Development of a Healthy Aging Score in the Population-Based Rotterdam Study: Evaluating Age and Sex Differences

Healthy ageing in a multi-ethnic population: A descriptive cross-sectional analysis from the HELIUS study

OBJECTIVE

We investigated ethnic health disparities in the Healthy Life in an Urban Setting multi-ethnic cohort using the multidimensional Healthy Ageing Score.

STUDY DESIGN

We conducted a cross-sectional analysis of the study baseline data (2011-2015) collected through questionnaires/physical examinations for 17,091 participants (54.8 % women, mean (SD) age = 44.5 (12.8) years) from South-Asian Surinamese (14.8 %), African Surinamese (20.5 %), Dutch (24.3 %), Moroccan (15.5 %), Turkish (14.9 %), and Ghanaian (10.1 %) origins, living in Amsterdam, the Netherlands.

MAIN OUTCOME MEASURES

We computed the Healthy Ageing Score developed in the Rotterdam Study, which has seven biopsychosocial domains: chronic diseases, mental health, cognitive function, physical function, pain, social support, and quality of life. That score was used to discern between healthy, moderate, and poor ageing. We explored differences in healthy ageing by ethnicity, sex, and age group using multinomial logistic regression.

RESULTS

The Healthy Ageing Score [overall: poor (69.0 %), moderate (24.8 %), and healthy (6.2 %)] differed between ethnicities and was poorer in women and after midlife (cut-off 45 years) across ethnicities (all p < 0.001). In the fully adjusted models in men and women, poor ageing (vs. healthy ageing) was highest in the South-Asian Surinamese [adjusted odds ratios (95 % confidence intervals)] [2.96 (2.24-3.90) and 6.88 (3.29-14.40), respectively] and Turkish [2.80 (2.11-3.73) and 7.10 (3.31-15.24), respectively] vs. Dutch, in the oldest [5.89 (3.62-9.60) and 13.17 (1.77-98.01), respectively] vs. youngest, and in the divorced [1.48 (1.10-2.01) and 2.83 (1.39-5.77), respectively] vs. married. Poor ageing was inversely associated with educational and occupational levels, mainly in men.

CONCLUSIONS

Compared with those of Dutch ethnic origin, ethnic minorities displayed less healthy ageing, which was more pronounced in women, before and after midlife, and was associated with sociodemographic factors.

Determinants and indicators of successful aging as a multidimensional outcome: a systematic review of longitudinal studies

Background

Successful aging (SA) has been coined as a term to describe the multidimensional aspects associated with achieving optimal combination of physical and mental health along with social well-being health, mental and social well-being at older age. In recent years there has been an increased interest in understanding the role of determinants of SA, such as demographic, biological, behavioral, psychological and social factors. To synthesize the recent evidence, we conducted a systematic review of longitudinal studies on a range of determinants and indicators of SA defined as a multidimensional outcome.

Methods

A systematic search of PubMed, MEDLINE and Web of Science for finding eligible papers published between August 2016 and June 2023 was conducted following the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) guidelines. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (Registration number: CRD42021250200). The web-based automated screening tool-Rayyan-was used for title and abstract screening. The study quality was assessed using the Quality in Prognosis Studies (QUIPS) tool.

Results

A total of 3,191 records were initially identified using the predefined search strategy. Out of 289 articles selected for full text screening, 22 were found eligible and included in the review. A variety of factors have been explored in relation to SA, ranging from socio-demographic factors, nutrition, lifestyle, biological pathways, psychological health, and well-being. Overall, the results of recent studies have confirmed the role of metabolic health, adherence to healthy dietary patterns, such as the Mediterranean diet, physical activity, non-smoking, and higher socio-economic status as main factors associated with higher odds for SA. Emerging research highlights the role of psycho-social factors and early life health as determinants of SA.

Conclusion

In summary, this review highlights the importance of healthy living and monitoring metabolic risk along with sustaining psychological well-being in adult life as major determinants of SA. Further methodological and research work on SA would pave the way toward development of adequate health promotion policies in aging societies.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250200, CRD42021250200.

Relationship between physical activity and perceptions of ageing from the perspective of healthy ageing among older people with frailty with chronic disease: a cross-sectional study

BACKGROUND

In Taiwan, the 2019 Elderly Frailty Assessment found that 11.2% of older people have frailty problems. Some researchers have found that older persons' negative perspectives on ageing aggravate the progression of frailty, thereby increasing their risk of disability. This study aimed to investigate associations of physical activity and perceptions of ageing on perspectives of healthy ageing in older people with frailty and chronic diseases and to compare the differences in their frailty status.

METHODS

This study used a descriptive cross-sectional design. Participants were recruited from community long-term care stations. The inclusion criteria were (1) no severe cognitive impairment and ability to communicate in Mandarin and Taiwanese; (2) over 65 years old; (3) at least one chronic disease; and (4) at least one debilitating item in the Study of Osteoporotic Fracture index. A total of 312 participants were recruited. The Brief Ageing Perceptions Questionnaire Chinese version, Healthy Ageing Perspectives Questionnaire, and Physical Activity Scale for the Elderly Chinese Version were used for measurement.

RESULTS

The study results found that demographic variables, perceptions of ageing, and physical activity were significantly correlated with perspectives on healthy ageing, including age, Activities of Daily Living, education, all domains of perceptions of ageing, and household- and work-related physical activity. With regard to the frailty status level, prefrailty was better than frailty from the perspective of healthy ageing in older people with chronic disease (t = 5.35, p < 0.05). Hierarchical regression analysis was used to predict the healthy ageing perspectives of older persons with chronic disease involving a chronic time-line, positive control, health-related changes, and work-related activities. Those domains could predict 21% of the variance in healthy ageing perspectives.

CONCLUSION

It is suggested that in community long-term care stations, health care providers can arrange activities to improve the perception of ageing that are acceptable for older people with frailty and chronic diseases and encourage older people to participate in service activities to achieve a sense of social participation.

Construction of healthy aging index from two different datasets

Introduction

The aging population presents both unique challenges and opportunities for societies around the world. To develop an effective healthy aging strategy, a tool for assessing aging process is needed. Numerous attempts to quantify the aging process have been made. However, there is still a challenge in developing and choosing a good enough score that is easy to apply, has a construct of variables that are available in most nationwide surveys for comparable results, and at the same time reflects the aging process of older individuals. The purpose of this study is to present our approach to construct a comparable Healthy Aging Index (HAI).

Materials and methods

In Latvia, data from Wave 8 of the Survey of Health, Aging and Retirement in Europe (SHARE), involving 420 respondents, were used. For comparative analysis, data from a HL20 study on the health and wellbeing of the older adults in Iceland, which included 1,033 respondents, were used.

Results

For Latvia, 13 items were selected, and for Iceland, nine items were selected. We constructed the HAI with four similar subscales for both countries-"Autonomy," "Health," "Wellbeing," and "Activities," and an additional subscale "Cognitive" for Latvia. We found matching items in all four subscales. For the Autonomy subscale, they were related to difficulties with everyday and daily tasks. In the Health subscale, the only matching item was self-rated physical health. One item related to loneliness was found for the Wellbeing subscale and one item related to social participation for the Activities subscale.

Discussion

In our study, we found evidence for the successful construction of a HAI in two different datasets. The strength of our construct lies in the use of data from one of the largest social science panel studies in Europe (SHARE). As we were able to apply the construct to the Icelandic study, we believe that items presented in our approach are available in other population-based studies as well, and, therefore, can be easily replicated by others. By examining the existing SHARE data, HAI could be used to analyze long-term changes and could provide a foundation for comparing and monitoring the evolution of aging over time as well as comparing the aging process across societies. This is required for the authorities to conduct further analyses, proposals, and action plans in support of healthy aging.

Healthy ageing from birth to age 84 years in the Helsinki Birth Cohort Study, Finland: a longitudinal study

BACKGROUND

The true prevalence of healthy ageing on a population level is unknown. In this study we aimed to examine the upper limit for the prevalence of healthy ageing, by quantifying the probability of surviving and remaining free of chronic diseases that could impact functioning (ie, healthy survival) across adulthood. We also estimated the prevalence of clinically assessed healthy ageing, and the determinants of healthy survival and healthy ageing.

METHODS

In this longitudinal study, we assessed men and women born in 1934-44 from the Helsinki Birth Cohort Study (Helsinki, Finland; n=13 140). We obtained information on chronic diseases, deaths, and early-to-midlife variables from national registers, databases, and health records for the period Jan 1, 1971, to Dec 31, 2017 (follow-up 951 088 person-years). We also collated data from clinical visits conducted in 2001-04 and 2017-18. Healthy ageing was defined on the basis of clinical data according to six criteria covering chronic diseases, cognitive function, physical performance, depressive symptoms, pain interference, and social functioning. We analysed the probability of healthy survival across adulthood using the Kaplan-Meier method, and the determinants of healthy survival using Cox regression models. We assessed the association of healthy ageing status in 2017-18 (n=813 with available data) with late-midlife factors collected in 2001-04 using age-adjusted logistic regression.

FINDINGS

The probability of healthy survival was 42·8% (95% CI 41·6-44·0) in men and 40·1% (38·9-41·4) in women at age 65 years, and 22·5% (21·5-23·6%) in men and 24·4% (23·3-25·6) in women at age 75 years. Healthy survival was associated with socioeconomic position in childhood (adjusted hazard ratio [aHR], upper-middle class vs manual worker, men: 1·21 [1·11-1·31]; women: 1·15 [95% CI 1·05-1·26]) and years of education (aHR per 1 SD increase, men: 1·12 [1·08-1·16]; women: 1·03 [1·00-1·07]). In men, healthy survival was also associated with lower maternal BMI in late pregnancy (aHR per 1 SD increase 0·93 [0·90-0·96]), and in women, with shorter height at age 7 years (aHR per 1 SD increase 0·95 [0·91-0·99]). Among the 813 individuals with relevant clinical assessment data, 159 (19·6%) met all six criteria for healthy ageing at mean age 76 years (SD 3). In addition to age, we found that nutrition (Alternative Healthy Eating Index, age-adjusted odds ratio [aOR] per 1 point increase 1·03 [1·01-1·05]), former smoker status (vs non-smoker status, aOR 0·68 [0·47-0·98], and use of lipid-lowering medication (vs not used, aOR 0·60 [0·42-0·87]) in late midlife (mean age 61 years [SD 3]) were associated with healthy ageing.

INTERPRETATION

The probability of healthy survival, as the upper limit for healthy ageing, was less than 50% from age 65 years. The probability of healthy survival and healthy ageing was influenced by several factors across the life course. Promotion of healthy ageing needs to take a life course approach.

FUNDING

Signe and Ane Gyllenberg Foundation, Samfundet Folkhälsan, Finska Läkaresällskapet, Medicinska Understödsföreningen Liv och Hälsa, European Commission Seventh Framework Programme, EU Horizon 2020, and the Academy of Finland.

Development of a composite healthy ageing score: evidence from middle-to-older aged Australians

We developed and validated a composite healthy ageing score (HAS) to address the absence of a definitive composite score comprising multiple health domains that measure healthy ageing in epidemiology. The HAS is developed from 13 health domains reported to influence healthy ageing. Data to measure these domains was extracted from the 45 and Up Study baseline. We applied best practices for scale validation and development. Physical functioning, cognitive function, mental health, sleep, quality of life, balance, social connections and overall health were retained. Functional capacity and resilience were uncovered as underlying latent structures. The HAS ranges from 0 to 16 with higher scores indicating a better health profile. This research contributes a comprehensive measuring tool, HAS, It enables examination and comparison of individual or collective health profiles and the investigation of the factors that influence their chances of living healthy for longer.

Psychosocial health modifies associations between HPA-axis function and brain structure in older age

BACKGROUND

Dysregulation of the negative feedback loop of the hypothalamic-pituitary-adrenal (HPA) axis may have damaging effects on the brain, potentially under influence of psychosocial health factors. We studied associations between functioning of the negative feedback loop of HPA-axis, measured with a very low-dose dexamethasone suppression test (DST), and brain structure in middle-aged and older adults, and whether these associations were modified by psychosocial health.

METHODS

From 2006 to 2008, 1259 participants (mean age 57.6 ± 6.4, 59.6 % female) of the population-based Rotterdam Study completed a very low-dose DST (0.25 mg) and underwent magnetic resonance imaging (MRI) of the brain. Self-reported psychosocial health (depressive symptoms, loneliness, marital status, perceived social support) were assessed in the same time period. Multivariable linear and logistic regression were used to study cross-sectional associations between cortisol response and brain volumetrics, cerebral small vessel disease markers and white matter structural integrity. To assess the effect of psychosocial health on these associations, analyses were further stratified for psychosocial health markers.

RESULTS

Cortisol response was not associated with markers of global brain structure in the overall study sample. However, in participants with clinically relevant depressive symptoms, a diminished cortisol response was associated with smaller white matter volume (mean difference: - 1.00 mL, 95 %CI = - 1.89;- 0.10) and smaller white matter hyperintensity volume (mean difference: - 0.03 mL (log), 95 %CI = - 0.05;0.00). In participants with low/moderate perceived social support compared to those with high social support, a diminished cortisol response was associated with larger gray matter volume (mean difference: 0.70 mL, 95 %CI = 0.01;1.39) and higher fractional anisotropy (standardized mean difference 0.03, 95 %CI = 0.00;0.06).

CONCLUSION

Diminished function of the HPA-axis is differently associated with brain structure in community-dwelling middle-aged and older adults with clinically relevant depressive symptoms or suboptimal social support, but not in adults without depressive symptoms or with optimal social support.

Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV)-CTN 314

The Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study, CTN 314, is the first Canadian cohort of people living with HIV aged 65 years and older. The cohort was established with the purpose of characterizing the multidimensional health status of this population and identifying factors influencing healthy aging. The study builds on the World Health Organization (WHO) Aging and Health conceptual framework, generating a comprehensive profile of health domains (physical, social, mental health, cognitive function, and quality of life), health determinants (biologic, personal, and environmental), and HIV-specific factors that may interact with and influence health in people aging with HIV. The data for the first 353 participants are presented, focusing on sociodemographic factors, comorbidities, coinfections, frailty, cognitive function, loneliness, and resilience using a sex/gender stratified analysis. The cohort thus far is 91% men and the median age is 70 years (range from 65 to 85). Several vulnerabilities were observed, including a high prevalence of comorbidities and frailty. Women especially faced financial insecurity and precarious social structures; a large proportion live alone and only 6% are married or in steady relationships. Identifying strategies to address these vulnerabilities will empower people aging with HIV to optimize their health, quality of life, and independence.

Identifying the needs of older people living with HIV (≥ 50 years old) from multiple centres over the world: a descriptive analysis

BACKGROUND

Older People Living with HIV (OPWH) combine both aging and HIV-infection features, resulting in ageism, stigma, social isolation, and low quality of life. This context brings up new challenges for healthcare professionals, who now must aid patients with a significant comorbidity burden and polypharmacy treatments. OPWH opinion on their health management is hardly ever considered as a variable to study, though it would help to understand their needs on dissimilar settings.

METHODS

We performed a cross-sectional, comparative study including patients living with HIV aged ≥50 years old from multiple centers worldwide and gave them a survey addressing their perception on overall health issues, psychological problems, social activities, geriatric conditions, and opinions on healthcare. Data was analyzed through Chisquared tests sorting by geographical regions, age groups, or both.

RESULTS

We organized 680 participants data by location (Center and South America [CSA], Western Europe [WE], Africa, Eastern Europe and Israel [EEI]) and by age groups (50- 55, 56-65, 66-75, >75). In EEI, HIV serostatus socializing and reaching undetectable viral load were the main problems. CSA participants are the least satisfied regarding their healthcare, and a great part of them are not retired. Africans show the best health perception, have financial problems, and fancy their HIV doctors. WE is the most developed region studied and their participants report the best scores. Moreover, older age groups tend to live alone, have a lower perception of psychological problems, and reduced social life.

CONCLUSIONS

Patients' opinions outline region- and age-specific unmet needs. In EEI, socializing HIV and reaching undetectable viral load were the main concerns. CSA low satisfaction outcomes might reflect high expectations or profound inequities in the region. African participants results mirror a system where general health is hard to achieve, but HIV clinics are much more appealing to them. WE is the most satisfied region about their healthcare. In this context, age-specific information, education and counseling programs (i.e. Patient Reported Outcomes, Patient Centered Care, multidisciplinary teams) are needed to promote physical and mental health among older adults living with HIV/AIDS. This is crucial for improving health-related quality of life and patient's satisfaction.

The Relationship Between Successful Aging and All-Cause Mortality Risk in Older Adults: A Systematic Review and Meta-Analysis of Cohort Studies

Background

This meta-analysis aimed to explore the effect of successful aging (SA) on all-cause mortality risk in older people to provide a theoretical basis for promoting SA.

Methods

PubMed, Embase, CINAHL, CNKI, and WanFang databases (inception to March 4, 2021) were searched for cohort studies to evaluate the relationship between SA and mortality in older people. A random-effects model was used to synthesis hazard ratio and 95% confidence intervals. Quality assessment was performed using the Newcastle–Ottawa scale. All statistical analyses were conducted in STATA 16.0.

Results

In total, 21,158 older adults from 10 studies were included in the current systematic review and meta-analysis. The SA group tended to have 50% lower risk of all-cause mortality than the non-SA group (pooled hazard ratio = 0.50, 95% confidence intervals: 0.35–0.65, P < 0.001; I² = 58.3%). The risk of all-cause mortality in older people increased by 17% for each unit increment in the healthy aging index (HAI) (I² = 0%, P = 0.964). Compared with the reference group (HAI 0-2), older people with HAI 3-4, HAI 5-6, and HAI 7-10 had 1.31-fold, 1.73-fold, and 2.58-fold greater risk of all-cause mortality, respectively. Subgroup analysis did not reveal possible sources of heterogeneity.

Conclusions

This meta-analysis suggests that older adults with SA reduced the risk of all-cause mortality by 50%. However, few interventional studies have been conducted. Therefore, healthcare providers must be aware of the relationship between SA and mortality risk and actively develop intervention methods for helping old people achieve SA.

Frailty in people living with HIV: an update

PURPOSE OF REVIEW

The HIV population is ageing with rising rates of frailty though strategies of how best to manage it remain ill-defined. It also remains unclear what the prevalence of frailty is within this cohort, how best to diagnose it and what factors are associated.

RECENT FINDINGS

The prevalence of frailty remains unclear because of heterogenous results. Routine screening in those 50+ is recommended and whilst the Fried Frailty Phenotype is currently preferred the Clinical Frailty Scale could be considered. No biomarkers are currently recommended. Looking at associated factors, HIV neurocognitive impairment and long-term alcohol usage has been shown to be associated with developing frailty whilst those who are frail have been shown to be less active and more likely to fall. NAFLD with fibrosis has been shown to be an indicator of metabolic age and the Pooled Cohort Equations has been shown to be more effective in diagnosing cardiovascular risk in frail people living with HIV.

SUMMARY

Whilst the prevalence of frailty differs between countries, with the addition of prefrailty, this represents a large proportion of people living with HIV. Services must ensure strategies are in place to support those living with HIV and frailty. Further longitudinal studies are required.

Aging mechanisms-A perspective mostly from Drosophila

A mechanistic understanding of the natural aging process, which is distinct from aging-related disease mechanisms, is essential for developing interventions to extend lifespan or healthspan. Here, we discuss current trends in aging research and address conceptual and experimental challenges in the field. We examine various molecular markers implicated in aging with an emphasis on the role of heterochromatin and epigenetic changes. Studies in model organisms have been advantageous in elucidating conserved genetic and epigenetic mechanisms and assessing interventions that affect aging. We highlight the use of Drosophila, which allows controlled studies for evaluating genetic and environmental contributors to aging conveniently. Finally, we propose the use of novel methodologies and future strategies using Drosophila in aging research.

Temporal Association between Abdominal Weight Status and Healthy Aging: Findings from the 2011-2018 National Health and Aging Trends Study

Background/objectives: The longitudinal effect of abdominal weight status (AWS) defined by waist circumference (WC) on healthy aging has not yet been comprehensively examined. Therefore, the purpose of the present study was to examine the temporal association between WC-defined AWS and a comprehensive assessment for healthy aging. Subjects/methods: This study utilized data from 5211 respondents aged 65+ who participated in the National Health and Aging Trends Study from 2011 to 2018. Mixed effects regression models were used to examine the association between baseline AWS and the annual change rate in healthy aging score (HAS) via interaction terms (AWS*round) adjusting for confounding effects. Further multiple mixed models examined the relationship of AWS and HAS over an 8-year period. Results: There were no annual change rate differences in HAS by baseline AWS, regardless of sex. However, males with abdominal obesity were more likely to have a lower HAS than males with normal AWS (β = −0.20, 95% CI: −0.30, −0.10, p < 0.001) but no difference in HAS was observed between males with overweight and normal AWS. A similar pattern was observed among females. Conclusions: Study results indicate that AWS was associated with HAS but it did not modify annual HAS change rate over time.

Proposal of Nursing Diagnosis "Readiness for Enhanced Healthy Aging": A Concept Analysis

PURPOSE

To analyze the concept of healthy aging and propose the development of a nursing diagnosis METHODS: Concept analysis using the method proposed by Walker and Avant FINDINGS: Four bibliographic databases were searched, and 36 articles were included in the analysis. Seven antecedents, seven attributes, and three consequences for "healthy aging" were identified.

CONCLUSIONS

The concept analysis supported the development of the new nursing diagnosis "readiness for enhanced healthy aging," which can assist nurses in implementing actions aimed at promoting the health of older adults.

IMPLICATION FOR NURSING PRACTICE

The establishment of a nursing diagnosis may provide nurses the opportunity to implement interventions that promote the maintenance of functional and cognitive capacity, psychological and spiritual well-being, and social engagement, aiming at healthy aging with high quality of life.

Objectives, design and main findings until 2020 from the Rotterdam Study

The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.

Pilot study assessing the Rotterdam Healthy Aging Score in a cohort of HIV-positive adults in Toronto, Canada

Objective:

The Rotterdam Healthy Aging Score (HAS) is a validated multidimensional index constructed from five health domains. We describe the HAS distribution in a cohort of HIV-positive adults and correlate it with health outcomes.

Design:

A cross-sectional pilot study of 101 adults aged at least 40 years, on suppressive antiretroviral therapy attending a tertiary HIV clinic in Toronto, Canada.

Methods:

Participants completed questionnaires to calculate their HAS (range 0–14). Demographics, HAS and sub-scores were compared by age and sex. The HAS was compared with results of the Fried Frailty Score, Short Performance Physical Battery score (SPPB) and measures of health utilization. Kruskal--Wallis Rank-Sum and Fisher's exact tests were used for all comparisons.

Results:

Median (IQR) age was 56 (50--62), 81 (80%) men and 50 (50%) born in Canada. Median (IQR) CD4⁺ cell count was 574 (417--794) cells/μl. Median (IQR) HAS was 12 (10--13) with 39 (39%) achieving a score more than 12 (considered healthy aging). Younger participants experienced more depression, whereas women had greater pain. The HAS score correlated with the Fried Frailty Score (P = 0.008) and trended with the SPPB Score (P = 0.077). Those with the poorest HAS scores were more likely to have been hospitalized in the preceding 6 months (P = 0.034).

Conclusion:

The HAS ranged from 5 to 14 in this cohort of older HIV adults with 39% attaining scores in the ‘healthy’ range. The HAS correlated with measures of physical performance and health utilization. Further validation of an objective outcome in HIV-positive patients will facilitate evaluation of interventional studies to improve healthy aging.

The healthy aging phenotype in older people in Manizales

Introducción.

El fenotipo de envejecimiento saludable está presente en aquellos individuos que envejecen con poca morbilidad, sin deterioro funcional ni cognitivo, y con un nivel aceptable de bienestar y de participación social.

Objetivo.

Establecer la frecuencia del fenotipo de envejecimiento saludable según un modelo multidimensional, uno biomédico y uno psicosocial, y determinar los factores de predicción en cada uno de ellos.

Materiales y métodos.

Se hizo un estudio de diseño transversal, observacional y descriptivo, que incluyó a 402 personas (50,1 % mujeres) de 65 años y más (promedio de edad, 69,2) en el área urbana de Manizales. El fenotipo de envejecimiento saludable se caracterizó en cinco dimensiones: salud metabólica y fisiológica, función física, función cognitiva, bienestar psicológico y bienestar social. Los factores asociados incluyeron aspectos sociodemográficos y de salud.

Resultados.

La prevalencia de envejecimiento saludable fue de 15,5 % en el modelo multidimensional, de 12,3 % en el biomédico y de 63,3 % en el psicosocial. El tener autopercepción de buena salud fue un factor de predicción independiente de envejecimiento saludable en los tres modelos, así como la satisfacción con los ingresos económicos en el modelo biomédico y en el psicosocial. Un tercer factor de predicción fue el estar casado, aunque fue significativo solamente en el modelo psicosocial.

Conclusiones.

La prevalencia del fenotipo de envejecimiento saludable fue baja en el modelo biológico y en el multidimensional (1 de cada 10 personas), y mayor en el modelo psicosocial (6 de cada 10). A pesar de ello, los factores predictores independientes fueron los mismos: la autopercepción de buena o muy buena salud, la satisfacción con los ingresos económicos y el estar casado.

Domains and Measurements of Healthy Aging in Epidemiological Studies: A Review

Purpose of the Study

Few studies have recommended the essential domains of healthy aging and their relevant measurement to assess healthy aging comprehensively. This review is to fill the gap, by conducting a literature review of domains and measures of healthy aging in epidemiological studies.

Design and Methods

A literature search was conducted up to March 31, 2017, supplemented by a search of references in all relevant articles in English. We made a final selection of 50 studies across 23 countries or regions.

Results

Nineteen studies applied Rowe and Kahn’s three standards to assess healthy aging. Thirty-seven studies measured physical capabilities mainly by (instrumental) activities of daily living. Cognitive functions were included in 33 studies. Nineteen of them applied Mini-Mental State Examination (MMSE). Twenty-six studies considered metabolic and physiological health, but they mainly asked the self-reported absence of diseases. Twenty-four studies assessed psychological well-being by employing diverse scales. Questions about participation in social activities were mainly asked to measure social well-being in 22 studies. Sixteen studies considered individuals’ general health status, which was mainly measured by self-rated health. Security questions were asked in five studies. Health behaviors were taken into account by three studies. Fifteen studies either applied SF-12/36 or developed health indices to assess healthy aging.

Implications

This review summarizes detailed scales or methods that have been used to assess healthy aging in previous epidemiological studies. It also discusses and recommends the essential domains of healthy aging, and the relevant instruments for further epidemiological research to use in the assessment of healthy aging.

Successful Present, Successful Future? Assessment of a Nonbinary Model of Successful Aging

PURPOSE

Though many models of successful aging exist, there is a need for assessments of the empirical validity of these models and their measures. This study tests the validity of the multidimensional model of successful aging presented by Young and colleagues.

DESIGN AND METHODS

Expanding on an earlier validation study, this analysis uses 1,211 respondents from the Americans' Changing Lives (ACL) study to determine predictive and discriminant validity. Respondents were surveyed in 1986, 1989, and 1994, providing an opportunity to assess if a baseline 5-point successful aging scale is associated with present and future outcomes. Validators include self-report items and interviewer recorded observations. In addition, a survival analysis of 24 years of ACL mortality data is conducted to confirm that baseline successful aging decreases risk of all-cause mortality.

RESULTS

Results illustrate that, in some cases as far as 8 years in the future, low successful aging scores correspond with higher risk of future hospitalization and depressive episodes, interviewer observed difficulty moving around, low self-rated health, and decreased life satisfaction. Lowest scorers also had a 356% higher risk of mortality compared to individuals with the highest scores.

IMPLICATIONS

These findings provide further evidence that Young and colleagues' successful aging construct is empirically valid and could be applied in future research and practice. Most respondents had middling scores, suggesting that future analyses should be cautious about concealing heterogeneity by operationalizing successful aging as a binary outcome.

Individual healthy aging indices, measurements and scores

The positive gerontological approach to aging has resulted in successive terminologies to describe the process of aging, including successful aging, active aging, healthy aging, or healthy and active aging, amongst others. Each definition proposed by geriatricians, psychologists, sociologists or public health specialists has been based on specific aspects of aging that are most important to the authors' discipline, explaining the current difficulty in determining which is the best set of criteria to determine "good aging". Two successive analyses of the measurements used in longitudinal studies from 1989 to 2018 testify to this heterogeneity in the types of questions proposed to evaluate the quality of the individual aging process. To confront this complexity, new and integrated indices have successively been proposed to quantify and qualify the survival period of aging individuals. The present paper aims to describe and compare the value of the "healthy aging index", the "modified healthy aging index", the "healthy aging score" and the "selfie aging test". Attempts to date to identify the best individual measurement of "aging well" have been interesting, and certainly show promise, but their limitations to specific populations call for more concerted effort from the scientific community to obtain worldwide validation. Another option would be to identify the best self-assessment questionnaire and include it in a mobile device, enabling longer term personal follow-up of aging functions. There is a clear lack of data of this type at present, and an urgent need to obtain such information, to enable early and targeted interventions.

Health and Aging: Unifying Concepts, Scores, Biomarkers and Pathways

Despite increasing research efforts, there is a lack of consensus on defining aging or health. To understand the underlying processes, and to foster the development of targeted interventions towards increasing one's health, there is an urgent need to find a broadly acceptable and useful definition of health, based on a list of (molecular) features; to operationalize features of health so that it can be measured; to identify predictive biomarkers and (molecular) pathways of health; and to suggest interventions, such as nutrition and exercise, targeted at putative causal pathways and processes. Based on a survey of the literature, we propose to define health as a state of an individual characterized by the core features of physiological, cognitive, physical and reproductive function, and a lack of disease. We further define aging as the aggregate of all processes in an individual that reduce its wellbeing, that is, its health or survival or both. We define biomarkers of health by their attribute of predicting future health better than chronological age. We define healthspan pathways as molecular features of health that relate to each other by belonging to the same molecular pathway. Our conceptual framework may integrate diverse operationalizations of health and guide precision prevention efforts.

Influence of Sociodemographic, Behavioral and Other Health-Related Factors on Healthy Ageing Based on Three Operative Definitions

OBJECTIVES

Healthy ageing (HA) is a key concept and highly desirable phenomenon in every ageing and already old societies. The aim of our study was to evaluate the influence of socio-economic conditions as well as life-style and other health-related factors on the WHO definition of HA.

DESIGN, SETTING, PARTICIPANTS

The study used cross-sectional data of the PolSenior Project - nationwide research evaluating different aspects of ageing in Poland - which included 4'653 respondents aged 65 years and over.

MEASUREMENTS

Data were collected by trained interviewers in respondents' homes. Three definitions of HA including or not the participants' chronic conditions were analyzed.

RESULTS

The prevalence of HA appeared as high as 17.6% if none or 1 chronic disease was present and 42.8% if no information about chronic diseases was taken into account. The association between known health predictors (age, marital status, education, income) and HA was observed. Moreover, HA appeared in relation with indicators of physical functioning and lifestyle. There was a strong concordance between HA and the fair self-rated health (OR = 1.87; 1.99, and 2.74 for the 1st, 2nd and 3rd definitions, respectively) and opposite relation with self-reported need for help (OR = 0.15; 0.15; and 0.13, respectively).

CONCLUSIONS

The HA definition based on no functional activity limitations, no cognitive impairment, no depressive symptoms, no more than one disease and being socially active seems to be a useful approach of HA.

The Rotterdam Study: 2018 update on objectives, design and main results

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.