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Purpose in Life Is Associated With a Reduced Risk of Incident Disability Among Community-Dwelling Older Persons
Open accessAbstract
Background Purpose in life is thought to be associated with positive health outcomes in old age, but its association with disability is unknown.Objective Test the hypothesis that greater purpose in life is associated with a reduced risk of incident disability, including impairment in basic and instrumental activities of daily living and mobility disability, among community-based older persons free of dementia.Design Participants were from the Rush Memory and Aging Project, a large longitudinal clinical-pathologic study of aging.Setting Retirement communities, senior housing facilities, and homes across the greater Chicago metropolitan area.Measurements All participants underwent baseline assessment of purpose in life and detailed annual clinical evaluations to document incident disability.Results The mean score on the purpose in life measure at baseline was 3.6 (standard deviation = 0.5, range: 2-5). In a series of proportional hazards models adjusted for age, sex, and education, greater purpose in life was associated with a reduced risk of disability in basic activities of daily living (hazard ratio [HR] = 0.60, 95% confidence interval [C1] = 0.45-0.81), instrumental activities of daily living (HR = 0.56, 95% CI = 0.40-0.78), and mobility disability (HR = 0.61, 95% CI = 0.44-0.84). These associations did not vary along demographic lines and persisted after the addition of terms to control for global cognition, depressive symptoms, social networks, neuroticism, income, physical frailty, vascular risk factors, and vascular diseases.Conclusions Among community-based older persons without dementia, greater purpose in life is associated with maintenance of functional status, including a reduced risk of developing impairment in basic and instrumental activities of daily living and mobility disability.
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In the citing paper
“Numerous prospective studies from 2 to 8 years would strongly suggest that high PIL results in better health and less disability.”
From Purpose in Life and Positive Health Outcomes Among Older Adults (2018) · cites this paper as [7]
Experimental — accuracy not yet measuredIn the citing paper
“Having a strong sense of purpose and meaning in life may be a protective factor in relation to health”
From Leading a meaningful life at older ages and its relationship with social engagement, prosperity, health, biology, and time use (2019) · cites this paper as [5]
In the citing paper
“with longitudinal studies documenting associations with reduced premature mortality, slower development of age-related disability, reduced incidence of cardiovascular disease, healthier lifestyles, and more preventive behaviors”
From Leading a meaningful life at older ages and its relationship with social engagement, prosperity, health, biology, and time use (2019) · cites this paper as [5]
In the citing paper
“In numerous prospective research studies, higher PIL has been associated with better self-rated health,22 fewer chronic diseases (eg, stroke,8,19 myocardial infarctions9), reduced pain,11 less disability,7,10,11 less dementia and Alzheimer's disease,23 and reduced mortality.6,10,11”
From Purpose in Life and Positive Health Outcomes Among Older Adults (2018) · cites this paper as [7]
In the citing paper
“As in other studies, there were minimal demographic differences with the exception of those 80 years of age and older having lower PIL.”
From Purpose in Life and Positive Health Outcomes Among Older Adults (2018) · cites this paper as [7]
In the citing paper
“However, the average PIL score of 3.9 in this study was generally in the same range as other studies with 5 responses.”
From Purpose in Life and Positive Health Outcomes Among Older Adults (2018) · cites this paper as [7]
In the citing paper
“The strong correlations between PIL, resilience, and social support have been documented in other studies as well.”
From Purpose in Life and Positive Health Outcomes Among Older Adults (2018) · cites this paper as [7]
In the citing paper
“Interventions focused exclusively on PIL have yet to be developed, although several researchers have recommended a focus on goal-driven, meaningful activities defined as hobbies, volunteerism, religious involvement, or physical activities.”
From Purpose in Life and Positive Health Outcomes Among Older Adults (2018) · cites this paper as [7]
In the citing paper
“Interventions focused exclusively on PIL have yet to be developed, although several researchers have recommended a focus on goal-driven, meaningful activities defined as hobbies, volunteerism, religious involvement, or physical activities.”
From Purpose in Life and Positive Health Outcomes Among Older Adults (2018) · cites this paper as [7]
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Religious Orders Study and Rush Memory and Aging Project
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“Other studies have found associations between purpose in life and higher levels of high-density lipoprotein and lower waist-hip ratios (49), reduced odds of disrupted sleep patterns (50), and greater maintenance of functional status among communitydwelling older adults (40).”
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“Similarly, an analysis of the Rush Memory and Aging Project found that incident disability in basic and instrumental ADLs and mobility was reduced among older people who reported greater purpose in life at baseline, independently of cognitive factors, depressive symptoms, social networks, frailty, and vascular disease…”
MethodPurpose in life and use of preventive health care services
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The impact of mobility limitations on health outcomes among older adults
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“Purpose in life is related to aspects of psychological health, including happiness, satisfaction, personal growth, and better sleep,(14,17,18,50) and associations between purpose in life and aspects of personality (ie, neuroticism, extraversion, and conscientiousness), as well as depressive symptoms,havebeenreported.(…”
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Purpose in Life Predicts Better Emotional Recovery from Negative Stimuli
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“purpose in life was associated with better ability to perform day-today activities and less mobility disability in the future [7].”
Eudaimonic and Hedonic Well-Being
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Purpose in Life and Positive Health Outcomes Among Older Adults
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“The strong correlations between PIL, resilience, and social support have been documented in other studies as well.(2,7,8,19) The present study utilized separate regression models to avoid underreporting the impact of these characteristics and their associations with PIL.”
BackgroundMethodResultInfluentialThe influence of cognitive decline on well-being in old age.
Wilson, R. S., Boyle, P. A., Segawa, E., Yu, L., Begeny, C. T., Anagnos, S. E., & Bennett, D. A. (2013) · Psychology and Aging · doi:10.1037/a0031196 · Cited by 226
“…component of the hypothesis: whether level of cognition in a specific wave predicted level of purpose in the subsequent wave, as hypothesized, and to compare this association to the more established correlation of purpose with subsequent cognition (Boyle et al., 2010; Boyle et al., 2012).”
BackgroundResultSelf-citationLoneliness, eudaimonia, and the human conserved transcriptional response to adversity
Cole, S. W., Levine, M. E., Arevalo, J. M. G., Ma, J., Weir, D. R., & Crimmins, E. M. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.07.001 · Cited by 238
“…data are consistent with previous epidemiologic observations relating eudaimonic well-being to favorable health outcomes (Boyle et al., 2009; Boyle et al., 2010; Boyle et al., 2010; Friedman et al., 2007; Hill and Turiano, 2014; Kim et al., 2014; Kim et al., 2013; Ryff, 2014; Yu et al.,…”
BackgroundResultInfluentialSense of purpose as a psychological resource for aging well.
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PURPOSE IN LIFE PROTECTS AGAINST COGNITIVE DECLINE AMONG OLDER ADULTS
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Purpose in life and cognitive functioning in adulthood
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“functioning to reduced inflammatory markers and better glycemic regulation [6–8] as well as decreased risk of cardiovascular disease [9], lower risk of disability and cognitive impairment [10, 11], greater resistance to infectious illness [12], and better health and longer lives [13–15].”
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Is meaning in life a flagship indicator of well-being?
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BackgroundPositive Psychological Functioning and the Biology of Health
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Quality of life attenuates age-related decline in functional status of older adults
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“Higher PIL is associated with increased longevity (Boyle et al., 2009), decreased risk of undergoing injury or disability (Boyle, Buchman, & Bennett, 2010), and a reduction in the risk of acquiring Alzheimer’s disease and other cognitive impairments (Boyle et al., 2010).”
BackgroundMethodPurpose in Life, Loneliness, and Protective Health Behaviors During the COVID-19 Pandemic
Kang, Y., Cosme, D., Pei, R., Pandey, P., Tartak, J. C., & Falk, E. B. (2021) · The Gerontologist · doi:10.1093/geront/gnab081 · Cited by 47
“Specifically, having a stronger sense of purpose in life was uniquely associated with increased longevity (Boyle et al., 2010), reduced risk of age-related conditions such as heart diseases (Cohen et al.”
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Purpose in life may delay adverse health outcomes in old age
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“These findings support prior research demonstrating an association between spiritual well-being and positive mental and physical health outcomes in cancer survivors.(17,18,27) Our study also identifies early cancer survivorship, as cancer patients transition from active treatment to follow-up care, as a key point at w…”
ResultIs purpose in life associated with less sleep disturbance in older adults?
Turner, A. D., Smith, C. E., & Ong, J. C. (2017) · Sleep Science and Practice · doi:10.1186/s41606-017-0015-6 · Cited by 39
“Previous works have shown that purpose in life is independently linked to numerous positive health outcomes and healthy behaviors, as well as longevity (Kim et al. 2013; Boyle et al. 2009; Boyle et al. 2010a; Boyle et al. 2010b; Boyle et al. 2012; Krause 2009; Roepke et al. 2014).”
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“Older people with a purpose in life have lower mortality [1], higher sense of well-being [2], and better maintenance of functional status, including a reduced risk of developing impairments in basic and instrumental activities of daily living (ADL) and mobility disability [3,4].”
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Important Correlates of Purpose in Life Identified Through a Machine Learning Approach
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“With few exceptions, PiL declines with age (13, 14) and men tend to possess higher PiL in older age than women (12, 15).”
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Purpose in Life Among Family Care Partners Managing Dementia: Links to Caregiving Gains.
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“Greater purpose in life associated with ability to maintain functional status, reduce the risk of developing impairment in daily activities and could prevent disability (Boyle et al., 2010).”
BackgroundCognition, mood, and purpose in life in neuromyelitis optica spectrum disorder
Hollinger, K. R., Franke, C., Arenivas, A., Woods, S. R., Mealy, M. A., Levy, M., & Kaplin, A. I. (2016) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2016.01.010 · Cited by 27
“Higher life purpose has been linked to decreased incidence of a variety of physical ailments, including Alzheimer's disease (AD) [16], incident disability in the elderly [17], stroke [18], and myocardial infarction [19,20].”
BackgroundSelf-concept Clarity and Meaning in Life: A Daily Diary Study in a Collectivistic Culture
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“Meaning in life is a key component of eudaimonic well-being (Diener et al., 2018; Ryff, 1989), contributing to positive development and better psychical and mental health (Bailey & Phillips, 2016; Boyle et al., 2010).”
Fastame, M. C., Mulas, I., & Pau, M. (2020) · International Psychogeriatrics · doi:10.1017/s1041610220001659 · Cited by 29
“Additionally, extending previous research (e.g. Boyle et al., 2010; Gale et al., 2014; Hybels et al., 2009; Kendig et al., 2014), higher depressive symptoms were associated with worsemotor performance (e.g. lower speed during the walk).”
BackgroundDoes meaning protect against loneliness? Exploring empirical studies and theory
Folker, A. P., Lauridsen, S., Hegelund, E. R., Wimmelmann, C. L., & Flensborg‐Madsen, T. (2020) · Health Promotion International · doi:10.1093/heapro/daaa081 · Cited by 27
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“Prospective studies show that a stronger sense of life purpose is linked to a lower incidence of depression [2], sleep disturbances [3, 4], disability [5, 6], cognitive decline [7, 8], myocardial infarction [9], stroke [10], and mortality [6, 11–13].”
BackgroundMusich, S. A., Wang, S. S., Schaeffer, J. A., Kraemer, S., Wicker, E. R., & Yeh, C. S. (2020) · Geriatric Nursing · doi:10.1016/j.gerinurse.2020.09.007 · Cited by 24
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Yeung, P., Severinsen, C. A., Good, G. A., & O’Donoghue, K. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1783375 · Cited by 25
“Emphasising the capabilities and real purposes that are available for older people to access resources and have choices that are important to them so that they can manage their disability and chronic illnesses as they age in a socially just environment [30,129,130].”
BackgroundAdvancing the Science of Well-Being
Ryff, C. D., Boylan, J. M., & Kirsch, J. A. (2021) · Oxford University Press eBooks · doi:10.1093/oso/9780197512531.003.0019 · Cited by 25
Massey, W. V., Szarabajko, A., Thalken, J., Perez, D., & Mullen, S. P. (2021) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2021.101948 · Cited by 28
Validity of the FACIT-Sp to Assess Spiritual Well-Being in Elderly Patients
Monod, S., Lécureux, E., Rochat, E., Spencer, B., Seematter‐Bagnoud, L., Martin-Durussel, A.-S., & Büla, C. (2015) · Psychology · doi:10.4236/psych.2015.610128 · Cited by 22
“Nevertheless, some studies found that having a purpose in life was one of the important components of well-being in elderly persons with dementia (Mak, 2011; Boyle et al., 2010).”
BackgroundGreat, purposeful expectations: predicting daily purposefulness during the COVID-19 response
Hill, P., Klaiber, P., Burrow, A. L., DeLongis, A., & Sin, N. L. (2020) · Journal of Positive Psychology · doi:10.1080/17439760.2020.1832251 · Cited by 16
“People who report a stronger sense of purpose tend to experience better health outcomes (Boyle et al., 2010; Cohen et al., 2016; Kim et al., 2013) and are more likely to engage in positive health behaviors (Hill et al., 2019; Hooker & Masters, 2016; Kim et al., 2014).”
BackgroundHill, P. L., Beck, E. D., & Jackson, J. J. (2021) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbab002 · Cited by 21
Tsuzishita, S., & Tadaaki, W. (2021) · Geriatrics · doi:10.3390/geriatrics6030073 · Cited by 21
“[5] investigated the effects of high and low life purpose on Activities of Daily Living (ADL) impairment, Instrumental Activities of Daily Living (IADL) impairment, and mobility impairment in community-dwelling older people.”
BackgroundPurpose in life promotes resilience to age-related brain burden in middle-aged adults
Abellaneda‐Pérez, K., Cattaneo, G., Cabello‐Toscano, M. R., Sánchez, J. S., Mulet‐Pons, L., Vaqué‐Alcázar, L., Perellón‐Alfonso, R., Solé‐Padullés, C., Bargalló, N., Tormos, J. M., et al. (2023) · Alzheimer s Research & Therapy · doi:10.1186/s13195-023-01198-6 · Cited by 28
The role of goal and meaning in life for older adults facing interpersonal stress
Lee, J. E., Kahana, E. F., Kahana, B., & Zarit, S. H. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1849020 · Cited by 23
Rozanski, A. (2016) · Cardiovascular Innovations and Applications · doi:10.15212/cvia.2016.0033 · Cited by 22
Sense of purpose in life and allostatic load in two longitudinal cohorts
Lewis, N. A., & Hill, P. L. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111346 · Cited by 18
Reconstruction of Meaning in Life: Meaning Made during the Pandemic of COVID-19
Chen, C., Zhang, Y., Xu, A., Chen, X., & Lin, J. (2020) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2020.011509 · Cited by 17
Kim, J. H., Sumerlin, T. S., Goggins, W. B., Kwong, E., Leung, J. C. S., Yu, B. W. M., & Kwok, T. C. Y. (2021) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2021.01.014 · Cited by 18
Lewis, N., Brazeau, H. A., & Hill, P. (2020) · Journal of Health Psychology · doi:10.1177/1359105318772656 · Cited by 17
“Furthermore, having a sense of purpose in life appears to be protective against a number of health conditions common in middle and older adulthood (e.g. Boyle et al., 2010, 2012; Kim et al., 2013a, 2013b; Yu et al., 2015).”
BackgroundUsing Concept Mapping Methods to Define “Healthy Aging” in Anchorage, Alaska
Howell, B. M., Seater, M., & Mclinden, D. J. (2020) · Journal of Applied Gerontology · doi:10.1177/0733464819898643 · Cited by 16
“Research indicates that these ideas are all ways in which seniors may find purpose-in-life, which is linked to better health outcomes across a variety of settings (Boyle et al., 2010; Pinquart, 2002).”
BackgroundBaumann, D., & Eiroá‐Orosa, F. J. (2016) · International Journal of Applied Positive Psychology · doi:10.1007/s41042-017-0004-0 · Cited by 16
Disparities in mental health, social support and coping among individuals with mobility impairment
Na, L., & Singh, S. (2020) · Disability and health journal · doi:10.1016/j.dhjo.2020.101047 · Cited by 18
Purpose in Life and Hospitalization for Ambulatory Care-Sensitive Conditions in Old Age
Wilson, R. S., Capuano, A. W., James, B. D., Amofa, P., Arvanitakis, Z., Shah, R. C., Bennett, D. A., & Boyle, P. A. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.06.022 · Cited by 18
“In previous research, this scale has shown adequate internal consistency (29) and predicted diverse health outcomes including disability (30), cognitive decline (20), dementia (17), and death (12).”
BackgroundSelf-citationRisk and protective factors for wellbeing in older veterans in New Zealand
Yeung, P., Allen, J., Godfrey, H. K., Alpass, F., & Stephens, C. V. (2018) · Aging & Mental Health · doi:10.1080/13607863.2018.1471584 · Cited by 13
Tamura, N. T., Shikimoto, R., Nagashima, K., Sato, Y., Nakagawa, A., Irie, S., Iwashita, S., Mimura, M., & Fujisawa, D. (2022) · Psychogeriatrics · doi:10.1111/psyg.12919 · Cited by 13
The Eudaimonics of Health: Exploring the Promise of Positive Well-Being and Healthier Living
Kimiecik, J. C. (2016) · International handbooks of quality-of-life · doi:10.1007/978-3-319-42445-3_23 · Cited by 13
Tickle‐Degnen, L., Stevenson, M. T., Gunnery, S. D., Saint‐Hilaire, M., Thomas, C. A., Martinez, L. S. S., Habermann, B., & Naumova, E. N. (2020) · Disability and Rehabilitation · doi:10.1080/09638288.2020.1741035 · Cited by 12
“It may contribute to having a purpose in life, which predicts slower progression of disability among older adults [46], and quicker recovery from severe mobility limitations [47].”
BackgroundTuijt, R., Leung, P., Profyri, E., & Orgeta, V. (2020) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5316 · Cited by 12
“Similarly to longitudinal studies in older people without dementia, this association persisted after controlling for depressive symptoms, self and carer-ratings of quality of life and carer mental health which may be confounding such an association.(12) Given the limited knowledge in the area, it is not possible to as…”
BackgroundPurpose in life, Neural Alcohol Cue Reactivity, and Daily Alcohol Use in Social Drinkers.
Kang, Y., Cosme, D., Lydon-Staley, D., Ahn, J., Jovanova, M., Corbani, F., Lomax, S., Stanoi, O. A., Strecher, V., Mucha, P., et al. (2022) · Addiction · doi:10.1111/add.16012 · Cited by 13
“Supportive of this view, purpose in life was uniquely associated with increased longevity [34, 35] and healthier lifestyles including better alcohol-related outcomes [36].”
BackgroundFischer, I. C., Tsai, J., Harpaz‐Rotem, I., McCutcheon, V. E., Schulenberg, S. E., & Pietrzak, R. H. (2022) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2022.09.010 · Cited by 13
Propósito de vida e desempenho de atividades avançadas de vida diária em idosos mais velhos
Ribeiro, C. C., Borim, F. S. A., Batistoni, S. S. T., Cachioni, M., Neri, A. L., & Yassuda, M. S. (2022) · Revista Brasileira de Geriatria e Gerontologia · doi:10.1590/1981-22562022025.210216.pt · Cited by 11
Tomioka, K., Shima, M., & Saeki, K. (2021) · Quality of Life Research · doi:10.1007/s11136-021-02780-x · Cited by 11
“We have also reported that women have a higher risk of incident functional disability than men, which is consistent with previous studies [36, 41].”
BackgroundResultThe Quality of Life of Older Adults in a Multiethnic Metropolitan: An Analysis of CASP-19
Lai, S. L., & Tey, N. P. (2021) · SAGE Open · doi:10.1177/21582440211029910 · Cited by 12
“There is ample evidence that points to the predominant effect of health on happiness (Blane et al., 2008; Boyle et al., 2010; Liu et al., 2016; Sexton et al., 2015).”
BackgroundMethod“Just Get Up and Get on.” Purpose in Later Life
Irving, J. (2024) · Activities Adaptation & Aging · doi:10.1080/01924788.2024.2317013 · Cited by 13
Ng, W. Q., & Yang, H. (2022) · Clinical Gerontologist · doi:10.1080/07317115.2022.2130847 · Cited by 11
Sense of Purpose and Experiences of Discrimination During Older Adulthood
Wilson, M. E., & Hill, P. L. (2023) · GeroPsych · doi:10.1024/1662-9647/a000306 · Cited by 10
Fischer, I. C., Feldman, D. B., Tsai, J., Harpaz‐Rotem, I., Lucas, K. A., Schulenberg, S. E., & Pietrzak, R. H. (2023) · International Psychogeriatrics · doi:10.1017/s1041610222001223 · Cited by 11
The Association of Psychological Well‐Being with Disablement Processes in a National Sample
Mishra, A. A., Friedman, E. M., Christ, S. L., & Denning, M. (2019) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12152 · Cited by 10
“Moreover, purpose in life has been © 2018 The International Association of Applied Psychology associated specifically with reduced disability (Boyle et al., 2010) and better physical performance (Kim et al., 2017) in longitudinal analyses.”
BackgroundInfluential
Metadata
- Authors
- Boyle, P. A., Buchman, A. S., & Bennett, D. A.
- Affiliations
- Rush University Medical Center (US)
- Corresponding author
- Boyle, Patricia A.
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2010-12
- Volume
- 18
- Issue
- 12
- Pages
- 1093-1102
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC2992099
- OpenAlex
- W2038900041
- Cited by
- 185
- References
- 50
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 17 · 2023: 13 · 2022: 15 · 2021: 17 · 2020: 21 · 2019: 9 · 2018: 14 · 2017: 17 · 2016: 13 · 2015: 11 · 2014: 7 · 2013: 8 · 2012: 4
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG017917, R01-AG-24480, R01‐AG17917, K23AG023040, K23AG040, R01AG024480)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Psychology › Developmental and Educational Psychology › Aging and Gerontology Research
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- meaning of life, incident disability, older adults, activities of daily living, instrumental activities of daily living, mobility impairment, functional status, community-dwelling older adults, retirement communities, Rush Memory and Aging Project
- MeSH terms
- Activities of Daily Living, Aged, Aged, 80 and over, Aging, Dementia, Disability Evaluation, Female, Goals, Humans, Longitudinal Studies, Male, Middle Aged, Residence Characteristics, Risk Factors, Intention
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