early or late; both
groups have similar well-being levels by age 70, according
to the study.
“Later formal retirement simply delays the subjective well-being
benefits of retirement,” she writes. “If it is necessary to
increase the retirement age by a few years to increase financial
stability, policymakers need not worry that they are
making people psychologically worse off in the long run.”
The study drew on comparable data from the U.S. HRS,
the Study of Health, Ageing, and
Retirement in Europe (SHARE), and
the English Longitudinal Study of
Ageing (ELSA), taking into account
policy differences among countries.
The subjective well-being measures
used included life satisfaction and a set
of questions that assessed the older person’s
sense of control, independence,
autonomy, and pleasure.
Lucas (2013) demonstrates how subjective well-being
measures might be useful to policymakers on a local level.
He identifies a link between life satisfaction in U.S. counties
and domestic in-migration. Counties with residents who
report high levels of life satisfaction tend to grow more
quickly than counties with residents who are less satisfied
with their lives on average. But he points out that high levels
of life satisfaction may reflect other factors that are already
being measured, such as high employment or low poverty.
This study combined census data with results of the U.S.
Center for Disease Control and Prevention’s Behavioral Risk
Factor Surveillance System, designed to track health conditions.
More than 2 million Americans participated in this
survey that included a question asking respondents to rate
how satisfied they were with their lives. Lucas suggests that
further research is needed to provide a better understanding
of the local factors associated with more satisfied populations;
the results might enable policymakers and local planners
to target funds in ways that increase life satisfaction.
Several studies in Latin America provide examples of how
subjective well-being measures can be used to evaluate the
impact of social interventions. The Piso Firme program
replaced dirt floors with cement for 300,000 homeowners in
Mexico (Cattaneo et al. 2009). The investigators surveyed
2,755 homeowners spread evenly throughout an urban area
that straddles two Mexican states—one that had already
implemented the program and one that had not yet begun.
When they compared mothers raising children in households
that received cement floors with those that still had dirt
floors, they found higher life satisfaction levels (19 percent)
and less depression and stress among those with cement
floors. Another study that examined the impact of replacing
slum housing with pre-fabricated dwellings in El Salvador,
Mexico, and Uruguay also found higher levels of life satisfaction
among recipients than among those who did not receive
the upgraded housing (Galiano, Gertler, and Bando 2015).
Similarly, research on government payments to low-income,
rural elderly in Mexico (a noncontributory pension program)
documented improvements in experienced
well-being among those who
received the cash payments compared to
those who did not (Galiani et al. 2013).
In recent years, a number of large U.S.
surveys have included questions measuring
subjective well-being, including
the HRS and the PSID. The results can identify differences
in well-being across the older population and could be used
to design and evaluate effective solutions. Researchers are just
beginning to explore how well-being influences the choices
older people make and how those decisions in turn influence
their health. Tracking the well-being of older people can
inform individual treatment strategies and health care policies,
but current well-being measures may not incorporate all
the factors that combine to shape an older person’s sense of
well-being. Efforts to refine these measures and apply them
in new settings could help policymakers and program planners
improve the quality of life of the growing U.S. older
Paola Scommegna is a senior writer/editor at PRB.
Please refer to PDF of report.