The research, published by CenterWell, the health care services arm of Humana, tracked participants between 2023 and 2025, making it one of the largest longitudinal studies of emotional well-being in older adults to date.

The findings land at a fraught moment for American happiness. Retired University of Chicago economist Sam Peltzman recently documented what he calls a “happiness crash unlike anything in history”—analyzing General Social Survey data, he found a 22.2 percentage point drop in self-reported happiness centered on 2020, the largest single move in the survey’s 50-year history. For the first time, Americans describing themselves as “not very happy” outnumbered those calling themselves “very happy”—and the data suggests the country has never fully recovered. Similarly, the CenterWell finding rested on a single survey question: “I feel very fulfilled.”

Peltzman’s research points to something deeper than pandemic disruption: trust in institutions—government, medicine, education, and media—collapsed simultaneously and has yet to rebound. That erosion matters for fulfillment in a direct way. Social engagement, community involvement, and faith in the structures that organize daily life are among the study’s core predictors of whether an older adult feels their life has meaning—and all of them depend, at least in part, on trust.

The new research challenges a long-held assumption in medicine that physical health is the primary barometer of how well someone is aging. Religion also emerged as a significant dividing line: Older adults who described themselves as religious were notably more likely to feel fulfilled than their non-religious peers—a finding that complicates any purely clinical or policy-based prescription for closing the gap. Cohabitation also mattered: Those living with at least one other person reported higher fulfillment, likely reflecting the emotional and social connection that shared living provides—a quiet indictment of the loneliness epidemic playing out among older Americans living alone.

“As a physician, my instinct was that physical health would dominate. It’s what we’re trained to prioritize because it’s visible and measurable,” Sanjay Shetty, MD, CenterWell’s chief executive, told Fortune. “What stood out instead was how consistently older adults pointed to things like purpose, optimism, and connection as central to fulfillment.”

In fact, when researchers scored each factor by its statistical weight, physical health ranked last among the named drivers—accounting for just 14% of fulfillment’s predictive model, compared to 39% for self-contentment alone. The study identifies 12 specific life factors that predict whether an older adult will age with dignity and resilience—and inner attitudes dominate: self-contentment, optimism, and a sense of purpose all outrank physical capability and financial security. Spiritual gratitude emerged as a more powerful predictor than whether someone can walk up a flight of stairs.

Kerry Burnight, a gerontologist and New York Times bestselling author, said the index builds on foundational well-being models but goes further.

“Older adults do not live in psychological silos,” she told Fortune. “Fulfillment reflects how emotional, social, and practical realities interact in everyday life.”

The implication is a complication for doctors used to clinical checklists: The most important things may be the hardest to measure. Shetty’s vision is to change that.

“The goal is to make fulfillment a routine, practical check-in alongside traditional measures like blood pressure and cholesterol,” he said. “The fulfillment lens gives care teams language to have more honest, human conversations about purpose, connection, emotional stability, and how people are experiencing their day-to-day lives. Those factors often shape health long before someone shows up with a clinical problem.”

The study itself was built to hold up to scrutiny. Researchers conducted the project in two phases: a 2023 pilot surveying 1,150 older adults alongside expert consultations in aging and health policy, followed by a 2025 nationally representative survey of 5,501 adults ages 62 and older. The predictive model’s accuracy improved significantly between phases, rising from 70.7% to 83.1% precision, with the ROC Index—a standard measure of model reliability—climbing from 89.8% to 91.7%. 

MIT AgeLab Research Scientist Lisa D’Ambrosio, Ph.D., served as co-author, lending academic rigor to findings that CenterWell will inevitably use to market its integrated care services.

The gap is not evenly distributed. Older adults with household incomes below $50,000, those enrolled in both Medicare and Medicaid, and seniors in underserved communities report significantly lower fulfillment than their wealthier peers—an echo of Peltzman’s finding that the happiness crash reshuffled the relationship between wealth, status, and wellbeing in ways that cut across demographic lines.

One of the report’s more counterintuitive findings involves timing.

“We’re very deliberate about not framing that dip as something ‘going wrong,'” Shetty said of the post-retirement fulfillment drop. “Retirement reshapes identity, daily structure, and social connection almost overnight. The point isn’t to intervene medically. It’s to be present earlier, with the right questions, at a moment we know is pivotal.”

Burnight agrees the window is critical—and closeable.

“The CenterWell Fulfillment Index shows that fulfillment is stable enough to measure, but it is not fixed,” she said. “When people regain purpose, structure, and connection, fulfillment can shift meaningfully within a year, especially during major life transitions like retirement.”

Gen Z also faces a fulfillment crisis

The trend is not confined to older Americans. A 2025 NBER working paper by economists David Blanchflower and Alex Bryson found young people—Gen Z in particular—have been reporting far higher levels of despair than those in midlife or older age for longer than we think. It reverses the longstanding pattern in which unhappiness peaked in middle age—a quarter-life crisis to replace the midlife crisis. The researchers linked the deterioration directly to the labor market: job insecurity, stagnating wages relative to living costs, and the erosion of worker autonomy are all driving mental distress among younger cohorts. The CenterWell data suggests those despairing young workers may be on a longer arc than they realize: Today’s Gen Z could face the same fulfillment dip in the early retirement years that today’s older adults are navigating now.

Reframing retirement

What can actually be done about it remains an open question, and the answer matters more than the diagnosis.

Burnight is direct: “The first intervention is reframing retirement. It is not an endpoint. It is a major transition that requires support.” Volunteering, caregiving, mentoring, learning—the activity matters less than whether it feels meaningful to the individual.

“This dip is common and predictable,” she added, “which means it is also preventable when we plan for it.”

Shetty framed it as a systems design challenge. “Retirement is one of the few health-impacting transitions we can anticipate years in advance,” he said. “When fulfillment is supported early, we see fewer crises later. That is better for individuals, and it is better for the system.”

As for whether CenterWell’s commercial interests color its conclusions, Shetty doesn’t dodge the question.

“Fulfillment isn’t proprietary. It’s a human measure,” he said. “If our work helps push the broader health care system to think more holistically about aging, that’s success regardless of whether someone ever becomes a CenterWell patient.”

Whether the broader health care system, fragmented and fee-for-service as it remains, will adopt that philosophy is a harder sell—but the data, at least, makes a compelling case for trying.