Abstract

Purpose in life (PiL) is defined as the sense that life has meaning and intentionality, and plays a guiding role in life goals and decision making regarding the use of personal resources. Objectives: to recognize and analyze data on PiL and conditions associated with good aging or with positive adaptation in aging. Method: an integrative review of articles in peer-reviewed journals published in the PubMed/Medline, Scopus, Web of Science, PsycInfo and Scielo/BVS/Lilacs databases was performed using the terms “purpose in life” and “aging” in the title, without temporal restriction. Results: twenty-seven articles were selected, 22 of which were conducted under large prospective longitudinal studies, 3 were cross-sectional studies and 2 were experimental studies. The studies revealed robust associations between high PiL scores and lower risk of death, Alzheimer’s disease, coronary and cerebrovascular diseases, disability, and sleep disorders; high PiL and positive outcomes in health, cognition, emotional regulation, subjective well-being, and sense of adjustment; PiL as a moderator or resilience resource between risks and adversities and good adaptation. These data are useful for research and intervention involving long-lived and vulnerable older persons.

Key words
Goals; Personal satisfaction; Longevity; Aging

Introduction

In the 1980s and 1990s, the study of subjective well-being already attracted the interest of psychologists who were concerned with identifying variables associated with good quality of life in old age. The construct was described as composed of two sets of variables: global satisfaction with life and satisfaction related to positive and negative domains and affect. In 1989, psychologist Carol D. Ryff¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081. proposed that these aspects of subjective well-being were hedonic in nature and, although necessary, were insufficient to explain the adaptation of adults and older persons. Referring to Aristotelian philosophical tradition, the author argued that the eudaimonic aspect (eu = good + daimon = talent or potential) should also be considered. The pursuit of personal excellence would be relevant to the continuity of development and to the sense of adjustment of adults and older persons¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727..

Ryff operationalized psychological well-being (PWB) or eudaimonic well-being based on classical theoretical propositions on adult development (life structures/life goals⁴4 Bühler C. The curve of life as studied in biographies. J Appl Psychol 1935; 19(4):405-409., individuation⁵5 Jung CG. Modern man in search of a soul. New York: Harcourt, Brace & World; 1933., personal development/qualities of ego⁶6 Erikson EH. Identity and the life cycle: Selected papers. Psychological Issues 1959; 1:1-171., search for meaning⁷7 Frankl VE. Man's search for meaning: An introduction to logotherapy. Boston: Beacon Press; 1959., maturity⁸8 Allport GW. Pattern and growth in personality. New York: Holt, Rinehart, & Winston; 1961., self-government⁹9 Rogers CR. On becoming a person. Boston: Houghton Mifflin; 1961., self-fulfillment¹⁰10 Maslow AH. Toward a psychology of being. 2nd ed. New York: Van Nostrand; 1968., and executive processes of personality¹¹11 Neugarten BL. Personality change in late life: A developmental perspective. In: Eisodorfer C, Lawton MP, editors. The psychology of adult development and aging. Washington: American Psychological Association; 1973. p. 311-335., life-span theory¹²12 Baltes PB, Baltes MM. Psychological perspectives on successful aging: The model of selective optimization with compensation. In: Baltes MM, Baltes PB, editors. Successful Aging: Perspectives from the Behavioral Sciences. European Network on Longitudinal Studies on Individual Development. Cambridge: Cambridge University Press; 1990. p. 1-34.) and combined qualitative and quantitative strategies in a research program¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.^,1313 Samman E. Psychological and subjective well-being: A proposal for internationally comparable indicators. Oxford Development Studies 2007; 35(4):459-486.

14 Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Wadsworth ME, Croudace TJ. Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women. Health Qual Life Outcomes 2006; 4(1):76.^-1515 Ryff CD, Singer BH. Best news yet on the six-factor model of well-being. Social Science Research 2006; 35(4):1103-1119.. This operationalization of PWB occurred through a scale based on six dimensions or factors: self-acceptance, personal growth, autonomy, environmental mastery, positive relationships with others, and purpose in life. In the original version¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081., the scale had 20 items in each domain, but subsequent versions produced instruments with 14 or fewer items, with good psychometric indicators of validity³3 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.^,1313 Samman E. Psychological and subjective well-being: A proposal for internationally comparable indicators. Oxford Development Studies 2007; 35(4):459-486.

14 Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Wadsworth ME, Croudace TJ. Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women. Health Qual Life Outcomes 2006; 4(1):76.^-1515 Ryff CD, Singer BH. Best news yet on the six-factor model of well-being. Social Science Research 2006; 35(4):1103-1119..

Theoretically, purpose in life (or simply purpose) is one of the two most important aspects to the definition of eudaimonic well-being (the other is personal growth). The construct was defined as a sense that life has meaning, direction and intentionality, and that this sense plays a guiding role in establishing life goals and decision making regarding the use of personal resources. Adults and older persons with a strong sense of purpose have life goals and a sense of direction, they feel that their past and current life is meaningful, and they have beliefs that give meaning to their lives, and have desires and goals that are worth living for¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.. The operationalization of the concept was made by one of the sub-scales of the measure of eudaimonic well-being. The Sub-Scale of Purpose had a first version with 14 items, and other versions with 3, 7 or 10 items³3 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.^,1515 Ryff CD, Singer BH. Best news yet on the six-factor model of well-being. Social Science Research 2006; 35(4):1103-1119.^,1616 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579., but the most used is the one with 10 items¹⁶16 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579..

The term Purpose in Life (PiL) also makes reference to another tradition of research and practice, mainly the clinical one, which maintains the notions of directionality and intentionality but adds the concepts of existential meaning, belief in transcendence, and investment in the pursuit of ultimate end of existence. These components are seen as essential to the maintenance of psychological health, especially in life-threatening situations, loss of dignity, suffering and hopelessness, when they act as a resource of resilience, useful to promote adaptation in the face of adversity or of a significant risk⁷7 Frankl VE. Man's search for meaning: An introduction to logotherapy. Boston: Beacon Press; 1959.^,1717 Koenig HG, Berk LS, Daher NS, Pearce MJ, Bellinger DL, Robins CJ, Nelson B, Shaw SF, Cohen HJ, King MB. Religious involvement is associated with greater purpose, optimism, generosity and gratitude in persons with major depression and chronic medical illness. J Psychosom Res 2014; 77(2):135-143.^,1818 Wong PTP. Spirituality, meaning, and successful aging. The human quest for meaning: A handbook of psychological research and clinical applications. Mahwah, NJ: Lawrence Erlbaum Associates Publishers; 1998. p. 359-394..

Since the late 1980s, when the Ryff Scale¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727. was made public, research on purpose as an element of eudaimonic well-being grew more systematically and rapidly than research about the sense of meaning in philosophical-religious-psychological terms. Large ongoing longitudinal prospective cohort studies in the United States¹⁹19 Bennett DA, Schneider JA, Buchman AS, Barnes LL, Boyle PA,Wilson, RS. Overview and findings from the Rush Memory and Aging Project. Curr Alzheimer Res 2012; 9(6):646-663.

20 Juster, FT, Suzman R. An overview of the Health and Retirement Study. J Hum Res.30; Special Issue on the Health and Retirement Study: Data quality and early results.1995; p. S7-S56.

21 Brim OG, Ryff CD, Kessler RC (2004). The MIDUS National Survey: An Overview. In: Brim OG, Ryff CD, Kessler RC, editors. The John D. and Catherine T. MacArthur foundation series on mental health and development. Studies on successful midlife development. How healthy are we?: A national study of well-being at midlife. Chicago: University of Chicago Press; 2004. p.1-34.^-2222 Bell B, Rose CL, Damon A. The Normative Aging Study. An Interdisciplinary and Longitudinal Study of Health and Aging. Aging Hum Devel 1972; 3(1):5-17 and another study in development in Australia²³23 Andrews G, Cheok F, Carr S. The Australian Longitudinal Study of Aging. Austr J Age 1989; 8(2):31-35., started in the 2000s, have included among their objectives the investigation of associations between PiL and aspects of successful adaptation in adulthood and old age.

Research on conditions that help in the adaptation of older persons, as for example PiL, is of particular relevance in developing countries characterized by strong social inequality, inefficient health service networks and social security, and low levels of education and income of the population. Together, these factors determine the accumulation of disadvantages throughout life, which are potentiated by adversities and losses associated with aging. From the theoretical point of view, psychological variables, including PiL, can function as protective factors and as dispositional factors in relation to competence and self-fulfillment, self-care in health, cognition, activity and motivation for social participation. These possibilities are an incentive for conducting research and controlled interventions in samples of Brazilian elderly.

In the present work, PiL in old age it was chosen as object of study firstly because it has been suggested that this variable is likely associated with favorable outcomes in this phase of life. Subjective variables are recognized as important influences on physical and mental health, cognition and participation of the elderly, despite their disadvantages in terms of health or for socioeconomic reasons. Knowledge about the behavior of this variable among older persons can contribute to the planning of works oriented to the improvement of their psychological well-being. The other reason for this study is that it fills a gap in the production of knowledge about this phenomenon in old age in our country.

Literature reviews are a useful for gathering, relating, and synthesizing data from studies published on a given subject. They aid in the analysis of theoretical knowledge, help to make decisions about further research questions and about the methods to be adopted to answer them, as well as contribute to the planning of interventions relevant to the population. Integrative reviews are less restrictive than systematic reviews and meta-analyses that, based on theories, compare designs and numerical data²⁴24 Souza MTS, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein 2017; 8(1 Pt 1):102-106.. They are well suited to start the empirical investigation of a given phenomenon, when the available theoretical propositions can serve as lenses to observe and intervene in reality.

We planned an integrative literature review with the goal to identify and analyze significant theoretical and empirical information about associations between PiL and conditions related to good aging or positive adaptation in aging.

Method

Integrative literature review is a method that synthesizes relevant information from available research on a given topic, and uses the product of such work to guide the practice and to plan further researches. It is organized in six phases: elaboration of the guiding question and the objective; systematic search through sampling or based on pre-established criteria according to the expected product; data collection; critical analysis; discussion of results; and presentation of the integrative review²⁴24 Souza MTS, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein 2017; 8(1 Pt 1):102-106..

Articles about purpose in life published in peer-reviewed journals were searched. The articles were indexed in the following databases: Medical Literature Analysis and Retrieval System Online (Medline/PubMed); Virtual Library in Health, Latin American and Caribbean Health Sciences Literature, the Scientific Electronic Library Online (BVS/Lilacs and SciELO); Scopus (Elsevier Science); Web of Science (Thompson Reuters) and the PsycInfo Data Base Record (American Psychological Association), with the descriptors “purpose in life” and “aging”, without temporal restriction. The inclusion criteria were: research articles with sample of adults and older persons aged 50 and over, published in English, Portuguese or Spanish; articles that had the term “purpose in life” in the title and that adopted the definition of PiL in terms of directionality, intentionality and orientation by goals and objectives that give meaning to the choices and use of individual resources¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.. Articles whose definition integrated philosophical concepts of meaning, ultimate ends of existence, transcendence and religiosity (theoretical criteria) were excluded, as well as reviews and psychometric articles (methodological criteria). Articles that appeared in more than one database were considered only once. The searches were conducted in June 2016 and updated in May 2018.

Results and discussion

The initial search in the databases identified 387 titles that met the specification of the subject and the age of the participants (“Purpose in life” and “aging”). Of these, 87 were selected because they had the term “purpose in life” in the title and 30 were eliminated because they were repetitions. The resulting 57 articles had the abstract, introduction, instruments, and bibliography examined by two evaluators who worked first independently and then together to identify the underlying theoretical approach. A total of 32 articles were selected. They had a definition of PiL that involved the notions of directionality and goal-oriented behavior. Twenty-five articles were excluded because their definition of purpose included philosophical and religious elements. Further, two systematic reviews, one of meta-analysis and two of psychometric nature, were excluded. At the end, 27 articles were kept, read in full length, and used in the literature review. Figure 1 shows the flowchart that represents these actions and their results.

Twenty-two of the studies analyzed had been developed in the context of large longitudinal studies in the United States and one had been conducted in Australia: the Rush Memory and Aging Project (RMAP)¹⁹19 Bennett DA, Schneider JA, Buchman AS, Barnes LL, Boyle PA,Wilson, RS. Overview and findings from the Rush Memory and Aging Project. Curr Alzheimer Res 2012; 9(6):646-663., the Health and Retirement Study (HRS)²⁰20 Juster, FT, Suzman R. An overview of the Health and Retirement Study. J Hum Res.30; Special Issue on the Health and Retirement Study: Data quality and early results.1995; p. S7-S56., Midilife Development in the United States (MIDUS)²¹21 Brim OG, Ryff CD, Kessler RC (2004). The MIDUS National Survey: An Overview. In: Brim OG, Ryff CD, Kessler RC, editors. The John D. and Catherine T. MacArthur foundation series on mental health and development. Studies on successful midlife development. How healthy are we?: A national study of well-being at midlife. Chicago: University of Chicago Press; 2004. p.1-34., the Veteran Affairs Normative Aging Study (NAS)²²22 Bell B, Rose CL, Damon A. The Normative Aging Study. An Interdisciplinary and Longitudinal Study of Health and Aging. Aging Hum Devel 1972; 3(1):5-17, and the Australian Longitudinal Study of Aging (ALSA)²³23 Andrews G, Cheok F, Carr S. The Australian Longitudinal Study of Aging. Austr J Age 1989; 8(2):31-35.. The inclusion of PiL among the measures of interest in these studies created excellent conditions of repetition, which have contributed to the increase of external validity of the results and of internal validity of PiL measures, and have contributed to theoretical advances.

The authorship of the articles is another indicative of integration between the studies. The authors can be grouped into four main blocks, led by researchers associated with longitudinal studies: in the RMAP, Boyle is the first author of four studies¹⁶16 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579.^,2525 Boyle PA, Buchman AS, Barnes LL, Bennett DA. Effect of a purpose in life on risk of incident Alzheimer disease and mild cognitive impairment in community-dwelling older persons. Arch Gen Psychiatry 2010; 67(3):304-310.

26 Boyle PA, Buchman AS, Bennett DA. Purpose in life is associated with a reduced risk of incident disability among community-dwelling older persons. Am J Geriatr Psychiatry 2010; 18(12):1093-1102.^-2727 Boyle PA, Buchman AS, Wilson RS, Yu L, Schneider JA, Bennett DA. Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age. Arch Gen Psychiatry 2012; 69(5):499-505. and coauthor in two²⁸28 Yu L, Boyle PA, Wilson RS, Levine SR, Schneider JA, Bennett DA. Purpose in life and cerebral infarcts in community-dwelling older people. Stroke 2015; 46(4):1071-1076.^,2929 Wilson RS, Capuano AW, James BD, Amofa P, Arvanitakis Z, Shah R, Bennett DA, Boyle PA. Purpose in life and hospitalization for ambulatory care-sensitive conditions in old age. Amer J Ger Psych 2018; 26(3):364-374.; in HRS, Kim is the first author of five publications²⁹29 Wilson RS, Capuano AW, James BD, Amofa P, Arvanitakis Z, Shah R, Bennett DA, Boyle PA. Purpose in life and hospitalization for ambulatory care-sensitive conditions in old age. Amer J Ger Psych 2018; 26(3):364-374.^,3131 Kim ES, Sun JK, Park N, Peterson C. Purpose in life and reduced incidence of stroke in older adults: 'The Health and Retirement Study'. J Psychosom Res 2013; 74(5):427-432.

32 Kim ES, Strecher VJ, Ryff CD. Purpose in life and use of preventive health care services. Proc Natl Acad Sci USA 2014; 111(46):16331-16336.

33 Kim ES, Hershner SD, Strecher VJ. Purpose in life and incidence of sleep disturbances. J Behav Med 2015; 38(3):590-597.^-3434 Kim ES, Kawachi I, Chen Y, Kubzansky LD. Association between purpose in life and objective measures of physical function in older adults. JAMA Psychiatry 2017; 74(10):1039-1045.; in the MIDUS, Hill and Turiano are responsible for four studies³⁷37 Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci 2014; 25(7):1482-1486.^,3939 Hill PL, Turiano NA, Mroczek DK, Burrow AL. The value of a purposeful life: Sense of purpose predicts greater income and net worth. J Res Pers 2016; 65:38-42.^,4141 Hill PL, Turiano NA, Burrow L. Early life adversity as a predictor of sense of purpose during adulthood. Int J Behav Dev 2018; 42(1):143-147.^,4242 Hill PL, Turiano NA, Spiro A, Mroczek DK. Understanding inter-individual variability in purpose in life: Longitudinal findings from the VA Normative Aging Study. Psychol Aging 2015; 30(3):529-533. and co-authors in two others⁴²42 Hill PL, Turiano NA, Spiro A, Mroczek DK. Understanding inter-individual variability in purpose in life: Longitudinal findings from the VA Normative Aging Study. Psychol Aging 2015; 30(3):529-533.^,5252 Burrow AL, Stanley M, Sumner R, Hill PL. Purpose in life as a resource for increasing comfort with ethnic diversity. Pers Soc Psychol Bull 2014; 40(11):1507-1516.; and Burrow is the first author of two articles³⁶36 Burrow AL, Sumner R, Ong AD. Perceived change in life satisfaction and daily negative affect: The moderating role of purpose in life. J Happiness Stud 2014; 15(3):579-592.^,5252 Burrow AL, Stanley M, Sumner R, Hill PL. Purpose in life as a resource for increasing comfort with ethnic diversity. Pers Soc Psychol Bull 2014; 40(11):1507-1516.. These and almost all other authors (n = 58 in the 27 articles) form groups with typical production. One article was published in 2009, two in 2010, one in 2011, one in 2012, three in 2013, four in 2014, six im 2015, four in 2016, two in 2017, and in from 2018.

The Rush Memory and Aging Project (RMAP)¹⁹19 Bennett DA, Schneider JA, Buchman AS, Barnes LL, Boyle PA,Wilson, RS. Overview and findings from the Rush Memory and Aging Project. Curr Alzheimer Res 2012; 9(6):646-663. is a longitudinal, epidemiological, clinical-pathological, and cohort study that focuses on chronic conditions common in old age, with emphasis on cognitive and motor decline and risk of Alzheimer’s disease. From September 1997 to November 2011, 1,556 adults and older persons recruited from retirement communities living in northeastern Illinois, United States, agreed to participate in the study. A total of 1,489 people completed the baseline measures (73.1% women). The mean age was 80.1 years and the mean schooling was 14.4 years. Among this sample, 1,409 did not present dementia in the clinical evaluation. The study focused on: (a) the relationship between risk factors and incident Alzheimer’s disease (AD); (b) incident mild cognitive impairment (MCI) and decline in cognitive and motor functions; (c) the relationship between neurobiological indexes and AD, MCI and cognitive and motor functions; (d) the neurobiological trajectories linking risk factors and clinical phenotypes. Three follow-ups were performed involving postmortem neuropathological exams in the brains of the elderly who died.

The Health and Retirement Study (HRS)²⁰20 Juster, FT, Suzman R. An overview of the Health and Retirement Study. J Hum Res.30; Special Issue on the Health and Retirement Study: Data quality and early results.1995; p. S7-S56. also involved a representative sample of men and women aged 50 and over. It began in 1991 as a longitudinal study of a cohort born between 1931 and 1941 in the pre-retirement period along with their spouses of any age. The sample was expanded in 1993 and 1998. Since then, every six years, a new cohort of people between the ages of 51 and 56 is included. Data are expected to be collected every four years. When a participant dies, an interview is conducted with family members to investigate the circumstances of the death and the socioeconomic conditions. Data on physical conditions, biomarkers, anthropometry, blood pressure, functional capacity, and psychosocial and socioeconomic variables are collected.

The Survey of Midlife Development in the United States (MIDUS)²¹21 Brim OG, Ryff CD, Kessler RC (2004). The MIDUS National Survey: An Overview. In: Brim OG, Ryff CD, Kessler RC, editors. The John D. and Catherine T. MacArthur foundation series on mental health and development. Studies on successful midlife development. How healthy are we?: A national study of well-being at midlife. Chicago: University of Chicago Press; 2004. p.1-34. is a study of national scope. It involved 7,108 participants from 25 to 75 years of age at the baseline, which occurred in 1995 and 1996. The design of this study involves follow-up measures at intervals of 9 to 10 years. The aim is to investigate the role of behavioral, psychological and social factors in determining age-related variations in physical and mental health.

The Normative Aging Study (NAS)²²22 Bell B, Rose CL, Damon A. The Normative Aging Study. An Interdisciplinary and Longitudinal Study of Health and Aging. Aging Hum Devel 1972; 3(1):5-17 is a longitudinal interdisciplinary study established in 1961 by the Veterans Hospital Administration (Boston, USA). The cohort consisted of 2,280 men recruited from a universe of 6,000 examined at the beginning of the study, in 1961, when they were between 21 and 80 years of age. Most were white individuals, survivors of World War II and the Korean War. The only inclusion criterion was that they were healthy, i.e. free of any known chronic condition at the start of the study. Follow-ups were performed every 3 years until 1999. The focus of NAS is non-pathological aging, i.e., the relationships between normal aging and the natural history of chronic diseases. The parameters came from clinical medicine, biochemistry, the five senses, dental health, anthropometry and behavior.

The Australian Longitudinal Study of Aging (ALSA)²³23 Andrews G, Cheok F, Carr S. The Australian Longitudinal Study of Aging. Austr J Age 1989; 8(2):31-35. included a sample of 2,087 men and women aged 65 years and older at baseline. The study sought to conduct a large prospective population survey whose data could be compared with those produced by studies in the United States. It began in 1992, with older persons randomly selected from Southern Australia’s electoral records, stratified by sex, age (five cohorts), and location where they lived. Between 1992 and 2000, six waves of objective measures of successful old age indicators were conducted with respect to health, physical functionality, cognition, affectivity and personality.

The present review also included two studies of a prospective nature, with smaller, non-probabilistic samples, not integrated to the abovementioned longitudinal studies. One investigated the path of changes in PiL in middle-aged adults (n = 163) throughout five measurement waves of the Foley Longitudinal Study of Adulthood⁴⁴44 Ko HJ, Hooker K, Geldhof GJ, McAdams DP. Longitudinal purpose in life trajectories: Examining predictors in late midlife. Psychol Aging 2016; 31(7):693-698.. Another study was developed in a rural area of the province of Nara, Japan, with a total population of 6,900 people and looked for data on mortality in older persons who presented disability in IADL (instrumental activities of daily living) and BADL (basic activities of daily living). The participants were all 65 years old and older (n = 1,853) with valid answers in baseline measurements, performed by postal service⁴⁵45 Tomioka K, Kurumatani N, Hosoi H. Relationship of having hobbies and a purpose in life with mortality, activities of daily living, and instrumental activities of daily living among community-dwelling elderly adults. J Epidemiol 2016; 26(7):361-370..

Chart 1 presents information on the authors, objectives, countries, designs and participants of the 27 studies analyzed. In this table and in the following, the articles were first assembled according to methodological criteria (type of design) and, within each type, in chronological order.

The measure of PiL used in 24 of the 27 studies was that constructed by Ryff et al.¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.^,1414 Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Wadsworth ME, Croudace TJ. Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women. Health Qual Life Outcomes 2006; 4(1):76.^,1616 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579. to function as one of the six sub-scales of their eudaimonic model of psychological well-being. The other three studies adopted measures compatible with the construct (asking if the elderly believed they had a motive and interests worth to live for)⁴⁵45 Tomioka K, Kurumatani N, Hosoi H. Relationship of having hobbies and a purpose in life with mortality, activities of daily living, and instrumental activities of daily living among community-dwelling elderly adults. J Epidemiol 2016; 26(7):361-370., scale of achievement motives⁴⁶46 Sano N, Kyougoku M. An analysis of structural relationship among achievement motive on social participation, purpose in life, and role expectations among community dwelling elderly attending day services. Peer J 2016; 4: e1655., scale of involvement with life⁴⁷47 Polenick CA, Kales HC, Birditt KS. Perceptions of purpose in life within spousal care dyads: Associations with emotional and physical caregiving difficulties. Ann Behav Med 2018; 52(1):77-87., and scale of achievement of goals⁵⁰50 Brandtstädter J, Renner G. Tenacious goal pursuit and flexible goal adjustment: Explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging 1990; 5(1):58-67.. Two studies introduced as an additional measure the full scale of psychological well-being¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.^,3333 Kim ES, Hershner SD, Strecher VJ. Purpose in life and incidence of sleep disturbances. J Behav Med 2015; 38(3):590-597. and the sub-scale of positive relations with others¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.^,3737 Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci 2014; 25(7):1482-1486.^,3838 Zilioli S, Slatcher RB, Ong AD, Gruenewald TL. Purpose in life predicts allostatic load ten years later. J Psychosom Res 2015; 79(5):451-457.. Chart 2 summarizes the variables and measures used.

A range of psychological variables was associated with measures of PiL, including positive affections and emotional self-regulation in laboratory situation³⁵35 Schaefer SM, Morozink Boylan J, van Reekum CM, Lapate RC, Norris CJ, Ryff CD, Davidson RJ. Purpose in life predicts better emotional recovery from negative stimuli. PloS one 2013; 8(11): e80329.; evaluations of current, past and future satisfaction, which would protect the PiL of adults and older persons who have high and stable or increasing satisfaction and would negatively affect those with decreasing levels of satisfaction³⁶36 Burrow AL, Sumner R, Ong AD. Perceived change in life satisfaction and daily negative affect: The moderating role of purpose in life. J Happiness Stud 2014; 15(3):579-592.; locus of control in health³⁸38 Zilioli S, Slatcher RB, Ong AD, Gruenewald TL. Purpose in life predicts allostatic load ten years later. J Psychosom Res 2015; 79(5):451-457.; personality factors such as neuroticism (negative correlation with PiL), optimism and organization (positive correlations with PiL)¹⁶16 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579.^,4242 Hill PL, Turiano NA, Spiro A, Mroczek DK. Understanding inter-individual variability in purpose in life: Longitudinal findings from the VA Normative Aging Study. Psychol Aging 2015; 30(3):529-533.^,4343 Windsor TD, Curtis RG, Luszcz MA. Sense of purpose as a psychological resource for aging well. Devel Psych 2015; 51(7):975-986.; depressive symptoms¹⁶16 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579.^,2727 Boyle PA, Buchman AS, Wilson RS, Yu L, Schneider JA, Bennett DA. Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age. Arch Gen Psychiatry 2012; 69(5):499-505.^,4343 Windsor TD, Curtis RG, Luszcz MA. Sense of purpose as a psychological resource for aging well. Devel Psych 2015; 51(7):975-986. that correlate negatively with PiL; social participation, role expectations and achievement motive, whose correlations with PiL are positive³⁷37 Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci 2014; 25(7):1482-1486..

However, neither the advancement of age nor any other sociodemographic variables protected the participants of the study reported by Hill et al.⁴¹41 Hill PL, Turiano NA, Burrow L. Early life adversity as a predictor of sense of purpose during adulthood. Int J Behav Dev 2018; 42(1):143-147. from the deleterious effects of experiencing adversities before the age of 18, suggesting that there is a limit to the performance of subjective variables of a motivational nature, such as PiL. Purpose in life tends to decline with age⁴²42 Hill PL, Turiano NA, Spiro A, Mroczek DK. Understanding inter-individual variability in purpose in life: Longitudinal findings from the VA Normative Aging Study. Psychol Aging 2015; 30(3):529-533., reflecting the effect of losses associated with aging or social prejudice in relation to the provision of opportunities of achievement for older people. However, there appears to be a dispositional pattern of PiL which is stable and tends to persist for relatively long periods regardless of age⁴⁴44 Ko HJ, Hooker K, Geldhof GJ, McAdams DP. Longitudinal purpose in life trajectories: Examining predictors in late midlife. Psychol Aging 2016; 31(7):693-698..

It was interesting to note that, with exception of age in some investigations, sociodemographic variables proved to be weak predictors of PiL. This data suggests that the phenomenon integrates a dimension that can be called structural or inherent to the human being, a notion that finds support in the theoretical foundations⁴4 Bühler C. The curve of life as studied in biographies. J Appl Psychol 1935; 19(4):405-409.

5 Jung CG. Modern man in search of a soul. New York: Harcourt, Brace & World; 1933.

6 Erikson EH. Identity and the life cycle: Selected papers. Psychological Issues 1959; 1:1-171.

7 Frankl VE. Man's search for meaning: An introduction to logotherapy. Boston: Beacon Press; 1959.

8 Allport GW. Pattern and growth in personality. New York: Holt, Rinehart, & Winston; 1961.

9 Rogers CR. On becoming a person. Boston: Houghton Mifflin; 1961.

10 Maslow AH. Toward a psychology of being. 2nd ed. New York: Van Nostrand; 1968.^-1111 Neugarten BL. Personality change in late life: A developmental perspective. In: Eisodorfer C, Lawton MP, editors. The psychology of adult development and aging. Washington: American Psychological Association; 1973. p. 311-335. of the eudaimonic model¹1 Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 1989; 57(6):1069-1081.

2 Ryff CD. Psychological well-being in adult life. Curr Dir Psychol Sci 1995; 4(4):99-104.^-33 Ryff CD, Keyes CL. The structure of psychological well-being revisited. J Pers Soc Psychol 1995; 69(4):719-727.^,1414 Abbott RA, Ploubidis GB, Huppert FA, Kuh D, Wadsworth ME, Croudace TJ. Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women. Health Qual Life Outcomes 2006; 4(1):76.

15 Ryff CD, Singer BH. Best news yet on the six-factor model of well-being. Social Science Research 2006; 35(4):1103-1119.^-1616 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579. of psychological well-being in which PiL is inserted. The fact that older persons with a moderate level of dementia were able to respond to the sub-scale of purpose and were affected by the level of PiL strengthens this idea. Something that may have contributed to this result is the generally high educational level of participants in the American, Australian, and Japanese studies. In the study by Hill et al.³⁹39 Hill PL, Turiano NA, Mroczek DK, Burrow AL. The value of a purposeful life: Sense of purpose predicts greater income and net worth. J Res Pers 2016; 65:38-42., income and net worth were significantly associated with PiL in the baseline measures and in subsequent follow-up measures, weakening the idea of PiL as a basic human need. These seemingly conflicting data need clarification. Data from Brazilian adults and elderly people with different levels of schooling and income and with different cognitive conditions from those observed in the countries of origin of these surveys may contribute to the debate.

The most impressive data observed in the set of studies analyzed concern the association between high level of PiL and better cognitive function, even despite the presence of neuropathological alterations typical of Alzheimer’s disease, as well as slower evolution of AD and MCI incidents and slower rhythm of cognitive decline in the presence of high level of PiL²⁷27 Boyle PA, Buchman AS, Wilson RS, Yu L, Schneider JA, Bennett DA. Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age. Arch Gen Psychiatry 2012; 69(5):499-505.. These data suggest that PiL promotes gains in neural reserves that protect the brain from the deleterious effects of changes associated with AD. Most of the physiological systems of the body, including the brain, withstand a considerable level of damage before presenting clinical manifestations of deficit²⁷27 Boyle PA, Buchman AS, Wilson RS, Yu L, Schneider JA, Bennett DA. Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age. Arch Gen Psychiatry 2012; 69(5):499-505..

Lower risk for AD in individuals with high PiL and statistically significant associations between high PiL scores and cognitive functions were also documented²⁵25 Boyle PA, Buchman AS, Barnes LL, Bennett DA. Effect of a purpose in life on risk of incident Alzheimer disease and mild cognitive impairment in community-dwelling older persons. Arch Gen Psychiatry 2010; 67(3):304-310.^,4040 Lewis NA, Turiano NA, Payne BR, Hill PL. Purpose in life and cognitive functioning in adulthood. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2017; 24(6):662-671.^,4343 Windsor TD, Curtis RG, Luszcz MA. Sense of purpose as a psychological resource for aging well. Devel Psych 2015; 51(7):975-986.. Adults and older persons with high PiL and good levels of global cognition and cognition in domains usually are more often involved in activities; they are competent in allocating time, energy and resources to reach their goals and usually invest more in their own health, which are conditions that benefit cognition. Further, there are relationships between PiL and reduced levels of inflammatory factors, such as IL-6 receptor, and between PiL and greater resistance to stress and better immune function, which are influenced by the indicated factors⁵³53 Friedman EM, Hayney M, Love GD, Singer BH, Ryff CD. Plasma interleukin-6 and soluble IL-6 receptors are associated with psychological well-being in aging women. Healt Psych 2007; 26(3):305-313.. Individuals with good biomarkers, low allostatic load, and more cognitive resources invest more personal resources in goals that benefit the acquisition of new repertoires and subjective well-being³⁸38 Zilioli S, Slatcher RB, Ong AD, Gruenewald TL. Purpose in life predicts allostatic load ten years later. J Psychosom Res 2015; 79(5):451-457.^,4040 Lewis NA, Turiano NA, Payne BR, Hill PL. Purpose in life and cognitive functioning in adulthood. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2017; 24(6):662-671..

The second set of data that draws attention in the literature sample analyzed concerns the capacity of PiL to predict mortality. The studies of Boyle et al.¹⁶16 Boyle PA, Barnes LL, Buchman AS, Bennett DA. Purpose in life is associated with mortality among community-dwelling older persons. Psychosomatic medicine 2009; 71(5):574-579., Hill and Turiano³⁷37 Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci 2014; 25(7):1482-1486., Windsor et al.⁴³43 Windsor TD, Curtis RG, Luszcz MA. Sense of purpose as a psychological resource for aging well. Devel Psych 2015; 51(7):975-986. and Tomioka et al.⁴⁵45 Tomioka K, Kurumatani N, Hosoi H. Relationship of having hobbies and a purpose in life with mortality, activities of daily living, and instrumental activities of daily living among community-dwelling elderly adults. J Epidemiol 2016; 26(7):361-370. assumed survival and mortality as dependent variables. In the first study, high PiL was associated with a higher probability of survival; the second indicated a higher risk of death for male, older and less educated elderly people and those who scored low on positive relationships with others and PiL; the third showed an increase in age as a risk factor for mortality and an increase in the PiL score as a predictor of survival; the last, associated low PiL scores with mortality and with decline in IADL and BADL. The biological bases of the association between PiL and mortality are unknown, but it is believed that high levels of PiL contribute to the functioning of multiple biological systems, protecting them from the deleterious effects of diseases and other adverse health conditions, using the same reasoning presented with regard to the incidence and progression of AD and MCI.

Studies of the potential of PiL to predict stroke and myocardial infarction, which are themselves predictors of physical and cognitive impairment, is one of the preferred goals of clinical practice and research, hence the importance of data reported by Yu et al.²⁸28 Yu L, Boyle PA, Wilson RS, Levine SR, Schneider JA, Bennett DA. Purpose in life and cerebral infarcts in community-dwelling older people. Stroke 2015; 46(4):1071-1076. and by Kim et al.³⁰30 Kim ES, Sun JK, Park N, Kubzansky LD, Peterson C. Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up. J Behav Med 2013; 36(2):124-133.^,3131 Kim ES, Sun JK, Park N, Peterson C. Purpose in life and reduced incidence of stroke in older adults: 'The Health and Retirement Study'. J Psychosom Res 2013; 74(5):427-432.. According to the authors, high PiL scores are associated with lower risk for stroke and for myocardial infarction. There are two possible explanations for the associations between PiL and stroke. First of all, PiL can help by promoting healthy lifestyles. Second, PiL may be directly implicated in neuroendocrine functions, for example levels of salivary cortisol, epinephrine and norepinephrine, which are related to subjective well-being. Another possible mechanism includes the action of inflammatory markers, such as C-reactive protein, IL-6, and tumor necrosis factor alpha. Third, PiL relates to several other psychological constructs, such as sense of coherence, sense of control, resilience, and optimism. It is a component of psychological well-being and a potentially modifiable factor promoting healthy aging²⁸28 Yu L, Boyle PA, Wilson RS, Levine SR, Schneider JA, Bennett DA. Purpose in life and cerebral infarcts in community-dwelling older people. Stroke 2015; 46(4):1071-1076.^,3131 Kim ES, Sun JK, Park N, Peterson C. Purpose in life and reduced incidence of stroke in older adults: 'The Health and Retirement Study'. J Psychosom Res 2013; 74(5):427-432..

The simple absence of negative psychological status and traits such as anxiety, hostility, depression and negative affections is insufficient to explain or prevent the occurrence of myocardial infarctions. Protein mechanisms may travel along biological (e.g. promoting better immune system function and better regulation of HDL levels), behavioral (e.g., optimism, positive emotions, self-efficacy, and problem-focused coping) and social (e.g., positive social relationships and participation in community affairs) trajectories, all of which are associated with high levels of PiL³⁰30 Kim ES, Sun JK, Park N, Kubzansky LD, Peterson C. Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: a two-year follow-up. J Behav Med 2013; 36(2):124-133..

High levels of PiL were associated with a lower risk of disability in BADL and mobility, regardless of sociodemographic variables, fragility, cardiovascular risk, vascular diseases, depression, neuroticism, and social networks²⁶26 Boyle PA, Buchman AS, Bennett DA. Purpose in life is associated with a reduced risk of incident disability among community-dwelling older persons. Am J Geriatr Psychiatry 2010; 18(12):1093-1102.. In the study by Kim et al.³⁴34 Kim ES, Kawachi I, Chen Y, Kubzansky LD. Association between purpose in life and objective measures of physical function in older adults. JAMA Psychiatry 2017; 74(10):1039-1045., each additional point in PiL was associated with a 13% decrease in the risk of developing low grip strength and with 14% decrease in the risk of presenting slow gait. There is insufficient data linking PiL and physical functions. Relationships are believed to be based in part on indirect effects (e.g., through health behaviors), and in part on direct effects (e.g., through change in biological functions). Thus, people with high levels of PiL are more proactive in health care, have better impulse control, and are more likely to engage in healthy activities. They have a better level of regulation of the physiological systems associated with physical functions (e.g., fewer inflammatory markers). These conditions mediate the relationship between PiL and functional capacity³⁴34 Kim ES, Kawachi I, Chen Y, Kubzansky LD. Association between purpose in life and objective measures of physical function in older adults. JAMA Psychiatry 2017; 74(10):1039-1045..

Windsor et al.⁴³43 Windsor TD, Curtis RG, Luszcz MA. Sense of purpose as a psychological resource for aging well. Devel Psych 2015; 51(7):975-986. and Tomioka et al.⁴⁵45 Tomioka K, Kurumatani N, Hosoi H. Relationship of having hobbies and a purpose in life with mortality, activities of daily living, and instrumental activities of daily living among community-dwelling elderly adults. J Epidemiol 2016; 26(7):361-370. confirmed these associations with similar data. Zilioli et al.³⁸38 Zilioli S, Slatcher RB, Ong AD, Gruenewald TL. Purpose in life predicts allostatic load ten years later. J Psychosom Res 2015; 79(5):451-457. observed better conditions to cope with stressors during a 10-year follow-up of elderly with high level of PiL. These advantages probably reflect and explain the occurrence of positive health assessments in the presence of high PiL levels⁴²42 Hill PL, Turiano NA, Spiro A, Mroczek DK. Understanding inter-individual variability in purpose in life: Longitudinal findings from the VA Normative Aging Study. Psychol Aging 2015; 30(3):529-533.^,4343 Windsor TD, Curtis RG, Luszcz MA. Sense of purpose as a psychological resource for aging well. Devel Psych 2015; 51(7):975-986..

High PiL in elderly patients in outpatient care predicts lower hospitalization rates than intermediate levels of PiL²⁹29 Wilson RS, Capuano AW, James BD, Amofa P, Arvanitakis Z, Shah R, Bennett DA, Boyle PA. Purpose in life and hospitalization for ambulatory care-sensitive conditions in old age. Amer J Ger Psych 2018; 26(3):364-374.. Further, higher PiL is associated with a greater probability of engaging in measures of self-care in health³²32 Kim ES, Strecher VJ, Ryff CD. Purpose in life and use of preventive health care services. Proc Natl Acad Sci USA 2014; 111(46):16331-16336.. Unlike the positive effects related to higher scores on PiL, lower scores predict sleep disorders³³33 Kim ES, Hershner SD, Strecher VJ. Purpose in life and incidence of sleep disturbances. J Behav Med 2015; 38(3):590-597. and other negative outcomes²⁹29 Wilson RS, Capuano AW, James BD, Amofa P, Arvanitakis Z, Shah R, Bennett DA, Boyle PA. Purpose in life and hospitalization for ambulatory care-sensitive conditions in old age. Amer J Ger Psych 2018; 26(3):364-374. (Chart 3).

The cross-sectional studies involved convenience samples and focused on theoretical questions⁴⁶46 Sano N, Kyougoku M. An analysis of structural relationship among achievement motive on social participation, purpose in life, and role expectations among community dwelling elderly attending day services. Peer J 2016; 4: e1655.^,4747 Polenick CA, Kales HC, Birditt KS. Perceptions of purpose in life within spousal care dyads: Associations with emotional and physical caregiving difficulties. Ann Behav Med 2018; 52(1):77-87. and validity of physical activity measures in relation to PiL⁴⁸48 Hooker SA, Masters KS. Purpose in life is associated with physical activity measured by accelerometer. J Health Psychol 2016; 21(6):962-971.. One of the three experimental studies analyzed involved a sample of MIDUS³⁵35 Schaefer SM, Morozink Boylan J, van Reekum CM, Lapate RC, Norris CJ, Ryff CD, Davidson RJ. Purpose in life predicts better emotional recovery from negative stimuli. PloS one 2013; 8(11): e80329. and was guided by the theory of social-emotional selectivity. According to the theory, aging implies an adaptive decline in intensity, variability and reaction time related to emotional expression, as well as a decline in the ability to discriminate signs of negative emotions in photographs and speech. The decline would be protective by allowing the elderly to save physiological resources to invest in selected domains, such as cognition. At the same time, elderly people retain the ability to perceive facial expressions of fear, even in photographs of crowds, possibly because of their adaptive value for the species⁴⁹49 Charles ST. Emotional experience and regulation in later life. In: Schaie KW, Willis SL, editors. Handbook of the Psychology of Aging. 7th ed. London: Elsevier; 2011. p. 295-310.. The intervention was important because it documented the possibility of intervening in PiL or in conditions associated with it. The second was guided by the notion of goal-oriented behavior as a fundamental strategy for the management of external and internal stressors⁵⁰50 Brandtstädter J, Renner G. Tenacious goal pursuit and flexible goal adjustment: Explication and age-related analysis of assimilative and accommodative strategies of coping. Psychol Aging 1990; 5(1):58-67.. Such a notion is inherent in the concept of PiL, but the novelty of the study was to test the possibility of communication with older persons with dementia regarding PiL and to effectively know if PiL affects their behaviors. Both endeavors were successful, providing important data to interventions with adults and older persons with dementia⁵¹51 Mak W. Self-reported goal pursuit and purpose in life among people with dementia. J Gerontol B Psychol Sci Soc Sci 2011; 66(2):177-184.. The third experimental study was different from the others due to the sensitive theme, attitudes regarding ethnic diversity in relation to other affective variables, including PiL, and cognitive variables⁵²52 Burrow AL, Stanley M, Sumner R, Hill PL. Purpose in life as a resource for increasing comfort with ethnic diversity. Pers Soc Psychol Bull 2014; 40(11):1507-1516.. The study was a relevant attempt to test the possibility of intervening in these conditions, in favor of society (Chart 4).

Final considerations

We performed an integrative review of literature on PiL that aimed to carry out the analysis of a sample of articles selected by theoretical and methodological criteria. In the decision to select articles that include the term in the title, we intended to focus on studies considered significant in the contexts in which they were produced and published. The vast majority of articles analyzed worked with secondary data or with sub-samples from large studies conducted in the United States, within the tradition of longitudinal studies. All are pioneers in the relationship between PiL and numerous biological, psychological and social variables indicative of good adaptation in old age.

The aging of the population and the increasing longevity in Brazil associated with normative and non-normative changes that occur in old age call attention to conditions of risk to adaptation, which generate the need to study variables that favor the well-being of the elderly and successful aging. Among them, the most important are those that can be modified, as for example psychological or eudaimonic well-being and one of its components, the purpose of life. For these reasons, the ultimate objective assumed by this work is to offer researchers and health professionals an analysis on relevant aspects of this construct, which can assist them in decision making during interventions.

In short, the data analyzed indicate that the tendency to extract meaning from life experiences and to have a sense of intentionality and direction can guide the behavior, contributing to successful aging. Adults and older persons with high levels of purpose in life, whose work is oriented by goals in life, face aging better, invest more in self-care and in developing their own skills, engage more socially, and tend to participate in meaningful activities. People with a higher level of purpose have a more positive view of aging and of their lives.

People with higher levels of PiL tend to be more resilient and their active pursuit of goals is likely to increase their goal-oriented strength and the efficiency of their biological systems. PiL is associated with numerous known psychological states and traits that can provide good health, such as optimism, self-efficacy, and absence of depression. It is associated with behaviors compatible with health preservation such as healthy eating, and regular physical activity, and avoidance of risks such as heavy alcohol consumption or smoking.

PiL acts as a significant protection factor in relation to mortality; cardiovascular and cerebrovascular diseases; cognitive changes compatible with AD and MCI; functional limitation and immobility; hospitalizations; and other negative health outcomes. It is relatively little affected by sociodemographic variables. It is stable throughout the ages, in adult life and in old age. Although it is a promoter of successful development and aging, the scope of its action to modify and prevent risks associated with aging is limited by the process of decline in more advanced old age.

Purpose can be improved by engaging in meaningful activities such as leisure, educational, philanthropic, social, cultural or family activities. Even small behavioral changes can contribute to a greater sense of purpose, usefulness and relevance. Interventions focused on the improvement of PiL in the elderly can contribute to strengthen neurological and cognitive reserves, the sense of control, competence and goal-oriented behavior. They may be of great value in attenuating, delaying, and slowing down the rate of cognitive decline and the development of morbidity and disability in old age.

Increased longevity among Brazilian elderly imposes challenges to society and aging individuals. The possibility of loss of physical and cognitive capacities and of experiencing individual and family adversities increases in advanced old ages. Gerontological research should produce knowledge about variables that can contribute to healthy longevity. PiL stands out as a significant marker of physical and mental health, with potential to guide innovative gerontological interventions.

References

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