Aging in later life is often portrayed as a steady slide toward physical and cognitive decline. But a new study by scientists at Yale University suggests an alternate narrative — that older individuals can and do improve over time and their mindset toward aging plays a major part in their success.
Analyzing more than a decade of data from a large, nationally representative study of older Americans, lead author Becca R. Levy, a professor of social and behavioral sciences at the Yale School of Public Health (YSPH), found that nearly half of adults aged 65 and older showed measurable improvement in cognitive function, physical function, or both, over time.
The improvements were not limited to a small group of exceptional individuals and, notably, were linked to a powerful but often overlooked factor: how people think about aging itself.
"Many people equate aging with an inevitable and continuous loss of physical and cognitive abilities," said Levy, an international expert on psychosocial determinants of aging health. "What we found is that improvement in later life is not rare, it's common, and it should be included in our understanding of the aging process."
The findings are published in the journal Geriatrics.
For the study, the researchers followed more than 11,000 participants in the Health and Retirement Study, a federally supported longitudinal survey of older Americans. The research team tracked changes in cognition using a global performance assessment, and physical function using walking speed — often described by geriatricians as a "vital sign" because of its strong links to disability, hospitalization, and mortality.
Over a follow-up period of up to 12 years, 45% of participants improved in at least one of the two domains, according to the study. About 32% improved cognitively, 28% improved physically, and many experienced gains that exceeded thresholds considered clinically meaningful. When participants whose cognitive scores remained stable over that period (rather than declining) were included, more than half defied the stereotype of inevitable deterioration in cognition.
"What's striking is that these gains disappear when you only look at averages," said Levy, author of the book "Breaking the Age Code: How Your Beliefs About Aging Determine How Long & How Well You Live." "If you average everyone together, you see decline. But when you look at individual trajectories, you uncover a very different story. A meaningful percentage of the older participants that we studied got better."
The authors also examined potential reasons for why some people improve and some do not. They hypothesized that an important factor could be participants' baseline age beliefs — or, specifically, whether they had assimilated more positive or more negative views about aging by the start of the study. In support of this hypothesis, they found that those with more positive age beliefs were significantly more likely to show improvements in both cognition and walking speed, even after accounting for factors such as age, sex, education, chronic disease, depression, and length of follow-up.
The findings build on Levy's stereotype embodiment theory, which posits that age stereotypes absorbed from culture — through a range of domains including social media and advertisements — eventually become self-relevant and biologically consequential. Levy's prior studies have found negative age beliefs predict poorer memory, slower walking speed, higher cardiovascular risk, and biomarkers associated with Alzheimer's disease.
The current study shows that those who have assimilated more positive age beliefs often show improvement, Levy said.
"Our findings suggest there is often a reserve capacity for improvement in later life," she said. "And because age beliefs are modifiable, this opens the door to interventions at both the individual and societal level."
The improvements were not limited to people who started out with impairments. Even among participants who had normal cognitive or physical function at baseline, a substantial proportion improved over time. That challenges the assumption that later-life gains reflect only people getting better after being sick or rebounding from earlier setbacks, the authors said.
The authors hope their findings will reverse the popular perception that continuous decline is inevitable and encourage policy makers to increase their support for preventive care, rehabilitation, and other health-promoting programs for older persons that draw on their potential resilience.
Martin Slade, a lecturer in occupational medicine at Yale School of Medicine and in the Department of Environmental Health Sciences at YSPH, is co-author of the study.
This research was supported by funding from the National Institute on Aging.
