The Practice of Purpose
Why It Might Be the Most Important Longevity Metric We Never Measure
My father told me a story recently that I keep thinking about.
He was at his "Medicare Wellness Visit” with his primary care physician. Blood pressure, labs, the usual. At some point in the visit, his doctor looked at him and asked: do you have a purpose in life?
My father paused. Not because he didn’t have an answer (he did), but because he’d never been asked that question in a medical setting before. In decades of annual exams, nobody had thought to ask it. And yet when his doctor asked him, it felt, he said, like the most important question of the whole appointment.
It wasn't on the standard questionnaire. His doctor just asked.
I’ve been thinking about why that is. I think that question represents something that most of medicine has slowly abandoned: the idea that a person’s sense of meaning is a clinical one. That it belongs in the exam room alongside blood pressure and cholesterol. That it is, in fact, a longevity metric.
Because the evidence says it is.
We spend a lot of time in medicine asking about what you eat, how much you exercise, and whether you sleep enough. We rarely ask why you want to be here for the long haul. But that question may matter just as much.
What the research actually shows
The relationship between purpose and longevity is not soft science or wishful thinking.
A 2019 study published in JAMA Network Open followed nearly 7,000 adults over age 50 and found that those with the lowest sense of life purpose were more likely to die during the follow-up period than those with the highest, even after controlling for health status, demographics, and health behaviors.
The Japanese have a word for this: ikigai — roughly translated as the reason you wake up in the morning. Nowhere has it been more associated with longevity than Okinawa. Research on Blue Zones populations consistently identifies a strong sense of purpose as one of the common denominators among centenarians. Interestingly, Okinawa has no word for retirement. The concept of an abrupt end to purposeful contribution doesn’t exist there.
Purpose is also associated with lower rates of Alzheimer’s disease, reduced stroke risk, better metabolic health, healthier sleep, and greater physical function in older adults. It seems to work through multiple biological pathways simultaneously: reducing chronic inflammation, supporting cortisol regulation, promoting health behaviors, and buffering the physiological impact of stress.
The best part: purpose in life is not a personality trait you either have or don’t. It is a modifiable risk factor. And it belongs in the same conversation as blood pressure and cholesterol.
Why doctors rarely ask the question
There are obvious reasons. The fifteen-minute appointment doesn’t leave a lot of room for existential questions. The electronic health record doesn’t have a field for ikigai. Purpose is hard to quantify, and medicine is increasingly organized around what can be measured, billed, and documented.
There is also, I think, a subtler reason. Medicine has become very good at treating disease, and less comfortable with the fuller question of what makes a life worth living. We are trained to identify pathology, not to explore meaning. And so we ask about symptoms and skip the question that might tell us the most about a patient’s actual trajectory.
My father’s doctor asked it anyway. And it didn’t feel like an intrusion, rather, it was one of the most humanizing moments he’d had in a clinical setting.
A physician with fifteen minutes cannot ask this question. A physician with time can, and that gap is worth closing.
What ‘purpose’ actually means, and what it doesn’t
The word “purpose” can sound grand in a way that makes people feel they are failing if they don’t have an answer that involves changing the world.
It doesn’t have to be that. Purpose, in the research, is defined broadly: a self-organizing life aim that provides a sense of direction. It can be creative work, faith, family, community, craft, mentorship, advocacy, or service. It can be tending a garden that your grandchildren will grow up in. It can be the research you’ve dedicated your career to, or the neighborhood you’re trying to improve, or the friendships you maintain with intention.
The specific form it takes is deeply personal. It’s different for everyone. Having something that organizes your attention, that pulls you forward, that makes getting up in the morning feel like more than maintenance — that is what predicts the outcomes.
What it is not: a to-do list or a career goal. Those things can serve purpose but they are not the same as it. A lot of high-achieving people in their 40s and 50s mistake busyness for meaning, and then discover the difference when the busyness stops.
How having a purpose works in the body
Purpose is actually biologically active. Here is what the research suggests is happening:
Inflammation. Higher purpose in life is associated with lower levels of inflammatory markers, including IL-6 and CRP. Chronic low-grade inflammation is one of the central drivers of accelerated aging. Purpose appears to dampen it, possibly through its effects on cortisol regulation.
Health behaviors. People with a strong sense of purpose sleep better, exercise more consistently, use preventive health services at higher rates, and are more likely to follow through on medical recommendations. Purpose is, in part, what makes other healthy behaviors sustainable over time — it provides the why that makes the habits stick.
Stress response. Purpose acts as a buffer against the physiological impact of acute and chronic stress. It doesn’t eliminate stress, but it changes how the body responds to it. People with high purpose show faster cortisol recovery after stressors.
Cognitive resilience. A sense of purpose is associated with reduced risk of Alzheimer’s disease and slower cognitive decline in aging adults, independent of baseline cognitive status. One proposed mechanism is that purpose promotes neural reserve — the richness of cognitive engagement that protects against neurodegeneration.
Cardiovascular protection. Purpose is independently associated with reduced cardiovascular events, lower rates of stroke, and lower all-cause cardiovascular mortality. The mechanism is likely related to reduced inflammation, better blood pressure regulation, and the downstream effects of more consistent health behaviors.
Why this question matters, especially in midlife
This conversation tends to surface in people’s 40s and 50s. Midlife is often when the structures that provided meaning by default — building a career, raising young children, establishing a home — begin to shift.
People who have organized their sense of purpose around those external structures sometimes find themselves, for the first time, uncertain about what they are here for.
This is a moment worth taking seriously. The research suggests that purpose levels in midlife are particularly predictive of health outcomes in later decades. This is a time when the question has a lot of leverage.
Do you have a purpose?
The answer may not come easily. If it does, that’s worth appreciating. Many people have more purpose than they give themselves credit for. It just doesn’t feel dramatic enough to call a purpose.
Showing up consistently for the people you love is a purpose. Building something that will outlast you is a purpose. Practicing a craft with intention across decades is a purpose.
If the answer doesn’t come easily, here are the questions that tend to open things up:
What do you want to have contributed by the time you are 80?
Who needs you in a way that only you can fill?
What are you doing when time disappears?
What would you do if the outcome didn’t depend on recognition or reward?
What problems in the world make you feel called rather than just concerned?
Purpose is often developed gradually. What matters is that you are asking. And that someone in your life, ideally including your physician, thinks it’s worth asking too.
It’s okay for your answer to change. It probably will.
My father’s answer was immediate. To help others, care for his family, write books that matter, give talks that inspire. He didn't hesitate for a second.
When I ask myself the same question, my answer has two parts. The first is close to home: a happy family and kids who feel loved. The second is to practice medicine in a way that actually sees people.
Neither of those answers would win a TED talk. Both of them are real. And I think that’s exactly the point.
Purpose is a practice. Not something you arrive at once and carry forever, but something you return to, tend to, and let evolve.
"I’ve been thinking about why that is. I think that question represents something that most of medicine has slowly abandoned: the idea that a person’s sense of meaning is a clinical one."
I have to agree with you wholeheartedly here. During my practice years I observed a very common phenomenon among my recently retired patients. During the first six months or so, it was the bliss of owning your own time, traveling, and doing all things work obligations interfered with in the past. After all that was done, a different realization set in.
For most people work becomes a part their identity through the years. Whether you realize it or not, your occupation defines your place in society and for the better part of your adult life, it constitute one endeavor that gives you a sense of purpose. Most retired people are empty nesters, children have since moved with their own lives. After the initial go-free phase of retirement the loss of purpose starts pressing heavily on you. That invariably led to many of my newly retired patients to an existential crisis eventually ending in depression.
Purpose is at the center of every human being sense of self-worth, provides us the drive to keep going, to thrive, to be. For all of you getting close or recently retired, along with all the other planning that goes with such a life changing event, add to those calculus — purpose. What am I going to do in retirement? What will drive me to get up every morning? What will be my new sense of purpose?
Thank you. I have been blessed with both my primary care physician and my team of specialists who adhere to what your Dad experienced. And what you suggest here. They are rare from what I have learned from others with my same or similar affliction. Keep up the good work, we notice, we care, and we appreciate you and your colleagues.