Increased frequency of light physical activity during midlife and old age buffers against cognitive declines.

Although it is well established that moderate-to-vigorous physical activity (MVPA) buffers against declines in cognitive health, less is known about the benefits of light physical activity (LPA). Research on the role of LPA is crucial to advancing behavioral interventions to improve late life health outcomes, including cognitive functioning, because this form of physical activity remains more feasible and amenable to change in old age. Our study examined the extent to which increases in LPA frequency protected against longitudinal declines in cognitive functioning and whether such a relationship becomes pronounced in old age when opportunities for MVPA are typically reduced. We analyzed 9-year data from the national Midlife in the United States Study (n = 2,229; Mage = 56 years, range = 33-83; 56% female) using autoregressive models that assessed whether change in LPA frequency predicted corresponding changes in episodic memory and executive functioning in middle and later adulthood. Increases in LPA frequency predicted less decline in episodic memory (ß = 0.06, p = .004) and executive functioning (ß = 0.14, p < .001) over the 9-year follow-up period, even when controlling for moderate and vigorous physical activity. Effect sizes for moderate and vigorous physical activity were less than half that observed for LPA. Moderation models showed that, for episodic memory, the benefits of increases in LPA frequency were more pronounced at older ages. Findings suggest that increases in LPA over extended periods of time may help slow age-related cognitive declines, particularly in later life when opportunities for MVPA are often diminished.

Perceived control moderates the internalized stigma model of seeking mental health services in distressed older adults.

Older adults are especially unlikely to seek mental health services, and internalized stigma is a key reason why. However, little research has investigated which older adults are particularly likely to have stigma influence help-seeking. To address this, we tested whether perceived control (PC) moderates an internalized stigma model in which public stigma is internalized as self-stigma, which negatively predicts help-seeking attitudes and help-seeking intentions. We employed moderated mediation analysis of cross-sectional, secondary data from 348 psychologically distressed Canadian adults aged 65 years and older. Participants completed an online survey that included measures of public stigma of help-seeking, self-stigma of help-seeking, help-seeking attitudes, conditional help-seeking intentions, psychological distress, and PC. PC emerged as a moderator of the internalized stigma model. Those lower in PC were more likely to have public stigma negatively predict help-seeking intentions through the serial mediation of (a) self-stigma and (b) help-seeking attitudes. Further, those lower in PC were more likely to have public stigma internalized as self-stigma and more likely to have negative help-seeking attitudes predict lower help-seeking intentions. Finally, those lower in PC also had lower help-seeking intentions in the face of low levels of self-stigma. These results contribute to a nuanced understanding of which older adults are unlikely to seek help. Identifying PC as a moderator of the internalized stigma model suggests that interventions that enhance PC should protect against public stigma's internalization and improve help-seeking behaviors for older adults who need such help. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Using Electronic Handgrip Dynamometry and Accelerometry to Examine Multiple Aspects of Handgrip Function in Master Endurance Athletes: A Pilot Study.

ABSTRACT: Klawitter, LA, Hackney, KJ, Christensen, BK, Hamm, JM, Hanson, M, and McGrath, R. Using electronic handgrip dynamometry and accelerometry to examine multiple aspects of handgrip function in master endurance athletes: A Pilot Study. J Strength Cond Res 37(9): 1777-1782, 2023-Electronic handgrip dynamometry and accelerometry may provide novel opportunities to comprehensively measure muscle function for human performance, especially for master athletes. This investigation sought to determine the multivariate relationships between maximal strength, asymmetry, rate of force development, fatigability, submaximal force control, bimanual coordination, and neuromuscular steadiness to derive one or more handgrip principal components in master-aged endurance athletes. We included n = 31 cyclists and triathletes aged 35-70 years. Maximal strength, asymmetry, rate of force development, fatigability, submaximal force control, bimanual coordination, and neuromuscular steadiness were measured twice on each hand using electronic handgrip dynamometry and accelerometry. The highest performing measures were included in the analyses. A principal component analysis was conducted to derive a new collection of uncorrelated variables from the collected handgrip measurements. Principal components with eigenvalues >1.0 were kept, and individual measures with a factor loading of |>0.40| were retained in each principal component. There were 3 principal components retained with eigenvalues of 2.46, 1.31, and 1.17. The first principal component, "robust strength," contained maximal strength, rate of force development, submaximal force control, and neuromuscular steadiness. The second principal component, "bilateral synergy," contained asymmetry and bimanual coordination, whereas the third principal component, "muscle conditioning," contained fatigability. Principal components 1, 2, and 3 explained 44.0, 31.6, and 24.4% of the variance, respectively. Different dimensions of muscle function emerged from our findings, suggesting the potential of a muscle function battery. Further research examining how these measures are associated with appropriate human performance metrics and lower extremity correlates is warranted.

The estimated prevalence of no reported dementia-related diagnosis in older Americans living with possible dementia by healthcare utilization.

BACKGROUND: Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS: This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS: The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS: The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%-93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1-90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1-91.4%). DISCUSSION: Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS: We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.

Reframing Achievement Setbacks: A Motivation Intervention to Improve 8-Year Graduation Rates for Students in Science, Technology, Engineering, and Mathematics (STEM) Fields.

Despite increased emphasis on educating students in science, technology, engineering, and mathematics (STEM) disciplines, nearly half of U.S. college students who enroll in these programs fail to graduate with STEM degrees. Using archival data from the Motivation and Academic Achievement Database, we tested whether a motivation intervention to reframe causal attributions for academic setbacks improved graduation rates for college students in STEM disciplines (N = 496). Results showed that the intervention increased the odds of 8-year graduation for students who were at risk of college dropout. Findings highlight the potential of theory-informed psychological interventions to increase persistence to graduation for at-risk students in STEM fields.

Downward adjustment of rehabilitation goals may facilitate post-stroke arm motor recovery.

Objective: Patients starting with physical rehabilitation often hold unrealistically high expectations for their recovery. Because of a lower-than-expected rate of recovery, such unrealistic goals have been linked to adverse effects on mental health. Additionally, overtraining due to overly ambitious goals can lead to suboptimal recovery. We investigated the effectiveness of adjusting rehabilitation goals to a more realistic level as a strategy to select appropriate exercise intensity and achieve better recovery outcomes. Design: Patients with arm paralysis from recent stroke were recruited and went through 6-8 weeks of telerehabilitation and in-clinic rehabilitation programme conducted at 11 US sites (N = 124). Main Outcome Measures: Adjustment of recovery goal was assessed in two timepoints during the rehabilitation programme and arm motor function was assessed before and after the clinical trial. Results: Greater use of goal adjustment strategies predicted better recovery of arm motor function, independent from therapy compliance. This pattern was observed only when the choice of exercises is patient-regulated rather than directed by a physical therapist. Conclusion: Benefits from goal adjustment were more pronounced among patients who entered the programme with poorer motor functions, suggesting that goal adjustment is the most beneficial when goals of complete recovery are most unrealistic.

The Role of Different Weakness Cut-Points for Future Cognitive Impairment in Older Americans.

OBJECTIVES: New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans. DESIGN: Longitudinal panel. SETTING AND PARTICIPANTS: The analytic sample included 11,116 participants aged ≥65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews. METHODS: The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations. RESULTS: Persons considered weak under the absolute cut-point had 1.62 (95% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points. CONCLUSIONS AND IMPLICATIONS: Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.

The Prevalence and Trends of Instrumental Activities of Daily Living Impairments in the United States from 2008-2018.

Background: Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States. Objective: This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans. Methods: A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged≥50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates. Results: Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period (p < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks. Conclusion: IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy.

The role of goal adjustment during rehabilitation from stroke.

We investigated motivational regulation involving adjustment of recovery goals in post-stroke rehabilitation via standard in-clinic physiotherapy and in-home telerehabilitation (TR). We used a secondary dataset collected at 11 US sites as part of a clinical trial using video games and game control pads designed to induce certain arm movements required for recovery (n = 124; Mage  = 61.44, SD = 13.30). Participants were randomly assigned to either the TR or in-clinic condition and underwent 36 therapy sessions, reporting on their activity-inherent enjoyment for 6-8 weeks. Compared with the in-clinic patients and TR patients with high game performance, TR patients with lower game performance reported lower activity-inherent enjoyment, which is an important motivational resource for successful recovery. The results suggest that these differences occur because TR patients become discouraged by low game score feedback, which may have signaled a poor prospect for recovery. However, the results also suggest that low game performers who successfully adjusted their recovery goals were resilient to the impact of low game score feedback on their motivational resources and satisfaction with therapy. The findings suggest that goal adjustment may be particularly beneficial when patients are discouraged by feedback indicating suboptimal recovery prospects.

Goal adjustment capacities in uncontrollable life circumstances: Benefits for psychological well-being during COVID-19.

Goal adjustment capacities (i.e., goal disengagement and goal reengagement) are core self-regulatory resources theorized to buffer psychological well-being during intractable life circumstances. However, research has yet to examine whether these capacities protect well-being for individuals who encounter uncontrollable losses in their ability to pursue important life goals due to the COVID-19 pandemic. Using a nationally-representative sample of U.S. adults aged 18-80 (n = 292), the present longitudinal study examined the extent to which goal disengagement and reengagement predicted levels and change in psychological well-being for individuals who differed in perceived control over their goals early in the pandemic. Results from multilevel growth models showed that goal reengagement, but not goal disengagement, capacities predicted higher levels of well-being during the pandemic (lower perceived stress, depressive symptoms; higher life satisfaction, meaning in life). Moderation models showed the benefits of goal reengagement for well-being were pronounced among individuals who perceived pandemic-induced declines in control over their goals. Findings inform theories of motivation and self-regulation and point to the adaptive value of goal reengagement capacities during uncontrollable life circumstances.

Attributional retraining: Promoting psychological wellbeing in older adults with compromised health.

Older adults make up the largest portion of the population of physically inactive individuals. Health challenges, and psychological barriers (e.g., maladaptive causal attributions), contribute to reduced activity engagement and low perceived control. This pilot study tested an attributional retraining (AR) intervention designed to increase control-related outcomes in a physical activity context for older adults with compromised health. Using a randomized treatment design, we examined treatment effects on a sample of older adults attending a day hospital (N = 37, M age = 80). We employed ANCOVAs, controlling for age, sex, and morbidity, to assess differences in post-treatment outcomes between AR and No-AR conditions. AR recipients (vs. No-AR) reported lower post-treatment helplessness and more perceived control over their health. Our study offers evidence for AR to increase control-related outcomes and lays the groundwork for further research into supporting older adult populations with compromised health.

Adjustment and acceptance beliefs in achievement settings: Implications for student wellbeing.

Research suggests that when dealing with personal setbacks, secondary control (SC) adjustment and acceptance beliefs can foster psychological wellbeing. However, little research has examined these beliefs, in combination, and how they impact students in their academic development. We conducted secondary analysis using an eight-month longitudinal study design over a two-semester introductory course on a sample of university students (n = 237; 64% female; M age = 19 years old). Multiple regression analyses assessed whether the students' Semester 1 adjustment and acceptance SC beliefs influenced Semester 2 learning-related emotions, perceived stress, and perceived course success, and whether Adjustment x Acceptance interactions emerged involving these outcomes. Adjustment beliefs promoted learning-related positive emotions (hope, pride), perceived course success, and reduced perceived stress; acceptance predicted higher shame and perceived stress. Students' adjustment predicted lower helplessness for students with high acceptance beliefs. These findings are discussed in light of the role that SC beliefs might play in curbing psychological distress reported by students on postsecondary campuses.

Undiagnosed Dementia Is Associated with Poor Physical Function in Older Adults.

BACKGROUND: Older adults with a cognitive impairment, including those not yet diagnosed, may have deficits in their physical function. OBJECTIVE: We sought to determine the associations of cognitive impairment consistent with dementia (CICD) diagnosis status on handgrip strength, gait speed, and functional disability in older adults. METHODS: The analytical sample included 8,383 adults aged ≥65-years without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured handgrip strength. Men with handgrip strength <26 kg and women <16 kg were weak. Gait speed was timed across a 2.5-m course and those with slowness had gait speed <0.8 m/s. Participants with difficulty or an inability in completing any basic activities of daily living had a functional disability. The adapted Telephone Interview of Cognitive Status evaluated cognitive function. Persons with scores <7 had a CICD. Healthcare provider dementia-related diagnosis was self-reported. Undiagnosed CICD was defined as no reported dementia-related diagnosis but had CICD, while diagnosed CICD was classified as reporting a dementia-related diagnosis. Covariate-adjusted logistic models were used for the analyses. RESULTS: Persons with undiagnosed CICD had 1.37 (95% confidence interval (CI): 1.04-1.80) greater odds for weakness and 2.02 (CI: 1.39-2.94) greater odds for slow gait speed. Older adults with diagnosed CICD had 2.29 (CI: 1.32-3.97) greater odds for slowness and 1.85 (CI: 1.19-2.90) greater odds for functional disability. CONCLUSION: Screening for CICD could be recommended when defects in physical function are observed in older adults.

A tale of two emotions: The diverging salience and health consequences of calmness and excitement in old age.

Although the benefits of positive affect in old age have been well established, little is known about the late-life salience or adaptive value of discrete positive emotions that have contrasting motivational functions. In two studies, we examined the prevalence and health consequences of individual differences in positive emotions posited to motivate a present-focused mindset that fosters rest and recovery (calmness) or a future-focused mindset that motivates pursuit of novelty and stimulation (excitement). Study 1 was based on a 1-week daily diary study (n = 146) that assessed the salience of these discrete emotions in older adults (M age = 75, SD = 6.82) relative to younger adults (M age = 23, SD = 3.91). Results from multilevel models showed that older adults experienced higher average levels of calmness and lower levels of excitement in comparison to younger adults. Study 2 was based on a 10-year study (n = 336, M age = 75, SD = 6.64) and examined the longitudinal health consequences of individual differences in calmness and excitement for older adults who perceived varying levels of control over their life circumstances. Results from multilevel growth models showed that calmness, but not excitement, buffered against longitudinal declines in psychological well-being (perceived stress, depressive symptoms) and physical health (physical symptoms, chronic conditions) for older adults experiencing low control circumstances. Findings inform theories of emotional aging in showing that positive emotions with disparate motivational functions become more or less salient with age and have diverging consequences for health in late life. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Risk of cognitive declines with retirement: Who declines and why?

Retiring is associated with increased risk of cognitive decline (e.g., Bonsang, Adam, & Perelman, 2012; Wickrama, O'Neal, Kwag, & Lee, 2013). However, little is known about the moderating role of motivational and demographic factors that are implicated in adaptive development and the retirement transition process. We used data from the Midlife in the United States Study (n = 732, Mage = 57, SD = 5.76, 50% female) to examine whether the association between retirement and cognitive decline depended on a key motivation factor (goal disengagement) in propensity score matched samples of older retirees and employees. We explored whether these effects were further moderated by gender. Results showed that those who retired (vs. remained employed) experienced steeper 9-year declines in episodic memory (b = -.41, p = .001) only if they were high in goal disengagement and female. Findings are consistent with theories of lifespan development and cognitive aging and provide initial evidence that retirement may be associated with increased cognitive declines for only certain individuals prone to disengage from highly challenging activities and goal pursuits. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Stress-Related Trajectories of Diurnal Cortisol in Older Adulthood Over 12 Years.

OBJECTIVE: Although evidence shows that stress experiences can predict both hyper- and hypo-cortisol regulation, there is a lack of research examining these associations longitudinally. Our study assessed whether levels and increases in psychological stress experiences predicted 12-year changes in circadian cortisol levels (area under the curve; AUC) and cortisol slopes in a sample of community-dwelling older adults. METHODS: In 2004, 190 community dwelling older adults (57 to 94 years) started providing three days of diurnal cortisol and stress experience data every two years for a total of seven waves of data. All analyses controlled for relevant covariates including: SES, BMI, age, sex, cortisol-related medication, chronic illness, and smoking status. RESULTS: Growth-curve modeling documented that compared to participants who reported generally lower stress experiences (T-ratio = -5.57, p < .01), their counterparts with higher stress experiences showed significantly steeper declines in cortisol AUC over time (T-ratio = -9.23, p < .01). Higher stress experience was associated with generally flatter cortisol slopes. In addition, among participants with high and increasing stress experience over 12 years, cortisol slopes became increasingly flatter over time (T-ratio = 2.78, p < .01). CONCLUSIONS: Among individuals with high, as compared to low, levels of chronic stress experience, cortisol levels displayed steeper declines across the study period. Moreover, cortisol slopes became increasingly flatter as a function of high and increasing stress experience. Implications for theory and research on the associations between stress experience and cortisol in the context of longitudinal observations are discussed.

Engagement with six major life domains during the transition to retirement: Stability and change for better or worse.

Active engagement with multiple life domains (cross-domain engagement) is associated with adaptation throughout the adult life span. However, less is known about the role of cross-domain engagement during significant life course transitions that can challenge motivational resources, such as the shift to retirement. Based on the motivational theory of life span development (Heckhausen, Wrosch, & Schulz, 2010, 2019), the present study used 9-year data from the national Midlife in the United States Study (MIDUS; n = 1,301, M age = 57, SD = 6.96, 56% female) to identify profiles of cross-domain engagement and to assess stability and change in these profiles during the transition to retirement. We also examined whether stability and change in the engagement profiles had implications for psychological adjustment. Results of latent profile analyses showed that three profiles of cross-domain engagement emerged both before and after retirement (high engagement, low work engagement, moderate engagement). Latent transition analyses indicated that most participants remained in their preretirement profiles at postretirement, with the majority classified in a profile defined by stable high engagement with multiple life domains. Results of ANCOVAs showed this stable high engagement profile was associated with the most adaptive 9-year changes in cross-domain perceived control, cross-domain situation quality, and cross-dimension eudaimonic well-being. Findings advance the literature by showing that cross-domain profiles of engagement can be identified and that stability and change in these profiles have consequences for longitudinal psychological adjustment in retirement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Attributions for physical activity in very old adults: predicting everyday physical activity and mortality risk.

OBJECTIVES: Although physical activity is recognised as a health-promoting behaviour for older adults, notable barriers exist that may reduce physical activity in this age group. Limited research has explored causal beliefs (attributions) as a barrier to physical activity. Our study assessed associations between older adults' attributions about physical activity and objective health outcomes. METHODS: We examined the role of attributions as a predictor of everyday physical activity (EPA) and subsequent mortality risk over a 10-year period (2006-2016) in a sample of older adults (Mage = 87, N = 261). RESULTS: OLS and Cox proportional hazard regression analyses revealed older adults who endorsed more internal and uncontrollable attributions for limited activity (physical incapacity) when feeling unwell had lower subsequent EPA (ß = -0.18), and higher 10-year mortality risk (HR = 1.46). Other attributions with different dimensional properties (e.g. internal and controllable) were not associated with EPA or mortality. DISCUSSION: Findings suggest that causal beliefs older adults have about their physical activity can influence their future behaviour and longevity. Psychological treatments designed to discourage maladaptive attributional thinking for older populations who face barriers to physical activity may be an important avenue for future research.

The Detrimental Consequences of Overestimating Future Health in Late Life.

OBJECTIVES: Although forecasting a positive future can be adaptive, it may not be when expectations are unmet. Our study examined whether such inaccurate expectations about future health status (overestimation) were maladaptive for older adults who commonly experience late life declines in physical functioning. METHOD: We analyzed data from the nationally representative German Aging Survey (DEAS; 1996-2011; n = 2,539; age range 60-85 years) using multilevel growth models that assessed the influence of inaccurate health expectations on older adults' physical functioning over a 9-year period. RESULTS: Overestimating future health status predicted reduced day-to-day physical functioning when age, gender, and self-rated health were controlled. A Time × Overestimation interaction indicated that the negative effects of overestimation on physical functioning became more pronounced over the 9-year period. DISCUSSION: Results suggest that repeatedly unmet health expectations may undermine motivational resources and accelerate late life declines in physical functioning.

A healthy dose of realism: The role of optimistic and pessimistic expectations when facing a downward spiral in health.

RATIONALE AND OBJECTIVES: Whether expectations about future health are adaptive or maladaptive in late life likely depends on the extent to which they conform to or defy a future reality of declining health. Our premise was that, when adults face a downward spiral in health, it can be adaptive to realistically expect poorer future health and maladaptive to unrealistically expect good health. METHOD: This 18-year-long study of community-dwelling older Canadians (n = 132, 72-98 years) involved a baseline interview to identify those who anticipated heath would decline (pessimistic expectation) or improve/remain stable (optimistic expectation). We determined initial (baseline) health status by assessing the severity of chronic conditions. An objective within-person measure of actual health change was derived by documenting hospital admissions (HAs) over time to capture a continuum that ranged from no declines (HAs remained stable) to greater declines in health (increasing numbers of HAs). Our a priori hypotheses examined the effects of health expectations (pessimistic, optimistic) and actual health change on the outcomes of depressive symptoms and mortality. RESULTS: Support was found for our premise that it is adaptive to be realistic when forecasting future health, at least at low levels of initial chronic condition severity. Regression analyses showed that realistically pessimistic (vs. unrealistically optimistic) expectations predicted significantly fewer depressive symptoms and a lower risk of death. The results also supported our premise that it is maladaptive to be unrealistically optimistic when health subsequently declines in reality: The risk of death was 313% higher for those with optimistic expectations that were unrealistic (vs. realistic). CONCLUSION: These findings provide insights for health care professionals regarding the messages they communicate to their patients. Together, they imply that, when good health is slipping away, it seems optimal to encourage a healthy dose of realism.