Self-worth systems in aging societies: a narrative review and conceptual framework from self-esteem to healthy longevity

Aging societies face not only challenges of health care, dependency and disease burden, but also a psychosocial challenge: how to preserve older adults' sense that their lives, choices, relationships and contributions continue to matter. This narrative review and conceptual framework examines later-life self-worth as a multilevel system shaped by personal, relational, institutional, cultural and policy conditions. We distinguish self-worth from global trait self-esteem and define later-life self-worth as the perceived significance of one's life, agency, dignity, contribution and social visibility under changing conditions of capacity and dependency. The proposed framework organizes self-worth around six dimensions: autonomy, dignity, mattering, reciprocity, role continuity and social visibility. We synthesize evidence on social connection, loneliness, reciprocity, retirement, ageism, functional decline, long-term care, digital exclusion and cultural disruption, while also identifying areas where evidence is indirect, heterogeneous or primarily correlational. We argue that self-worth may influence healthy aging through psychological, behavioral, social, cognitive and stress-related biological pathways, but that causal claims remain limited and require longitudinal, experimental and mixed-method research. Finally, we discuss strategies for preserving self-worth, including autonomy-supportive environments, dignity-centered care, social prescribing, intergenerational programs and digital inclusion. Healthy longevity should therefore be understood not only as survival, function or disease control, but also as the preservation of a life that is recognized, chosen, connected and meaningful.