Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years | Cardiology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Association Between Life Purpose and Mortality Among US Adults Older Than 50 Years

Educational Objective
To understand whether an association exists between life purpose and all-cause or cause-specific mortality among people older than 50 years participating in the US Health and Retirement Study.
1 Credit CME
Key Points

Question  Does an association exist between life purpose and all-cause or cause-specific mortality among people older than 50 years participating in the US Health and Retirement Study?

Findings  This cohort study of 6985 adults showed that life purpose was significantly associated with all-cause mortality.

Meaning  Life purpose is a modifiable risk factor and as such the role of interventions to improve life purpose should be evaluated for health outcomes, including mortality.


Importance  A growing body of literature suggests that having a strong sense of purpose in life leads to improvements in both physical and mental health and enhances overall quality of life. There are interventions available to influence life purpose; thus, understanding the association of life purpose with mortality is critical.

Objective  To evaluate whether an association exists between life purpose and all-cause or cause-specific mortality among older adults in the United States.

Design, Setting, and Participants  The Health and Retirement Study (HRS) is a national cohort study of US adults older than 50 years. Adults between the ages of 51 to 61 were enrolled in the HRS, and their spouses or partners were enrolled regardless of age. Initially, individuals born between 1931 and 1941 were enrolled starting in 1992, but subsequent cohort enrichment was carried out. The present prospective cohort study sample was drawn from 8419 HRS participants who were older than 50 years and who had filled out a psychological questionnaire during the HRS 2006 interview period. Of these, 1142 nonresponders with incomplete life purpose data, 163 respondents with missing sample weights, 81 participants lost to follow-up, 1 participant with an incorrect survival time, and 47 participants with missing information on covariates were excluded. The final sample for analysis was 6985 individuals. Data analyses were conducted between June 5, 2018, and April 22, 2019.

Exposures  Purpose in life was assessed for the 2006 interview period with a 7-item questionnaire from the modified Ryff and Keyes Scales of Psychological Well-being evaluation using a Likert scale ranging from 1 to 6, with higher scores indicating greater purpose in life; for all-cause and cause-specific mortality analyses, 5 categories of life purpose scores were used (1.00-2.99, 3.00-3.99, 4.00-4.99, 5.00-5.99, and 6.00).

Main Outcomes and Measures  All-cause and cause-specific mortality were assessed between 2006 and 2010. Weighted Cox proportional hazards models were used to evaluate life purpose and mortality.

Results  Of 6985 individuals included in the analysis, 4016 (57.5%) were women, the mean (SD) age of all participants was 68.6 (9.8) years, and the mean (SD) survival time for decedents was 31.21 (15.42) months (range, 1.00-71.00 months). Life purpose was significantly associated with all-cause mortality in the HRS (hazard ratio, 2.43; 95% CI, 1.57-3.75, comparing those in the lowest life purpose category with those in the highest life purpose category). Some significant cause-specific mortality associations with life purpose were also observed (heart, circulatory, and blood conditions: hazard ratio, 2.66; 95% CI, 1.62-4.38).

Conclusions and Relevance  This study’s results indicated that stronger purpose in life was associated with decreased mortality. Purposeful living may have health benefits. Future research should focus on evaluating the association of life purpose interventions with health outcomes, including mortality. In addition, understanding potential biological mechanisms through which life purpose may influence health outcomes would be valuable.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: April 3, 2019.

Published: May 24, 2019. doi:10.1001/jamanetworkopen.2019.4270

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2019 Alimujiang A et al. JAMA Network Open.

Corresponding Author: Celeste Leigh Pearce, PhD, MPH, Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 (

Author Contributions: Dr Pearce had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Alimujiang, Fleischer, Mukherjee, Pearce.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Alimujiang, Wiensch, Boss, Mukherjee, Pearce.

Critical revision of the manuscript for important intellectual content: Alimujiang, Fleischer, Mondul, McLean, Mukherjee, Pearce.

Statistical analysis: Alimujiang, Boss, Mukherjee, Pearce.

Obtained funding: Pearce.

Administrative, technical, or material support: Alimujiang, Wiensch, Mukherjee.

Supervision: Fleischer, Mukherjee, Pearce.

Conflict of Interest Disclosures: Dr Pearce reported receiving grants from Congressionally Directed Medical Research Programs during the conduct of the study. No other disclosures were reported.

Funding/Support: The study was supported by grants from the National Cancer Institute (5P30-CA-46592) and the Department of Defense Congressionally Directed Medical Research Programs (W81XSH-16-2-0010).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank the participants, field workers, and data managers for their time and cooperation.

Cohen  R, Bavishi  C, Rozanski  A.  Purpose in life and its relationship to all-cause mortality and cardiovascular events: a meta-analysis.  Psychosom Med. 2016;78(2):122-133. doi:10.1097/PSY.0000000000000274PubMedGoogle ScholarCrossref
Wood  AM, Joseph  S.  The absence of positive psychological (eudemonic) well-being as a risk factor for depression: a ten year cohort study.  J Affect Disord. 2010;122(3):213-217. doi:10.1016/j.jad.2009.06.032PubMedGoogle ScholarCrossref
McKnight  PE, Kashdan  TB.  Purpose in life as a system that creates and sustains health and well-being: an integrative, testable theory.  Rev Gen Psychol. 2009;13(3):242. doi:10.1037/a0017152Google ScholarCrossref
Ryff  CD, Keyes  CLM.  The structure of psychological well-being revisited.  J Pers Soc Psychol. 1995;69(4):719-727. doi:10.1037/0022-3514.69.4.719PubMedGoogle ScholarCrossref
Kim  ES, Strecher  VJ, Ryff  CD.  Purpose in life and use of preventive health care services.  Proc Natl Acad Sci U S A. 2014;111(46):16331-16336. doi:10.1073/pnas.1414826111PubMedGoogle ScholarCrossref
Kim  ES, Hershner  SD, Strecher  VJ.  Purpose in life and incidence of sleep disturbances.  J Behav Med. 2015;38(3):590-597. doi:10.1007/s10865-015-9635-4PubMedGoogle ScholarCrossref
Kim  ES, Sun  JK, Park  N, Peterson  C.  Purpose in life and reduced incidence of stroke in older adults: ‘The Health and Retirement Study’.  J Psychosom Res. 2013;74(5):427-432. doi:10.1016/j.jpsychores.2013.01.013PubMedGoogle ScholarCrossref
Owolabi  MO.  Consistent determinants of post-stroke health-related quality of life across diverse cultures: Berlin-Ibadan study.  Acta Neurol Scand. 2013;128(5):311-320.PubMedGoogle Scholar
Rasmussen  NH, Smith  SA, Maxson  JA,  et al.  Association of HbA1c with emotion regulation, intolerance of uncertainty, and purpose in life in type 2 diabetes mellitus.  Prim Care Diabetes. 2013;7(3):213-221. doi:10.1016/j.pcd.2013.04.006PubMedGoogle ScholarCrossref
Gruenewald  TL, Karlamangla  AS, Greendale  GA, Singer  BH, Seeman  TE.  Feelings of usefulness to others, disability, and mortality in older adults: the MacArthur study of successful aging.  J Gerontol B Psychol Sci Soc Sci. 2007;62(1):28-37. doi:10.1093/geronb/62.1.P28PubMedGoogle ScholarCrossref
Sone  T, Nakaya  N, Ohmori  K,  et al.  Sense of life worth living (ikigai) and mortality in Japan: Ohsaki Study.  Psychosom Med. 2008;70(6):709-715. doi:10.1097/PSY.0b013e31817e7e64PubMedGoogle ScholarCrossref
Tanno  K, Sakata  K, Ohsawa  M,  et al; JACC Study Group.  Associations of ikigai as a positive psychological factor with all-cause mortality and cause-specific mortality among middle-aged and elderly Japanese people: findings from the Japan Collaborative Cohort Study.  J Psychosom Res. 2009;67(1):67-75. doi:10.1016/j.jpsychores.2008.10.018PubMedGoogle ScholarCrossref
Okamoto  K, Tanaka  Y.  Subjective usefulness and 6-year mortality risks among elderly persons in Japan.  J Gerontol B Psychol Sci Soc Sci. 2004;59(5):246-249. doi:10.1093/geronb/59.5.P246PubMedGoogle ScholarCrossref
Nakanishi  N, Fukuda  H, Tatara  K.  Changes in psychosocial conditions and eventual mortality in community-residing elderly people.  J Epidemiol. 2003;13(2):72-79. doi:10.2188/jea.13.72PubMedGoogle ScholarCrossref
Hill  PL, Turiano  NA.  Purpose in life as a predictor of mortality across adulthood.  Psychol Sci. 2014;25(7):1482-1486. doi:10.1177/0956797614531799PubMedGoogle ScholarCrossref
Krause  N.  Meaning in life and mortality.  J Gerontol B Psychol Sci Soc Sci. 2009;64(4):517-527. doi:10.1093/geronb/gbp047PubMedGoogle ScholarCrossref
Boyle  PA, Barnes  LL, Buchman  AS, Bennett  DA.  Purpose in life is associated with mortality among community-dwelling older persons.  Psychosom Med. 2009;71(5):574-579. doi:10.1097/PSY.0b013e3181a5a7c0PubMedGoogle ScholarCrossref
Ryff  CD.  Happiness is everything, or is it? explorations on the meaning of psychological well-being.  J Pers Soc Psychol. 1989;57(6):1069. doi:10.1037/0022-3514.57.6.1069Google ScholarCrossref
Ryff  CD, Singer  BH, Dienberg Love  G.  Positive health: connecting well-being with biology.  Philos Trans R Soc Lond B Biol Sci. 2004;359(1449):1383-1394. doi:10.1098/rstb.2004.1521PubMedGoogle ScholarCrossref
Van Dierendonck  D.  The construct validity of Ryff’s Scales of Psychological Well-being and its extension with spiritual well-being.  Pers Individ Dif. 2004;36(3):629-643. doi:10.1016/S0191-8869(03)00122-3Google ScholarCrossref
Akin  A.  The scales of psychological well-being: a study of validity and reliability.  Educ Sci Theor Pract. 2008;8(3):741-750. Accessed April 29, 2019.Google Scholar
Sonnega  A, Faul  JD, Ofstedal  MB, Langa  KM, Phillips  JW, Weir  DR.  Cohort profile: the Health and Retirement Study (HRS).  Int J Epidemiol. 2014;43(2):576-585. doi:10.1093/ije/dyu067PubMedGoogle ScholarCrossref
Wallace  RB, Herzog  AR.  Overview of the health measures in the Health and Retirement Study.  J Hum Resour. 1995;30:S84-S107. doi:10.2307/146279Google ScholarCrossref
Smith  J, Fisher  G, Ryan  L, Clarke  P, House  J, Weir  D. Psychosocial and lifestyle questionnaire 2006-2010. Documentation report core section LB. Published February 2013. Accessed April 13, 2019.
Weir  DR. Validating mortality ascertainment in the health and retirement study. Published November 3, 2016. Accessed April 13, 2019.
World Health Organization. Global Database on Body Mass Index (BMI). Accessed April 13, 2019.
Servais  MA. Overview of HRS public data files for cross-sectional and longitudinal analysis. Published June 2004. Updated June 2010. Accessed April 13, 2019.
Fredrickson  BL, Grewen  KM, Coffey  KA,  et al.  A functional genomic perspective on human well-being.  Proc Natl Acad Sci U S A. 2013;110(33):13684-13689. doi:10.1073/pnas.1305419110PubMedGoogle ScholarCrossref
Harris  TB, Ferrucci  L, Tracy  RP,  et al.  Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly.  Am J Med. 1999;106(5):506-512. doi:10.1016/S0002-9343(99)00066-2PubMedGoogle ScholarCrossref
Reuben  DB, Cheh  AI, Harris  TB,  et al.  Peripheral blood markers of inflammation predict mortality and functional decline in high-functioning community-dwelling older persons.  J Am Geriatr Soc. 2002;50(4):638-644. doi:10.1046/j.1532-5415.2002.50157.xPubMedGoogle ScholarCrossref
De Martinis  M, Franceschi  C, Monti  D, Ginaldi  L.  Inflammation markers predicting frailty and mortality in the elderly.  Exp Mol Pathol. 2006;80(3):219-227. doi:10.1016/j.yexmp.2005.11.004PubMedGoogle ScholarCrossref
Tan  EJ, Xue  Q-L, Li  T, Carlson  MC, Fried  LP.  Volunteering: a physical activity intervention for older adults—the Experience Corps program in Baltimore.  J Urban Health. 2006;83(5):954-969. doi:10.1007/s11524-006-9060-7PubMedGoogle ScholarCrossref
George  DR, Singer  ME.  Intergenerational volunteering and quality of life for persons with mild to moderate dementia: results from a 5-month intervention study in the United States.  Am J Geriatr Psychiatry. 2011;19(4):392-396. doi:10.1097/JGP.0b013e3181f17f20PubMedGoogle ScholarCrossref
Konrath  S, Fuhrel-Forbis  A, Lou  A, Brown  S.  Motives for volunteering are associated with mortality risk in older adults.  Health Psychol. 2012;31(1):87-96. doi:10.1037/a0025226PubMedGoogle ScholarCrossref
Ruini  C, Fava  GA.  Well-being therapy for generalized anxiety disorder.  J Clin Psychol. 2009;65(5):510-519. doi:10.1002/jclp.20592PubMedGoogle ScholarCrossref
Jacobs  TL, Epel  ES, Lin  J,  et al.  Intensive meditation training, immune cell telomerase activity, and psychological mediators.  Psychoneuroendocrinology. 2011;36(5):664-681. doi:10.1016/j.psyneuen.2010.09.010PubMedGoogle ScholarCrossref
Carlson  LE, Doll  R, Stephen  J,  et al.  Randomized controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer.  J Clin Oncol. 2013;31(25):3119-3126. doi:10.1200/JCO.2012.47.5210PubMedGoogle ScholarCrossref
Lengacher  CA, Johnson-Mallard  V, Post-White  J,  et al.  Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer.  Psychooncology. 2009;18(12):1261-1272. doi:10.1002/pon.1529PubMedGoogle ScholarCrossref
kumanu: purpose in action. Better lives: stronger organizations. Accessed April 13, 2019.
Griauzde  DH, Kullgren  JT, Liestenfeltz  B, Richardson  C, Heisler  M.  A mobile phone-based program to promote healthy behaviors among adults with prediabetes: study protocol for a pilot randomized controlled trial.  Pilot Feasibility Stud. 2018;4(1):48. doi:10.1186/s40814-018-0246-zPubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity



My Saved Searches

You currently have no searches saved.

With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right