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© 2015 Springer Publishing Company
http://dx.doi.org/10.1891/0198-8794.35.145
CHAPTER 7
Longitudinal Research on Subjective
Aging, Health, and Longevity
Current Evidence and New Directions for
Research
Gerben J. Westerhof and Susanne Wurm
ABSTRACT
In this chapter, we carry out a narrative review of the longitudinal impact of sub-
jective aging on health and survival. We have a specifi c focus on the different
pathways which can explain the relation of subjective aging to health and survival.
We focus on the three most common conceptualizations of subjective age: (a) age
identity, (b) self-perceptions of aging, and (c) self-perceptions of age-related growth
and decline. For each concept, we present the theoretical background, the empiri-
cal studies on the effects on health and survival, and conclude with the pathways
which might explain these effects. The chapter ends with a heuristic model that
synthesizes the theories and fi ndings in describing how subjective aging is related
to different psychological resources, which are in turn related to health and sur-
vival. Last, we provide some possible directions for further research in this area.
INTRODUCTION
Over the past several decades, life expectancy has increased substantially. Given
the fact that old age is nowadays a phase in life that is attainable for most people,
the concept of subjective aging, that is, the way in which individuals think about
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146 ANNUAL REVIEW OF GERONTOLOGY AND GERIATRICS
their own aging process, may be more important than ever before. Although
life expectancy has increased, people also tend to live longer with more chronic
diseases. How adults perceive and experience their own aging may contribute to
how individuals try to prevent and cope with illness in later life. In this chapter,
we will review evidence of the longitudinal impact of subjective aging on health
and longevity. Furthermore, we will develop a heuristic model that may be use-
ful in guiding future empirical research on how subjective aging contributes to
health and survival in adulthood and old age.
One of the particularities of human beings is that they are able to refl ect on
themselves as persons and thereby also on their own process of growing older.
People attribute meaning to the intricate mix of changes and events in biologi-
cal, social, and psychological functioning, which happen as they grow older. In
this process, they develop cognitive representations of their own aging process.
Researchers have used different concepts to describe these cognitive representa-
tions, such as subjective age, age identity, aging self, attitudes toward one’s own
aging, self-perceptions of aging, or satisfaction with aging (Diehl et al., 2014). In
this chapter, we will use the concept of subjective aging as an overarching term
that describes different aspects of these cognitive representations.
Subjective aging is related to the physical and psychological functioning of
aging individuals. Numerous studies have shown that feeling younger and hav-
ing more positive representations of one’s own aging process are associated with
better physical health and subjective well-being (Barak & Stern, 1986; Barrett,
2003; Peters, 1971; Steverink, Westerhof, Bode, & Dittmann-Kohli, 2001;
Westerhof, Whitbourne, & Freeman, 2012). Because of their cross-sectional and
correlational design, these studies, however, have not permitted the determina-
tion of the directionality of effects, that is, the examination of whether subjective
aging affected psychophysical functioning or whether the effects were the other
way around. Thus, it is possible to argue both ways. Subjective aging may be
shaped by several individual and sociocultural factors. On the individual level,
one might think of personality traits, personal values, individual role models of
aging (e.g., one’s grandparents), individual stereotypes about older persons in
general, as well as personal experiences with growing older, such as a person’s
own declining health. On the sociocultural level, social interactions, messages
in the mass media, cultural values, social policies, social structures, and societal
institutions provide a framework of aging which contributes to subjective aging
(see also Chapters 2 and 9 in this volume).
Although being shaped by individual and sociocultural factors, subjective
aging might also contribute to further life span development and aging processes.
How people understand and attribute meaning to their own aging processes
might infl uence how they grow old(er) themselves. For example, a person who
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Longitudinal Research on Subjective Aging 147
believes that symptoms of rheumatism are part of the aging process might not
seek adequate help and thus contribute to a further worsening of the symptoms
(Bode, Taal, Westerhof, van Gessel, & Van der Laar, 2012; Leventhal & Prohaska,
1986). Fortunately, during the last decade or so, evidence has also been accumu-
lating from longitudinal studies which analyzed the effects of subjective aging on
health and survival. In a recent meta-analysis, we found a small but signifi cant
effect of subjective aging on health and survival (Westerhof et al., in press). In
this chapter, we will add to this meta-analysis by (a) synthesizing the evidence on
the psychological pathways through which subjective aging might affect health
and longevity and (b) developing a heuristic model based on empirical evidence
and theoretical reasoning which may guide further empirical research on how
subjective aging may contribute to health and survival.
In this chapter, we carry out a narrative review of longitudinal studies. We
did a similar search as in the meta-analysis, using different databases (PsycInfo,
Web of Science, PubMed, and Scopus) and different search terms for subjective
aging (“subjective aging,” “age identity,” “subjective age,” “felt age,” “perceived
age,” “self-perceptions of aging,” “satisfaction with aging,” “view on aging,” and
“aging-related cognitions”) and longitudinal studies (“longitudinal,” “panel,”
“prospective”). We did not add search terms for outcomes or pathways but
included all longitudinal studies which assessed the effects of subjective aging on
physical and psychological functioning later in time. The present chapter thus
uses more studies than the meta-analysis because that study focused on health
and longevity as outcomes.
Subjective aging has been conceptualized in several different ways in lon-
gitudinal studies. As a fi rst step in the analysis of possible pathways, we focus on
the three most common conceptualizations which were used in the studies we
found in our search: (a) age identity, (b) self-perceptions of aging, and (c) self-
perceptions of age-related growth and decline. Age identity refers to the differ-
ence between one’s subjective (i.e., felt or perceived) and one’s chronological age.
Self-perceptions of aging refer to general evaluations of one’s own aging process
and are also referred to as satisfaction with aging. Self-perceptions of age-related
growth and decline refer to perceptions of gains and losses in different domains
of functioning.
In the following text, we will describe how each of these concepts stems
from a somewhat different theoretical background and focuses on a different facet
of subjective aging. Consequently, the pathways that are proposed in explaining
the effects of subjective aging on health and survival are also different for differ-
ent concepts. For each concept, we will fi rst present the theoretical background
and then the empirical studies on the effects on health and survival. We conclude
with discussing the pathways which might explain these effects.
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148 ANNUAL REVIEW OF GERONTOLOGY AND GERIATRICS
AGE IDENTITY, HEALTH, AND LONGEVITY
Conceptualization
The fi rst conceptualization of subjective aging that has been used in longitudinal
studies is age identity . Drawing on the cultural maxim that “one is only as old
as one feels,” this has mainly been studied using a single item on subjective age :
“What age do you feel?” (Barak & Stern, 1986; Peters, 1971). Age identity is then
operationalized as the difference between the person’s subjective and chronologi-
cal age (Westerhof, Barrett, & Steverink, 2003)—a difference that is nowadays
often defi ned in terms of the percentage which the person feels younger than his
or her chronological age (Rubin & Berntsen, 2006). In terms of a variation of this
approach, Uotinen, Rantanen, and Suutama (2005) asked whether older adults felt
mentally and physically younger, the same, or older than their calendar age. Other
operationalizations refer to age identity in terms of identifying with a specifi c age
group, such as middle-aged or older persons, or to cognitive age (i.e., feel-age,
look-age, do-age, and interest-age; Kastenbaum, Derbin, Sabatini, & Artt, 1972).
However, these operationalizations have not been used in longitudinal studies.
Subjective age was fi rst conceived as an indicator of age that might be related
stronger to a person’s level of functioning than chronological age (Havighurst &
Albrecht, 1953). Nowadays, theories about age identity have anchored the con-
cept more strongly in theories about self and identity (Westerhof et al., 2012).
Building on the classical work of William James (1890/1981) and Erik Erikson
(1997), these theories describe different motivated processes of the self, includ-
ing the need for self-consistency and self-enhancement, which underlie a per-
son’s age identity. Self-consistency refers to the motive of remaining the same
stable person over time and is advocated most strongly in self-verifi cation theory
(Swann, Rentfrow, & Guinn, 2003). Self-enhancement refers to maintaining or
promoting a positive self-image and mainly draws on research on self-esteem as a
positive illusion (Taylor & Brown, 1988). Both processes of self-consistency and
self-enhancement may be at work in shaping age identities (Keyes & Westerhof,
2012; Westerhof et al., 2012). Individuals are able to maintain consistency by
assimilating new experiences into their existing self-concepts and thereby iden-
tifying with the younger age they used to be. In a culture that devalues old age,
identifying with younger ages and age groups allows older adults to also enhance
their self-esteem and well-being (Weiss & Lang, 2009, 2012).
Empirical Evidence
Several studies found that age identity is related to health and survival. Most of
these studies controlled for sociodemographic indicators, such as age, gender,
and education, as well as psychological factors such as control beliefs or loneli-
ness, which are known causes of health and longevity. Studying middle-aged
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Longitudinal Research on Subjective Aging 149
and older adults, Spuling, Miche, Wurm, and Wahl (2013) found evidence of
6-year prospective relations of younger age identities with better subjective
health and less physical illnesses in the German Aging Survey. In a study on
cancer patients in Germany, Boehmer (2006, 2007) asked for subjective age one
month and six months after surgery for malignant tumors. She found that feeling
younger and remaining to feel younger across time were related to more positive
self-reported health outcomes, such as health-related quality of life, perceived
disability, and recovery satisfaction. Other studies examined survival in older
adults. An American study on adults aged 60 years and older found a signifi cant
association between a younger age identity and a higher chance of survival over a
4-year period (Markides & Pappas, 1982). The Finnish Evergreen Project found
a signifi cant effect on longevity of a younger physical but not a younger men-
tal age identity in 65- to 84-year-olds (Uotinen et al., 2005). The Berlin Aging
Study did fi nd support for the relation between a younger age identity and sur-
vival in adults aged 70 years and older (Kotter-Grühn, Kleinspehn-Ammerlahn,
Gerstorf, & Smith, 2009). However, Lim et al. (2013) did not fi nd evidence
that age identities were related to survival in cancer patients who were treated
with chemotherapy. The authors acknowledged that their study might have been
somewhat underpowered, but the study also differed from previous studies in
that it focused on a patient population which was somewhat younger than previ-
ous population studies.
Pathways
To our knowledge, there have been no longitudinal studies that directly addressed
the pathways through which age identities might be related to health and sur-
vival over time. Given that the motives of self-consistency and self-enhancement
operate in maintaining younger age identities, a major pathway may operate
through the accumulation of subjective well-being, which would result from
these motives (Westerhof & Barrett, 2005; Westerhof et al., 2012). Subjective
well-being has been defi ned as the presence of positive affect, the absence of
negative affect, and satisfaction with life in general (Diener, Suh, Lucas, &
Smith, 1999). Although evidence exists that health is a predictor of subjective
well-being, more recent meta-analyses have shown that subjective well-being
is related to physical functioning and survival in the general population as well
as in patient populations, in particular in older adults (Chida & Steptoe, 2008;
Lamers, Bolier, Westerhof, Smit, & Bohlmeijer, 2012; Pressman & Cohen, 2005;
Veenhoven, 2008). Subjective well-being might thus be a mediator in the asso-
ciation of age identity with health and survival.
At least indirect support for this assumption comes from two studies which
have indeed found that age identity is longitudinally related to indicators of
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subjective well-being. Spuling et al. (2013) found younger age identities to be
associated with lower depressive symptoms over a 6-year period in participants
in the German Aging Survey, whereas depressive symptoms and other health
indicators did not predict subjective age over time. Similarly, Mock and Eibach
(2011) found associations of younger age identities with better subjective well-
being over a period of 10 years in the Midlife Development in the United States
(MIDUS) study (participants’ age ranged from 25 to 74 years at the fi rst time of
assessment).
Based on these fi ndings, we can conclude that there is rather consistent
empirical evidence that younger age identities are related to better health and
a longer life. Furthermore, some empirical evidence suggests that maintaining
younger age identities may contribute to feeling well across time, which, in turn,
might result in better health and longevity. However, this pathway has not been
examined explicitly in empirical studies.
GENERAL SELF-PERCEPTIONS OF AGING,
HEALTH, AND LONGEVITY
Conceptualization
Self-perceptions of aging are a second conceptualization of subjective aging
that has been used in longitudinal studies. The concept originated from work
by Lawton (1975), who saw attitudes toward own aging as a component of
morale or subjective well-being. The Attitudes Toward Own Aging Scale is
part of his Philadelphia Geriatric Center Morale Scale (Lawton, 1975; Liang
& Bollen, 1983) and includes items such as “Things keep getting worse as I
get older,” “As you get older, you are less useful,” or “I am as happy now as I
was when I was younger.” Some authors who used this scale as an indicator
of subjective aging also refer to it as measuring satisfaction with aging (e.g.,
Maier & Smith, 1999) or self-perceptions of aging (Levy, Slade, & Kasl, 2002).
Following Levy, Slade, and Kasl (2002), we will use it as a measure of self-
perceptions of aging.
Theoretically, self-perceptions of aging play an important role in Levy’s
(2009) stereotype embodiment theory . Levy mainly drew on the symbolic interac-
tionist theories of Mead (1934) who argued that societal beliefs are internalized
in the self-concept and the work of Goffman (1963) who focused on the per-
sonal consequences of social stigma. She combined this symbolic interactionist
approach with the functionalist perspective of Merton (1957), who coined the
concept of self-fulfi lling prophecy. The stereotype embodiment theory holds that
individuals internalize negative stereotypical beliefs about older persons from a
very young age on. When they grow old, individuals start to apply these negative
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Longitudinal Research on Subjective Aging 151
stereotypes to their own person. They thereby construe negative self-perceptions
of their own aging process, which contribute to a self-fulfi lling prophecy of age-
related decline.
Empirical Evidence
Several studies have addressed the impact of self-perceptions of aging on health
and survival, again controlling for sociodemographic and psychological factors
which are known causes of health and longevity. The fi rst study on functional
health was based on the Ohio Longitudinal Study of Aging and Retirement
(OLSAR), focusing on adults aged 50 years and older and using a measure of the
ability to perform activities of daily life. Based on this study, Levy, Slade, and Kasl
(2002) showed that individuals with more positive self-perceptions of aging were
better able to maintain better functional health over a period of 20 years. In the
Australian Longitudinal Study of Aging (ALSA; adults aged 65 years and older),
Sargent-Cox, Anstey, and Luszcz (2014) used objective physical performance
tests on balance, gait, and rising from a chair. They found evidence that more
positive self-perceptions of aging had an effect on these measures of physical
functioning over a period of 16 years. Moser, Spagnoli, and Santos-Eggimann
(2011) used data collected in the Swiss Lausanne Cohort study (adults in the
age range of 65–70 years) and found evidence of preventive effects of positive
self-perceptions of aging on basic and instrumental activities of daily living, falls,
and hospitalizations across a period of 1–3 years. Whereas these studies focused
on the general population, Cheng, Yip, Jim, and Hui (2012) focused on a spe-
cifi c group of institutionalized middle-aged and older persons with schizophre-
nia. They found that more positive self-perceptions of aging were related to less
medical events 3 months later.
All studies on survival reported positive effects of more positive self-per-
ceptions of aging on longevity. The included studies which addressed all-cause
mortality based on the OLSAR over a period of 23 years (Levy, Slade, Kunkel, &
Kasl, 2002), the ALSA over a period of 15 years (Sargent-Cox et al.,2014) and
the Berlin Aging Study (Kotter-Grühn et al., 2009, with a follow-up of 16 years;
Maier & Smith, 1999, with a follow-up of 4.5 years). Levy and Myers (2005) also
used the OLSAR study with a follow-up of 23years but focused on survival from
a specifi c class of diseases, namely respiratory diseases.
Pathways
The stereotype embodiment theory proposes three types of pathways from stereo-
types through self-perceptions of aging to functioning in later life: psychological,
behavioral, and physiological pathways (Levy, 2009). One of the psychological
pathways refers to the self-fulfi lling prophecy in which self-perceptions of aging
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152 ANNUAL REVIEW OF GERONTOLOGY AND GERIATRICS
act as expectations about the aging process. The behavioral pathway is mainly
illustrated by engagement in health practices, with adults with more positive
self-perceptions engaging in more constructive health practices. One possible
physiological pathway has been illustrated in experiments, for example, on the
infl uence of subliminal priming with stereotypes of older persons on cardiovas-
cular functioning (Levy, Hausdorff, Hencke, & Wei, 2000). Only psychological
and behavioral pathways have been examined in longitudinal studies.
Different psychological and behavioral pathways have been proposed that
might explain the effects of self-perceptions of aging on health and survival.
The basic idea is that more positive self-perceptions of aging help to accumu-
late psychological resources and guide behavioral regulation which supports
health and longevity. Regarding psychological pathways, Levy, Slade and Kasl
(2002) studied whether or not personal control beliefs mediate the association
between self-perceptions of aging and functional health. Individuals who have
more positive self-perceptions of aging may also believe that they have more
choice among responses that are effective in achieving desired outcomes, which,
in turn, may contribute to physical functioning. This mediating pathway could
explain part of the longitudinal relation between self-perceptions and functional
health. Another psychological pathway proposed by Levy, Slade, Kunkel and
Kasl (2002) involves will to live in relation to survival. In particular, will to live
partially mediated the relation between self-perceptions of aging and survival. In
another article on the OLSAR study, Levy and Myers (2004) proposed a behav-
ioral pathway and analyzed the effects of self-perceptions of aging on preventive
health behaviors, including attending a physical examination, taking medica-
tions, dieting, exercising, as well as consuming alcohol and smoking tobacco.
Although more positive self-perceptions of aging were indeed associated with
these health behaviors, the study did not address their mediating role regarding
physical functioning or survival.
To conclude, the effects of self-perceptions of aging on health and survival
have been consistently documented with samples of adults in different Western
countries, using self-reports of activities of daily living as well as objective mea-
sures of physical functioning and survival. Possible pathways include the accu-
mulation of psychological and behavioral resources which may prevent negative
self-perceptions of aging from becoming a self-fulfi lling prophecy.
SELF-PERCEPTIONS OF AGE-RELATED GROWTH AND
DECLINE, HEALTH, AND LONGEVITY
Conceptualization
The fi rst longitudinal fi ndings on the impact of self-perceptions of aging on
health and longevity by Levy and colleagues (Levy, Slade, & Kasl, 2002; Levy,
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Longitudinal Research on Subjective Aging 153
Slade, Kunkel, et al., 2002b) encouraged several additional studies on this
topic. As we have seen, some of these studies were also based on the previously
described unidimensional scale on self-perceptions of aging. In this section,
we will describe studies which have used multidimensional, domain-specifi c
scales to assess adults’ perceptions of their own aging. The multidimensional
perspective on subjective aging derives from theories on life span development
that emphasize the multidimensionality and multidirectionality of adult devel-
opment and aging. In particular, life span developmental theorizing emphasizes
that human development can be characterized by a life-long pattern of both gains
and losses, even though the ratio between gains and losses becomes more nega-
tive with age (e.g., Baltes, 1987; Heckhausen, Dixon, & Baltes, 1989). Midlife
marks the shift from the predominance of growth and gains to an increasing risk
of age-related losses. Also, changes related to restricted time perspective and
declining physical functioning tend to start in midlife and continue into old age
(Heckhausen, 2001).
Building on these basic tenets of life span developmental theory about the
multidimensional and multidirectional nature of aging, some researchers have
studied self-perceptions of aging as a multifaceted phenomenon to understand
the differential impact of various views on aging. This approach did not only
draw from a theoretical perspective but was also grounded in qualitative studies
on self-perceptions of aging showing that older adults often view aging as both
accompanied by losses—mainly in the physical and social domain—and gains,
such as more freedom and time for new interests (Connidis, 1989; Dittmann-
Kohli, 1995; Keller, Leventhal, & Larson, 1989). Based on these theoretical and
empirical insights, Steverink et al. (2001) developed a multidimensional scale
measuring cognitions about aging as physical decline, social loss, and ongoing
development. This scale has been used both in several cross-sectional studies
(e.g., Steverink et al., 2001; Westerhof, 2003; Westerhof et al., 2012) as well
as longitudinal studies (e.g., Wurm, Tesch-Römer, & Tomasik, 2007; Wurm,
Tomasik, & Tesch-Römer, 2010). All items of this multidimensional scale begin
with the stem “Aging means to me . . .” followed by domain-specifi c endings.
Exemplary items for the view that aging is accompanied by physical losses are
“Aging means to me that I am less healthy” or “Aging means to me that I am
less energetic and fi t,” whereas the items “Aging means to me that I continue to
make plans” or “Aging means to me that my capabilities are increasing” are two
examples for the view of aging as ongoing development.
Empirical Evidence
The German Aging Survey is a longitudinal study on healthy aging that is based
on a nationally representative sample of individuals in their second half of life
(40–85 years). The longitudinal studies on subjective aging used the scales of
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aging as physical losses and aging as ongoing development. These two domain-
specifi c self-perceptions of aging were signifi cant predictors for health and sub-
jective well-being over and above major sociodemographic and socioeconomic
indicators (e.g., age, gender, education) and beyond psychological factors such
as control beliefs (Wurm et al., 2007; Wurm, Tomasik, & Tesch-Römer, 2008).
Moreover, both the loss-oriented self-perception of aging as physical decline and
the gain-oriented view of ongoing development have been shown to be better
predictors of physical health than the other way around (Wurm et al., 2007).
This fi nding is in line with previously described studies showing a higher impact
of general self-perceptions of aging on functional health than vice versa (Levy,
Slade & Kasl, 2002; Sargent-Cox, Anstey, & Luszcz, 2012). In addition, a recent
study on domain-specifi c self-perceptions of aging and longevity showed that the
perception of aging as ongoing development was predictive of survival, even after
controlling for sociodemographic and health indicators (i.e., self-rated health,
chronic conditions, and functional limitations). The same, however, was not the
case for the self-perception of aging as physical loss (Wiest & Wurm, 2012).
Pathways
To understand how the gain-related view on aging as ongoing development
might impact health and longevity, Wurm et al. (2010) examined physical activ-
ity as one possible behavioral pathway. They showed that middle-aged and
older individuals who viewed aging as ongoing development were physically
more active and better able to maintain a higher level of activity over time than
those with a less gain-related view on aging. Furthermore, the authors were
interested in the question of whether the positive effect of a gain-related view
on aging might come to its limits when a serious health event occurs (Wurm
et al., 2008). Because serious falls and illnesses can considerably hamper the
striving for ongoing development, individuals with gain-related views on aging
might have more diffi culties to adapt to such an event. However, this assump-
tion was not supported by the data. Individuals with a more gain-related view
were able to maintain better self-rated health and life satisfaction even after a
serious health event.
Furthermore, a recent study examined the question of how domain-specifi c
self-perceptions of aging as physical losses might impede health and well-being
over a 6-month period (Wurm, Warner, Ziegelmann, Wolff, & Schüz, 2013).
In this study, the occurrence of a serious health event predicted the increased
use of strategies of developmental regulation: Selection, Optimization, and
Compensation (SOC; Baltes & Baltes, 1990). These, in turn, predicted higher
self-rated health and life satisfaction. However, this effect was moderated by the
domain-specifi c self-perception of aging as physical losses; that is, in the case of
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Longitudinal Research on Subjective Aging 155
a serious health event, a self-perception of aging as physical losses was associated
with a lower use of SOC strategies. These fi ndings point to a possible psycho-
logical pathway of how a loss-related view on aging can turn into a self-fulfi lling
prophecy through less effective developmental regulation strategies and, hence,
can contribute to poorer health and lower life satisfaction (Wurm et al., 2013).
Taken together, domain-specifi c self-perceptions of aging refl ect the cur-
rent view on life-span development as both growth and decline and shed more
light on possible mechanisms, explaining the link between self-perceptions of
aging, health, and longevity. Although perceiving aging as associated with fur-
ther goals and plans seems to be benefi cial, the contrary was found for the self-
perception of aging as physical losses.
A HEURISTIC MODEL
As mentioned earlier, we have reviewed the conceptualizations, empirical evi-
dence, and possible pathways through which subjective aging might affect health
and longevity over time. As this review shows, there is substantial evidence that
subjective aging is related to health and survival in a way that more youthful
age identities, more positive general self-perceptions of aging, as well as more
positive perceptions of age-related decline and growth serve to protect health
and contribute to longevity (Westerhof et al., in press). We have discussed sev-
eral pathways which may account for the effects of subjective aging on health
and longevity. We have seen that there is some, but only limited, empirical evi-
dence for these pathways. To synthesize the reviewed studies and to guide fur-
ther research, we have synthesized the theoretical pathways in a heuristic model
(Figure 7.1).
The left box of Figure 7.1 shows the three different conceptualizations of
subjective aging which were addressed in this chapter: age identity, general self-
perceptions of aging, and self-perceptions of aging as growth and decline. The
second box groups the different psychological resources which were discussed
in this chapter: subjective well-being, control beliefs, will to live, developmental
regulation (SOC), and health behaviors. The third box concerns different indica-
tors of health, and the last box concerns survival. All four boxes are placed in a
larger box, referring to the context in which these processes operate. The basic
idea of the pathways indicated by the arrows is that subjective aging contributes
to the accumulation of psychological resources that help to maintain a good
health which, in turn, contribute to survival. The processes take place in a con-
text that is indicated by the larger box. A fi nal characteristic of the model is that
we also included feedback loops. That is, the loss of psychological resources or
health may affect subjective aging in a negative way.
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156 ANNUAL REVIEW OF GERONTOLOGY AND GERIATRICS
Subjective Aging
Individual and Sociocultural Context
Age identity
Self-perceptions of aging
Self-perceptions of age-
related growth and decline
Psychological
Resources
Subjective well-being
Control beliefs
Will to live
Developmental regulation
Health behaviors
Subjective health
Functional health
Physical health
Health Survival
FIGURE 7.1 A heuristic model of pathways linking subjective aging to psychological resources, health, and survival.
Copyright © Springer Publishing Company, LLC
Longitudinal Research on Subjective Aging 157
The heuristic model can be of help in guiding further research. The fi rst direc-
tion concerns variables which were put together in one box but might have dif-
ferential contributions to different pathways. We will focus on the different aspects
of subjective aging distinguished in this chapter. The second direction focuses on
the role of health as a separate box between subjective aging and survival. The third
direction addresses the role of the individual and sociocultural context.
Differential Contributions of Different Aspects of Subjective Aging
The impact of different aspects of subjective aging has rarely been studied together
in one study. This is why the question is still open how the relations between the
different indicators of subjective aging should be conceptualized; that is, how
are they connected with each other and how do they differentially impact health
and longevity. Little is known about the interrelations among age identities, self-
perceptions of aging, and self-perceptions of age-related growth and decline. It
can therefore not be ruled out that effects on health and survival do not exist
independently because the different measures, as would be expected, do have
some conceptual and empirical overlap (Diehl et al., 2014). Furthermore, new
concepts have been proposed, such as awareness of age-related change and prep-
aration for aging, which also need to be incorporated when further longitudinal
evidence is collected (Diehl & Wahl, 2010).
Different aspects of subjective aging may have different consequences for
the accumulation of psychological resources. In methodological terms, they
may show differential validity. For example, the main pathway of age identity
to health and survival that was addressed in this chapter was through subjective
well-being. The pathways of self-perceptions of aging and age-related growth
and decline were through processes such as will to live, control beliefs, health
behaviors, or processes of developmental regulation. It thus remains a task for
future research to further study which pathways are most important for which
indicators of subjective aging and which developmental outcomes.
The Role of Health
In most studies, health is seen as an endpoint in itself. We have placed it in between
psychological resources and survival because one might argue that declining health
itself plays an important role in survival. We believe that it is hard to imagine a
pathway from subjective aging to survival without considering the mediating role
of health. However, the effects of subjective aging on survival through health have
not been studied extensively yet. Rather, studies addressing the impact of subjec-
tive aging on longevity have controlled for health indicators as possible confound-
ers. Although this is justifi ed in establishing evidence on the unique relations of
subjective aging to survival, this might also have led to an underestimation of the
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158 ANNUAL REVIEW OF GERONTOLOGY AND GERIATRICS
relation because indirect effects through health were not considered. We therefore
propose to study the indirect effects of subjective aging on survival through health
more intensively and in particular in a prospective longitudinal way.
The role of health might indeed be even more complex. Findings from
longitudinal studies (e.g., Kleinspehn-Ammerlahn, Kotter-Grühn, & Smith,
2008; Sargent-Cox et al., 2012; Schafer & Shippee, 2010b; Uotinen, Rantanen,
Suutama, & Ruoppila, 2006; Wurm et al., 2013) suggest that physical health
and changes in physical health play an important role in developing older age
identities and more negative self-perceptions of aging. When people experience
health problems, they may attribute their health problems to age (rather than,
for example, to lifestyle) and, hence, may start to feel older. This, in turn, may
lead to the reinforcement of already existing negative age stereotypes and the
development of more negative self-perceptions of aging. Furthermore, negative
self-perceptions of aging may in turn diminish psychological resources such as
subjective well-being, control beliefs, will to live, developmental regulation strat-
egies, and health behaviors and thereby contribute to an even worse health. This
would again lead to older and more negative perceptions of aging and so on.
In this way, a vicious cycle of breakdown in later life could occur (Kuypers &
Bengtson, 1973).
Individual and Sociocultural Context
The third focus for future research involves the inclusion of the individual and
sociocultural context. Individual characteristics, such as personality traits or
personal values, may affect subjective aging in fundamental ways. For example,
neuroticism has been related to lower levels of subjective well-being as well as
worse physical functioning and survival (e.g., Friedman & Kern, 2014; Wilson,
de Leon, Bienias, Evans, & Bennett, 2004). Kotter-Grühn et al. (2009) consid-
ered neuroticism as a covariate in their analyses on subjective aging and found
that the effect of subjective aging remained independently signifi cant after emo-
tional instability had been accounted for. Further research could clarify whether
it is indeed subjective aging that results in the proposed pathways or whether
other characteristics of the individual and sociocultural context can explain part
of these relations. Similarly, the sociocultural context, such as social relations,
media portrayals, social policies, health care systems, or institutional arrange-
ments may infl uence the proposed pathways as well. For example, although
social policies regarding aging have changed over the past decades, few studies
have addressed how these changing social policies might have had an impact
on subjective aging. It would therefore be prudent to take these individual and
sociocultural contexts into account when studying the impact of subjective aging
on health and longevity.
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Longitudinal Research on Subjective Aging 159
Another approach would be to assess whether individual and sociocultural
contexts are conditional to the proposed pathways. For example, Schafer and
Shippee (2010a) found a relationship in the MIDUS study between age iden-
tity and expectations concerning cognitive aging for women but not for men.
Furthermore, fi ndings from the German Aging Survey suggested that middle-
aged individuals with more positive self-perceptions of age-related growth and
decline not only engaged in sports more frequently but even increased the activ-
ity over time, provided that they were healthy enough to do so (Wurm et al.,
2010). Older individuals with more positive self-perceptions of aging, however,
mainly walked more regularly and increased walking over time, which is positive
because walking is often the only physical activity that is even recommended in
the presence of health problems (Wurm et al., 2010).
Besides individual characteristics, the sociocultural context may also play a
moderating role. In our meta-analysis, we found that effects of subjective aging
on health and survival were stronger in the United States than in Western Europe
(Westerhof et al., in press). This fi nding may be related to differences in wel-
fare state regimes (Bambra, 2007; Esping-Andersen, 1990). In the United States,
which has a so-called liberal welfare regime, there is a strong need for individuals
to take responsibility for their own aging process and for their fi nancial security
in old age because the social security provisions from the states and/or the federal
government are very limited. In European countries, the so-called conservative
welfare states, such as the German one, more state provisions and social security
policies, including policies for late life, are in place. Aging individuals may thus
feel less responsible for their own aging process because they feel that economic
security and health care are generally provided by society. Also, in European
countries, eligibilities and entitlements are still more often tied to chronological
age (e.g., obligatory retirement at age 65 years), and this may make chronologi-
cal age more salient for the individual. Further research could therefore assess
whether individual and sociocultural contexts play a moderating role in the asso-
ciation between subjective aging and health and survival.
CONCLUSION
The goal of this chapter was to synthesize existing evidence from longitudinal
studies and to develop a heuristic model which may guide future empirical
research on how subjective aging may contribute to health and survival. We
found evidence in support of the predictive value of subjective aging for health
and survival and proposed three further directions for research. These direc-
tions focus on the differential contributions of different dimensions of subjec-
tive aging, the role of health, and the role of the individual and sociocultural
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160 ANNUAL REVIEW OF GERONTOLOGY AND GERIATRICS
context. It is our hope that pursuing these new directions will contribute to
further evidence and insights into the processes involved in subjective aging.
Specifi cally, such research needs to focus on the further clarifi cation of ques-
tions about the pathways from subjective aging to survival as well as the con-
ditions under which these pathways operate. Gaining insights into the vicious
cycle that might be at work between subjective aging and physical decline would
also provide the needed information to intervene in this process. Given the exist-
ing evidence, public health professionals would be well-advised to start think-
ing about positive and constructive interpretations of the aging process which
may help adults to escape the vicious breakdown cycle, but further evidence
is needed on how exactly this could be possible. First steps have been made in
developing interventions aiming at changing negative self-perceptions of aging
to promote a healthier lifestyle (Sarkisian, Prohaska, Davis, & Weiner, 2007;
Wolff, Warner, Ziegelmann, & Wurm, 2014). However, more research in this
direction is needed by simultaneously considering that overly positive views on
aging might also be diffi cult, because aging is not only associated with gains but
with increasing losses as well.
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