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As we age there are significant changes to our brain structure and cognitive functioning. There is a substantial body of literature exploring changes to memory and attention during healthy adult aging. There has been considerably less focus on the impact of aging on other areas of cognition, specifically, decision-making. This is surprising given that choices are ubiquitous in daily life across the lifespan. For example, older adults still face many significant decisions including those concerning finances in light of reduced income and choices about lifestyle factors in response to potential healthcare issues. Recently, the research community has increasingly shown appreciation of these issues and the literature on changes to decision-making function due to healthy aging is beginning to converge on key themes that are particularly telling in terms of how aging affects decision-making. The literature has focused predominantly on the negative effects of healthy aging on decision-making, particularly in terms of risk-processing. However, although fewer in number, some studies have identified age-related positive effects commonly attributed to an accumulation of ‘wisdom’ by the older adult. This review will provide an overview of the negative and positive changes to decision-making as we age and will, uniquely, converge these two streams of research and put forward the hypothesis that age-related changes in decision-making, underpinned by changes to the structure and function of the aging brain, underlie both positive and negative changes, the manifestation of which depends on choice context.

Healthy Adult Aging and Decision-Making: Is It All Downhill from Here?