As of 2022, there were 57.8 million adults aged 65 and older living in the United States, representing 17.3% of the total population. This group will continue to increase in size, and it is projected that by 2034, older adults will outnumber children for the first time in US history.
Given this trend, supporting healthy aging is a public health priority in the US, and there has been a growing focus on modifiable risk factors, the various things we can do to improve and maintain health as we age. Current recommendations include regular exercise and healthy diet; however, it is increasingly clear that psychosocial factors play an important role in maintaining health and enhancing longevity. For example, the work of Robert Waldinger, MD in the Harvard Study of Adult Development clearly supports the importance of social connection as a component of healthy aging.
Gratitude is a potentially modifiable psychological factor that may enhance health and well-being in older adults. In a recent study published in JAMA Psychiatry, Olivia Okereke, MD, MS, Director of Geriatric Psychiatry at Mass General Hospital and colleagues at the Harvard T.H. Chan School of Public Health examine the association between gratitude and mortality in females participating in the Nurses’ Health Study.
Study Design
In this population-based prospective cohort study, researchers analyzed data from self-reported questionnaires and medical records from 49,275 US older female registered nurses who participated in the Nurses’ Health Study between 2016 and 2020.
Gratitude was assessed using a validated and widely used questionnaire, the 6-item Gratitude Questionnaire or GQ-6. As a measure of one’s tendency to experience grateful affect, the questionnaire asks respondents to agree or disagree with statements such as “I have so much in life to be thankful for” and “Long amounts of time can go by before I feel grateful to something or someone”.
Deaths were identified using the National Death Index, state statistics records, reports by next of kin, and the postal system. Causes of death were ascertained in a review of death certificates and medical records.
Key Findings of the Study
Among the 49,275 female participants (mean [SD] age at baseline, 79 [6.16] years), 4608 deaths were identified over four years (151,496 person-years) of follow-up. Highers levels of gratitude reported at baseline were associated with a lower risk of mortality. More specifically:
- Participants with gratitude scores in the highest third had a 9% lower risk of death compared to those in the lowest third (HR, 0.91; 95% CI, 0.84-0.99).
- The finding remained significant after adjusting for other sociodemographic characteristics that affect mortality, including social activity, religious involvement, physical health, lifestyle factors, cognitive function, and mental health.
- Gratitude appeared to have the most significant effect on death related to cardiovascular disease (HR, 0.85; 95% CI, 0.73-0.995).
Is Gratitude a Modifiable Risk Factor?
This study provides the first empirical evidence indicating that the experience of gratitude is associated with increased longevity in a group of older adults. This finding adds to a growing body of literature indicating that higher levels of gratitude are associated with greater emotional and social well-being, lower risk of depression, better sleep quality, and healthier biomarker profiles.
Exactly how gratitude may improve longevity is not clear; however, the authors propose several potential mechanisms through which gratitude might influence longevity. Gratitude is associated with improved mental health and social well-being, factors that are associated with longevity. In addition, individuals with higher levels of gratitude may be more motivated to take care of their health. Previous research has also linked gratitude to improved cardiovascular health, reduced inflammation, and improved cholesterol levels, factors which are associated with improved health and longevity.
Future studies will help us to better understand how gratitude improves outcomes. In addition, the findings will need to be replicated in studies with more diverse samples. This study focused on a relatively homogenous population, all female, mostly college-educated, with the majority self-identifying as non-Hispanic White.
The big question is whether interventions that increase or emphasize gratitude could be used to improve overall health and decrease morbidity and mortality. One example of such an intervention is the gratitude list, where individuals list three to five things they felt grateful for during the day. Even the simple act of writing a thank-you note can have beneficial psychological effects. While experimental studies examining interventions designed to increase gratitude have observed that boosting levels of gratitude may lead to small to moderate improvements in emotional and social well-being, evidence supporting the beneficial effects of gratitude on physical well-being and health has been scant. This is the first study to demonstrate an association between gratitude and longevity.
Although we still need more research to fully understand the beneficial effects of gratitude on our health, it is not going to hurt any of us to take a little time to be grateful.
Other contributors to this project include Ying Chen, Eric S Kim, Henning Tiemeier, Laura Kubzansky, and Tyler VanderWeele.
Read More
Chen Y, Okereke OI, Kim ES, Tiemeier H, Kubzansky LD, VanderWeele TJ. Gratitude and Mortality Among Older US Female Nurses. JAMA Psychiatry. 2024 Jul 3:e241687.
In the News
Gratitude enhances health, brings happiness — and may even lengthen lives (Harvard Health Publishing)
Be grateful for what you have. It may help you live longer (Los Angeles Times)
Practicing gratitude could help you live longer, according to new study (CNN)
