Association of Positive Affect Instability With All-Cause Mortality in Older Adults in England

IMPORTANCE: There is increasing recognition that positive affective states have a protective association for all-cause mortality. However, positive states of happiness and excitement vary over time, and little is known about the association of fluctuations in positive affect with survival. OBJECTIVE: To investigate the association of positive affect instability, conceptualized as fluctuations in momentary positive affect, with mortality in a population-based sample of older adults in England. DESIGN, SETTING, AND PARTICIPANTS: This survey study used data from a longitudinal survey collected in wave 2 (2004) of the English Longitudinal Study of Ageing, a nationally representative sample of older men and women living in England, with follow-up continuing until March 2018. Participants included people aged 50 years or older at recruitment. Data were analyzed from September 2019 to April 2020. MAIN OUTCOMES AND MEASURES: The main outcome was all-cause mortality. Positive and negative affect were measured at 4 time points over the course of 1 day: soon after waking, 30 minutes after waking, at 7:00 pm, and at bedtime. RESULTS: Data were analyzed from 3834 participants (mean [SD] age at baseline, 64.0 [7.4] years; 2082 [54.3%] women) with a mean (SD) follow-up of 12.25 (2.60) years. Adjusting for demographic characteristics, baseline illness, health behaviors, and mean level and instability in negative affect, Cox proportional hazards regression showed that high positive affect instability was associated with greater mortality, with a hazard ratio of 1.25 (95% CI, 1.04-1.49; P = .02). Associations did not differ by age, suggesting that the increased mortality risk associated with high positive affect instability was not restricted to older ages. CONCLUSION AND RELEVANCE: These findings suggest that temporal fluctuations in positive affect were associated with mortality risk in older adults. These findings illustrate the value of incorporating dynamic assessments of positive affect in distal health outcomes such as mortality.