Views of Aging and Subjective Cognition in Middle-Aged and Older Adults: A Systematic Review

Perceptions, attitudes, or expectations of one’s own age or old age in general as well as the aging process are cumulatively described as views of aging [1]. Individuals’ views of aging are associated with many aspects of health including a range of physiological (e.g., longevity) and psychological (e.g., depression) outcomes [2, 3]. More positive views of aging are also linked with better cognitive outcomes in older adulthood, specifically higher scores on objective measures of cognitive performance [4, 5] and slower rates of cognitive decline [6]. In addition to objective cognition, subjective cognition (i.e., self-perceptions of cognitive functioning) is also an important component of health and well-being in aging. Poorer subjective cognition is associated with higher depressive symptoms and aging-related anxiety [7], lower quality of life [8], as well as higher risk for mild cognitive impairment (MCI) [9] and Alzheimer’s disease [10]. Although associations between views of aging and many aspects of health and well-being have been well studied, relationships between views of aging and subjective cognition have not been comprehensively reviewed. Previous reviews on factors associated with self-perceptions of cognitive functioning in aging have focused on affective symptoms as well as the types of questions used to assess subjective cognition [7, 11]. However, associations between older adults’ views of aging and subjective cognition have not been comprehensively reviewed.

Views of aging is a broad term that includes both generalized views, or socially shared beliefs about aging and older adults, as well as personal views, or views about one’s own aging process [12]. Multiple concepts under these broader categorizations are commonly examined, including attitudes toward aging, subjective age (i.e., perceptions of age relative to one’s chronological age), self-perceptions of aging, and aging stereotypes. The health impacts of one’s views of aging are relevant across adulthood, as individuals at midlife begin psychologically linking periods of life to define their identity as they look ahead [13, 14]. Holding more positive (compared to negative) views of one’s current age or expectations regarding aging is associated with a greater likelihood of engaging in health-promoting behaviors such as healthy eating, exercising, and reduced tobacco use [15, 16], lower daily negative affect [17], and lower mortality [18, 19]. Furthermore, evidence suggests that the inverse is also true: holding more negative views of aging are associated with poorer functional and behavioral outcomes in middle and later life [2].

A recently proposed model, the Multidimensional, Multitemporal and Ecological Framework (MMEF), of subjective views of aging helps explain the links between views of aging and health outcomes [12]. Briefly, the MMEF proposes that: generalized views of aging can influence personal views of aging, and vice versa; views of aging are composed of multiple dimensions (e.g., subjective age, aging stereotypes); and multiple processes (e.g., control beliefs, health behaviors) link views of aging with health outcomes, including physical, functional, cognitive, and mental health [20, 21]. Furthermore, the effects of aging stereotypes specifically are described in Stereotype Embodiment Theory (SET), which highlights a possible pathway by which negative aging stereotypes are covertly acquired and hold pervasive and insidious outcomes for health and well-being [22]. From this perspective, aging stereotypes are first made salient through messages and behaviors observed in the cultural consciousness (e.g., “over the hill” cards, ageist jokes), are reinforced over time, and are ultimately internalized to become implicit beliefs about aging and older people. Such beliefs can influence behavior, such as avoiding health-promoting activities due to viewing age-related declines as inevitable [16]. As in the MMEF, SET highlights the multidimensional nature of aging stereotypes and their potential to influence health and well-being via physiological, behavioral, and psychological pathways [22]. Studies examining mechanisms linking other dimensions of views on aging (e.g., self-perceptions of aging) to health outcomes also support both behavioral and psychological processes as contributors [23‒25]. Linking MMEF and SET to the present review, more negative views of aging in general or one’s own aging process specifically may influence perceptions of changes in cognition with aging, such as expecting cognitive decline as an inevitable consequence. Aligning with this, Chapman et al. [26] found that individuals who both identified with older adults (regardless of their actual age) and perceived aging to be a fixed (unmodifiable) experience, were more likely to report subjective cognitive decline (SCD); this suggests there is a linkage between views of aging and perceptions of cognitive performance. SCD, in turn, is important to better understand given its associations with an increased risk of MCI and dementia [27].

Assessment of subjective cognition varies across studies. Some questionnaires focus on current functioning (e.g., the Memory Functioning Questionnaire [28]) and assess a range of cognitive demands individuals may experience, asking them to rate their ability to meet each demand. Other measures aim to capture changes (typically declines) in functioning across time. For example, the Everyday Cognition scale [29] and the Cognitive Change Index (CCI) [30] ask individuals to compare their current performance on a range of cognitive tasks to past performance. The lack of consistency in assessments of subjective cognition has spurred researchers to enhance the diagnostic category of SCD with distinct features [31]. These include worry about the decline, changes over the last 2 years, and confirmation from an informant, among others. Relative to their counterparts who only report SCD, individuals who report SCD along with one of these additional features perform more poorly on cognitive testing as well as exhibit brain volumetrics more similar to individuals with dementia [32]. This suggests a need to further refine the factors impacting subjective cognition to enhance the specificity of SCD as an indicator of risk for more substantial progression.

Although SCD tends to be more common at older ages overall, a large study of over 200,000 adults in the USA found that the prevalence among those 45–54 years old was 10.4%, with the highest prevalence was in those aged 75 and older (14.3%) [33]. Interestingly, reporting of SCD was lowest in those 65–74 years old, at just under 10%, suggesting that age differences may be important to consider when examining factors that influence subjective cognition. The approach to assessment of subjective cognition may also play a role in age differences. For example, one study found that differences between older and younger individuals were more consistent with general assessments of SCD, but less consistent when specific aspects of SCD were assessed (e.g., frequency of forgetting) [34].

Age differences in views of aging have also been examined and results also suggest nuanced associations. In general, feeling younger than one’s chronological age (i.e., lower subjective age) is associated with better cognition [35], including subjective cognition [36]. Other domains of views of aging have demonstrated age differences as well. For example, in a study examining associations between aging experiences and views of aging, adults in early midlife (i.e., 50–59 years) were less likely to attribute discriminatory experiences to age compared with older age groups, even though those at early midlife reported experiencing more discriminatory experiences [37]. Overall, views of aging have been shown to change with life transitions and roles as people age (e.g., caregiving; death of a spouse or partner) [38]. Taken together, evidence suggests that a full understanding of relationships between subjective cognition and views of aging necessitates exploration of the role of age.

Given the consistent associations between views of aging and health (including cognitive health) in the literature, as well as the importance of understanding factors potentially influencing SCD and other aspects of subjective cognition, we systematically reviewed the evidence examining relationships between views of aging and subjective cognition. We sought to answer the following questions.

• 1.

  How are views of aging (e.g., attitudes toward one’s own aging; subjective age) related to subjective cognition (e.g., SCD; memory complaints) in middle-aged and older adults?

• 2.

  Do these relationships differ based on age and/or do they change as people age?

We conducted this systematic review in accordance with the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) [39] criteria. The completed PRISMA 2020 Checklist is included as an online Supplementary Table (for all online suppl. material, see https://doi.org/10.1159/000542507). This review was registered prospectively with PROSPERO (ID: CRD42022296347; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=296347) [40] before its initiation. The Covidence systematic review software tool was used to organize retrieved articles and facilitate the selection process [41].

Literature searches were initially conducted in four databases (PubMed, CINAHL, PsycINFO, and ProQuest Dissertations and Theses) on November 1, 2022, and a second, updated search was then conducted on November 1, 2023, to identify any recent publications after the initial search. Searches on both dates used the same syntax and procedure. Search terms were built based on the primary concepts of “views of aging” and “subjective cognition” (see Table 1 for full search strategy). Keywords were generated for each primary concept by reviewing related articles and synonyms, in consultation with a research librarian. These keywords were then combined with MeSH terms for PubMed searches and Subject Headings for CINAHL. In addition to the structured database searches, hand searches were conducted using the reference lists of identified sources as well as a gray literature search of relevant professional and governmental websites.

Eligibility criteria included reports of primary research available in English, with a sample limited to individuals 40 years or older, or studies that included analysis of a subsample that met this criterion. Given the goal of the review pertained to understanding the relationship between views of aging and subjective cognition, studies were excluded if the sample comprised only individuals with Alzheimer’s disease or other dementia, or if results from a subsample without dementia were not reported. Experimental or quasi-experimental as well as qualitative studies were excluded. A full list of inclusion and exclusion criteria can be found in Table 2.

After importing all search results into Covidence and removing duplicates, five members of the review team performed abstract and title screening, with two votes required to include or exclude an article. Any conflicts in inclusion/exclusion were mediated by the first author. Next, full-text review was performed by two team members, with any conflicts discussed with the entire team for final determination. After inclusion, data extraction was completed by one team member per article, with a second member verifying the extraction. Extracted data were placed into an evidence table that included article citation, study design, setting, sample size, participant characteristics, measure(s) of views of aging, measure(s) of subjective cognition, results relevant to review purposes, and study limitations.

The Critical Appraisal Skills Programme (CASP) checklists, as appropriate for each study’s design, were used to facilitate quality appraisal [42]. All studies were evaluated on nine CASP items, plus two additional CASP items for longitudinal studies. Each study was appraised independently by two team members, with the first author resolving discrepancies as needed. Sources were not excluded based on the outcome of quality appraisal; however, the components of quality appraisal were considered during data synthesis.

A narrative synthesis of the extracted data was used to integrate findings across studies, guided by the recommendations of Popay et al. [43]. Due to the heterogeneity of study designs and characteristics, it was determined that meta-analysis was not appropriate. The primary review question, “How are views of aging related to subjective cognition in middle-aged and older adults?” guided development of the elements of synthesis.

First, we reviewed and organized study results to determine the domain(s) of views of aging that were investigated. Initial domain codes were based on themes previously identified in a scoping review by Hausknecht et al.: attitudes toward one’s own aging, aging well, aging stereotypes and self-stigma, and subjective age. One additional domain was identified in our included studies: essentialist beliefs about aging (i.e., viewing the aging process as fixed or inevitable rather than modifiable) [44]. Next, we compared and contrasted findings within each domain to determine patterns across studies including similarities or differences in study characteristics and outcomes. Third, we reviewed studies across the domains of views of aging that included examinations of age effects or age group comparisons. Finally, we drew conclusions regarding the characterization and strength of the evidence for each view of aging domain as well as differences in relationships between views of aging and subjective cognition based on age.

A total of 5,867 sources were screened after duplicate removal. Following title and abstract review, 152 sources underwent full-text review, and 20 were ultimately selected for inclusion (Fig. 1). One included dissertation [45] reported on two studies, both of which were relevant to this systematic review. Therefore, our review includes a total of 21 studies using data extracted from 20 sources. Details of each included study are provided in Table 3. Below, we first summarize study characteristics, measures, and quality appraisal results, followed by synthesis of findings across studies, structured based each domain of views of aging as well as differences in associations based on age.

Included studies were published between 1996 and 2023. The majority (n = 16) were published after 2010, with nine studies published within the last 5 years. Study designs included six longitudinal and 15 cross-sectional studies. Seven countries were represented: Canada (4), China (2), Germany (3), Ireland (2), Israel (1), the United Kingdom (2), and the USA (8). Sample sizes of cross-sectional studies ranged from 40 to 6,056 and longitudinal studies ranged from 504 to 1,584.

Views of aging were assessed with a wide variety of instruments ranging from established multi-item measures or subscales to single questions (see Table 3 for details). The most common measure was the attitudes toward own aging subscale from Philadelphia Geriatric Center Morale Scale, used in three studies [56‒58]. One measure was used in two studies, both by the same author and reported in a dissertation: ratings of scenarios depicting an “average 65–75-year-old” [45]. All other measures were used in a single study, and among these, four studies used a single question to assess views of aging.

Subjective cognition was also assessed with a variety of measures (see Table 3 for details). Most used were the Cognitive Failure Questionnaire (2 studies) [51, 52], Everyday Memory Questionnaire (2 studies) [45, 58], and Nuremberg Self-Assessment List (2 studies) [49, 57]. Six studies used a single question to assess subjective cognition: “How would you rate your memory at the present time?” or a variation of the question (4 studies) [47, 48, 55, 59] and “Do you think you have become more forgetful in recent years?” (2 studies) [50, 55]. All other subjective cognition measures were used in a single study.

Eight studies met all CASP criteria, while the remaining 13 studies met the majority of CASP criteria (see Table 4 for all CASP appraisal results). The specific CASP criteria not met across studies varied, but the most common areas of potential concern were related to measurement of views of aging (n = 7) and subjective cognition (n = 6). Among the six longitudinal studies, all met the additional two CASP criteria specific to their study design: completeness and length of follow-up assessments. It is important to note that three studies were part of dissertations [45, 59] and therefore not peer-reviewed.

The identified studies examined five different domains of views of aging: aging stereotypes and self-stigma (n = 8), subjective age (n = 7), attitudes toward one’s own aging (n = 6), aging well (n = 3), and essentialist beliefs about aging (n = 3). The majority (n = 17, 81%) found an association between at least one aspect of views of aging and subjective cognition; however, there were inconsistencies across studies. Results for each domain of aging views are synthesized below.

Aging stereotypes and self-stigma are a domain of views of aging that describes the extent to which older adults believe in societally held aging stereotypes or apply stigmatized beliefs about aging to themselves [22]. The relationship between aging stereotypes/self-stigma and subjective cognition was examined in eight studies (38%), with mixed results. In a study of community dwelling middle-aged and older adults in Canada, more negative views of aging were associated with poorer subjective memory [46]. Similarly, an earlier Canadian study found that endorsing negative aging stereotypes was associated with greater subjective memory decline [45] An Israel-based study with adults aged 50 or older found that ageist attitudes were related to subjective cognitive complaints [61]. Specifically, ageist attitude domains of psychological loss and physical change were positively associated with cognitive complaints, and the domain of psychological growth was negatively associated. A study that measured two domains of ageism, benevolent and hostile ageism, among older adults in the USA found differing associations based on type of subjective cognition [60]. Specifically, higher perceptions of hostile ageism were associated with more frequent self-reported memory failures as well as poorer perceptions of one’s memory performance compared to same-age peers (i.e., age-anchored comparisons). Perceived benevolent ageism, however, was only correlated with age-anchored comparisons, and neither domain was associated with older adults’ memory satisfaction.

One longitudinal study examined aging stereotypes in the context of the COVID-19 pandemic. Cohn-Schwartz et al. [47] assessed attitudes among community-dwelling older adults in the USA over a 10-month period and found that participants who perceived a decline in societal respect for seniors during the pandemic were more likely to perceive their memory as worse at baseline and also experienced a stronger decline in subjective memory over time.

Several studies, however, examined aging stereotypes/self-stigma and found no relationship with subjective cognition. In a study of adults aged 59–65 in Germany, endorsing negative age stereotypes did not predict cognitive complaints [49]. Similarly, in studies with middle- and old-aged adults in the USA and Canada, respectively, SCD was not correlated with explicit or implicit aging stereotypes [26], and no association was found between aging stereotypes and self-rated forgetting [45]. Finally, a cross-sectional study with middle-aged and older adults in the USA found no relationship between anxiety about aging and subjective memory [54].

Comparing studies that did and did not find a relationship, CASP criteria were similar, including several studies in each group that met all criteria and similar criteria not met in the remaining studies (i.e., identification and control of confounding factors). In summary, the evidence regarding the relationship between aging stereotypes or self-stigma with subjective cognition is mixed. Considering the strength of the evidence does not support a more definitive conclusion.

Subjective age, examined in seven (33%) of the reviewed studies, is the age a person feels or identifies with, which may be younger or older than their chronological age [63]. Cross-sectional associations between higher subjective age and poorer subjective cognition were found among community-dwelling middle-aged and older adults in China, the United Kingdom (UK), Ireland, and Israel [36, 50, 56, 61]. Three of these studies further investigated potential differences in associations based on aspects of subjective cognition or participant characteristics. Opdebeeck et al. found that subjective memory and subjective attention were associated with subjective age; however, subjective executive function was not [36]. A UK-based study found that subjective age was related to perceived losses in cognition among adults aged 51–75, while adults over the age of 76 only displayed an association between subjective age and perceived cognitive losses [56]. Weissberger et al. [61] found that the relationship between subjective age and subjective cognitive complaints was moderated by chronological age, with the relationship getting stronger at higher chronological ages. An investigation of older adults in China found that the relationship between self-perceived forgetfulness and subjective age was only significant in those dwelling in rural, not urban, areas [50]. Only one cross-sectional study reported no association between subjective age and subjective cognition [26].

Longitudinal evidence regarding subjective age and subjective cognition was somewhat mixed. Pearman et al. [53] found that among older adults in Germany, higher subjective age was associated with higher memory complaints at baseline, but did not predict changes in memory complaints over a 6-year period. However, in a sample of over 15,000 middle- and older aged adults in the USA, Hülür et al. [48] found that lower subjective age predicted higher subjective memory at baseline and higher subjective age was associated with steeper declines in subjective memory over 6 years. Overall, cross-sectional associations between subjective age and subjective cognition were largely consistent across studies, but longitudinal evidence is limited.

Attitudes toward one’s own aging, which describes individuals’ negative and/or positive views of how they have aged [64], was examined in six (29%) of the included studies. Evidence from cross-sectional studies with a large sample in the UK (n = 6,056), and a small sample in Canada (n = 40), found that more negative attitudes toward one’s own aging were related to poorer subjective cognition and higher memory complaints, respectively [56, 58]. However, a study of 1,137 older adults in China found that memory complaints were not associated with the extent to which individuals are aware of their own aging (e.g., “I feel my age in everything that I do.”) [62].

Longitudinally, there is evidence to support relationships between attitudes toward one’s own aging and subjective cognition, at both shorter and longer term follow-up points. In a study of Irish adults aged 50 and older, participants’ negative perceptions of their own aging at baseline were associated with declines in subjective memory over 2 years [55]. In a study of middle- and older aged adults in Germany, participants with fewer initial cognitive complaints saw less decline in attitudes toward their own aging over a 20-year period [57]. Only one longitudinal study did not support a relationship between attitudes toward one’s own aging and changes in subjective memory [59], and this was the only longitudinal study in this domain that did not meet all CASP criteria. Overall, the evidence largely supports associations between attitudes toward one’s own aging and subjective cognition, such that more positive aging attitudes were related to better subjective cognition cross-sectionally as well as longitudinally.

Aging well refers to one’s positive perceptions of aging, including what it means to age successfully [64]. Three (14%) of the studies in this review included aging well in cross-sectional investigations, and all found a relationship with subjective cognition. In the USA, Moore et al. [52] found that reports of aging well among adults 58 and older were associated with fewer cognitive complaints, and Martin et al. [51] found that higher levels of successful aging were associated with fewer cognitive complaints in those aged 50–74. Similarly, a study of older adults in Israel found that self-reported successful aging predicted cognitive complaints, including after accounting for objective cognitive performance [61]. Therefore, although limited, existing evidence consistently supports a link between middle- and older ages adults’ perspectives of aging well and better subjective cognition.

Essentialist beliefs about aging refer to the extent to which individuals perceive aging as a predominantly fixed process or if its trajectory can be altered through individual actions [65]. Three (14%) studies investigated the relationship between essentialist beliefs about aging and subjective cognition, all finding a relationship. In a USA-based sample of middle-aged and older adults, higher SCD was associated with greater beliefs that aging is primarily fixed [26]. Similarly, in a study conducted in China, higher beliefs that aging outcomes were within their control were associated with a lower risk for memory complaints in older adults [62]. A longitudinal investigation of adults age 50 and older in Ireland found that beliefs that there are negative consequences of aging that cannot be controlled were associated with an increased likelihood of reporting subjective memory decline over a 2-year period; however, participants’ positive beliefs that they do have control over aging outcomes were not associated with subjective memory decline [55]. Similar to the “aging well” domain of aging views, evidence supporting relationships between essentialist beliefs about aging and subjective cognition is relatively consistent across studies, but limited.

As part of our review, we aimed to examine differences in the relationship between views of aging and subjective cognition based on age (e.g., middle- vs. older ages) or as an individual ages. Of the 21 studies identified, only three included results that helped address this question. Sabatini et al. [56] examined age group differences in several domains of aging views and found that subjective age was associated with subjective cognition across all age groups (51 and older). However, attitudes toward one’s own aging were correlated with subjective cognitive losses for participants ages 51–65 only. Weissberger et al. [61] investigated multiple domains of aging views using two samples, one aged 50 and older (sample 1), the second aged 65 and older (sample 2). In both samples, the relationship between subjective age and cognitive complaints was moderated by chronological age such that the strength of the relationship increased with age. In sample 1, ageist attitudes were also examined, and positive associations between the domains of psychological loss and physical change with cognitive complaints were greater at older ages. Siebert et al. [57] examined longitudinal relationships in two age groups (midlife vs. older ages) over 20 years. Throughout midlife (between their 40s and 60s), individuals with more decline in attitudes toward their own aging had greater increases in cognitive complaints. At older ages (beginning at age 60) higher cognitive complaints at baseline predicted more decline in attitudes toward their own aging over the 20-year period. Due to the limited number of studies, examining differences in associations between views on aging and subjective cognition by age group or changes over time, as well as differences in domains of aging views included across the three studies, at present there is insufficient evidence to draw a conclusion about the influence of age or aging on these relationships.

In this systematic review, we synthesized the evidence on relationships between middle-aged and older adults’ views of aging and subjective cognition, including whether and how these relationships may differ based on age or over time as people age. Across the 21 studies identified, evidence largely supported relationships between more positive views of aging and better subjective cognition (e.g., fewer memory complaints, lower SCD). However, several studies reported mixed results depending on factors such as the domain of views of aging assessed or demographic characteristics of the sample. In addition, due to the small number of studies (n = 3) that examined age group differences, we were not able to draw conclusions about differences in relationships across middle- and older ages. Individuals’ perceptions of cognitive changes are an important early indicator of cognitive decline in aging, including detection of MCI and Alzheimer’s disease or other dementias, but are known to be influenced by a variety of factors [31]. The findings of this review help refine understanding of how specific aspects of aging views may inform the reporting or interpretation of perceived cognitive changes in aging.

Views of aging domains consistently associated with subjective cognition were subjective age, attitudes toward one’s own aging, aging well, and essentialist beliefs about aging. Across these domains, more positive views of aging were associated with better subjective cognition (e.g., fewer memory complaints), or alternatively, more negative views were associated with endorsing cognitive problems or more negative perceptions of cognition. These findings align with the Multidimensional, Multitemporal and Ecological Framework (MMEF) of subjective views of aging and their relationship with health, which recognizes that both generalized views about aging overall and personal views about one’s own experience with aging can influence cognitive health through multiple pathways [12]. Subjective age has been widely associated with many aspects of health and well-being in aging, including depressive symptoms and objective cognition [35]. In our review, subjective age was also one of the most common domains of aging views identified, second only to stereotypes/self-stigma. In addition to our finding that higher subjective age was associated with poorer subjective cognition in most studies, we did identify factors for further investigation that may play a role in these relationships: specific aspects of subjective cognition (e.g., subjective memory vs. subjective executive function) and chronological age. Expectations of aging have been linked to subjective age: those who feel younger than their actual age tend to have more optimistic views on aging and are more likely to practice healthy habits [22]. Our review suggests that positive views of aging more broadly are linked with optimistic views of cognition specifically as well. Based on the consistent associations between subjective age (the age you feel), beliefs about control in aging (e.g., modifiable vs. fixed), and subjective cognition, these are important factors to further study for their applicability to SCD. Furthermore, given that older adults with SCD, compared to those without, are up to twice as likely to develop MCI or dementia in the future [27], refining our understanding of factors that may influence the experience or reporting of SCD could hold important implications for assessing cognitive decline risk.

Within the MMEF, health is influenced by views of aging through a complex interaction of intrapersonal processes (e.g., control beliefs, health behaviors) and other factors. The findings of our review on essentialist beliefs about aging and subjective cognition are particularly well-aligned with these proposed mechanisms. We found that across studies, individuals who viewed aging as more fixed had poorer subjective cognition, i.e., those who felt they had less control about their aging were also more likely to report cognitive decline. Our approach to this review included essentialist beliefs about aging as one domain of views of aging [44]. However, the MMEF also describes interpersonal processes that may influence one’s views of aging; essentialist beliefs about aging could instead reflect such a process (e.g., believing the aging process is unmodifiable then affects other domains of aging views negatively). Although we did not identify any studies that examined essentialist beliefs about aging, other domains of aging views, and subjective cognition together to determine how they may interplay, this is an important area for further investigation. In addition, our review focused on one aspect of cognitive health (subjective cognition) but views of aging have effects across health domains [23], and subjective cognition is known to be consistently associated with depressive and anxiety symptoms in particular [7]. Relatedly, a recent study found that changes in essentialist beliefs about cognitive aging predicted changes in mental health over a 10-year period, and this association was not moderated by age (mean age = 55.4; range = 28–84 years) [66]. Further investigation into the role of control beliefs in the association between other views on aging, subjective cognition, as well as mental health and cognitive decline (e.g., MCI or dementia), is important to better understand the intrapersonal processes that may play a mechanistic role in these relationships.

For the remaining views of aging domain, aging stereotypes or self-stigma, about half of the studies reviewed found a significant relationship. A critical component of these inconsistent relationships may be personal salience or whether cues exist that activate one’s identification as an older adult, in line with SET [22]. For example, negative aging stereotypes may not be chronically activated. In fact, many of the results that were found among the other domains of views of aging, including subjective age, support this supposition. In this review, holding negative attitudes toward one’s own aging and holding essentialist beliefs about aging were both associated with poorer subjective cognition (potentially reflecting more consistent activation of negative aging stereotypes), while feeling subjectively younger was associated with better outcomes. These findings may indicate less salience of older adult stereotypes, and together, speak to the ideas of awareness and personal identification as an older adult being associated with subjective cognition. This is in line with seminal review work that identified midlife as a highly complex time in the lifespan, as individuals vary on the point at which they identify as an older adult [67]. Another factor that may help explain the inconsistent results found across the eight studies of aging stereotypes/self-stigma is the wide range of measures within this domain. For example, in the study by Kliegel and Zimprich [49], a 6-item scale assessed endorsement of negative aging stereotypes such as “In old age, one can’t expect anything more from life.” Whereas Chasteen et al. [46] assessed participants’ concerns about their age using the Age-based Rejection Sensitivity Questionnaire, which asks questions about potential scenarios. For example, “Imagine that you are involved in a minor accident while driving. It is unclear who is at fault. How concerned/anxious would you be that the blame for the accident might be placed on you because of your age?” In addition to the differences in concepts assessed in these measures, they also differ in that one reflects on more general beliefs about older age (and potentially societal beliefs), while the other is specifically self-referential, asking an individual their beliefs about negative effects of their own aging.

In this review, views of aging were broadly associated with (and at times, predictive of) subjective cognition. However, these views were broadly defined and therefore captured many different aspects of aging perceptions, both generalized and personally held. Given these considerations, we speculate that our findings may be best distilled into three main categories. Based on our interpretation, this supports examination of patterns across potentially disparate perceptions. The three categories are as follows: (1) fears of aging and embodiment of negative aging stereotypes, (2) personal perceptions of one’s age and aging well, and (3) general beliefs about aging broadly, which include heuristic judgments and are informed by culture.

As a category, fear of aging and concerns of presenting oneself as an example of aging “poorly” could also be conceptualized as self-directed perceptions shaped by internalization of negative perceptions and cues associated with one’s own aging [22]. Within the present review, holding more negative views of aging, such as fear of aging [46], believing that aging trajectories are unmodifiable [26], and feeling less control over one’s aging [55], were all associated with poorer subjective cognition (both cross-sectionally and longitudinally). The caveat to this pattern of results in several studies was how much the participant appeared to identify with being an older adult (i.e., stereotyped out-group). Further, among individuals who believed that they had greater control over their aging trajectories, there was generally lower risk of memory complaints [62].

In contrast to the previous category, subjective age and perceptions of successful aging represent generally positive attitudes toward one’s aging. These features are often influenced by how one perceives themselves to be operating compared to others (social comparison) within the domains of physical, psychological, and social functioning [68, 69]. Perhaps unsurprisingly, the pattern of results across measures of subjective age, attitudes toward one’s aging, and perceptions of successful aging is almost uniformly, inversely related to cognitive concerns. Specifically, holding a lower subjective age, or reporting that one feels younger than their chronological age, was associated with higher ratings of cognition and memory [36, 48], and lower rates of memory complaints [53]. Similarly, holding positive attitudes toward one’s aging, as well as believing oneself to be aging successfully was also related to fewer memory and cognitive complaints [51, 52, 57, 61], while the opposite pattern of more complaints was true for individuals who held worse attitudes toward their own aging.

The final category captures results related to the endorsement of general stereotypes about aging and age-based discrimination or bias (ageism [70]). In contrast to the previous two, this view of aging may not directly reflect beliefs about the participants’ own aging, but instead gauges their overall positivity or negativity toward older adults as a group, or how they believe society feels about older adults. From this perspective, general age-related biases and endorsement of ageism from the participants within these studies inform how they believe themselves to be functioning, perhaps demonstrating a context effect (e.g. [71]). Overall, across several studies, the pattern that emerged was such that holding more stereotypes about older adults and endorsing greater ageism was associated with poorer perceptions of one’s cognitive functioning [45, 60, 61]. Interestingly, Sublett and Bisconti (2023) found that the relationship between frequency of reported memory failures and ageism was similar for both benevolent (i.e., well-intentioned, yet patronizing behavior that reinforces older adults as incompetent or dependent [72]) and hostile (i.e., overt, age-based discrimination) ageism. Further, Cohn-Schwartz and colleagues (2022) found that perceptions of greater societal ageism during the pandemic were also associated with greater subjective memory decline. Together, these results suggest that merely perceiving negative cues about older adults as a whole, or holding general ageist attitudes (even benevolent beliefs), can color one’s personal perceptions of their cognitive functioning in later life.

There are two primary limitations to consider alongside the findings of our review. First, for both of our main constructs of interest (views of aging and subjective cognition), a wide variety of measures were used across studies, 16 for subjective cognition and 22 for views of aging. The heterogeneity of measures used to assess subjective cognition has been previously identified as a limitation in drawing strong conclusions from evidence in this area [73]. Although we did examine results by domain of views of aging, there was still substantial heterogeneity in measurement within most domains. Furthermore, nine of the 21 studies (43%) did not meet the CASP criterion for measurement of subjective cognition (n = 2), views of aging (n = 3), or both (n = 4). Second, we initially planned to conduct a mixed methods review incorporating both quantitative and qualitative evidence, but only two qualitative articles were identified in our search. Therefore, no meaningful meta-synthesis could be performed, and these articles were ultimately excluded. In one study, older adults who reported perceived memory decline, versus those who did not, described more fears about aging and, for some, concerns about developing dementia [74]. In both studies, older adults expressed how the experience of memory problems negatively influenced their views of themselves (to differing degrees), but also often normalized such problems as part of aging [74, 75]. Although qualitative evidence is limited, it does support the need to examine the underlying psychosocial mechanisms by which one’s views of aging may influence subjective cognition, and vice versa, as well as individual characteristics or experiences that contribute to these experiences.

Findings of this review largely support associations between views of aging and subjective cognition, but also indicate areas for future research. Although many studies were highly rated for scientific rigor using the CASP criteria, two areas for improvement are precision of measurement (as discussed above) and control for potentially confounding factors. Depressive and anxiety symptoms [7], personality traits such as neuroticism [76], as well as dementia worry [77] are all important to consider given their potential influence on subjective cognition. In addition, future work should also be attentive to study designs that support the examination of sociodemographic factors such as education, race and ethnicity, socioeconomic status, and health literacy. As noted previously, very little longitudinal or qualitative research has been conducted on the relationships, highlighting two clear areas for further developing our understanding how views of aging and subjective cognition are associated, as well as in which contexts (e.g., patient-clinician/provider interactions, changes in health status over time).

Assessing subjective cognition is an efficient and practical approach for clinicians to gain initial insight on changes in cognitive performance within everyday contexts, including helping identify individuals who may be at greater risk for future non-normative declines such as MCI and Alzheimer’s disease [31]. Our findings that views of aging can influence the perceptions of cognitive difficulties indicate that such views may need to be accounted for in assessment tools to effectively target preventative and supportive care. However, more research is needed to determine the processes underlying these relationships and how they may differ across people. For some older adults with more negative views of aging, there is the potential for over-endorsement of cognitive difficulties. Conversely, some of these individuals may consider cognitive difficulties as an inevitable consequence of aging and therefore fail to report them to healthcare providers. Either situation could delay access to critical resources that may preserve cognitive functioning or slow cognitive decline [78]. Furthermore, negative views of aging are strongly related to depressive or anxiety symptoms [79], and these symptoms in turn increase risk for cognitive decline [80, 81]. Assessing views on aging in addition to subjective cognition could improve the ability of clinicians to assess the earliest symptoms of cognitive decline as well as to tailor intervention strategies with more precision. Finally, improving understanding of how views of aging and subjective cognition relate may identify areas for intervention development. For example, targeted interventions to improve middle-aged adults’ views of aging may influence their perceptions of cognition as they age, leading to improved well-being and better contextualized perspectives of cognitive changes.

Views of aging are linked with many aspects of health and well-being in later life, including cognitive health. In this systematic review, we found that multiple domains of views of aging, notably more positive perceptions of subjective age, attitudes toward one’s own aging, aging well, and beliefs that aging is modifiable, were consistently associated with better subjective cognition in middle-aged and older adults. Although findings were more mixed for negative aging stereotypes and self-stigma, factors including measurement approach and sociodemographic characteristics may contribute to these differences. Overall, this review identified consistent associations between views of aging and subjective cognition in middle-aged and older adults, across a body of evidence with highly heterogenous measurement approaches. Findings also support future research to better understand these relationships, refine assessment of SCD, and guide interpretation of cognitive concerns in research and practice settings.

An ethics statement is not applicable because this study is based exclusively on published literature.

The authors have no conflicts of interest to declare.

This study was not supported by any sponsor or funder.

N.L.H. conceptualized the systematic review, developed the methodology, participated in the screening and extraction process, and contributed to writing the manuscript. J.D. participated in the screening and extraction process and contributed to writing the manuscript. E.B.-W., J.R.T., and A.S. participated in the screening process and contributed to writing the manuscript. C.F. participated in the screening and extraction process and contributed to writing the manuscript. J.M. assisted in the development of the review, participated in the screening and extraction process, and contributed to writing the manuscript.

This study is based exclusively on published literature, and all references are included in this article. Further inquiries can be directed to the corresponding author.