Affective well-being in the last years of life: The role of health decline

Oliver K. Schilling*, Dorly J.H. Deeg, Martijn Huisman

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Adding to recent evidence of terminal decline in affective well-being, this study examined the role of physical health in accounting for time-to-death-related changes in positive affect (PA) and negative affect (NA). We distinguished effects of preterminal health levels predicting levels ("preserved differentiation") and terminal changes ("differential preservation") and of terminal health declines predicting terminal changes ("terminal reactivity") of affective well-being in the terminal period of life. Data were used from the first cohort of the Longitudinal Aging Study Amsterdam, including 3-yearly measurements from 1992-1993 to 2011-2012 (N = 2310, age = 55-85 at baseline). Measures of PA and NA were derived from the Center for Epidemiologic Studies Depression Scale. Health measures included self-rated health, self-reported functional limitations, and gait speed. Exponential time-to-death-related trajectories in PA and NA were analyzed with mixed regression models. Results confirmed accelerated time-to-deathrelated decline of PA and increase of NA. Regarding health effects, the findings support terminal reactivity, in that the amount of end-of-life changes in affective well-being was closely linked to the concurrent terminal changes in health. Preterminal health levels did not predict the amount of terminal changes in affective well-being; however, reaching the final years of life with better levels of functional health appeared to promote longer maintenance of better levels of affective well-being and terminal declines more "compressed" to a shorter period prior to death. The findings point to needs to strengthen individuals' resources to compensate for health losses at the end of their life span.

Original languageEnglish
Pages (from-to)739-753
Number of pages15
JournalPsychology and Aging
Issue number5
Publication statusPublished - Aug 2018


The Longitudinal Aging Study Amsterdam is financially supported mainly by the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. Findings presented in this article have not been published or otherwise disseminated before, except parts of descriptive information included in Table 1. Similar analyses of terminal affective changes run on depressive symptom scores (including the positive and negative affect components) from the database used in the present study have been presented at the 21st IAGG World Congress of Gerontology and Geriatrics, July 2017, San Francisco, California, and at the Joined Meeting of the Sections for Developmental Psychology and Educational Psychology of the German Society for Psychology, September 2017, Münster (Germany). Oliver K. Schilling and Dorly J. H. Deeg contributed equally to this article and should both be regarded as first authors.

FundersFunder number
Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care


    • Longitudinal study
    • Physical health
    • Positive and negative affect
    • Terminal decline
    • Time to death


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