Aging Clinical and Experimental Research

, Volume 25, Issue 5, pp 517–525 | Cite as

Optimism and survival: does an optimistic outlook predict better survival at advanced ages? A twelve-year follow-up of Danish nonagenarians

  • Henriette Engberg
  • Bernard Jeune
  • Karen Andersen-Ranberg
  • Torben Martinussen
  • James W. Vaupel
  • Kaare Christensen
Original Article


Background and aims

Studies examining predictors of survival among the oldest-old have primarily focused on objective measures, such as physical function and health status. Only a few studies have examined the effect of personality traits on survival, such as optimism. The aim of this study was to examine whether an optimistic outlook predicts survival among the oldest-old.


The Danish 1905 Cohort Survey is a nationwide, longitudinal survey comprising all individuals born in Denmark in 1905. At baseline in 1998, a total of 2,262 persons aged 92 or 93 agreed to participate in the intake survey. The baseline in-person interview consisted of a comprehensive questionnaire including physical functioning and health, and a question about whether the respondent had an optimistic, neutral or pessimistic outlook on his or her own future.


During the follow-up period of 12 years (1998–2010) there were 2,239 deaths (99 %) in the 1905 Cohort Survey. Univariable analyses revealed that optimistic women and men were at lower risk of death compared to their neutral counterparts [HR 0.82, 95 % CI (0.73–0.93) and 0.81, 95 % CI (0.66–0.99), respectively]. When confounding factors such as baseline physical and cognitive functioning and disease were taken into account the association between optimism and survival weakened in both sexes, but the general pattern persisted. Optimistic women were still at lower risk of death compared to neutral women [HR 0.85, 95 % CI (0.74–0.97)]. The risk of death was also decreased for optimistic men compared to their neutral counterparts, but the effect was non-significant [HR 0.91, 95 % CI (0.73–1.13)].


An optimistic outlook appears to be a significant predictor of survival among the oldest-old women. It may also be a significant predictor for men but the sample size is small.


Predictors of mortality Survival Optimism Oldest-old 



The study was supported by U.S. National Institute on Aging Research Grant PO1AG08761. The Danish Aging Research Center is supported by a grant from the VELUX foundation.

Conflict of interest

The authors declare that they have no conflict of interest regarding the paper.


  1. 1.
    Cuijpers P, Smit F (2002) Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 72:227–236PubMedCrossRefGoogle Scholar
  2. 2.
    Kuper H, Marmot M, Hemingway H (2002) Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease. Semin Vasc Med 2:267–314PubMedCrossRefGoogle Scholar
  3. 3.
    Kubzansky LD, Cole SR, Kawachi I, Vokonas P, Sparrow D (2006) Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: a prospective study in the normative aging study. Ann Behav Med 31:21–29PubMedCrossRefGoogle Scholar
  4. 4.
    Schillerstrom JE, Royall DR, Palmer RF (2008) Depression, disability and intermediate pathways: a review of longitudinal studies in elders. J Geriatr Psychiatry Neurol 21:183–197PubMedCrossRefGoogle Scholar
  5. 5.
    Dalle CL, Maggi S, Noale M et al (2009) Physical disability and depressive symptomatology in an elderly population: a complex relationship. The Italian Longitudinal Study on Aging (ILSA). Am J Geriatr Psychiatry 17(2):144–154CrossRefGoogle Scholar
  6. 6.
    Chida Y, Steptoe A (2008) Positive psychological well-being and mortality: a quantitative review of prospective observational studies. Psychosom Med 70:741–756PubMedCrossRefGoogle Scholar
  7. 7.
    Pressman SD, Cohen S (2005) Does positive affect influence health? Psychol Bull 131:925–971PubMedCrossRefGoogle Scholar
  8. 8.
    Rasmussen HN, Scheier MF, Greenhouse JB (2009) Optimism and physical health: a meta-analytic review. Ann Behav Med 37:239–256PubMedCrossRefGoogle Scholar
  9. 9.
    Forgeard MJC, Seligman MEP (2012) Seeing the glass half full: a review of the causes and consequences of optimism. Pratiques Psychologiques 18:107–120CrossRefGoogle Scholar
  10. 10.
    Giltay EJ, Geleijnse JM, Zitman FG, Hoekstra T, Schouten EG (2004) Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly Dutch men and women. Arch Gen Psychiatry 61:1126–1135PubMedCrossRefGoogle Scholar
  11. 11.
    Brummett BH, Helms MJ, Dahlstrom WG, Siegler IC (2006) Prediction of all-cause mortality by the Minnesota Multiphasic Personality Inventory Optimism–Pessimism Scale scores: study of a college sample during a 40-year follow-up period. Mayo Clin Proc 81:1541–1544PubMedCrossRefGoogle Scholar
  12. 12.
    Giltay EJ, Kamphuis MH, Kalmijn S, Zitman FG, Kromhout D (2006) Dispositional optimism and the risk of cardiovascular death: the Zutphen Elderly Study. Arch Intern Med 166:431–436PubMedGoogle Scholar
  13. 13.
    Kubzansky LD, Sparrow D, Vokonas P, Kawachi I (2001) Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the normative aging study. Psychosom Med 63:910–916PubMedGoogle Scholar
  14. 14.
    Tindle HA, Chang YF, Kuller LH et al (2009) Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s health initiative. Circulation 120:656–662PubMedCrossRefGoogle Scholar
  15. 15.
    Giltay EJ, Zitman FG, Kromhout D (2006) Dispositional optimism and the risk of depressive symptoms during 15 years of follow-up: the Zutphen Elderly Study. J Affect Disord 91:45–52PubMedCrossRefGoogle Scholar
  16. 16.
    Scheier MF, Matthews KA, Owens JF et al (1999) Optimism and rehospitalization after coronary artery bypass graft surgery. Arch Intern Med 159:829–835PubMedCrossRefGoogle Scholar
  17. 17.
    Carver CS, Smith RG, Antoni MH, Petronis VM, Weiss S, Derhagopian RP (2005) Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer. Health Psychol 24:508–516PubMedCrossRefGoogle Scholar
  18. 18.
    Allison PJ, Guichard C, Fung K, Gilain L (2003) Dispositional optimism predicts survival status 1 year after diagnosis in head and neck cancer patients. J Clin Oncol 21:543–548PubMedCrossRefGoogle Scholar
  19. 19.
    Maruta T, Colligan RC, Malinchoc M, Offord KP (2000) Optimists vs pessimists: survival rate among medical patients over a 30-year period. Mayo Clin Proc 75:140–143PubMedGoogle Scholar
  20. 20.
    Peterson C, Seligman ME (1987) Explanatory style and illness. J Pers 55:237–265PubMedCrossRefGoogle Scholar
  21. 21.
    Peterson C, Seligman ME, Vaillant GE (1988) Pessimistic explanatory style is a risk factor for physical illness: a thirty-five-year longitudinal study. J Pers Soc Psychol 55:23–27PubMedCrossRefGoogle Scholar
  22. 22.
    Scheier MF, Carver CS (1985) Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol 4:219–247PubMedCrossRefGoogle Scholar
  23. 23.
    Scheier MF, Carver CS (1987) Dispositional optimism and physical well-being: the influence of generalized outcome expectancies on health. J Pers 55:169–210PubMedCrossRefGoogle Scholar
  24. 24.
    Isaacowitz DM, Seligman ME (2002) Cognitive style predictors of affect change in older adults. Int J Aging Hum Dev 54:233–253PubMedCrossRefGoogle Scholar
  25. 25.
    Nybo H, Petersen HC, Gaist D et al (2003) Predictors of mortality in 2,249 nonagenarians—the Danish 1905-Cohort Survey. J Am Geriatr Soc 51:1365–1373PubMedCrossRefGoogle Scholar
  26. 26.
    Bravell ME, Berg S, Malmberg B (2008) Health, functional capacity, formal care, and survival in the oldest old: a longitudinal study. Arch Gerontol Geriatr 46:1–14PubMedCrossRefGoogle Scholar
  27. 27.
    Xie J, Matthews FE, Jagger C, Bond J, Brayne C (2008) The oldest old in England and Wales: a descriptive analysis based on the MRC Cognitive Function and Ageing Study. Age Ageing 37:396–402PubMedCrossRefGoogle Scholar
  28. 28.
    Roth M, Tym E, Mountjoy CQ et al (1986) CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 149:698–709PubMedCrossRefGoogle Scholar
  29. 29.
    Nybo H, Gaist D, Jeune B et al (2001) The Danish 1905 cohort: a genetic-epidemiological nationwide survey. J Aging Health 13:32–46PubMedCrossRefGoogle Scholar
  30. 30.
    Nybo H, Gaist D, Jeune B, McGue M, Vaupel JW, Christensen K (2001) Functional status and self-rated health in 2,262 nonagenarians: the Danish 1905 Cohort Survey. J Am Geriatr Soc 49:601–609PubMedCrossRefGoogle Scholar
  31. 31.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919PubMedCrossRefGoogle Scholar
  32. 32.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRefGoogle Scholar
  33. 33.
    George LK, Blazer DF, Winfield-Laird I et al (1988) Psychiatric disorders and mental health service use in later life: evidence from the Epidemiologic Catchment Area Program. In: Brody J, Maddox G (eds) Epidemiology and Aging. Springer, New York, pp 189–219Google Scholar
  34. 34.
    Fillenbaum GG, George LK, Blazer DG (1988) Scoring nonresponse on the Mini-Mental State Examination. Psychol Med 18:1021–1025PubMedCrossRefGoogle Scholar
  35. 35.
    Lin DY, Wei LJ, Ying Z (1993) Checking the Cox model with cumulative sums of martingale-based residuals. Biometrika 80:557–572CrossRefGoogle Scholar
  36. 36.
    STATA Corporation STATA Statistical Software Release 11.1. College Station TX 77845 USA: STATA Corporation, 2010Google Scholar
  37. 37.
    Oksuzyan A, Juel K, Vaupel JW, Christensen K (2008) Men: good health and high mortality. Sex differences in health and aging. Aging Clin Exp Res 20:91–102PubMedCrossRefGoogle Scholar
  38. 38.
    Malinchoc M, Offord KP, Colligan RC (1995) PSM-R: Revised Optimism–Pessimism Scale for the MMPI-2 and MMPI. J Clin Psychol 51:205–214PubMedCrossRefGoogle Scholar
  39. 39.
    Nes LS, Segerstrom SC (2006) Dispositional optimism and coping: a meta-analytic review. Pers Soc Psychol Rev 10:235–251PubMedCrossRefGoogle Scholar
  40. 40.
    Rasmussen HN, Wrosch C, Scheier MF, Carver CS (2006) Self-regulation processes and health: the importance of optimism and goal adjustment. J Pers 74:1721–1747PubMedCrossRefGoogle Scholar
  41. 41.
    Salovey P, Rothman AJ, Detweiler JB, Steward WT (2000) Emotional states and physical health. Am Psychol 55:110–121PubMedCrossRefGoogle Scholar
  42. 42.
    Carver CS, Scheier MF, Segerstrom SC (2010) Optimism. Clin Psychol Rev 30:879–889PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Henriette Engberg
    • 1
    • 2
  • Bernard Jeune
    • 1
  • Karen Andersen-Ranberg
    • 1
  • Torben Martinussen
    • 3
  • James W. Vaupel
    • 1
    • 4
    • 5
  • Kaare Christensen
    • 1
    • 6
    • 7
  1. 1.Department of Epidemiology, The Danish Aging Research Center, Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
  2. 2.Research Unit of Clinical Epidemiology, Institute of Clinical ResearchUniversity of Southern Denmark and Centre for National Clinical Databases, South, Odense University HospitalOdense CDenmark
  3. 3.Department of BiostatisticsUniversity of CopenhagenCopenhagenDenmark
  4. 4.Max Planck Institute for Demographic ResearchRostockGermany
  5. 5.Max Planck Odense Center on the Biodemography of AgingOdenseDenmark
  6. 6.Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdenseDenmark
  7. 7.Department of Clinical GeneticsOdense University HospitalOdenseDenmark

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