By Kiran Athar. I write about psychology and human development for a general audience. I am not a psychologist, therapist, or clinician. What follows is my reading of the research on ageing and adversity, offered as an interpretation.
Watch two people receive the same diagnosis. Both in their late seventies. Both with roughly the same access to good medical care. Both with families who love them. One of them, over the following year, seems to find a way through. The other doesn’t. Same illness, same care, roughly the same life circumstances. Different outcome.
Ask most people to guess what accounts for the difference and they’ll point at physical resilience or financial resources. The healthier one will cope better. The wealthier one will have more options. Both of these matter, and neither should be discounted. But when researchers have actually followed large numbers of older adults through serious illness and asked what predicts coping best, physical health and financial resources are rarely at the top of the list. The factor that turns up over and over, in study after study, is something quieter, and something a person can, uncomfortably enough, still build after seventy.
If any of this is landing, we came across a short video on what actually happens when a person has been through too much in life.
The factor is a sense of purpose in life. Not purpose in the grand, dramatic sense. Not “I have discovered my life’s calling.” Something more ordinary. The working belief that one’s days still matter, that there are things worth doing, and that one’s presence in the world is contributing to something beyond one’s own comfort. The clinical term for this in the research literature is “purpose in life,” and the researcher most responsible for bringing it into gerontology is Patricia Boyle, a neuropsychologist at Rush University Medical Center in Chicago.
In Boyle and colleagues’ 2009 paper published in Psychosomatic Medicine, the researchers followed 1,238 older adults for up to five years, measuring purpose in life at baseline and tracking who died during the follow-up period. Older adults with high purpose in life had roughly half the mortality risk of those with low purpose. What made the finding remarkable is what happened when the researchers added controls. Even after adjusting for depression, disability, neuroticism, chronic medical conditions, and income, the effect held. Whatever purpose was doing, it wasn’t a proxy for being cheerful or being healthy or being well-off. It was doing something independent.
Later work in the same research program extended these findings. Higher purpose has been linked to lower risk of Alzheimer’s dementia, slower rates of cognitive decline, better ability to perform day-to-day activities, and reduced mobility disability. In a 2013 study published in PLOS One by Schaefer and colleagues, researchers found that people with higher purpose showed faster emotional recovery from negative images in the laboratory. Which is a finding worth pausing on. It suggests purpose isn’t just changing how a person feels about their life in the abstract. It’s changing how their nervous system responds to distress in the moment. When something painful happens, the purposeful person recovers from it more quickly.
That last piece is what makes purpose particularly important when it comes to serious illness. Illness is, at bottom, a sustained series of hard events. Bad news. Uncomfortable procedures. Loss of function. Uncertainty about the future. What determines whether an older adult can move through those events with something resembling equilibrium, on the current research, is less about how healthy or wealthy they were going in, and more about whether the internal machinery for finding meaning is intact.
Which brings us to the piece the title is pointing at. If purpose in life is the factor that most reliably distinguishes older adults who cope well from those who don’t, and if a reader of this piece is somewhere north of seventy and worried they haven’t cultivated much of it, is it too late? The research says no. In a 2014 study published in Psychological Science by Patrick Hill and Nicholas Turiano, the researchers used longitudinal data from the Midlife in the United States study to examine whether purpose predicted longevity across the adult lifespan. Purposeful individuals lived longer than their less purposeful counterparts across the fourteen years of follow-up. Crucially for our question, this benefit was not conditional on age. Purpose in a person’s seventies produced roughly the same protective effect as purpose in a person’s forties. What matters, on the current evidence, is not when the sense of purpose was acquired but whether it is present.
What purpose looks like in practice, for an older adult, isn’t usually dramatic. It’s often small and concrete. Being needed by someone. Contributing to a group. Having something to attend to that requires one’s participation. Grandparenting. Volunteering. Mentoring a younger person. Maintaining a garden that other people benefit from. Continuing to do the daily work of a marriage or a friendship. Reading a book to a great-grandchild. Making a particular dish for a family gathering. Anything that positions the older adult, in their own mind and in the mind of the people around them, as someone whose presence is doing something in the world.
The threat to purpose in later age isn’t usually a lack of opportunity. It’s that the roles that had been carrying purpose in earlier life gradually stop functioning. The job ends. The children move away. The spouse dies or becomes unable to receive care in the old ways. A slow contraction happens, in which the daily texture of being needed by others thins out, without the person noticing when it did. And when serious illness arrives on top of that contraction, the person has less to hold onto than they did a decade earlier.
The finding that matters most for anyone reading this in their sixties or seventies with a serious diagnosis on the horizon is that the machinery of purpose remains buildable. Not through grand reinvention. Through the slow rebuilding of small roles that give the days a shape. A weekly commitment. A modest responsibility. A person who is counting on you to show up. Something that requires you to still be here for something other than yourself.
The core finding of the research isn’t that purposeful older adults live forever. They don’t. What they do, on the data, is move through the last chapter of life with a texture that the less purposeful ones don’t have. They cope better with the daily setbacks that illness brings. They arrive at the end with something that looks, from the outside, like equanimity.
Which is available, in principle, to almost anyone still able to think and to act. Even at seventy. Even at eighty. Even at ninety.
The thing that ought to trouble a reader in midlife isn’t that this factor exists. It’s that most people assume it can’t be built after the working years are over. And on the current research, that assumption is wrong.