Edited by: Pamela M. Greenwood, George Mason University, USA
Reviewed by: Nathan Ward, Tufts University, USA; Maren Westphal, Pace University, USA
*Correspondence: Ruchika Shaurya Prakash
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The growing interest in mindfulness interventions for use in aging samples has been met with promising evidence of cognitive, emotional, and physiological benefits. The purpose of this review is to provide an overview of the impact of mindfulness training on three areas of functioning in older adults: behavioral and neural correlates of attentional performance, psychological well-being, and systemic inflammation. We have previously proposed that mindfulness training is uniquely suited as a rehabilitative tool for conferring both cognitive and emotional benefits for older adults. Specifically, mindfulness training's promotion of focused attention may mitigate the decline of attentional control abilities across late development and allow older adults to capitalize on their preserved emotion regulation abilities. Existing evidence points to some improvements in facets of attentional control in older adults, although some studies have shown no benefits in performance. Further, there is evidence of enhancements in both psychological and physical aspects of well-being, and accompanying improvements in systemic inflammation, following mindfulness training. The scientific investigation of mindfulness training is still relatively nascent, with only a limited number of studies, particularly randomized controlled trials utilizing active comparison conditions. It will be important for future research to incorporate placebo-controlled comparison groups to clearly establish the causal role of mindfulness practices in promoting holistic health in older adults.
Mindfulness training has gained increasing traction in recent years as a feasible and promising intervention for enhancing facets of both psychological and physical health across development. Broadly defined as the cultivation of sustained attention in a framework of non-reactivity and acceptance (Kabat-Zinn,
Training in such mindfulness practices has been evaluated for its prophylaxis for various metrics of overall health including, but not limited to, improvements in behavioral and neural metrics of cognitive functioning, particularly attentional control (Tang et al.,
We have previously proposed that mindfulness training is particularly useful in aging populations as it orients the practitioner, in an accepting and non-judgmental framework, to the mind's tendency to wander (Bishop et al.,
Prakash et al., |
Mindfulness disposition and default-mode network connectivity in older adults | Correlational | Older adults ( |
n/a | n/a | n/a | Resting-state default-mode network connectivity | Trait mindfulness is associated with greater connectivity in the dorsal posterior cingulate cortex and precuneus, regions of the default-mode network. |
Fiocco and Mallya, |
The importance of cultivating mindfulness for cognitive and emotional well-being in late life | Correlational | Older adults ( |
n/a | none | n/a | Set-shifting (trail making test A & B), verbal fluency (controlled oral word association task), declarative memory (california verbal learning test). | Trait mindfulness is positively associated with set-shifting, but not verbal fluency or declarative memory. |
Prakash et al., |
The role of emotion regulation and cognitive control in the association between mindfulness disposition and stress | Correlational | Older adults ( |
n/a | Young adults ( |
n/a | Inhibitory control (flanker task), working memory (N-back task), set-shifting (Task-switching paradigm) | Trait mindfulness is not significantly associated with inhibitory control, working memory, or set-shifting in older adults. |
Pagnoni and Cekic, |
Age effects on gray matter volume and attentional performance in zen meditation | Cross-sectional comparison | Adult meditators ( |
n/a | Older-adult non-meditators ( |
n/a | Sustained attention (rapid visual information processing task) | Meditators did not show a significant negative correlation between gray matter volume and attentional performance with age, as observed in controls. |
van Leeuwen et al., |
Age effects on attentional blink performance in meditation | Cross-sectional comparison | Older-adult meditators ( |
n/a | Older-adult non-meditators ( |
n/a | Temporal capacity of attention (attentional blink task) | Older-adult meditators showed a smaller attentional blink than age-matched and young-adult non-meditators. |
Prakash et al., |
Long-term concentrative meditation and cognitive performance among older adults | Cross-sectional comparison | Older-adult meditators ( |
n/a | Older-adult non-meditators ( |
n/a | Working memory (digit span), response inhibition (stroop color word task), processing speed (letter cancelation, digit symbol substitution), set-shifting Ttrail making test, rule shift card test | Older-adult meditators performed better than age-matched non-meditators on all tests of attention except the digit span backwards test. |
Lenze et al., |
Mindfulness-based stress reduction for older adults with worry symptoms and co-occuring cognitive dysfunction | Feasbility | Older adults with clinically significnat anxiety and cognitive dysfunction ( |
8-week MBSR: 2.5-h weekly meetings and a 1-day retreat ( |
12-week MBSR: 2.5-h weekly meetings and a 2.5-h retreat day ( |
Not explicitly stated, but followed the MBSR protocol that presumably included at-home practices | Verbal fluency, response inhibition (stroop task), short-term working memory (digit span forward), list learning (immediate and delayed), paragraph learning (immediate and delayed), | Significant pre to post changes were observed for list learning (delayed recall), paragraph learning (immediate and delayed), verbal fluency, and response inhibition. |
O'Connor et al., |
The effects of mindfulness-based cognitive therapy on depressive symptoms in elderly bereaved people with loss-related distress: a controlled pilot study | Feasibility | Distressed older adults ( |
MBCT: 2-h weekly meetings for 8 weeks ( |
Wait-list group ( |
40 min of daily practice | Working memory (letter-number sequencing from WAIS-III administered via telephone) | Mindfulness group showed improvements in working memoyt at post-training compared to wait-list control participants. |
McHugh et al., |
Mindfulness as a potential intervention for stimulus over-selectivity in older adults | Experimental induction | Older adults ( |
10-min mindfulness induction | 10-min unfocused attention" induction | n/a | stimulus over-selectivity | Brief mindfulness induction significantly reduced stimulus over-selectivity |
Mallya and Fiocco, |
Effects of mindfulness training on cognitive and well-being in older adults | Quasi-RCT | Older adults ( |
MBSR: 2.5-h weekly meetings for 8 weeks ( |
Reading and Relaxation group: 2.5-h weekly meetings for 8 weeks ( |
30 min. of daily practice | Simple attention and switching (trail making tests A and B), processing speed (controlled oral word association test), episodic memory (CVLT) | No significant differences between groups on any of the measures following the intervention. |
Alexander et al., |
Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly | RCT | Older adults ( |
30 min. once/week sessions for 8 weeks: 1) Transcendental Meditation ( |
Relaxation group ( |
20 min of twice daily practice for the active groups | Paired associate learning (DST subtest), cognitive flexibility (overlearned verbal task, Stroop color word test [RT interference]), perceived control, verbal fluency (DST subtest) | TM and mindfulness groups improved more than both control groups on paired associate learning and one measure of cognitive flexibility. TM outperformed mindfulness meditation on both of these measures. |
Moynihan et al., |
Mindfulness-based stress reduction in older adults: effects on executive function, frontal alpha asymmetry and immune function. | RCT | Older adults ( |
MBSR: 2.5-h weekly meetings for 8 weeks and a 7-h intensive retreat ( |
Wait-list group ( |
none | Processing speed (trail making test A) and set-shifting (trail making B/A ratio); left frontal alpha asymmetry | There were improvements in set-shifting and a reduced shift to rightward frontal alpha activation immediately following mindfulness training compared to wait-list, but these effects were not maintained at follow-up. |
Fiocco and Mallya, |
The importance of cultivating mindfulness for cognitive and emotional well-being in late life | Correlational | Older adults ( |
n/a | none | n/a | Psychological well-being (depressive symptoms, quality of life, stress) | Trait mindfulness is associated with greater psychological well-being on all measures. |
Prakash et al., |
The role of emotion regulation and cognitive control in the association between mindfulness disposition and stress | Correlational | Older adults ( |
n/a | Young adults ( |
n/a | Perceived stress, emotion dysregulation | Trait mindfulness is negatively associated with perceived stress and emotion dysregulation mediates this relationship. |
Prakash et al., |
Mindfulness and emotion regulation in older and young adults | Correlational | Older adults ( |
n/a | Young adults ( |
n/a | Emotion dysregulation, emotion regulation strategy use | Thought avoidance mediates the association between trait mindfulness and emotion dysregulation across both age groups. Age moderated this effect such that less mindfulness in young adults is associated with greater use of thought avoidance and greater emotion dysregulation. |
Morone et al., |
“I felt like a new person.” The effects of mindfulness meditation on older adults with chronic pain: qualitative narrative analysis of diary entries | Feasability (qualitative) | Older adults with chronic pain ( |
8-week mindfulness meditation program modeled on MBSR: 1.5-h weekly meetings | none | 50 min of daily practice | Diary contents | Diary themes reflected beneficial effects on pain, attention, sleep (latency and quality), achieving well-being (mood elevation, global quality of life). |
Splevins et al., |
Do improvements in emotional distress correlate with becoming more mindful? A study of older adults | Feasibility | Older adults with significant stress or symptoms of depression or anxiety ( |
MBCT: 2-h weekly meetings for 8 weeks | none | none | Emotional wellbeing (depression, anxiety, stress levels) | Signfiicant improvements in emotional well-being post-MBCT. Increased mindfulness associated with improved emotional wellbeing; act with awareness and accept without judgmenet associated with reduced depression. |
Szanton et al., |
Examining mindfulness-based stress reduction: perceptions from minority older adults residing in a low-income housing facility | Feasibility (qualitative focus groups) | Older-adult, African American, low-income women ( |
Mindfulness meditation program modeled on MBSR: meeting duration not specified | none | none | Focus group discussion content | Primary themes: stress management, applying mindfulness, social support of group meditation; Used MBSR for stressors: growing older with physical pain, medical tests, financial strain, having grandchildren with significant mental, physical, financial, or legal hardships; used MBSR for coping with medical procedures and managing depression and anger. |
Foulk et al., |
Mindfulness-based cognitive therapy with older adults: an exploratory study | Feasibility | Older adults with depression and/or anxiety ( |
MBCT: weekly meetings for 8 weeks and one 6-h retreat | none | 30-40 min of daily practice | Anxiety (hospital anxiety and depression scale), rumination (ruminative responses scale), depressive symptoms (geriatric depression scale- short form), insomnia (sleep problems scale) | Participation in MBCT resulted in significant improvements in reported anxiety, ruminative thoughts, and sleep problems; reduced depressive symptoms. |
Morone et al., |
A mind–body program for older adults with chronic low back pain: results of a pilot study | RCT | Older adults with lower back pain ( |
8-week mindfulness meditation program modeled on MBSR: 1.5-h weekly meetings | Education group ( |
50 min of daily practice | Disability, psychological function, pain severity | Both groups improved on measures of disability, pain, and psychological function at post-intervention and 4-month follow-up. No between group differences. |
Young and Baime, |
Mindfulness-based stress reduction: effect on emotional distress in older adults | Feasibility | Older adults with clinically significant depression and anxiety ( |
MBSR: weekly meetings for 8 weeks | none | 45 min of daily practice | Change in mood states (profile of mood states, short form) | Overall emotional distress and all subscales improved signfiicantly, >50% reduction in number of older adults with clinically significant depression and anxiety |
Creswell et al., |
Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized Controlled Trial | RCT | Older adults ( |
MBSR: 2-h weekly meetings for 8 weeks and one 7-h retreat ( |
Wait-list group ( |
30 min of daily practice | Loneliness | Mindfulness training produced greater reductions in loneliness than the wait-list group. |
Lenze et al., |
Mindfulness-based stress reduction for older adults with worry symptoms and co-occuring cognitive dysfunction | Feasbility | Older adults with clinically significnat anxiety and cognitive dysfunction ( |
8-week MBSR: 2.5-h weekly meetings and a 1-day retreat ( |
12-week MBSR: 2.5-h weekly meetings and a 2.5-h retreat day ( |
Not explicitly stated, but MBSR protocol includes at-home practices | Worry (Penn State worry questionaire) | Participants exhibited improvements in worry severity, with no additional benefit of the 12-week intervention over the 8-week intervention. |
Creswell et al., |
Mindfulness-based stress reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial | RCT | Older adults ( |
MBSR: 2-h weekly meetings for 8 weeks and one 7-h retreat ( |
Wait-list group ( |
30 min of daily practice | Pro-inflammatory gene expression (NF-κB leukocytes, C reactive protein) | Baseline loneliness was associated with and NF-κB gene expression. Compared to the wait-list group, MBSR participants exhibited down-regulation of NF-κB expression and reduced C-reactive protein levels, but no difference in IL-6 levels. |
Gallegos et al., |
Toward identifying the effects of the specific components of mindfulness-based stress reduction on biologic and emotional outcomes among older adults | RCT | Older adults ( |
MBSR ( |
Wait-list group ( |
Participants engaged in at-home activities, but requirement not specified | Immune function (IL-6), circulating insulin-like growth factor (IGF)-1 concentrations, positive affect | More yoga practice associated with higher post-treatment IGF-1 and greater improvement in positive affect across intervention; sitting meditation associated with post-treatment IGF-1; greater use of body scanning associated with reduced antigen-specific IgM and IgG 3 weeks postintervention (but not 24 weeks); no associations between MBSR activities and IL-6 levels. |
Moynihan et al., |
Mindfulness-based stress reduction in older adults: effects on executive function, frontal alpha asymmetry and immune function. | RCT | Older adults ( |
MBSR: 2.5-h weekly meetings for 8 weeks and a 7-h intensive retreat ( |
Wait-list group ( |
none | Antibody response (immunoglobulin G response to protein antigen). | There were higher baseline antibody levels after MBSR, but lower antibody responses 24 weeks after antigen challenge. |
Black et al., |
Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances | RCT | Older adults with moderate sleep disturbance ( |
Mindful awareness practices intervention: 2-h weekly meetings ( |
Sleep hygeine education ( |
Graduated daily practice (5-20 min) | Sleep disturbance (pittsburgh sleep quality index); insomnia, depression, anxiety, stress, and fatigue; inflammatory signaling NF-κB | Mindfulness group improved more on PSQI, insomnia symptoms, depression symptoms, fatigue interference, fatigue severity. No between group differences for anxiety, stress, or NF-κB (but these levels declines significantly over time in both groups). |
Attentional control is broadly defined as the ability to streamline information processing by selecting and amplifying task-relevant information while ignoring irrelevant, interfering information in order to conduct complex goal-oriented behaviors (Petersen and Posner,
In addition to age-related declines in selective attention, age decrements in sustained attention have also been systematically evaluated. Employing vigilance tasks in which participants are asked to respond to targets and withhold responses to non-targets, older adults were found to exhibit decreased hit rates and increased false-alarm rates compared to young adults (Parasuraman and Giambra,
There is relatively strong support for age-related declines in executive types of attention (e.g., Chao and Knight,
Given that attentional control is posited to be a primary skill that is utilized during and facilitated by engagement in mindfulness practices, and considering the reviewed evidence that attentional control abilities decline with age, there is an emerging literature examining the impact of mindfulness on attentional control abilities in older adults. Within the mindfulness and attention literature, researchers have primarily employed three study designs: (1) correlational studies examining associations between trait levels of mindfulness and performance on attentional tasks, (2) cross-sectional comparisons of individuals with extensive mindfulness experience (i.e., expert meditators) and meditation-naïve individuals on attentional tasks, and (3) longitudinal studies of change in attentional performance across mindfulness interventions.
A number of correlational studies have examined the associations among dispositional measures of mindfulness and various facets of attentional control in older adults. Across studies, older adults show higher levels of self-reported dispositional mindfulness compared with young adults (Frank et al.,
A cross-sectional comparison of older adults with at least 10 years of meditation experience to age-matched individuals with no experience found that meditators exhibited better inhibitory control, processing speed, set-shifting, and working memory (Prakash et al.,
One of the seminal studies to examine the causal role of mindfulness training in improving cognitive functioning of older adults compared transcendental meditation, involving the use of a mantra as a tool for turning attention inward to subtler levels of thought with: (1) the Langer mindfulness training method, in which the emphasis is placed on creative ways of problem solving; (2) a mental relaxation group; and (3) a no treatment condition. Participants were assessed on measures of paired associate learning, cognitive flexibility, and word fluency (Alexander et al.,
More recently, three RCTs have evaluated the effects of the more standardized and widely used 8-week Mindfulness Based Stress Reduction program (MBSR; Kabat-Zinn,
Given the relative dearth of RCT studies in the literature, there is a clear need for further rigorous investigation of the attentional benefits following mindfulness training in older adults (See Future Directions box in Figure
By building from a systematic, basic science foundation, researchers can best choose and measure meaningful outcome variables for intervention studies. It will also be important for studies to evaluate specific mindfulness training programs in order to provide aggregate evidence for a particular program's benefits. This will necessitate the creation and use of standardized manuals for the implementation of such training programs. Studies should have randomized designs and include active comparison groups, in which control participants engage in training that is devoid of the component of interest (i.e., mindfulness) but that is matched for key nonspecific factors (e.g., duration, group size, instructor expertise, etc.), in addition to waitlist control groups that receive no training. Such practices will allow us to characterize the benefits that are specific to mindfulness training, rather than group interventions in general, and bolster our ability to make causal claims. And finally, much is still unknown regarding the dose-response relationship between mindfulness training and attentional improvements, the longitudinal impacts of training, and the degree of transfer of benefits to other domains of cognitive functioning in older adults. Future studies incorporating more ecologically valid measures of cognitive and affective functioning can allow for a systematic examination of the benefits of mindfulness training for older adults.
Much work has focused on characterizing the neural changes that occur across development and elucidating the contribution of such changes to cognitive decline. In comparison to the more selective recruitment of the right prefrontal cortex observed in young adults during tasks of attentional control, older adults showed decreased prefrontal lateralization (Cabeza,
Theoretical accounts of mindfulness posit that its salutary effects on attentional and emotional regulation occur through increased top-down modulation of limbic and brainstem systems by the prefrontal cortex (Chiesa et al.,
Given that mindfulness involves the active allocation of attention, either to internal or external stimuli, trait levels of mindfulness are hypothesized to be associated with preserved integrity of the DMN with advanced age. A cross-sectional investigation testing this hypothesis found that mindfulness disposition in older adults was in fact associated with greater integrity of the DMN, particularly in the dorsal posterior cingulate cortex and precuneus (Prakash et al.,
The examination of neural outcomes as a function of mindfulness training in older adults is currently limited to one study. This RCT examined the effects of an 8-week MBSR program on neural activation in older adults (Moynihan et al.,
The reviewed studies provide preliminary evidence that mindfulness training might have implications for preventing and/or ameliorating age-related declines in brain structure and function and associated cognitive functions. However, much work is needed to more fully characterize the benefits of mindfulness training for neural functioning. One unique challenge presented by the study of older adults is the large variability in structural and functional changes in the brain with age (e.g., Raz et al.,
Successful aging is not limited to preserved cognitive function, but is conceptualized as multi-dimensional, including the preservation of both physical and cognitive functions, the maintenance of social interactions, and continued engagement in meaningful activities (Rowe and Kahn,
Quality of life and well-being are integrally important to the holistic health of older adults, particularly as isolation increases due to decreases in the number and frequency of social contacts (Steptoe et al.,
Preliminary cross-sectional evidence suggested that trait levels of mindfulness were associated with enhanced psychological well-being, measured as self-reported depressive symptoms, quality of life, and stress, in older adults (Fiocco and Mallya,
Qualitative studies have used focus groups and content analysis of group discussions and diaries to explore the central themes reported by individuals who have participated in mindfulness training. One such study in older adults suffering from chronic pain found that participants reported beneficial effects of mindfulness training on pain, sleep, and achieving well-being (Morone et al.,
Expanding upon these qualitative data, other investigations of mindfulness training have provided experimental evidence for mindfulness training's ability to ameliorate emotional distress and promote well-being. For example, an 8-week MBSR program produced significant reductions in loneliness compared to a waitlist group (Creswell et al.,
The use of mindfulness training in clinical settings is of great interest, and there is accumulating evidence that such interventions can be useful in reducing symptoms of psychopathology. MBSR has been found to produce a >50% reduction in the number of older-adult participants with clinically significant depression and anxiety (Young and Baime,
Together, the results of studies evaluating the emotional benefits of mindfulness are promising. Mindfulness training appears to yield benefits for older adults with both clinical and sub-clinical symptoms of emotional distress, highlighting the potential for flexible application of mindfulness in many contexts. Moreover, the effects of mindfulness are not limited to reducing negative symptoms, such as depression and anxiety, but extend into increasing social support and promoting well-being. Nonetheless, there is still much to be learned regarding the effect of mindfulness-specific components on psychological health for both community-dwelling and clinical populations of older adults.
Symptoms of emotional distress and/or psychopathology can be accompanied by changes in inflammatory processes, which are further linked to a myriad of health sequelae. Although much is still unknown regarding the full spectrum of mindfulness training's health benefits, there is a great deal of interest in using mindfulness training programs to improve health both in clinical and community-dwelling settings. There are several mechanisms through which mindfulness training may alter inflammatory processes: alteration of hypothalamic-pituitary-adrenal axis or sympathetic nervous system functioning. These two systems are implicated in the transduction of the brain's perception of socio-environmental conditions into genomic responses through their production of stress-related hormones such as cortisol, epinephrine, and norepinephrine that directly alter expression of pro-inflammatory genes (Cole,
In a study of community-dwelling older adults, baseline levels of loneliness were associated with expression of the pro-inflammatory gene NF-κB in leukocytes and those who participated in an 8-week MBSR course exhibited significant down-regulation of NF-κB expression compared to a waitlist group (Creswell et al.,
The last study evaluating inflammatory processes in older adults recruited participants with moderate sleep disturbance who were randomized to a 6-week mindful awareness practices intervention or sleep hygiene education group (Black et al.,
There is great interest, both from the public and from healthcare providers, in the application of mindfulness techniques. This review article discussed what is currently known about the effect of mindfulness training on key areas of interest within geropsychology: attentional control performance (behavioral and neural correlates), psychological well-being, and inflammatory processes. Although the majority of the reviewed studies provide positive results for mindfulness training in each of these domains, the field is currently limited in its scope and much more work is needed in order to establish the causal impact of mindfulness practice on these outcomes. Moreover, the conclusions that might be drawn from the existing studies are obscured by the heterogeneity of samples and limitations of the methods being employed. Whereas some studies focused on older adults with chronic health conditions, others recruited participants with specific psychological symptoms or diagnoses, and many aimed to examine relatively healthy older adults. There are also inconsistencies in the training programs being tested and a myriad of outcomes being evaluated within each domain. The creation and dissemination of standardized training protocols and identification of theoretically informed dependent variables will allow for the systematic evaluation of mindfulness training's effects. Further, given the relative dearth of RCTs, future studies will need to replicate existing findings and employ rigorous experimental tests in order to lay the foundation for the continued growth of this field.
Given that mindfulness is often broadly defined, and often considered to be multifaceted, future research should focus on identifying which components of mindfulness training confer which benefits. Developing and testing a mechanistic account of mindfulness training's effects will allow for the optimal application of training to promote healthy aging. Researchers might then begin to address the gaps in what is known about the degree to which these benefits are maintained longitudinally across continually advancing age. Another important target of future research is to examine to what extent these benefits transfer to broader functions that are critically implicated in the everyday lives of older adults. These might include comprehension of medical information, health behaviors, social engagement, and functional status, all of which have a foundation in intact attentional control processes.
The reviewed evidence suggests that mindfulness may be advantageous for promoting cognitive, emotional, and physical health within the context of advanced aging. Moreover, these beneficial effects are conferred to those with little to no psychological symptoms as well as those with diagnosed psychological or medical conditions. This suggests that mindfulness training might be easily integrated into a variety of contexts, such as senior centers and group homes, and that it would be valuable and appropriate for such heterogeneous audiences. We previously described an ideal training program for older adults as one that is pragmatic; that capitalizes on older adults' increased motivation toward emotional well-being; and that exhibits transfer effects to multiple domains ranging from specific cognitive processes to broad, everyday function (Prakash et al.,
SF and RP contributed significantly to the conception of the work. SF completed the initial drafting the work and RP provided critical revisions for important intellectual content. RP provided final approval of the version to be published. SF and RP agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.