The healthiest super-agers may have one thing in common: stable cognition

By Vijay Kumar MalesuReviewed by Susha Cheriyedath, M.Sc.Aug 5 2026

Older adults who maintained their cognitive abilities over time experienced fewer unplanned healthcare encounters and the most consistently favorable aging outcomes.

Study: Health Care Outcomes Associated With Cognitive Super-Ageing. Image Credit: Bilderstoeckchen / Shutterstock

In a recent study published in The American Journal of Geriatric Psychiatry, researchers in Australia examined whether cognitive super-aging is associated with more favorable healthcare outcomes and determined which definition of super-aging shows the strongest relationship with positive aging outcomes.

Background

How do some older people retain their mental sharpness well into their 70s and beyond, while others suffer from cognitive decline? As populations around the world age, preserving cognitive health is becoming increasingly important, as cognitive decline is associated with greater reliance on healthcare services, reduced independence, and poorer quality of life.

Cognitive super-agers are older adults who have preserved strong cognitive abilities despite advancing age. Previous studies have explored their biological, genetic, and clinical characteristics. However, less is known about whether they experience better real-world health outcomes, including hospitalization, dementia, falls, and residential aged care placement. Further research is needed to understand these associations and find the most meaningful and reliable definition of cognitive super-aging.

About the study

Participants were drawn from the Sydney Memory and Aging Study (MAS), a community-based cohort that commenced in 2005 in Sydney, New South Wales, Australia. The study included 1,003 community-dwelling adults aged 70-90 years whose health records were linked to hospital and mortality databases.

The analysis was restricted to participants who experienced at least one hospitalization during follow-up. Individuals with dementia at enrollment, major neurological disorders, severe psychiatric illness, developmental disability, active cancer, or a Mini-Mental State Examination (MMSE) score of 23 or lower were excluded.

Health records were linked to the New South Wales Emergency Department Data Collection, the Admitted Patient Data Collection, and mortality records from the New South Wales Register of Births, Deaths and Marriages (RBDM) to evaluate healthcare outcomes over 10 years.

Participants were classified according to three potentially overlapping cognitive super-aging definitions: individuals with cognitive performance comparable to that of younger adults (SA1), individuals with superior cognitive performance for their age (SA2), and individuals who maintained cognitive performance over time (SA3).

Participants who met none of these definitions were classified as typical agers. Several indicators were considered: visits to emergency departments, unscheduled admissions to hospitals, falls, injury-related hospitalizations, delirium, dementia diagnoses, residential aged care placement, and mortality.

Statistical analyses included regression and competing-risk models, with correction for multiple comparisons. Regression models controlled for age, sex, comorbidities, and walking speed.

Study results

Among the 1,003 participants, cognitive super-agers generally demonstrated more favorable baseline characteristics than typical agers. They were younger, had more years of education, generally used fewer medications, and were less likely to have polypharmacy, and experienced lower levels of anxiety and depressive symptoms, as well as lower rates of multimorbidity. They also had a faster walking speed, indicating better physical functioning and preserved cognition.

Descriptive analyses showed that participants classified as SA1 and SA3 had fewer emergency department visits and unplanned hospital admissions than typical agers, with a median of two events compared with three among typical agers. Hospital stays were also shorter across all super-aging definitions, with median lengths of stay ranging from 7 to 13 days, compared with 18 days in typical agers. Fall-related hospitalizations occurred less frequently across all three super-aging definitions in the descriptive analysis. Rates of delirium were substantially lower in SA1 (16.7%) and SA3 (11.5%) than in typical agers (26.6%).

Hospital-recorded dementia diagnoses during follow-up were significantly lower across the three super-ager groups than among typical agers. Similarly, placement in residential aged care after 10 years was less prevalent among super-agers than among typical agers. After 10 years, participants in the SA1 and SA3 groups also had lower mortality rates. Regression analyses supported many of these associations after adjustment for age, sex, comorbidities, and walking speed.

Cognitive super-aging, overall, as well as the SA1 and SA3 definitions, was associated with fewer emergency department attendances and fewer unplanned hospital admissions. The corresponding associations for SA2 were not statistically significant. Injury-related hospitalizations did not differ significantly between super-agers and typical agers. Although fall rates were generally lower among super-agers, a statistically significant reduction was observed only among SA3. Super-aging overall and the SA1 and SA3 definitions were also associated with fewer episodes of delirium, with the strongest association again observed in the SA3 group.

Time-to-event analyses also showed that all three definitions of cognitive super-aging were associated with a lower risk of receiving a hospital-recorded dementia diagnosis during the ten-year follow-up period.

Overall, cognitive super-aging and the SA1 definition were both associated with a reduced risk of placement in residential aged care. Only SA3 showed a statistically significant reduction in the risk of death compared with typical agers, revealing a 46% lower mortality risk. SA3 showed the strongest overall pattern of associations with favorable healthcare outcomes, suggesting that maintaining cognitive abilities in later life was more strongly associated with better health outcomes than demonstrating high performance in cognitive tests at a single time point.

Conclusions

The results showed that cognitive super-aging was related to favorable health outcomes in old age. Overall, super-aging was associated with fewer emergency department visits and unplanned hospitalizations, fewer delirium episodes, a lower risk of hospital-recorded dementia, and less residential aged care placement. Among the three classifications examined, maintaining cognitive performance over time showed the strongest relationship with positive outcomes and was also associated with lower mortality.

The cohort was recruited from relatively socioeconomically advantaged areas of Sydney, was predominantly of European ancestry, and included no participants who identified as Aboriginal or Torres Strait Islander, limiting the generalizability of the findings. The analysis also excluded members of the original cohort without post-enrollment hospital records, which may affect the interpretation of the healthcare-use findings. Several outcomes relied on hospital coding, which may underidentify dementia and other conditions, and the observational design cannot establish causality.

Overall, these findings underscore the connection between cognitive and physical health in aging and suggest that strategies supporting cognitive health may have broader benefits for healthy aging, healthcare use, and independence, although the study did not establish that preserving cognition directly caused these outcomes.