Life aspirations, risk-benefit perceptions, and public acceptance of candidate gerotherapeutic medications: a preregistered national survey in Singapore

Background Despite growing interest in gerotherapeutic medications, research on public acceptance has relied predominantly on Western convenience samples and has not tested integrated models linking motivational goals to risk-benefit perceptions. Drawing on intrinsic and extrinsic life goals and secondary risk theory, this study addresses these gaps by examining willingness among Singapore residents to take drugs like metformin for health optimization. Methods Data came from a preregistered, nationally representative survey of 2,003 Singapore adults. Structural equation modeling tested relationships among life aspirations, desired lifespan, risk-benefit perceptions, and willingness to take health optimization medications. Results Most respondents expressed a preference for living 60–90 years in optimal health, and about one-third indicated willingness to use health optimization medications. Life aspirations were positively associated with desired lifespan ( R 2 = 0.04), but desired lifespan was unrelated to medication willingness. In contrast, willingness was positively related to worry about chronic disease, perceived efficacy, and perceived societal costs and negatively related to perceived health risks and perceived ethical costs ( R 2 = 0.39). Conclusion These findings suggest that motivational goals and risk-benefit perceptions are independent pathways to medication willingness. They highlight the need for communicating efficacy evidence while addressing safety and ethical concerns, perhaps through targeted messaging and framing. However, the conservative lifespan preferences in Singapore suggest that desired longevity may reflect cultural factors beyond health framing.