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Can adherence to moral standards and ethical behaviors help maintain a sense of purpose in life? Evidence from a longitudinal study of middle-aged and older adults

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Abstract

Personal factors, such as character strengths, have been shown to be favorably associated with concurrent and future well-being. Positive associations have also been reported between purpose in life and concurrent and subsequent health and well-being. Evidence on antecedents of purpose in life is, however, limited. This study examines whether the adherence to moral standards and ethical behaviors (AMSEB) is associated with subsequent purpose in life. Data from the Health and Retirement Study obtained from a sample of 8,788 middle-aged and older adults in the US (mean age = 64.9 years, age range 50–96 years) were used. The prospective associations between AMSEB and purpose in life were examined using generalized linear models. A rich set of covariates and prior outcomes were used as controls to reduce the risk of reverse causation. The robustness analyses included computation of sensitivity measures, E-values, and running a set of secondary analyses conducted on subsamples of respondents and using a limited set of covariates. It was found that middle-aged and older adults who demonstrated higher AMSEB reported a higher sense of purpose in life after the 4-year follow-up period. This association was found to be monotonic, moderately robust to potential unmeasured confounding and independent of demographics, prior socioeconomic status, prior health conditions, and health behaviors as well as prior psychological predispositions such as dispositional optimism and life satisfaction. It was also robust to missing data patterns. Policymakers and health practitioners may consider a predisposition to adherence to moral standards and ethical behaviors as a potential intervention target, as its improvement and/or maintenance has the potential to improve longevity and to help promote healthy and purposeful aging.
RESEARCH ARTICLE
Can adherence to moral standards and ethical
behaviors help maintain a sense of purpose in
life? Evidence from a longitudinal study of
middle-aged and older adults
Dorota Weziak-BialowolskaID
1,2
*, Piotr Bialowolski
2,3
1Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University,
Cracow, Poland, 2Human Flourishing Program, Institute for Quantitative Social Science, Harvard University,
Cambridge, MA, United States of America, 3Department of Economics, Kozminski University, Warsaw,
Poland
*doweziak@hsph.harvard.edu
Abstract
Personal factors, such as character strengths, have been shown to be favorably associated
with concurrent and future well-being. Positive associations have also been reported
between purpose in life and concurrent and subsequent health and well-being. Evidence on
antecedents of purpose in life is, however, limited. This study examines whether the adher-
ence to moral standards and ethical behaviors (AMSEB) is associated with subsequent pur-
pose in life. Data from the Health and Retirement Study obtained from a sample of 8,788
middle-aged and older adults in the US (mean age = 64.9 years, age range 50–96 years)
were used. The prospective associations between AMSEB and purpose in life were exam-
ined using generalized linear models. A rich set of covariates and prior outcomes were used
as controls to reduce the risk of reverse causation. The robustness analyses included com-
putation of sensitivity measures, E-values, and running a set of secondary analyses con-
ducted on subsamples of respondents and using a limited set of covariates. It was found
that middle-aged and older adults who demonstrated higher AMSEB reported a higher
sense of purpose in life after the 4-year follow-up period. This association was found to be
monotonic, moderately robust to potential unmeasured confounding and independent of
demographics, prior socioeconomic status, prior health conditions, and health behaviors as
well as prior psychological predispositions such as dispositional optimism and life satisfac-
tion. It was also robust to missing data patterns. Policymakers and health practitioners may
consider a predisposition to adherence to moral standards and ethical behaviors as a poten-
tial intervention target, as its improvement and/or maintenance has the potential to improve
longevity and to help promote healthy and purposeful aging.
Introduction
A sense of purpose in life refers to an inclination to derive meaning from life events and to feel
a sense of direction in life. It has also been perceived as a central component of eudaimonic
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OPEN ACCESS
Citation: Weziak-Bialowolska D, Bialowolski P
(2022) Can adherence to moral standards and
ethical behaviors help maintain a sense of purpose
in life? Evidence from a longitudinal study of
middle-aged and older adults. PLoS ONE 17(8):
e0273221. https://doi.org/10.1371/journal.
pone.0273221
Editor: Ce
´sar Gonza
´lez-Blanch, University Hospital
Marques de Valdecilla, SPAIN
Received: February 14, 2022
Accepted: August 4, 2022
Published: August 19, 2022
Copyright: ©2022 Weziak-Bialowolska,
Bialowolski. This is an open access article
distributed under the terms of the Creative
Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in
any medium, provided the original author and
source are credited.
Data Availability Statement: Detailed information
concerning methodological aspects of the HRS as
well as access to data is available at the HRS
website (https://hrs.isr.umich.edu/).
Funding: Yes. DWB: The research leading to these
results has received funding from the Norwegian
Financial Mechanism 2014-2021 (UMO-2020/37/
K/HS6/02772; https://eeagrants.org/resources/
regulation-implementation-norway-grants-2014-
well-being [13]. This trait-like tendency to pursue goals and have a sense of accomplishment
has been recently recognized as a protective factor against ill health and as a positive health
asset contributing to human flourishing. In particular, for example for middle-aged and older
adults, there is accumulating observational and experimental evidence suggesting that demon-
strating a higher sense of purpose and meaning is prospectively associated with good mental
and physical health, more prevalent use of preventive care services, lower risk of unhealthy
behaviors, a reduced risk of developing impairment in basic and instrumental activities of
daily living as well as mobility limitations, lower risk of dementia onset and the pathologic
changes of Alzheimer’s disease to cognition, fewer cardiovascular events such as myocardial
infarction, lower risk of stroke, fewer sleep disturbances, and reduced mortality risk [415].
Although sense of purpose in life has been a well-recognized factor positively affecting
health, well-being and longevity, especially in middle-aged and older adulthood, evidence on
its antecedents is only emerging [16]. Some preliminary evidence from the population of US
nurses, US students, Mexican factory workers and UK middle-aged and older adults suggests
that positive affect, social connections and feeling of purpose while at work are associated with
subsequent higher levels of purpose and meaning in life, while psychological distress is associ-
ated with subsequent lower levels of purpose and meaning in life [1720]. Additionally, for
middle-aged and older adults in the UK, it has been reported that favorable economic condi-
tions and greater physical activity can positively contribute to an improved sense of a mean-
ingful life at a 2-year follow-up [18]. Regarding physical health, for middle-aged and older
adults from the UK, it has been reported that prior number of chronic diseases and prior lack
of pain are associated with a greater experience of meaning in life [18], but no prospective
associations with purpose in life have been reported for prior health behaviors or prior physical
health among US nurses [17].
Therefore, more research is still needed to better understand the determinants and mecha-
nisms of promoting, maintaining, and restoring purpose in life as a health asset. These aspects
are crucial to designing effective interventions with a sense of purpose as a resource for pro-
moting health- and well-being and/or preventing disease.
Consequently, this study aims to examine adherence to moral standards and ethical behav-
iors as an antecedent to purpose in life. Our interest in this particular exposure results from,
first, the previous arguments that finding purpose in life may be consequential of personal
attributes related to personality traits [21,22] and associated with prior levels of orientation to
do and promote good [23]. Second, it is ensuing from theoretical arguments that morally val-
ued personality traits that are fundamental to one’s identity produce positive outcomes for
oneself and/or others, and contribute to the greater good [24,25], were categorized as personal
enablers of well-being and mitigators against the unfavorable impact of life events and difficul-
ties [3,26]. Third, our interest also results from prior theoretical arguments and empirical
findings indicating that the predisposition to act according to ethical standards and accepted
rules of good, honest and/or moral behaviors, as well as having thoughts and taking actions
that contribute to the good of oneself and others, contribute to an attainment of complete
eudaimonic well-being and better health [23,2730]. In particular, prior research indicate that
a tendency to act according to moral standards and ethical behaviors is associated with lower
risks of incident cognitive impairment not dementia, depression and unfavorable health-
related behaviors as well as lower limitations in mobility and less difficulty in instrumental
activities of daily living among middle-aged and older adults [3032]. Additionally, other stud-
ies on related constructs have also shown that prosocial behaviors such as generosity or kind-
ness, providing emotional and economical support to others, and performing acts of altruistic
behaviors may favorably affect health and increase the well-being of the giver [3336]. Conse-
quently, in this study, we test the hypothesis that the adherence to moral standards and ethical
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2021). The funder had no role in study design, data
collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
behaviors is favorably associated with higher subsequent purpose in life, and this prospective
association holds even after adjusting for a wide range of potential confounders (i.e., sociode-
mographic and psychological factors, health behaviors, and prior health conditions).
Materials and methods
Data
The main source of data was the nationally representative panel study–the Health and Retire-
ment Study (HRS)–which is conducted every two years in the US and collects data from people
aged 50 and older (henceforth referred to as middle-aged and older adults) [37,38]. In this
study, we used demographic, socioeconomic and health data from the HRS core questionnaire
collected in 2004–2014 as well as psychological data collected using the ‘Psychosocial and Life-
style Questionnaire’ in waves 2008/2010-2012/2014 (all waves in which these data were col-
lected). In the construction of the analytical sample, we took into account the fact that the HRS
uses a mixed-mode design for collecting data from the ‘Psychosocial and Lifestyle Question-
naire’, which implies that the alternating random 50% subsample of the longitudinal panel is
asked to fill in this questionnaire every 4 years [38,39]. Therefore, we combined data from two
subcohorts (2008 and 2010) to increase the sample size and to improve statistical power. Con-
sequently, three “combined” waves (i.e., pre-baseline, baseline and outcome waves, being 4
years apart from each other) were analyzed.
The analytical sample was limited to individuals who (i) completed the AMSEB questions
and (i) purpose in life questions from the ‘Psychosocial and Lifestyle Questionnaire’ at base-
line. This resulted in a final sample size of 8,788 middle-aged and older adults. Detailed infor-
mation concerning methodological aspects of the HRS as well as access to data is available at
the HRS website (https://hrs.isr.umich.edu/). Because this study used deidentified, publicly
available data, it was exempted from review by the Harvard Longwood Campus Institutional
Review Board.
Measures
In this study, we used both single questions and psychosocial scales available in the HRS. They
have been shown to be useful in previous studies, and the scale has also been rigorously vali-
dated [37,39,40].
Adherence to moral standards and ethical behaviors. Adherence to moral standards
and ethical behaviors was assessed using a four-item instrument “Virtue of adherence to moral
standards and ethical behavior” available in the HRS [39,41]. The instrument constitutes a
subscale of the conscientiousness measure and is conceptualized to capture beliefs correspond-
ing to adherence to moral standards of honesty and as a predisposition to act in accordance
with established rules of good and ethical behavior as well as attempting to be a moral exem-
plar [41]. Therefore, henceforth, this scale will be referred to as the scale of adherence to moral
standards and ethical behaviors (AMSEB). The AMSEB items comprise: ‘If I could get away
with it, I would not pay taxes’ (reverse scored); ‘I could be insincere and dishonest, if the situa-
tion required me to do so’ (reversed scored); ‘If the cashier forgot to charge me for an item, I
would tell him or her’; ‘When I was in school, I would rather get a bad grade than copy some-
one else’s homework’. Agreeability with each item was assessed using a six-point Likert-type
scale: 1 = Strongly disagree, 2 = Somewhat disagree, 3 = Slightly disagree, 4 = Slightly agree,
5 = Somewhat agree, 6 = Strongly agree. Scores for negatively worded items were reversed, and
the scale of AMSEB was calculated as an average of the scores across items. Consequently, the
scale ranges from 1 to 6, and higher score is indicative of higher adherence to moral standards
and ethical behaviors reflected in a predisposition to act in accordance with established rules
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of good, honest, and ethical behavior. As suggested by the HRS guide [39], the final score was
set to missing if there were more than two items with missing values.
The instrument has been psychometrically validated (including established unidimension-
ality, satisfactory reliability and validity) in the US and UK populations [41,42]. It has also
been used in various studies of mental and physical health, cognitive impairment, well-being,
and quality of life [30,31,43].
The AMSEB was assessed in the baseline wave (2008/2010; the only waves in which this vari-
able was measured). It was standardized (mean = 0, standard deviation = 1) and used in the anal-
yses as a continuous variable. Additionally, to examine possible nonlinear threshold effects, a
categorical variable according to the tertiles of data based on the baseline distribution of the
AMSEB scale scores in the analytic sample was constructed and used in the secondary analyses.
Purpose in life. Purpose in life was assessed using a seven-item instrument available in
the HRS. The instrument constitutes a subscale of the Psychological Well-Being measure [2].
It intends to capture the belief that one’s life is purposeful and meaningful. The instrument has
been psychometrically validated [44] and proved useful in various studies on associations
between sense of purpose in life and health outcomes [8,45,46]. The exemplary items include
‘I have a sense of direction and purpose in my life’ and ‘I do not have a good sense of what it is
I’m trying to accomplish in life’. Respondents rated their agreeability with items using a six-
point Likert-type scale: 1 = Strongly disagree, 2 = Somewhat disagree, 3 = Slightly disagree,
4 = Slightly agree, 5 = Somewhat agree, 6 = Strongly agree. Negatively worded items were
reverse scored, and the scale of purpose in life was calculated as an average of the scores across
all seven items. Following the HRS protocols [39], the final score was set to missing if there
were more than three items with missing values. The scale ranged from 1 to 6, with higher
scores indicating greater levels of purpose in life.
In the study, we considered the purpose in life a standardized continuous variable
(mean = 0, standard deviation = 1). Following the study design, the purpose in life was assessed
4 years after the AMSEB exposure in the outcome wave (2012/2014). To reduce the risk of
reverse causation, we also controlled for the prior level of purpose in life at baseline (the mea-
surement of this variable started in HRS in 2006 and limited the possibility to control for it in
the prebaseline wave).
Covariates. Prior research indicated a wide range of possible predictors of purpose in life
and character strengths including demographic (e.g., gender, age, race/ethnicity, and marital
status), economic (e.g., income and wealth), psychological (e.g., positive and negative affect),
and health factors (e.g., health behaviors and health condition) [30,4751]. Therefore, we
adjusted for participants’ characteristics including sociodemographic factors, health behaviors,
health conditions and psychological factors. Regarding sociodemographic variables, we con-
trolled for age (50–59, 60–69, 70–80, 80+), gender (male or female), race (White/Caucasian,
Black/African American, other), educational attainment (less than high school, GED, high
school graduate, some college, college and above), marital status (married, married but spouse
absent, partnered, separated, divorced, widowed, never married), annual personal income
(logarithm), and household wealth (logarithm). With respect to health behaviors, alcohol con-
sumption (number of days per week), smoking (yes or no) and BMI were accounted for in the
analyses. We also controlled for health conditions, including in the set of covariates self-
reported variables on the presence/absence of obtaining a doctor’s diagnosis for six physical
health conditions, such as stroke, diabetes, cancer, lung disease, heart condition, and high
blood pressure. Next, a mental health condition was controlled for. Depression was measured
by the Center for Epidemiological Studies Depression eight-item scale (CES-D8) [52]. Addi-
tionally, two physical functioning factors were also controlled for: limitations in instrumental
activities of daily living as measured by the IADL index available in the RAND HRS
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Longitudinal File 2016 [5355] and limitations in mobility, strength and fine motor skills
reflected in the mobility index also already available in the RAND HRS Longitudinal File 2016
[55]. Finally, psychological predispositions such as life satisfaction measured with the 5-item
Diener Satisfaction with Life Scale [56] and dispositional optimism assessed with the Life Ori-
entation Test [57] were accounted for.
Sociodemographic covariates, health behaviors and physical and mental health conditions,
including daily life functioning, were assessed via self-reports in the prebaseline wave (2004/
2006). Psychological covariates were measured in the baseline wave. The assessment in the pre-
baseline wave was not feasible due to (1) the mixed-mode design with biennially alternating
samples and (2) the fact that the ‘Psychosocial and Lifestyle Questionnaire’ was introduced in
2006 and administered only to alternating half of the sample [39].
Statistical analysis
All statistical analyses were performed using Stata/SE 17.0 for Mac.
The prospective associations were modeled using generalized linear models. Two alterna-
tive specifications of the exposure variable were examined. The AMSEB scale was applied as a
standardized continuous variable (mean = 0, standard deviation = 1) as well as a categorical
variable indicating the tertiles of the AMSEB scale. The aim was to examine possible nonlinear
threshold effects. Standardized regression estimates were reported. Control for prebaseline (if
prebaseline was not available, the baseline was used instead) covariates, and prior outcome
was used to reduce the risk of reverse causation.
Since we used a rich set of covariates, the risk of overfitting the model emerged. Therefore, the
primary model was run under three alternative specifications, excluding particular subsets of
covariates. In Model 1, we controlled only for social determinants of health, that is, sociodemo-
graphic characteristics, wealth, and income. In Model 2, compared to Model 1, we added vari-
ables related to health behaviors. Model 3 additionally controlled for health conditions, and
Model 4 (i.e., the primary model) included all covariates, that is, additional psychosocial factors.
To decrease the risk of reverse causation, all models also controlled for the prior outcome.
To examine the generalizability of the results, potential interactions between AMSEB and
sociodemographic covariates (i.e., gender, age, education, race, income and total wealth) were
examined. The moderating effects were tested in the model with the most extensive set of
covariates (i.e., Model 4).
All missing covariate and outcome variables were imputed using the chained equations.
Ten sets of imputed data were generated [58], and the multiple imputation estimates pooled
using Rubin’s rule [59] were presented. A series of robustness checks was also conducted.
First, the robustness of the results was examined using the E-values [60]. These are sensitivity
measures that aim to examine the magnitude of association between a potential unmeasured
confounder and both the exposure and the outcome to entirely cancel out the observed associ-
ation. Second, all models were rerun after excluding anyone with a history of chronic condi-
tions (i.e., heart attack, hypertension, high blood cholesterol, stroke, diabetes, cancer and
depression; the threshold 3 on CES-D8 was used to classify respondents as having clinically
significant depressive symptoms [52]). Finally, the primary set of models was reanalyzed using
complete-case analysis to assess the robustness of the results to missing data patterns.
Results
Descriptive analysis
In the prebaseline wave (2004/2006), participants were 64.9 (SD = 8.47, age range 50–96 years)
years old on average. They were mostly women (59.7%), married (64.1%), predominantly
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Caucasian (84.4%), and had a high school education (32.8%). They scored 5.0 on average on
the AMSEB scale (SD = 0.95l range: 1–6) and were mostly healthy at baseline. Participants
scoring higher on the AMSEB scale, compared with those scoring the lowest, reported more
favorable health behaviors and better psychological conditions. In Table 1 we present partici-
pant characteristics by AMSEB tertiles.
Adherence to moral standards and ethical behaviors and purpose in life
During the 4-year follow-up period, middle-aged and older adults who scored higher on the
AMSEB scale had a substantially greater sense of purpose in life. These prospective associations
were highly consistent across all four models (Table 2, Models 1–4). After adjusting for socio-
demographic factors, prior health behaviors and prior health conditions (Model 3), one stan-
dard deviation increase in AMSEB was associated with a subsequent increase in the sense of
purpose in life by 0.055 points on its standardized score (β= 0.055, 95% CI = 0.037; 0.074;
p<0.001). Controlling for each additional set of covariates led to an attenuation of the prospec-
tive association between AMSEB and purpose in life. However, the association remained sig-
nificant (p<0.001) in all of the models (Table 2, Models 1–4). Finally, potential interactions
between AMSEB and gender, age, education, race, income, and total wealth were examined.
The moderating effects were found not to be significant for any of the covariates (S1 Table).
The analysis also confirmed a monotonic association between AMSEB and subsequent pur-
pose in life (Table 2; columns–tertile 1, tertile 2 and tertile 3). Compared with individuals who
scored the lowest on the AMSEB, participants who scored in the third tertile after the 4-year
follow-up period had higher scores on the purpose in life scale (β= 0.134; 95% CI = 0.089;
0.179, p<0.001). Similar to the previous analyses, adding each additional set of covariates
resulted in a slight attenuation of the prospective association between AMSEB and purpose in
life.
Robustness analysis
Sensitivity analyses conducted with the E-values showed that the observed association between
AMSEB and purpose in life was moderately robust to potential unmeasured confounding (e.g.,
confounding by a personality factor such as neuroticism) (Table 3). For example, to explain
away the observed prospective association between AMSEB and purpose in life, an unmea-
sured confounder would need to be associated with both AMSEB and purpose in life by risk
ratios of 1.25 each above and beyond the measured covariates for the standardized AMSEB
and of risk ratio of 1.51 each above and beyond the measured covariates for the third tertile of
AMSEB. The weaker confounder would not be sufficient. Regarding the E-value for the limit
of the 95% CI, to shift the lower limit of the CI for the observed association between AMSEB
and purpose in life to include the null value, this unmeasured confounder would need to be
associated with both AMSEB and purpose in life by 1.19-fold each, above and beyond the mea-
sured covariates for the standardized AMSEB and by 1.39-fold each, above and beyond the
measured covariates for the third tertile of AMSEB.
Excluding participants who had any of the health conditions at prebaseline yielded similar
results for the standardized AMSEB in all examined models regarding the sets of covariates
(Table 4, limited sample). However, for the tertiles of the AMSEB scale, the effects became
insignificant and less precise for the second tertile compared to the first tertile in all models.
Regarding the third tertile, the effects continued to be significant but were of slightly lower
magnitude.
With respect to the full case scenario, the significant associations between AMSEB and sub-
sequent purpose in life remained significant in both specifications, i.e., for the standardized
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Table 1. Distribution of participant characteristics by adherence to moral standards and ethical behaviors at study baseline, health and retirement study, US.
AMSEB
Participant Characteristic Total (N = 8,788) Tertile 1 (N = 3,620) Tertile 2 (N = 2,870) Tertile 3 (N = 2,298)
% Mean (SD) % Mean (SD) % Mean (SD) % Mean (SD)
Sociodemographic factors
Gender (male) 40.2 47.10 40.59 29.29
Age group
50–59 29.72 33.40 29.23 24.54
60–69 40.76 40.39 41.43 40.51
70–79 24.23 21.57 25.05 27.37
80+ 5.29 4.64 4.29 7. 57
Race
White/Caucasian 84.35 80.35 86.83 85.99
Black/African American 11.27 13.12 9.62 10.40
Other 4.38 5.52 3.55 3.61
Marital status
Married 64.14 63.43 66.03 62.91
Married but spouse absent 0.66 0.64 0.59 0.78
Partnered 3.03 3.90 2.75 2.00
Separated 1.06 1.33 0.84 0.91
Divorced 10.18 10.80 9.97 9.27
Widowed 17.94 16.47 17.45 21.03
Never married 3.00 3.45 2.37 3.09
Education attainment
Less than high school 15.49 18.71 11.12 15.88
GED 4.61 5.06 4.25 4.35
High school graduate 32.75 31.80 32.14 34.99
Some college 23.51 22.13 24.05 25.02
College and above 23.64 22.30 28.44 19.76
Annual personal income ($) 17,068 (77,631) 19,044(113,67) 18,823 (39,353) 11,781 (26,898)
Household net financial assets ($) 441,405
(1,092,141)
404,816
(906,498)
492,671
(1,283,796)
435,166
(1,097,899)
Health Behaviors
Alcohol consumption (no. of days per week) 1.22 (2.12) 1.33 (2.20) 1.28 (2.16) 0.95 (1.93)
Smoking (yes) 54.64 60.34 52.70 48.10
BMI 28.25 (5.63) 28.61 (5.64) 28.02 (5.53) 27.97 (5.72)
Psychosocial factors
Dispositional optimism; 1–6 4.55 (1.13) 4.37 (1.15) 4.61 (1.04) 4.78 (1.16)
Life satisfaction; 1–7 5.03 (1.49) 4.83 (1.50) 5.09 (1.42) 5.27 (1.52)
Physical Health
Diagnosis of stroke 3.77 4.10 3.50 3.60
Diagnosis of diabetes 16.12 17.96 14.99 14.64
Diagnosis of cancer 12.15 11.23 12.95 12.59
Prior diagnosis of chronic lung disease 7.86 8.33 7.39 7.71
Diagnosis of heart condition 20.01 19.65 20.33 20.19
Diagnosis of high blood pressure 52.67 53.56 51.65 52.52
Mental Health
Depression based on CES-D8 scale; 0–8 1.22 (1.84) 1.41 (1.95) 1.07 (1.70) 1.11 (1.79)
Depression based on CES-D83 16.78 19.87 14.35 14.95
(Continued)
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indicator of AMSEB and for the tertiles of AMSEB (Table 4, full case scenario). This corrobo-
rated the robustness of the associations, with some reservations for people with no health con-
ditions. However, a supplementary analysis with an interaction term between standardized
AMSEB and indicator of being free of any health condition yielded no significant estimate for
this interaction (S1 Table). This provided further evidence that the prospective association
between AMSEB and purpose in life is robust to the health status of respondents.
Discussion
There has been a growing interest in the role of positive psychological factors and attitudes for
health and well-being. Two positive health determinants have attracted academic attention.
These are a sense of purpose and/or meaning in life and morally valued personality traits.
These two positive factors have been shown to be independently favorably associated with sub-
sequent health and well-being outcomes [11,30,6163]. However, little is known about the
antecedents of the two. In this study, we looked for some empirical evidence on whether the
adherence to moral standards and ethical behaviors can be perceived as an antecedent of sense
of purpose in life. We found that middle-aged and older adults who scored higher on the
AMSEB scale (highlighting a predisposition to follow moral standards and behave ethically)
after the 4-year follow-up period reported a higher sense of purpose in life. This association
was found to be monotonic, moderately robust to potential unmeasured confounding and
independent of demographics, prior socioeconomic status, prior health conditions, and health
Table 1. (Continued)
AMSEB
Participant Characteristic Total (N = 8,788) Tertile 1 (N = 3,620) Tertile 2 (N = 2,870) Tertile 3 (N = 2,298)
% Mean (SD) % Mean (SD) % Mean (SD) % Mean (SD)
Daily functioning
Limitations with instrumental activities of daily living scale
(IADL); 0–3
0.05 (0.26) 0.06 (0.29) 0.03 (0.22) 0.04 (0.25)
Mobility Index; 0–5 0.80 (1.21) 0.84 (1.23) 0.72 (1.17) 0.82 (1.23)
AMSEB = adherence to moral standards and ethical behavior, SD = standard deviation, BMI = body mass index.
https://doi.org/10.1371/journal.pone.0273221.t001
Table 2. Standardized regression estimates for the association between baseline adherence to moral standards and ethical behaviors and purpose in life over a four-
year follow-up period in middle-aged and older adulthood. Health and Retirement Study, US, 2012/2014–2016/2018, n = 8,497
b
.
Model Standardized AMSEB Tertile 1 Tertile 2 Tertile 3
β(95% CI) p-value Reference β(95% CI) p-value β(95% CI) p-value
Model 1
a
0.064 (0.045; 0.082) <0.001 Reference 0.063 (0.022; 0.104) 0.003 0.168 (0.123; 0.213) <0.001
Model 2
a
0.061 (0.043; 0.080) <0.001 Reference 0.058 (0.016; 0.099) 0.006 0. 163 (0.117; 0.209) <0.001
Model 3
a
0.055 (0.037; 0.074) <0.001 Reference 0.052 (0.011; 0.094) 0.013 0.156 (0.110; 0.201) <0.001
Model 4
a
0.046 (0.028; 0.064) <0.001 Reference 0.040 (-0.001; 0.081) 0.053 0.134 (0.089; 0.179) <0.001
AMSEB = adherence to moral standards and ethical behaviors; CI = confidence interval
a
Model 1 controls for sociodemographic characteristics, wealth, income + prior purpose in life; Model 2 is controls for sociodemographic characteristics, wealth, and
income + health behaviors + prior purpose in life; Model 3 controls for sociodemographic characteristics, wealth, and income + health behaviors + health conditions
+ prior purpose in life; Model 4 controls for all covariates + prior purpose in life.
b
All missing covariate and outcome variables were imputed using the chained equations. Ten sets of imputed data were generated [58], and the multiple imputation
estimates pooled using Rubin’s rule [59] are presented.
https://doi.org/10.1371/journal.pone.0273221.t002
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behaviors as well as prior psychological predispositions such as dispositional optimism and life
satisfaction.
Our results provide additional evidence on the possible determinants of purpose in life.
They show that adherence to moral standards and ethical behaviors can be perceived as a pre-
dictor of subsequent purpose in life, which adds to the list of previously identified predictors
Table 3. Robustness to unmeasured confounding (E-values) for assessing the associations between adherence to moral standards and ethical behaviors (standard-
ized values and tertile 3 vs. tertile 1) and subsequent health outcomes in middle-aged and older adulthood, health and retirement study, US
d
.
Standardized AMSEB Tertile 3 vs. tertile 1
E-Value for Effect Estimate
a
E-Value for CI Limit
b
E-Value for Effect Estimate
a
E-Value for CI Limit
b
Model 1
c
1.31 1.25 1.60 1.48
Model 2
c
1.30 1.24 1.59 1.47
Model 3
c
1.28 1.22 1.57 1.45
Model 4
c
1.25 1.19 1.51 1.39
AMSEB = adherence to moral standards and ethical behaviors; CI = confidence interval.
a
The E-values for effect estimates are the minimum strength of association on the risk ratio scale that an unmeasured confounder would need to have with both the
exposure and the outcome to fully explain away the observed associations of receiving employee recognition with various health and well-being outcomes, conditional
on the measured covariates.
b
The E-values for the limit of the 95% CI closest to the null denote the minimum strength of association on the risk ratio scale that an unmeasured confounder would
need to have with both the exposure and the outcome to shift the confidence interval to include the null value, conditional on the measured covariates.
c
Model 1 is run controlling for sociodemographic characteristics, wealth, income + prior purpose in life; model 2 is run controlling for sociodemographic
characteristics, wealth, and income + health behaviors + prior purpose in life; model 3 is run controlling for sociodemographic characteristics, wealth, and income
+ health behaviors + health conditions + prior purpose in life; model 4 is run controlling for all covariates + prior purpose in life.
d
All missing covariate and outcome variables were imputed using the chained equations. 10 sets of imputed data were generated [58] and the multiple imputation
estimates pooled using the Rubin’s rule [59] were presented.
https://doi.org/10.1371/journal.pone.0273221.t003
Table 4. Robustness analyses. Standardized Regression Estimates for the Association Between Baseline Adherence to Moral Standards and Ethical Behaviors and Purpose
in Life over a Four-Year Follow-Up Period in Middle-Aged and Older Adulthood. Health and Retirement Study, US, 2012/2014–2016/2018, Full Case Scenario and Lim-
ited Sample Analyses.
Model Standardized AMSEB Tertile 1 Tertile 2 Tertile 3
β(95% CI) p-value Reference β(95% CI) p-value β(95% CI) p-value
Limited sample
b
(N = 2,405)
Model 1
a
0.059 (0.025; 0.093) 0.001 Reference 0.055 (-0.018; 0.127) 0.142 0.134 (0.03; 0.215) 0.001
Model 2
a
0.053 (0.020; 0.088) 0.002 Reference 0.041 (-0.033; 0.114) 0.276 0. 123 (0.041; 0.205) 0.003
Model 3
a
0.050 (0.016; 0.084) 0.004 Reference 0.036 (-0.037; 0.109) 0.336 0.116 (0.034; 0.198) 0.005
Model 5
a
0.036 (0.003; 0.071) 0.034 Reference 0.021 (-0.052; 0.093) 0.580 0.087 (0.005; 0.169) 0.037
Full case scenario
Model 1
a
(N = 8,622) 0.064 (0.045; 0.082) <0.001 Reference 0.061 (0.002; 0.103) 0.003 0. 167 (0.121; 0.212) <0.001
Model 2
a
(N = 8,427) 0.061 (0.042; 0.080) <0.001 Reference 0.056 (0.015; 0.099) 0.008 0.160 (0.115; 0.207) <0.001
Model 3
a
(N = 7,930) 0.055 (0.036; 0.074) <0.001 Reference 0.058 (0.015; 0.104) 0.008 0.156 (0.110; 0.203) <0.001
Model 4
a
(N = 7,793) 0.047 (0.028; 0.066) <0.001 Reference 0.049 (0.007; 0.092) 0.023 0.141 (0.094; 0.188) <0.001
AMSEB = adherence to moral standards and ethical behaviors; CI = confidence interval
a
Model 1 is run controlling for sociodemographic characteristics, wealth, income + prior purpose in life; model 2 is run controlling for sociodemographic
characteristics, wealth, and income + health behaviors + prior purpose in life; model 4 is run controlling for all covariates + prior purpose in life; model 5 is run
controlling for sociodemographic characteristics, wealth, and income + health behaviors + psychological factors + prior purpose in life.
b
Analysis on a limited sample of people with no health conditions in the pre-baseline wave. Analysis run on the imputed dataset. All missing covariate and outcome
variables were imputed using the chained equations. 10 sets of imputed data were generated [58] and the multiple imputation estimates pooled using the Rubin’s rule
[59] were presented
https://doi.org/10.1371/journal.pone.0273221.t004
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including social relations, psychological well-being and positive affect, as well psychological
distress and mental health conditions already identified in previous studies [1719,22,64].
They also strengthen prior evidence that being a good human being and doing good translate
into higher purpose and meaning in life, which was confirmed for one year follow-up [23].
Our results extend this period and show that these associations can be observed even after four
years. This, in turn, provides some indications that the adherence to moral standards and ethi-
cal behaviors may have the potential to maintain, cultivate and restore purpose in life. Addi-
tionally, our results reinforce the evidence from prior studies highlighting that maintaining
moral standards and engaging in altruistic activities that contribute to the good of others and
themselves may be beneficial for health (e.g., protecting against cognitive impairment, depres-
sion, and risky health-related behaviors) and better functioning (e.g., mitigating risks of limita-
tions in mobility and activities of daily living) [3032]. The implications of our findings are as
follows. First, our results indicate a potential contribution of adherence to moral standards
and ethical behaviors to greater purpose in life and consequently, to better functioning in mid-
dle-aged and older adulthood. Since there is ample evidence that purpose in life decreases in
late adulthood [2,22,64,65], the predisposition to follow moral standards and behave ethically
seems to be of importance for cultivating purpose in life and indirectly for promoting health
and the quality of life in old age. Second, according to self-determination theory, people have
intrinsic inclinations toward acting positively and making self-directed efforts to do what is
right, moral and needed even in ethically questionable situations [6668]. Additionally,
numerous studies confirm that interventions targeting positive morally valued personality
traits are effective [69] and that the traits associated with honesty, integrity and moral values
can be stimulated and reinforced over time [25,70]. Given the above arguments and our
results, a predisposition to adhere to moral standards and ethical behaviors has the potential to
play a vital role in promoting purpose in life in middle-aged and older adulthood. In other
words, having strong moral principles, acting just and doing good for the advancement of
one’s and others’ well-being, might be an important, unexploited factor for promoting active
and healthy aging.
Strengths and limitations
This study adds to the literature in the following ways. First, using a large, prospective, and
nationally representative sample of US middle-aged and older adults (aged 50 years), this
study showed a prospective association between the adherence to moral standards and ethical
behaviors and purpose in life and thus provided new longitudinal evidence on the probable
determinant of purpose in life. Second, the longitudinal design and the adjustment for a wide
range of covariates and prior values of the purpose in life outcome provided some support that
the established associations are not subject to reverse causation and unmeasured confounding.
Third, the sensitivity analysis for unmeasured confounding (using the E-values) provided fur-
ther evidence for the robustness of identified associations. Finally, a series of secondary analy-
ses strengthened the evidence in favor of the robustness of our results.
Despite its strengths, this study is also subject to certain limitations. In this study, the adher-
ence to moral standards and ethical behaviors was considered an antecedent of purpose in life.
It may be, however, that the relation is reciprocal. Due to the design of HRS and lack of
repeated measurements of AMSEB in the study, it was not possible, however, to examine the
reciprocal relation (i.e., no control for (pre)baseline AMSEB was possible). Future research
might follow-up with the examination of bidirectional pathways between purpose in life and
AMSEB. Similarly, prevalence rather than incident exposure was evaluated, and it may be a
concern. However, this resulted from the study design. Additionally, since personality traits
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including morally valued ones evolve rather slowly over time [51] and this study did not exam-
ine any intervention effect, measuring prevalence of adherence to moral standards and ethical
behaviors rather than its incidental change seemed more substantiated.
Supporting information
S1 Table. Standardized regression estimates for the association between baseline adher-
ence to moral standards and ethical behavior and purpose in life over a four-year follow-
up period in middle-aged and older adulthood (model with an interaction term). Health
And Retirement Study, US, 2012/2014–2016/2018, N = 8,497
a
. AMSEB = adherence to moral
standards and ethical behavior; CI = confidence interval;
a
All missing covariate and outcome
variables were imputed using the chained equations. 10 sets of imputed data were generated
and the multiple imputation estimates pooled using the Rubin’s rule were presented.
(DOCX)
Author Contributions
Conceptualization: Dorota Weziak-Bialowolska.
Data curation: Dorota Weziak-Bialowolska, Piotr Bialowolski.
Funding acquisition: Dorota Weziak-Bialowolska.
Methodology: Dorota Weziak-Bialowolska, Piotr Bialowolski.
Writing original draft: Dorota Weziak-Bialowolska.
Writing review & editing: Dorota Weziak-Bialowolska, Piotr Bialowolski.
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PLOS ONE
Moral standards and sense of purpose in life
PLOS ONE | https://doi.org/10.1371/journal.pone.0273221 August 19, 2022 14 / 14
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Article
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Potential antecedents to having a sense of purpose in life remain understudied. As researchers begin contemplating purpose as a promising target of public health intervention, it is critical to identify its antecedents. Using prospective data from the Nurses' Health Study II (2009-2016; N ranged from 3,905 to 4,189), this study evaluated a wide range of potential antecedents of purpose, including: psychosocial well-being, psychological distress, employment characteristics, lifestyle, and physical health factors. In separate regression models we regressed purpose in life on each candidate antecedent. In each model, we adjusted for the prior value of purpose, prior values of all exposure variables, and various other covariates simultaneously. Bonferroni correction was used to correct for multiple testing. The results suggested that positive affect and the number of close relatives were each associated with higher purpose (e.g., β=0.14, 95% CI: 0.11, 0.17 for positive affect). Several psychological distress indicators were inversely associated with purpose, including depressive symptoms, anxiety symptoms, loneliness, and hopelessness (e.g., β=-0.16, 95% CI: -0.19, -0.13 for depressive symptoms). There was also some evidence suggesting that fewer close friends, living alone, and unemployment/retirement were associated with lower purpose. There was, however, little evidence that health behaviors or physical health were associated with subsequent purpose. This study extends the literature by providing longitudinal evidence with rigorous analytic methodologies, and by considering a wide range of potential antecedents of purpose including some that have seldom been examined previously.
Article
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Purpose: We examined the impact of an orientation to promote good—one aspect of strengths of character, understood as having consistent thoughts and taking actions that contribute to the good of oneself and others—on flourishing outcomes. Design: We used data from 2 longitudinal observational studies. The primary study used 2 waves of data collected in June 2018 and July 2019. The secondary study used 3 waves of data collected in February 2017, March 2018, and March 2019. Setting: Two culturally different populations of adults were examined: (1) a large service organization based in the United States and (2) a Mexican apparel company in the supply chain of a major global brand. Subjects: 1,209 U.S. employees and 495 Mexican apparel workers were included in the study. Measures: Self-reports of orientation to promote good, Well-Being Assessment, Flourishing Index, the CDC Health-Related Quality of Life and the Job-Related Affective Well-Being Scale were used. Analysis: An outcome-wide approach and lagged regression analyses were applied. To combine the estimates across samples meta-analytic estimates were computed. Bonferroni correction was used to correct for multiple testing. Robustness of the results to potential unmeasured confounding was examined using E-values. Results: Orientation to promote good was positively associated with subsequently higher levels of life satisfaction and happiness (b 1⁄4 0.14, 95% CI: 0.09, 0.19), self-assessed mental health (b 1⁄4 0.11, 95% CI: 0.06, 0.15) and physical health (b 1⁄4 0.08, 95% CI: 0.04, 0.12), social connectedness (b 1⁄4 0.102, 95% CI: 0.06, 0.15) and purpose in life (b 1⁄4 0.07, 95% CI: 0.03, 0.11). It was also associated with decreased anxiety (b 1⁄4 -0.11, 95% CI: -0.17, -0.06), depression (b 1⁄4 -0.07, 95% CI: -0.1, -0.02) and loneliness (b 1⁄4 -0.09, 95% CI: -0.13, -0.04). Possible effects on both positive affect (feeling happy) and negative affect (feeling sad, stressed and lonely) in general and while-at-work were also identified. Conclusions: Policymakers and practitioners should consider orientation to promote good as an important factor for improving population health and human flourishing while also at work.
Article
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Accumulating evidence shows that a higher sense of purpose in life is associated with lower risk of chronic conditions and premature mortality. Health behaviors might partially explain these findings, however, the prospective association between sense of purpose and health behaviors is understudied. We tested whether a higher sense of purpose at baseline was associated with lower likelihood of developing unhealthy behaviors over time. Prospective data were from the Health and Retirement Study, a national sample of U.S. older adults. Our sample included 13,770 adults assessed up to five times across eight years. Among people who met recommended guidelines for a given health behavior outcome at baseline, those in the top versus lowest quartile of purpose in life had 24% lower likelihood of becoming physically inactive (95% CI: 0.68–0.85), 33% lower likelihood of developing sleep problems (95% CI: 0.58–0.79), and 22% lower likelihood of developing unhealthy body mass index (BMI) (95% CI: 0.69–0.87) in sociodemographic-adjusted models. Further there was a marginal reduction in smoking relapse (HR = 0.65, 95% CI: 0.41–1.03) and no association with heavy alcohol use (HR = 1.02, 95% CI: 0.81–1.29). Findings for physical inactivity, sleep problems, and unhealthy BMI remained evident after further adjusting for baseline health status and depression. Our results, suggest that a sense of purpose in life might emerge (with further research) as a valuable target to consider for interventions aimed at helping older adults maintain some health behaviors.
Article
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The sense that one is living a meaningful life is associated with positive health outcomes, but less is known about the role of changes in sense of meaning. This outcome-wide analysis investigated bidirectional associations between changes in ratings of doing worthwhile things in life and 32 factors in 6 domains of human function in 5,694 men and women (M = 66.65 years) from the English Longitudinal Study of Ageing. Participants rated the extent they felt that the things they did in life were worthwhile in 2012 and 2014. Analyses were adjusted for age, gender, education and social class, and were weighted for non-response. We found that health (e.g. few chronic diseases, no chronic pain), emotional wellbeing (e.g. few depressive symptoms, good sleep), greater physical activity, social factors (e.g. close relationships, friends, organizational membership, volunteering, cultural engagement), and economic factors (wealth, income), at baseline were associated with 2 year increases in worthwhile ratings. Conversely, increases in worthwhile ratings over 2 years were related to more favourable health, emotional, behavioural, and social changes between 2012 and 2016 independently of baseline levels. These bidirectional relationships highlight the importance of maintaining worthwhile activities at older ages.
Article
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Understanding reciprocal relationships between specific arenas in life and at work is critical for designing interventions to improve workplace health and safety. Most studies about the links between dimensions of well-being in life and at work have been cross-sectional and usually narrowly focused on one of the dimensions of the work-life well-being link. The issues of causality and feedback between life and work well-being have often not been addressed. We overcome these issues by measuring six aspects of well-being for both the work arena and life in general, using longitudinal data with a clear temporal sequence of cause and effect, and by explicitly accounting for feedback with potential effects in both directions. 954 Mexican apparel factory workers at a major global brand participated in two waves of the Worker Well-Being Survey. Data on life satisfaction and job satisfaction, happiness and positive affect, meaning and purpose, health, and social relationships in life and at work were used. Lagged regression controlling for confounders and prior outcomes was employed. Sensitivity analysis was used to assess the robustness of the results to potential unmeasured confounding. For the relationships between life satisfaction and job satisfaction and between happiness in life and happiness at work effects in both directions were found. Nevertheless, indication of a larger effect of life satisfaction on job satisfaction than the reverse was obtained. For depression and meaning in life, there was evidence for an effect of life well-being on work-related well-being, but not for the reverse. For social relationships and purpose, there was evidence for an effect of work-related well-being on life well-being, but not the reverse. Relationships based on the longitudinal data were considerably weaker than their respective cross-sectional associations. This study contributes to our understanding of the nature of the relationship between aspects of well-being in the arenas of life and work. Findings from this study may facilitate the development of novel workplace programs promoting working conditions that enable lifelong flourishing in life and at work.
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Background: Increasing evidence suggests that psychological well-being (PWB) is associated with lower disease and mortality risk, and may be enhanced with relatively low-cost interventions. Yet, dissemination of these interventions remains limited, in part because insufficient attention has been paid to distinct PWB dimensions, which may impact physical health outcomes differently. Methods: This essay first reviews the empirical evidence regarding differential relationships between all-cause mortality and multiple dimensions of PWB (e.g., life purpose, mastery, positive affect, life satisfaction, optimism). Then, individual-level positive psychology interventions aimed at increasing PWB and tested in randomized-controlled trials are reviewed as these allow for easy implementation and potentially broad outreach to improve population well-being, in concert with efforts targeting other established social determinants of health. Results: Several PWB dimensions relate to mortality, with varying strength of evidence. Many of positive psychology trials indicate small-to-moderate improvements in PWB; rigorous institution-level interventions are comparatively few, but preliminary results suggest benefits as well. Examples of existing health policies geared towards the improvement of population well-being are also presented. Future avenues of well-being epidemiological and intervention research, as well as policy implications, are discussed. Conclusions: Although research in the fields of behavioral and psychosomatic medicine, as well as health psychology have substantially contributed to the science of PWB, this body of work has been somewhat overlooked by the public health community. Yet, the growing interest in documenting well-being, in addition to examining its determinants and consequences at a population level may provoke a shift in perspective. To cultivate optimal well-being-mental, physical, social, and spiritual-consideration of a broader set of well-being measures, rigorous studies, and interventions that can be disseminated is critically needed.
Article
Psychological traits, such as character strengths, have been already established in experimental studies as factors playing a favorable role for well-being and potentially reducing the risk of depression. Positive associations have been also reported between character strengths and physical fitness, self-reported physical and mental health. Yet, evidence with large scale, epidemiological data on the role of character strength of honesty and integrity (CSHI) in shaping subsequent health outcomes and daily functioning remains unexplored. We examined whether the character strength of honesty and integrity was prospectively associated with six physical health outcomes, two depression outcomes, and two daily functioning outcomes. We used data from the Health and Retirement Study obtained from a sample of 9813 older adults. We found that after a 4-year follow-up period, compared with individuals who scored the lowest in CSHI, participants who scored in the third tertile had a 18% lower risk of lung disease (RR = 0.824; 95% CI = 0.732; 0.927), and a 11% lower risk of depression (RR = 0.891; 95% CI = 0.806; 0.986). They also reported lower limitations in mobility (β = −0.048; 95% CI (−0.089; −0.008)] and less difficulty in instrumental activities of daily living [β = −0.088; 95% CI (−0.128; −0.047)]. These associations were independent of demographics, prior socioeconomic status, psychological factors, health conditions, and health behaviors. Policy makers and practitioners may consider the character strength of honesty and integrity as a factor for promoting healthy longevity, limiting risks of becoming physically inactive and reducing risk of physical and mental disease.
Article
Objective Test the hypothesis that a higher level of purpose in life is associated with an older age of Alzheimer's dementia onset and later mortality. Design Prospective cohort studies of aging and Alzheimer's dementia. Setting Community-based. Participants 2,558 older adults initially free of dementia underwent assessments of purpose in life and detailed annual clinical evaluations to document incident Alzheimer's dementia and mortality. General accelerated failure time models examined the relation of baseline purpose in life with age at Alzheimer's dementia diagnosis and mortality. Exposures Purpose in life was assessed at baseline. Main Outcomes Alzheimer's dementia diagnosis was documented annually based on detailed clinical evaluations and mortality was documented via regular contacts and annual evaluations. Results During a mean of 6.89 years of follow-up, 520 individuals were diagnosed with incident Alzheimer's dementia at a mean age of 88 (SD = 6.7; range: 64.1 to 106.5). They had a mean baseline level of purpose in life of 3.7 (SD = 0.47; range: 1 to 5). A higher level of purpose in life was associated with a considerably later age of dementia onset (estimate = 0.044; 95% CI: 0.023, 0.065); specifically, individuals with high purpose (90th percentile) developed Alzheimer's dementia at a mean age of about 95 compared to a mean age of about 89 for individuals with low purpose (10th percentile). Further, the estimated mean age of death was about 89 for individuals with high purpose compared to 85 for those with low purpose. Results persisted after controlling for sex and education. Conclusions and relevance Purpose in life delays dementia onset and mortality by several years. Interventions to increase purpose in life among older persons may increase healthspan and offer considerable public health benefit.
Article
This paper addresses three basic questions about moral motivation. Concerning the nature of moral motivation, it argues that it involves responsiveness to both reasons of morality and the value of persons and everything else of value. Moral motivation is thus identified as reason-responsive appropriate valuing. Regarding whether it is possible for people to be morally motivated, the paper relies on Self-Determination Theory (SDT) to show how moral motivation is a likely product of education that is need-supportive in modeling appropriate valuing and engaging students in the kinds of reasoning that are essential to moral motivation. Virtuous motivation that inclines people to engage in morally motivated acts is equated with being morally self-determining or achieving the right kind of integrated motivation. SDT shows how people come to be morally motivated, and the paper concludes that an identified aspiration to be virtuous may play a significant role.