Aging and the HPA axis: Stress and resilience in older adults
Open accessAbstract
Hypothalamic-pituitary-adrenal (HPA) axis function may change over the course of aging, and altered diurnal or stress-induced secretion of the hormone cortisol could predispose older adults to negative health outcomes. We propose that psychological resilience may interact with diurnal cortisol to affect health outcomes later in life. Emotion regulation and social support are two constructs that contribute to resilience and exhibit age-specific patterns in older adults. Determining how the use of resilience resources interacts with age-related diurnal cortisol will improve our understanding of the pathways between stress, resilience, and well-being. In this review, we assess published studies evaluating diurnal cortisol in older adults to better understand differences in their HPA axis functioning. Evidence thus far suggests that diurnal cortisol may increase with age, although cross-sectional studies limit the conclusions that can be drawn. We also review extant evidence connecting age-specific signatures of emotion regulation and social support with diurnal cortisol. Conclusions are used to propose a preliminary model demonstrating how resilience resources may modulate the effects of cortisol on health in aging.
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Aging and social isolation exacerbate HPA dysregulation, creating a feedforward loop of immune senescence, neuroinflammation, and frailty, especially in neurodegenerative conditions such as Alzheimer's disease.
“Moreover, aging and social isolation appear to exacerbate HPA dysregulation, creating a feedforward loop of immune senescence, neuroinflammation, and frailty, especially in neurodegenerative conditions such as Alzheimer’s disease [54].”
From Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation (2025) · cites this paper as [54]
Section 3.2.1 reports an association between social strain and altered cortisol patterns in older adults, while Section 1.2 links HPA-axis disturbances with decreased immunity and higher cortisol with frailty. Section 4.1 says aging can either increase or decrease chronic stress. The copy does not establish the claimed feedforward loop involving immune senescence and neuroinflammation, or its particular relevance to Alzheimer’s disease. Page numbers were not available in the indexed passages. (LLM, conf=0.88)
Experimental — accuracy not yet measuredHealthy older adults exhibit higher mean diurnal levels of stress biomarkers than younger individuals.
“More precisely, healthy older adults exhibit higher mean diurnal levels of stress biomarkers than younger individuals7.”
From Benefits from one session of deep and slow breathing on vagal tone and anxiety in young and older adults (2021) · cites this paper as [7]
Section 2.1 reports greater diurnal cortisol output in screened older adults than in middle-aged and young adults, supporting the comparison for cortisol. The claim broadens this finding to stress biomarkers generally; the cited passages address diurnal cortisol, not multiple biomarkers. The Conclusions (section 5) also describe the evidence as limited but suggestive. (LLM, conf=0.86)
Experimental — accuracy not yet measured
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What’s yours is mine”: Partners’ everyday emotional experiences and cortisol in older adult couples
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Nokkaew, W., Intarapuk, A., Sakulthai, A., Wajjwalku, W., & Thongtip, N. (2022) · Veterinary World · doi:10.14202/vetworld.2022.647-654 · Cited by 3 · see citing works
- Authors
- Gaffey, A. E., Bergeman, C. S., Clark, L. A., & Wirth, M. M.
- Affiliations
- University of Notre Dame (US)
- Corresponding author
- Gaffey, Allison E.
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 68
- Pages
- 928-945
- ISSN
- 0149-7634 (ISSN-L)
- PMC
- PMC5621604
- OpenAlex
- W2463112166
- Cited by
- 273
- References
- 209
- Citations by year
- 2026: 24 · 2025: 37 · 2024: 31 · 2023: 27 · 2022: 28 · 2021: 35 · 2020: 29 · 2019: 26 · 2018: 21 · 2017: 13 · 2016: 2
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Notre Dame Emotion and Stress Physiology Laboratory
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
- Keywords
- hypothalamic-pituitary-adrenal axis, aging, diurnal cortisol, psychological resilience, older adults, stress, emotion regulation, social support, cortisol secretion, well-being, age-related changes
- MeSH terms
- Adult, Aging, Circadian Rhythm, Cross-Sectional Studies, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Saliva, Stress, Psychological
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