Self-Perceptions of Aging: A Systematic Review of Longitudinal Studies

As the population of older adults increases, it is important to understand what may assist every older person to live well and longer. Using a systematic review, this study examined the longitudinal consequences of self-perceptions of aging (SPA), a measure of internalized stereotypes of aging, in participants 50 years or older. The sample comprised 21 studies published in English that used the Attitudes Toward Own Aging (ATOA) scale to measure SPA. Studies were conducted in the United States (10), Germany (7), Australia (2), and one each from Israel and Switzerland. Risk of bias was low, study design and assessment showed good to high quality, and the ATOA scale was reliable in all studies. Primary outcomes were physiological (N = 15; longevity and better health, health behaviors, and diseases) and psychological (N = 6; depression, cognitive function, and other psychological outcomes) rather than social. More positive SPA was consistently associated with healthier longitudinal outcomes, including better self-rated health and less obesity, greater longevity, better performance of the activities of daily living, less depression, and better cognitive functioning (including reductions in cognitive decline and incidence of dementia). These were both direct and indirect pathways and provide support for the consequences of aging stereotypes, providing support for Levy's Stereotype Embodiment theory. The results have public health implications, broadly as community messaging about the benefits of positive SPA and usual and healthy aging, and more narrowly in using ATOA to screen for middle-aged adults with negative SPA to prevent future physical and psychological decline.