It is well known that depression predicts mortality in old age. However, little is known about the impact of positive emotions. We investigated the impact of positive life orientation on mortality and permanent institutional care in aged birth cohorts. Participants (born 1904, 1909, and 1914) underwent detailed assessments with follow-up at 5 and at 10 years. Positive life orientation was determined as answering “yes” to all the following items: being satisfied with life, having zest for life, having plans for the future, feeling needed, seldom feeling lonely or depressed. Of participants, 102 (20.8%) had a positive life orientation. After 10 years, 54.5% of them were alive, whereas in the rest of the sample 39.5% survived ( P = .004). After controlling for age, gender, and health measures, the impact of positive life orientation was still significant (HR = 0.89, 95% CI 0.83–0.93). At 5 years, only 2.9% of those having a positive life orientation but 17.5% of the rest of the sample were in permanent institutional care ( P = 0.003), with a positive life orientation remaining a significant protector against institutional care (OR 0.58, 95% CI 0.36–0.93). Positive attitudes have a long-standing impact on prognosis in old age.