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. 2021 Jan 18;76(2):242-251.
doi: 10.1093/geronb/gbz080.

Cognitively Intact and Happy Life Expectancy in the United States

Anthony R Bardo  1 , Scott M Lynch  2
Affiliations

Cognitively Intact and Happy Life Expectancy in the United States

Anthony R Bardo et al. J Gerontol B Psychol Sci Soc Sci. .

Abstract

Objectives: We examined the number of years to be lived with and without cognitive impairment and with high self-assessed quality of life (i.e., happiness) among a nationally representative sample of Americans aged 65 years and older. Two key questions are addressed: Can people have a high quality of life despite being cognitively impaired? Which is longer: happy life expectancy or cognitively intact life expectancy?

Method: Data from nine waves of the Health and Retirement Study (1998-2014) were used to estimate transition probabilities into and out of cognitively intact/impaired-un/happy states, as well as to death. Recently extended Bayesian multistate life table methods were used to estimate age-specific cognitively intact and happy life expectancy net of sex, race/ethnicity, education, and birth cohort.

Results: Happiness and cognitive impairment were shown to coexist in both the gross cross-tabulated data and in the life tables. Happy life expectancy is approximately 25% longer than cognitively intact life expectancy at age 65 years, and by age 85, happy life expectancy is roughly double cognitively intact life expectancy, on average.

Discussion: Lack of cognitive impairment is not a necessary condition for happiness. In other words, people can have a high quality of life despite being cognitively impaired.

Keywords: Cognitive impairment; Health and Retirement Study; Mortality; Quality of life; Subjective well-being.

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Figures

Figure 1.
Figure 1.
State space used in multistate life table modeling. Transition probabilities, p, shown between (1) happy and cognitively intact, (2) happy and cognitively impaired, (3) unhappy and intact, (4) unhappy and impaired, and (5) dead states. The general state space is the same across all ages, although the transition probabilities are modeled as a function of age and covariates.
Figure 2.
Figure 2.
Proportion of life expectancy in each of the four states, with 95% CIs: Results of multistate life tables computed from Health and Retirement Study 1998–2014 data (total person spells = 53,120). Results from model with covariates set at mean values: cohort = 1930, education 12 years, male = 0.41, black = 0.15, Hispanic = 0.08, other = 0.03. Sum of proportions in states may not add to 1 because of rounding. Vertical gray reference lines denote 0.50.
Figure 3.
Figure 3.
Length of happy life expectancy versus cognitively intact life expectancy: 95% CIs for ratio of happy life expectancy to cognitively intact life expectancy: Results of multistate life tables computed from Health and Retirement Study 1998–2014 data (total person spells = 53,120). Results from model with covariates set at mean values: cohort = 1930, education 12 years, male = 0.41, black = 0.15, Hispanic = 0.08, other = 0.03. Sum of proportions in states may not add to 1 because of rounding.
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