Aging populations face a particular set of challenges in preserving well-being and in decreasing the cost of age-related illnesses. Recognizing the relationship between these challenges, Drs. Benjamin Seligman (Geriatrics Attending/GRECC Research Fellow at the New England Geriatrics Research, Education, and Clinical Center), Maddalena Ferranna (Research Associate at the Harvard T.H. Chan School of Public Health), David E. Bloom (Clarence Gamble Professor of Economics and Demography at the Harvard T.H. Chan School of Public Health), and Ariela Orkaby (Assistant Professor at the New England Geriatrics Research, Education, and Clinical Center) applied for funding to investigate the associations between happiness and frailty, a physical condition associated with aging. Their research project was one of three proposals to receive the Center’s 2020 Innovations in Positive Health seed grant, which supports pioneering research in positive health science. In this Research Spotlight, Dr. Maddalena Ferranna and Dr. Benjamin Seligman discuss the context for their research, as well as the implications beyond public health.
“Frailty, in some ways, encapsulates what we worry about as we age: having difficulty caring for oneself, becoming susceptible to big health shocks. So it has profound links to well-being and happiness,” Dr. Ferranna said. “At the same time, it’s dynamic: it can progress and it can regress.” Nutrition and physical activity, for example, can both affect the progression or reversal of frailty. “Understanding the role of happiness in those changes gives insight into how [happiness] affects an important part of aging,” Dr. Ferranna said.
Dr. Seligman, the project’s principal investigator, describes himself as a newcomer to studying positive well-being. “There is certainly a lot to learn,” he said. “There are multiple ways to approach happiness and multiple definitions to use, which begs the question of what kind(s) of happiness we care about. It’s also dynamic, as is frailty, so considering feedback between them will be an interesting methodological challenge.” This project will use life satisfaction as a primary measure of happiness, while also considering hedonic well-being and eudemonic well-being measures.
With support from the Innovations in Positive Health seed grant, the team will determine the cross-individual association between happiness and frailty for different countries and levels of income. The project is unique in its scope of data analyzed, as well as its consideration of 44 countries – including the U.S., China, India, and Mexico – providing insight across socio-economic status, demographics, and levels of social support. Next, the team will investigate whether happiness affects transitions to and from frailty, and whether the reverse relationship occurs.
A physician-scientist, Dr. Seligman brings a clinical perspective to his work in public health. “The medical conditions I manage are frequently the result of a lifetime of accumulated social disadvantage. So public health gives context to my patients’ concerns, and I use public health tools, like Adult Protective Services or Area Agencies on Aging,” he said. “As a geriatrician, I rely on the work of public health practitioners to inform how I care for patients. Often, I’m not addressing traditional medical problems, but rather social challenges: isolation or unsafe living situations.”
Dr. Seligman believes public health, in turn, can benefit from connections to the medical practice. “The devastation COVID-19 has brought on nursing homes also shows that public health needs to be informed by geriatrics so that the needs of older adults aren’t lost,” he said. In understanding the needs of both disciplines, the team aims to build a foundation for healthier aging. A focus on happiness, in particular, will inform future interventions that protect from health deterioration and increase psychological well-being, creating the conditions for thriving in old age.