Significance Ratings of the meaningfulness of life have been adopted in UK national surveys and are advocated internationally. This study demonstrates the value of a simple rating of the extent to which people feel that the things they do in life are worthwhile, by documenting positive associations with social relationships and broader social engagement, economic prosperity, mental and physical health, biomarkers, health-related behaviors, and time use. These associations were observed both cross-sectionally and longitudinally, suggesting that feeling life is worthwhile contributes to subsequent well-being and human flourishing at older ages. Given the widely recognized policy importance of promoting subjective well-being at older ages, a wider adoption of worthwhile ratings in large-scale surveys would provide valuable policy-relevant evidence internationally.

Abstract The sense that one is living a worthwhile and meaningful life is fundamental to human flourishing and subjective well-being. Here, we investigate the wider implications of feeling that the things one does in life are worthwhile with a sample of 7,304 men and women aged 50 and older (mean 67.2 y). We show that independently of age, sex, educational attainment, and socioeconomic status, higher worthwhile ratings are associated with stronger personal relationships (marriage/partnership, contact with friends), broader social engagement (involvement in civic society, cultural activity, volunteering), less loneliness, greater prosperity (wealth, income), better mental and physical health (self-rated health, depressive symptoms, chronic disease), less chronic pain, less disability, greater upper body strength, faster walking, less obesity and central adiposity, more favorable biomarker profiles (C-reactive protein, plasma fibrinogen, white blood cell count, vitamin D, high-density lipoprotein cholesterol), healthier lifestyles (physical activity, fruit and vegetable consumption, sleep quality, not smoking), more time spent in social activities and exercising, and less time spent alone or watching television. Longitudinally over a 4-y period, worthwhile ratings predict positive changes in social, economic, health, and behavioral outcomes independently of baseline levels. Sensitivity analyses indicate that these associations are not driven by factors such as prosperity or depressive symptoms, or by outcome levels before the measurement of worthwhile ratings. The feeling that life is filled with worthwhile activities may promote healthy aging and help sustain meaningful social relationships and optimal use of time at older ages.

The sense that one is living a meaningful and worthwhile life is a key component of subjective well-being and human flourishing (1) and is related to a range of social, economic, and health factors (2). The importance of the concept to public policy has been endorsed by the Office for National Statistics (ONS) in the United Kingdom, which has included ratings of how worthwhile people think the things they do in their lives are within the national program of personal well-being since 2011 (3).

Having a strong sense of purpose and meaning in life may be a protective factor in relation to health, with longitudinal studies documenting associations with reduced premature mortality, slower development of age-related disability, reduced incidence of cardiovascular disease, healthier lifestyles, and more preventive behaviors (4⇓–6). Much of this research has focused on the health domain, while studies on social, economic, and emotional outcomes have largely been cross-sectional (2). Maintaining a sense that life is worthwhile may be particularly important at older ages when social and emotional ties often fragment, social engagement is reduced, and health problems may limit personal options.

Accordingly, we tested the association between the ONS rating of life being worthwhile and a range of social, economic, health, biomarker, and health-related behaviors in the English Longitudinal Study of Ageing (ELSA), a representative population sample of men and women aged 50 and over living in England (7). Cross-sectional associations and longitudinal relationships between life being worthwhile and outcomes over a 4-y period were analyzed. We also explored the relationship between time use and having a meaningful life (8), so as to identify patterns of social, solitary, and productive activities over the day.

Discussion Meaning of life is a complex concept involving notions of life being comprehensible and coherent, having purpose and direction, as well as having significance and being worth living (10). The sense of life being worthwhile is a component of eudemonia (10). It is also correlated with hedonic well-being (feelings of joy or sadness) and with evaluative well-being (life satisfaction), and these facets together contribute to overall subjective well-being (11). Our analyses indicate that ratings of doing worthwhile things among older people show associations with a wide spectrum of social, economic, health, biological, and behavioral factors both cross-sectionally and longitudinally. Analyses controlled for a number of time-invariant factors that potentially impinge on these outcomes, including age, sex, educational background and SES. Sensitivity analyses showed that the associations were not driven by economic resources or negative emotional states (operationalized as depressive symptoms). The E value is an indicator of the minimum strength of association that an unmeasured confounder would need to fully explain away an association. E-values were relatively modest, which could suggest that further inclusion of confounders would lead to the attenuation of results (12). Additionally, we followed recent recommendations for outcome-wide studies in including a range of preexposure variables in sensitivity analyses (9). Cross-sectionally, worthwhile ratings were associated with stronger personal relationships (marriage, number of close relationships, regular contact with friends) and broader social engagement (involvement in organizations, cultural activity, volunteering), while living alone and loneliness were related to lower worthwhile ratings. Longitudinally, it has been shown that social, cultural, and volunteer engagement predict purpose in life (13, 14). In these analyses, we found the reverse: worthwhile ratings predict greater contact with friends, a lower likelihood of living alone, greater cultural engagement, and a greater likelihood of persistent volunteering over 4 y. The feeling that one is doing worthwhile things in life therefore appears not only to be the product of social relationships and activities but also to contribute to future personal relationships and prosocial outcomes. We found a positive association between worthwhile ratings and wealth and income, and a longitudinal relationship with future wealth over 4 y that was independent of current wealth. Since these associations were independent of occupational prestige and education, they do not merely reflect SES effects but distinct processes related to economic prosperity. An analysis of the Midlife in the United States (MIDUS) study showed that sense of purpose predicts greater income and net wealth independently of covariates (15). The present results extend these observations into older ages. The analyses of health variables indicate that the sense of doing worthwhile things in life is related to healthier profiles in terms of better self-rated health, less limiting illness and chronic disease, fewer depressive symptoms, less disability, and less chronic pain. Worthwhile ratings also predicted less incidence of chronic disease, depressive symptoms, and the development of disability and chronic pain over 4 y. We were able to corroborate these associations with analyses of objective measures of physical function, finding negative cross-sectional associations with obesity and waist circumference as well as longitudinal associations with obesity (waist circumference was only measured cross-sectionally). We also identified cross-sectional associations with upper body strength and longitudinal relationships with gait speed. These effects mesh with our results concerning the development of disability and physical activity and sedentary behavior, implicating a meaningful life in the maintenance of physical capability and activities at older ages. Not only are these important facets of sustained healthy life, they are also relevant to reduced risk of premature mortality (16). The biomarker panel included three indicators of inflammation: C-reactive protein, plasma fibrinogen, and white blood cell count, all of which showed marked inverse associations with worthwhile ratings. Purpose in life has previously been associated with lower levels of single inflammatory markers (17), a finding extended in our study to include further measures known to predict future cardiovascular disease, less healthy aging, poorer mental health, and premature mortality (18, 19). Additionally, we found associations with higher vitamin D concentration, which has been linked with a range of health outcomes, while the inverse relationship with HDL-cholesterol is relevant to reduced cardiovascular disease risk. In combination, the objective biomarker data document a generally favorable profile of biological risk among people who feel their activities are worthwhile. The health of older people with higher worthwhile ratings is also likely sustained by health-related behaviors such as fruit and vegetable consumption, physical activity, good sleep and not smoking. Worthwhile ratings predicted future increases in fruit and vegetable consumption, physical activity, and sustained sleep quality over the follow-up period independently of baseline levels, extending previous findings linking health behaviors with broader dimensions of subjective well-being (11). The alcohol results are harder to interpret, since worthwhile ratings were associated with an increase in alcohol consumption over time but not with baseline levels. However, the relationship between alcohol consumption and well-being may be curvilinear, with both abstinence and high levels associated with poorer mental health (20). The increases in consumption seen here may also reflect changes from very low to moderate levels of intake. The associations we observed between worthwhile ratings and time use support our findings with broader social and behavioral measures. Worthwhile ratings were inversely associated not only with loneliness and living alone, but also with time spent alone on the previous day; a similar pattern has been described in the Health and Retirement Study (21). The observation that people with higher worthwhile ratings spent more time walking or exercising is consistent with the physical activity results. In other studies of time use, work and volunteering emerge as among the most rewarding activities in population samples (8), and this is endorsed by the associations between time spent in these activities and worthwhile ratings. There was considerable variation in the strength of associations between worthwhile ratings and other variables. Both cross-sectionally and longitudinally, the strongest effects related to emotional well-being (depressive symptoms, loneliness), disability (ADLs), health behaviors (physical activity, sleep), and social function (close relationships, marriage). Notably, these associations cut across several different domains, with no single area appearing to predominate. This attests to the broad significance of the feelings that the things we do in life are worthwhile. This is an observational study, so causal conclusions cannot be drawn, and unmeasured confounders may be relevant. Relationships are likely to be bidirectional, but the fact that worthwhile ratings predict future levels of such a wide range of outcomes independently of baseline values suggests that living a meaningful life may contribute to future health and optimal aging. In the context of this broad population study, we were only able to address rather general factors relevant to the sense that the things we do in life are worthwhile, and idiosyncratic factors will be relevant to each individual. Worthwhile activities in later life may center around maintaining harmonious family relationships, working toward goals in hobbies, the achievements of a favorite sports team, communing with nature, religious or spiritual faith, making money, intellectual accomplishment, satisfaction with work, stimulating travel, or other experiences. However, whatever the source, our findings suggest that engaging in activities perceived to be worthwhile has wide ramifications across many domains of human experience at older ages. This simple measure of life being worthwhile has been implemented in a number of national surveys in the United Kingdom, including the Annual Population Survey, the Wealth and Assets Survey, and the National Crime Survey. Wider adoption in other national and international surveys would provide important policy-relevant evidence.

Materials and Methods Participants and Measures. Data were analyzed from the English Longitudinal Study of Ageing (ELSA), a nationally representative longitudinal panel study of English adults aged 50 and older (7). See SI Appendix for details. The study was approved through the National Research Ethics Service, and all participants provided informed consent. Life being worthwhile was assessed through answers to the question “to what extent do you feel the things you do in your life are worthwhile?” with responses from 0 = not at all to 10 = very. Covariates, social, economic, health, biomarkers and health behaviors are detailed in SI Appendix. We measured time use with an adaptation of the Day Reconstruction Method devised for the Health and Retirement Study (22), asking about the amount of time spent on selected activities over the previous day. Statistical Analysis. Associations with social, economic, health, and biological factors were analyzed using logistic regression for binary outcomes and ordinary least squares regression for continuous outcomes, with worthwhile ratings being modeled as a continuous variable. We included age, sex, educational attainment, and socioeconomic status (SES) defined by occupational standing as covariates. We also computed E-values: indicators of how robust findings are to potential unmeasured confounding (12).

Acknowledgments The English Longitudinal Study of Ageing is administered by a team of researchers based at the University College London, NatCen Social Research, the Institute for Fiscal Studies, and the University of Manchester. Funding is provided by National Institute on Aging Grant R01AG017644 and by a consortium of UK government departments coordinated by Wellcome Trust Award 205407/Z/16/Z.

Footnotes Author contributions: A.S. designed research; A.S. performed research; A.S. and D.F. analyzed data; and A.S. and D.F. wrote the paper.

The authors declare no conflict of interest.

This article is a PNAS Direct Submission.

Data deposition: The data in this paper have been deposited with the UK Data Service, www.ukdataservice.ac.uk/ (accession no. GN33368).

This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1814723116/-/DCSupplemental.