Perceptions of a good life: Associations with culture, age, wellbeing, and health.

What does a good life look like? The present research investigated individual differences in people's perceptions of the factors that are most important for living a good life using two waves of data in probability samples from the U.S. (MIDUS; N = 4,041) and Japan (MIDJA; N = 381). We examined country- and age-related similarities and differences in perceptions of a good life and associations of perceptions of a good life with experiences of wellbeing and physical health. Some factors were considered important for living a good life in both countries and across age (e.g., positive relationships with family), whereas other factors varied between countries (e.g., U.S. participants were more likely to perceive faith as important) and by age (e.g., younger adults were more likely to perceive having a good job as important). Further, perceptions of a good life were related to experiences of wellbeing and physical health concurrently and prospectively. This research informs our understanding of how people differ from one another in their perceptions of a good life, and how these differences may matter for individuals' experiences of a good life.

Obstacles to Biosimilar Acceptance and Uptake in Oncology: A Review.

Importance: Biosimilar drugs provide cost-effective yet clinically indistinguishable replications of target drugs. During initial development, this class of biologic medicines was expected to revolutionize pharmaceutical markets; however, following US Food and Drug Administration approval of the first biosimilar drug in 2015, the commercialization of biosimilars has been limited. The lack of biosimilar use may be especially salient in oncology, given that biosimilar distribution in this particularly high-cost area of medicine would bring savings on the order of many billions of dollars. Observations: While researchers have focused on salient economic barriers to biosimilar uptake in the US, the present review provides insight regarding noneconomic barriers. This review discusses psychological, attitudinal, and educational factors among both health care professionals and payers in the US that may play a role in slowing biosimilar uptake. More specifically, these factors include a lack of health care professional education, concerns of safety and efficacy, and overly complex product naming systems. Conclusions and Relevance: The pathway to biosimilar use has been obstructed by economic elements as well as attitudinal and psychological factors. For biosimilar drugs to achieve their potential in decreasing treatment costs and thus increasing patient access, it will be essential for both economic and noneconomic factors to be identified and systematically addressed.

Do We Become More Lonely With Age? A Coordinated Data Analysis of Nine Longitudinal Studies.

Loneliness is a pervasive experience with adverse impacts on health and well-being. Despite its significance, notable gaps impede a full understanding of how loneliness changes across the adult life span and what factors influence these changes. To address this, we conducted a coordinated data analysis of nine longitudinal studies encompassing 128,118 participants ages 13 to 103 from over 20 countries. Using harmonized variables and models, we examined loneliness trajectories and predictors. Analyses revealed that loneliness follows a U-shaped curve, decreasing from young adulthood to midlife and increasing in older adulthood. These patterns were consistent across studies. Several baseline factors (i.e., sex, marital status, physical function, education) were linked to loneliness levels, but few moderated the loneliness trajectories. These findings highlight the dynamic nature of loneliness and underscore the need for targeted interventions to reduce social disparities throughout adulthood.

Valuing versus having: The contrary roles of valuing and having money and prestige on well-being.

Using data from Midlife in the United States (N=3,767), this study investigates how believing having money or occupational prestige is important for a good life is associated with different aspects of well-being. Actual income was positively associated with sense of purpose, personal growth, self-acceptance, environmental mastery, and life satisfaction, negatively associated with negative affect, and was not associated with autonomy, positive relations with others, or positive affect. Meanwhile, perceiving having enough money or extra money as important for a good life predicted poorer well-being across all nine well-being indicators. Occupational prestige was positively associated with sense of purpose, autonomy, personal growth, self-acceptance, environmental mastery, and life satisfaction, while perceiving having occupational prestige as important was negatively associated with autonomy, personal growth, self-acceptance, positive relations with others, and positively with negative affect. The discussion focuses on how desiring money or prestige can influence well-being beyond having-or not having-those desires.

Approaches to protocol standardization and data harmonization in the ECHO-wide cohort study.

The United States (U.S.) National Institutes of Health-funded Environmental influences on Child Health Outcomes (ECHO)-wide Cohort was established to conduct high impact, transdisciplinary science to improve child health and development. The cohort is a collaborative research design in which both extant and new data are contributed by over 57,000 children across 69 cohorts. In this review article, we focus on two key challenging issues in the ECHO-wide Cohort: data collection standardization and data harmonization. Data standardization using a Common Data Model and derived analytical variables based on a team science approach should facilitate timely analyses and reduce errors due to data misuse. However, given the complexity of collaborative research designs, such as the ECHO-wide Cohort, dedicated time is needed for harmonization and derivation of analytic variables. These activities need to be done methodically and with transparency to enhance research reproducibility. IMPACT: Many collaborative research studies require data harmonization either prior to analyses or in the analyses of compiled data. The Environmental influences on Child Health Outcomes (ECHO) Cohort pools extant data with new data collection from over 57,000 children in 69 cohorts to conduct high-impact, transdisciplinary science to improve child health and development, and to provide a national database and biorepository for use by the scientific community at-large. We describe the tools, systems, and approaches we employed to facilitate harmonized data for impactful analyses of child health outcomes.

Longitudinal Associations Between Multimorbidities and Patient-Reported Quality of Life.

OBJECTIVES: The global prevalence of multimorbidity is increasing as the population ages. As individuals get older, they are likely to develop multiple chronic conditions, and nearly two-thirds of older adults in the United States are estimated to experience 2 or more chronic conditions. The present preregistered study examined whether multimorbidity was associated with longitudinal changes in health-related quality of life (i.e., anxiety, depression, and physical function) and whether these associations were moderated by sociodemographic factors (i.e., sex, race, marital status, income, insurance, and education). METHODS: Data come from the Health Literacy and Cognitive Function Among Older Adults Longitudinal Study (LitCog), a prospective cohort study of English-speaking older adults (N = 900). At each measurement occasion, participants reported anxiety, depression, and physical function using the Patient Reported Outcomes Information System, chronic conditions, and sociodemographic characteristics. We employed multilevel growth models to estimate changes in health-related quality of life, with multimorbidities as a predictor and sociodemographics as covariates. RESULTS: Results indicated that individuals with multiple chronic conditions reported persistently high levels of anxiety and depression, and worse physical function. We found evidence for racial health disparities, such that individuals who identified as non-White experienced worse health-related quality of life as multimorbidities increased, relative to White participants. DISCUSSION: These results contribute to the current conversation about the long-term impacts of structural and systemic barriers experienced by minoritized groups. We further discuss the public health implications of multimorbidity in older adulthood.

Personality predictors of dementia diagnosis and neuropathological burden: An individual participant data meta-analysis.

INTRODUCTION: The extent to which the Big Five personality traits and subjective well-being (SWB) are discriminatory predictors of clinical manifestation of dementia versus dementia-related neuropathology is unclear. METHODS: Using data from eight independent studies (Ntotal = 44,531; Ndementia = 1703; baseline Mage = 49 to 81 years, 26 to 61% female; Mfollow-up range = 3.53 to 21.00 years), Bayesian multilevel models tested whether personality traits and SWB differentially predicted neuropsychological and neuropathological characteristics of dementia. RESULTS: Synthesized and individual study results indicate that high neuroticism and negative affect and low conscientiousness, extraversion, and positive affect were associated with increased risk of long-term dementia diagnosis. There were no consistent associations with neuropathology. DISCUSSION: This multistudy project provides robust, conceptually replicated and extended evidence that psychosocial factors are strong predictors of dementia diagnosis but not consistently associated with neuropathology at autopsy. HIGHLIGHTS: N(+), C(-), E(-), PA(-), and NA(+) were associated with incident diagnosis. Results were consistent despite self-report versus clinical diagnosis of dementia. Psychological factors were not associated with neuropathology at autopsy. Individuals with higher conscientiousness and no diagnosis had less neuropathology. High C individuals may withstand neuropathology for longer before death.

Rural-urban differences in personality traits and well-being in adulthood.

OBJECTIVE: One large focus of personality psychology is to understand the biopsychosocial factors responsible for adult personality development and well-being change. However, little is known about how macro-level contextual factors, such as rurality-urbanicity, are related to personality development and well-being change. METHOD: The present study uses data from two large longitudinal studies of U.S. Americans (MIDUS, HRS) to examine whether there are rural-urban differences in levels and changes in the Big Five personality traits and well-being (i.e., psychological well-being, and life satisfaction) in adulthood. RESULTS: Multilevel models showed that Americans who lived in more rural areas tended to have lower levels of openness, conscientiousness, and psychological well-being, and higher levels of neuroticism. With the exception of psychological well-being (which replicated across MIDUS and HRS), rural-urban differences in personality traits were only evident in the HRS sample. The effect of neuroticism was fully robust to the inclusion of socio-demographic and social network covariates, but other effects were partially robust (i.e., conscientiousness and openness) or were not robust at all (i.e., psychological well-being). In both samples, there were no rural-urban differences in Big Five or well-being change. CONCLUSIONS: We discuss the implications of these findings for personality and rural health research.

Associations Between Generativity and Social Asymmetry Among Older Adults in Japan.

OBJECTIVES: Loneliness and social isolation are major public health concerns among older adults in Japan. Generativity, the concern for and commitment to future generations, may buffer older adults from loneliness. This study examined the cross-sectional and longitudinal associations between generativity and social asymmetry (the discrepancy between social isolation and loneliness) among older adults in Japan. METHODS: Data were from 2 waves (2008 and 2012) of the Midlife in Japan survey, a nationally representative longitudinal study of 645 adults aged 30-79 residing in the Tokyo metropolitan area. Generativity was measured using the 6-item Loyola Generativity Scale. Social asymmetry was computed as the residual score from regressing loneliness onto social isolation. RESULTS: Higher generativity levels were associated with lower social asymmetry scores (B=-0.21, SE=0.04), but generativity change across waves did not predict social asymmetry 4 years later (B=-0.04, SE=0.06). DISCUSSION: Generativity may play a protective role in buffering older adults from the adverse effects of social isolation on loneliness. Promoting generativity among older adults may be a potential intervention strategy to reduce loneliness and improve well-being in aging populations in Japan.

Longitudinal associations among the Big Five personality traits and healthcare utilization in the U.S.

OBJECTIVE: One critical component of individual and public health is healthcare utilization, or the extent to which individuals have routine check-ups, schedule treatments, or use emergency services. However, we know little about who uses healthcare services and what types, the conditions that exacerbate utilization, or the factors that explain why people seek out services. The present study fills these gaps in the literature by investigating the role of personality factors in predicting various forms of healthcare utilization, how these associations vary by age, socioeconomic resources, and chronic conditions, as well as one potential psychological mediating mechanism (i.e., sense of control). METHODS: We use data from a large longitudinal sample of Americans (N = 7108), with three assessments spanning 20 years. Participants reported on their Big Five personality traits using the Midlife Development Inventory, healthcare utilization across three domains (routine visits, scheduled treatment, urgent care), age, income, insurance, chronic conditions, and sense of control. RESULTS: Multilevel models showed that people who were more agreeable and neurotic tended to use more healthcare services. Moreover, on occasions when people were more extraverted and open, they tended to use more healthcare services. There were several nuances in personality-healthcare utilization associations depending on the type of healthcare service, age, and socioeconomic resources. Longitudinal mediation analyses demonstrated sense of control as one mechanism linking personality traits to healthcare utilization in the U.S. CONCLUSIONS: We discuss the theoretical and practical implications of interactions between individuals and structural systems for promoting the health of aging U.S. Americans.

Does personality always matter for health? Examining the moderating effect of age on the personality-health link from life span developmental and aging perspectives.

Extensive evidence has been found for the associations between personality traits and health. However, it remains unknown whether the relationships between personality and health show differential patterns across different life stages. The current research examined how the associations between the levels of and changes in the Big Five personality traits and different types of health outcomes (self-rated, physical, and physiological health outcomes) differ across ages over the life span (Sample 1, age range: 15-100) and during the aging process (Sample 2, age range: 50-109) in particular. Using data from the two large longitudinal studies-the Household, Income, and Labor Dynamics in Australia Survey and the Health and Retirement Study, we observed three important patterns. First, levels of and changes in personality traits were significantly associated with health across different life phases, and these effects were observed even in very old ages. Second, overall, the prospective relations between personality traits/changes in personality traits and health outcomes increased in strength in middle adulthood and/or early stages of late adulthood; however, the strength of their connections diminished in very old ages. Finally, there were some trait-specific and health outcome-specific patterns in the age-differential associations between personality and health. Findings from the present study contribute to enhancing our understanding of the personality-health link from a developmental perspective and provide critical information for the design and implementation of screening and interventions targeting health promotion. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Availability of Cognitive Resources in Early Life Predicts Transitions Between Cognitive States in Middle and Older Adults From Europe.

Background and Objectives: The existing literature highlights the importance of reading books in middle-to-older adulthood for cognitive functioning; very few studies, however, have examined the importance of childhood cognitive resources for cognitive outcomes later in life. Research Design and Methods: Using data from 11 countries included in the Survey of Health, Ageing, and Retirement in Europe (SHARE) data set (N = 32,783), multistate survival models (MSMs) were fit to examine the importance of access to reading material in childhood on transitions through cognitive status categories (no cognitive impairment and impaired cognitive functioning) and death. Additionally, using the transition probabilities estimated by the MSMs, we estimated the remaining years of life without cognitive impairment and total longevity. All models were fit individually in each country, as well as within the pooled SHARE sample. Results: Adjusting for age, sex, education, and childhood socioeconomic status, the overall pooled estimate indicated that access to more books at age 10 was associated with a decreased risk of developing cognitive impairment (adjusted hazard ratio = 0.79, confidence interval: 0.76-0.82). Access to childhood books was not associated with risk of transitioning from normal cognitive functioning to death, or from cognitive impairment to death. Total longevity was similar between participants reporting high (+1 standard deviation [SD]) and low (-1 SD) number of books in the childhood home; however, individuals with more access to childhood books lived a greater proportion of this time without cognitive impairment. Discussion and Implications: Findings suggest that access to cognitive resources in childhood is protective for cognitive aging processes in older adulthood.

Is there intergenerational continuity in early life experiences? Findings from the Harvard Study of Adult Development.

There has been longstanding and widespread interdisciplinary interest in understanding intergenerational processes, or the extent to which conditions repeat themselves across generations. However, due to the difficulty of collecting longitudinal, multigenerational data on early life conditions, less is known about the extent to which offspring experience the same early life conditions that their parents experienced in their own early lives. Using data from a socioeconomically diverse, White U.S. American cohort of 1,312 offspring (50% female) and their fathers (N = 518 families), we address three primary questions: (1) To what extent is there intergenerational continuity in early life experiences (social class, home atmosphere, parent-child relationship quality, health)? (2) Is intergenerational continuity in early life experiences greater for some domains of experience compared to others? and (3) Are there person-level (offspring sex, birth order, perceptions of marital stability) and family-level factors (family size, father education level and education mobility, marital stability) that moderate intergenerational continuity? Multilevel models indicated that intergenerational continuity was particularly robust for childhood social class, but nonsignificant for other early life experiences. Further, intergenerational continuity was moderated by several family-level factors, such that families with higher father education/mobility and marital stability, tended to have offspring with the most optimal early life experiences, regardless of what their father experienced in early life. We discuss the broader theoretical implications for family systems, as well as practical implications for individual-level and family-level interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations for Sense of Purpose with Smoking and Health Outcomes Among Adults with Diabetes.

BACKGROUND: Health complications from diabetes place major strain on individuals, financially and emotionally. The onset and severity of these complications are largely driven by patients' behaviors, making psychosocial factors that influence behaviors key targets for interventions. One promising factor is sense of purpose or the degree to which a person believes their life has direction. METHOD: The current study investigated whether sense of purpose predicts self-rated health, cardiovascular disease, and smoking status among adults with diabetes concurrently and prospectively. Moreover, it tested whether these associations held across multiple samples and cultures. Coordinated analysis using 12 datasets cross-sectionally and eight longitudinally (total N = 7277) estimated the degree to which sense of purpose is associated with subjective health, smoking status, and cardiovascular disease among adults with diabetes. Coordinated analysis allows for greater generalizability of results across cultures, time periods, and measurement instruments. Datasets were included if they concurrently included a measure of sense of purpose and diabetes status and at least one health measure: self-rated health, current smoking status, or heart condition status. RESULTS: Sense of purpose was associated with higher self-rated health, smoking status, and cardiovascular disease cross-sectionally and self-rated health prospectively. Purpose was unassociated with changes in health over time. CONCLUSION: These results highlight the relationship of a key individual difference, sense of purpose, to the behaviors and outcomes of adults with diabetes. While more research is needed to determine the boundaries of this relationship, it seems sense of purpose may be considered in the future as a potential target for intervention.

Personality traits and health care use: A coordinated analysis of 15 international samples.

Some people use health care services more than others. Identifying factors associated with health care use has the potential to improve the effectiveness, efficiency, and equity of health care. In line with the Andersen behavioral model of health care utilization and initial empirical findings, personality traits may be key predisposing factors associated with health care use. Across 15 samples, the present study examined cross-sectional and prospective associations between Big Five personality traits and the likelihood of dental visits, general medical practitioner visits, and hospitalizations. Using coordinated data analysis, we estimated models within each of 15 samples individually (sample Ns ranged from 516 to 305,762), and then calculated weighted mean effect sizes using random-effects meta-analysis across samples (total N = 358,803). According to the synthesized results, people higher in conscientiousness, agreeableness, extraversion, and openness, and lower in neuroticism were more likely to visit the dentist; people higher in neuroticism were more likely to visit general medical practitioners; and people lower in conscientiousness and agreeableness and higher in neuroticism were more likely to be hospitalized. Associations tended to be small with odds ratios around 1.20 (rs ≈ .05). These findings provide evidence across 15 international samples for small but consistent associations between personality traits and health care use and demonstrate that personality-health care associations differ by type of care. We discuss directions for future research, including examining more specific personality facets (e.g., productiveness vs. responsibility) as well as important dimensions of health care (e.g., preventative vs. reactive care; acute vs. chronic care). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Big Five personality traits and allostatic load in middle to older adulthood: A systematic review and meta-analysis.

Further understanding of the associations between personality traits and allostatic load (AL) may be important for predicting, addressing, and optimizing health outcomes. This review synthesized the existing literature reporting the association between the Big Five personality traits and AL in adults to identify the generalizability and robustness of relationships, potential mechanisms underlying the associations, and study characteristics that may be contributing to inconsistencies in the field. Published and unpublished empirical reports were included if at least one of the Big Five traits was examined and an AL index was constructed using at least two biomarkers in a sample of adults. The methodological plan and standardized coding guide were pre-registered and reported (https://osf.io/rxw5a). Based on 11 studies that met eligibility, meta-analysis of correlation coefficients indicated a small but significant positive association between neuroticism and AL, and small but significant inverse associations between both conscientiousness and openness with AL. This review identifies strengths and limitations within the field, as well as several avenues for future research.

How financial incentives in parenting skills programs affect engagement and outcomes: a systematic review and meta-analysis protocol.

OBJECTIVE: This systematic review will investigate the effects of financial incentives on engagement with and outcomes of evidence-based parenting skills programs to prevent and treat disruptive behavior disorders. INTRODUCTION: Evidence-based parenting skills programs are a first-line treatment in disruptive behavior disorders (ie, oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder), but fewer than half of referred parents complete these programs. When untreated, children affected by disruptive behavior disorders are at elevated risk of incarceration, drug misuse, and educational under-performance. Financial incentives can improve parents' engagement with parenting skills programs, and are increasingly popular strategies in public health policy to increase rates of compliance with health interventions. However, no previous systematic review or meta-analysis of financial incentives in parenting skills programs has been conducted. INCLUSION CRITERIA: Randomized controlled trials or quasi-experimental studies (ie, studies with a control group allocated through a non-random process) testing the effects of financial incentives on engagement will be included. Study participants must be in a guardian role to a person under 18 years of age. There will be no restrictions on country setting. Only English-language publications will be included. METHODS: We will search PubMed, CINAHL, Sociological Abstracts, Cochrane Trials, and PsycINFO databases for relevant articles. Two independent reviewers will screen abstracts for eligibility. Data will be extracted from eligible articles by 2 researchers and results will be presented in tabular and narrative format, along with a meta-analysis using a random effects model and assessment of heterogeneity. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022336210.

Associations Between Loneliness and Cognitive Resilience to Neuropathology in Older Adults.

OBJECTIVES: Loneliness in the aging population is associated with decreased cognitive function and increased neuropathology; less is understood about the association of loneliness and cognitive resilience (CR), defined as the discordance between a person's actual and expected cognition given their neuropathology. Here we assess the effect of loneliness and change in loneliness on CR at end of life and across older adulthood. METHODS: Data were combined from 2 longitudinal studies of older adults. CR proximate to death (CRlast_level) and across time (CRslope) was obtained by independently regressing global cognition and change in cognition onto multiple neuropathology indicators and extracting the resulting residuals. We used a series of simple linear regression models to assess the effect of loneliness level and change on CRlast_level and CRslope. RESULTS: Higher baseline loneliness was associated with lower CRlast_level (ß = -0.11, 95% confidence interval [95% CI; -0.18, -0.04], p < .01); higher baseline loneliness and increasing loneliness over time was associated with lower CRslope (ß = -0.13, 95% CI [-0.22, -0.05], p < .01 and ß = -0.12, 95% CI [-0.20, -0.04], p < .01, respectively). Results were robust to covariate inclusion and independent of objective social isolation. DISCUSSION: Higher and increasing loneliness was associated with lower CR in the face of neuropathology. These results suggest that some individuals are less resilient to the accumulation of neuropathology than others, and experiencing high/increasing loneliness is a key factor putting some at risk. Interventions aimed at optimizing cognitive function across older adults should include loneliness reduction as a potential area of focus.

Medical Oncologists' Knowledge and Perspectives on the Use of Biosimilars in the United States.

PURPOSE: Despite increasing availability of biosimilar cancer treatments, little is known about oncologists' knowledge and concerns regarding biosimilar use in the United States. We surveyed medical oncologists to examine their knowledge, attitudes, and experience with biosimilars. METHODS: Oncologists recruited via the ASCO Research Survey Pool completed a 29-question survey in 2020 designed with input from clinical and health care system experts and literature review. RESULTS: Of the 269 respondents, most treated patients with biosimilars (n = 236, 88%) and reported that biosimilars were required at their institution (n = 168, 63%). Approximately half (n = 140, 52%) of oncologists correctly responded that biosimilars were not the same as generic medicines. Commonly reported barriers to use of biosimilars included concerns regarding a perceived lack of relevant research (n = 85, 33% reporting quite a bit/very much), the potential for extrapolation (n = 83, 33%), and efficacy limitations (n = 77, 30%). More oncologists from university hospitals (n = 36, 22%) than from community/private hospitals (n = 28, 38%) or private practices (n = 13, 38%) were concerned about biosimilar efficacy. A high proportion of oncologists reported that information on safety (n = 259, 99%) and efficacy (n = 255, 99%) is important when considering whether to use biosimilars. Less than half reported that their institution provided education about biosimilars (n = 108, 40%). CONCLUSION: In this sample of medical oncologists, knowledge about basic features of biosimilars was limited and access to information about biosimilars was insufficient. The present study determined that educational programs on biosimilars for oncologists are needed and identified priorities for such efforts.

Personality traits, cognitive states, and mortality in older adulthood.

Research suggests that personality traits are associated with mild cognitive impairment (MCI), dementia, and mortality risk, but the timing of when traits are most important in the progression to dementia and the extent to which they are associated with years of cognitive health span are unclear. This project applied secondary data analysis to the Rush Memory and Aging Project (N = 1954; baseline Mage = 80 years; 74% female) over up to 23 annual assessments. Multistate survival modeling examined the extent to which conscientiousness, neuroticism, and extraversion, assessed using the NEO Five Factor Inventory, were associated with transitions between cognitive status categories and death. Additionally, multinomial regression models estimated cognitive health span and total survival based on standard deviation units of personality traits. Adjusting for demographics, depressive symptoms, and apolipoprotein (APOE) ε4, personality traits were most important in the transition from no cognitive impairment (NCI) to MCI. For instance, higher conscientiousness was associated with a decreased risk of transitioning from NCI to MCI, hazard ratio (HR) = 0.78, 95% CI [0.72, 0.85] and higher neuroticism was associated with an increased risk of transitioning from NCI to MCI, HR = 1.12, 95% CI [1.04, 1.21]. Additional significant and nonsignificant results are discussed in the context of the existing literature. While personality traits were not associated with total longevity, individuals higher in conscientiousness and extraversion, and lower in neuroticism, had more years of cognitive health span, particularly female participants. These findings provide novel understanding of the simultaneous associations between personality traits and transitions between cognitive status categories and death, as well as cognitive health span and total longevity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).