title: High morale is associated with increased survival in the very old.
abstract: BACKGROUND
  high morale is defined as future-oriented optimism. Previous research suggests that a high morale independently predicts increased survival among old people, though very old people have not been specifically studied.
  
  
  OBJECTIVE
  to investigate whether high morale is associated with increased survival among very old people.
  
  
  METHODS
  the Umeå 85+/GErontological Regional DAtabase-study (GERDA) recruited participants aged 85 years and older in northern Sweden and western Finland during 2000-02 and 2005-07, of whom 646 were included in this study.
  
  
  METHODS
  demographic, functional- and health-related data were collected in this population-based study through structured interviews and assessments carried out during home visits and from reviews of medical records. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to assess morale.
  
  
  RESULTS
  the 5-year survival rate was 31.9% for participants with low morale, 39.4% for moderate and 55.6% for those with high morale. In an unadjusted Cox model, the relative risk (RR) of mortality was higher among participants with low morale (RR = 1.86, P < 0.001) and moderate morale (RR = 1.59, P < 0.001) compared with participants with high morale. Similar results were found after adjustment for age and gender. In a Cox model adjusted for several demographic, health- and function-related confounders, including age and gender, mortality was higher among participants with low morale (RR = 1.36, P = 0.032) than those with high morale. There was a similar but non-significant pattern towards increased mortality in participants with moderate morale (RR = 1.21, P value = 0.136).
  
  
  CONCLUSIONS
  high morale is independently associated with increased survival among very old people.
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Niklasson
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Hörnsten
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: Conradsson
authors.affiliation: Mental Health Promotion Unit, National Institute for Health and Welfare (THL), Vaasa, Finland.
authors.forename: Fredrica
authors.initials: F
authors.lastname: Nyqvist
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Olofsson
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Hugo
authors.initials: H
authors.lastname: Lövheim
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000369:Aged, 80 and over; D000375:Aging; D003863:Depression / Q000401:mortality* / Q000523:psychology; D005260:Female; D005387:Finland / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D008297:Male; D009013:Morale; D011581:Psychological Tests; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology
keywords: aged, 80 and older; longevity; morale; mortality; older people; survival