Impact of physical and mental health on life satisfaction in old age: a population based observational study

Abstract

Background: It is widely assumed that poor health lowers life satisfaction when ageing. Yet, research suggests this relationship is not straightforward. This study investigated how older people evaluate their life when facing disease and disabilities.

Methods: The Leiden 85-plus Study, a prospectively followed cohort of a cohort of a middle-sized city in the Netherlands, all aged 85 years, that was age-representative of the general population, was used. Those with severe cognitive dysfunction were excluded (n = 501). Comorbidities, physical performance, cognitive function, functional status, residual lifespan, depressive symptoms and experienced loneliness were measured during home visits. Life satisfaction was self-reported with Cantril's ladder. All analyses were performed using regression analysis.

Results: Participants reported high life satisfaction (median 8 out of 10 points) despite having representative levels of disease and disability. Comorbidity, low cognitive function, and residual lifespan as markers of health were not associated with life satisfaction. Poor physical performance and low functional status were weakly but significantly associated with lower life satisfaction (p < 0.05 respectively p < 0.001), but significance was lost after adjustment for depressive symptoms and perceived loneliness. Depressive symptoms and perceived loneliness were strongly related to lower life satisfaction (both p < 0.001), even after adjustment for physical health characteristics.

Conclusion: Poor physical health was hardly related to lower life satisfaction, whereas poor mental health was strongly related to lower life satisfaction. This indicates that mental health has a greater impact on life satisfaction at old age than physical health, and that physical health is less relevant for a satisfactory old age.

Keywords: Cohort study; Life satisfaction; Mental health; Physical health; Vitality.

Fig. 1

Life satisfaction at age 85 determined by physical health characteristics. Estimates represent marginal estimated mean scores; error bars represent standard errors of mean. Crude estimates were adjusted for demographic variables only and adjusted estimates for demographic and mental health characteristics. a Diseases. b Physical performance (quartiles). c Cognitive function (quartiles). d Functional status (quartiles)

Fig 2

Life satisfaction at age 85 estimated by mental health characteristics. Estimates represent marginal estimated mean scores; error bars represent standard errors of mean. Crude estimates were adjusted for demographic characteristics only and adjusted estimates for both demographic and physical health characteristics

Fig. 3

Life satisfaction estimated by residual lifespan, for all and for residual lifespan < 1 (n = 38). Estimates represent marginal estimated mean scores; error bars represent standard errors of mean. Crude estimates were adjusted for demographic variables only and adjusted estimates for demographic and mental health characteristics