Lessons Learned From Blue Zones, Lifestyle Medicine Pillars and Beyond: An Update on the Contributions of Behavior and Genetics to Wellbeing and Longevity

Nationwide Mortality Trends from 2001 to 2020 in Greece: Health Policy Implications under the Scope of Aging Societies

INTRODUCTION

This nationwide study aims to analyze mortality trends for all individual causes in Greece from 2001 to 2020, with a specific focus on 2020 - a year influenced by the coronavirus pandemic. As Greece is the fastest-aging country in Europe, the study's findings can be generalized guiding the re-evaluation of global health policies.

METHODS

Data on the population and the number of deaths were retrieved from the Hellenic Statistical Authority. We calculated age-standardized mortality rates (ASMR) and cause-specific mortality rates by gender in three age groups (0-64, 65-79, and 80+) from 2001 to 2020. Proportional mortalities for 2020 were determined. Statistical analysis used generalized linear models with Python Programming Language.

RESULTS

From 2001 to 2020, cardiovascular diseases (CVD) ASMR decreased by 42,7% (p<0,0001), with declines in most sub-causes, except for hypertensive diseases, which increased by 2,8-fold (p<0,0001). In 2020, the proportional mortalities of the three leading causes were 34,9% for CVD, 23,5% for neoplasms, and 9,6% for respiratory diseases (RD). In 2020, CVD dominate in ages 80+ (39,3%), while neoplasms prevail in ages 0-79 (37,7%). Among cardiovascular sub-causes, cerebrovascular diseases dominate in ages 80+ (30,3%), while ischemic heart diseases prevail in ages 0-79 (up to 60,0%).

CONCLUSIONS

The global phenomenon of population aging necessitates a re-framing of health policies in our aging societies, focusing on diseases with either a high mortality burden, such as CVD, neoplasms, and RD, or those experiencing increasing trends, such as hypertensive diseases.

Cognitive Reserve, Physical Reserve, and Cognitive Efficiency of Older People Living in the Sardinian Blue Zone. An Exploratory Study

This study mainly intended to disentangle the role played by physical reserve as a mediator of the relationship between cognitive reserve and global cognitive functioning in older people aging well. A sample of 120 67-101-year-old community-dwellers was recruited in the Sardinian Blue Zone, an area characterized by the extreme longevity of its inhabitants. Each respondent completed a battery of tests examining cognitive functioning, perceived physical health, cognitive reserve, and physical reserve (objectively assessed through accelerometric-derived measures). Significant associations were found among measures of cognitive reserve, physical reserve, perceived physical health, and cognition. Besides, two mediational analyses pointed out that physical reserve and distinct indexes of cognitive reserve explained 18% and 32% of the variance associated with global cognitive functioning. In conclusion, the combination of high cognitive reserve and more preserved motor functioning seems to contribute to the maintenance of healthy cognition in older people aging well.

Redefining Age-Friendly Neighbourhoods: Translating the Promises of Blue Zones for Contemporary Urban Environments

The longevity and healthy ageing observed in Blue Zones offer valuable insights for contemporary urban neighbourhood planning and design. This paper reviews the age-friendly features of the built environment in Blue Zones, aiming to translate these insights into actionable strategies for urban neighbourhood development. Employing a systematic literature review and Convolutional Neural Networks (CNNs) analysis of Google Street View imagery, this study assesses the built environments in Blue Zones, including housing, public spaces, and transportation systems. Key findings highlight the presence of adaptable housing, building designs that foster a connection with nature, and semi-public spaces that encourage social interaction and physical activity. A notable emphasis on walkability and limited public transport access was observed. The CNN analysis corroborated these findings, providing a quantitative view of age-friendly features. This research contributes to the academic discourse in urban planning and design by providing practical insights for developing age-friendly neighbourhoods, inspired by Blue Zones. It concludes by offering policy advice and future research directions for creating sustainable and inclusive urban environments conducive to ageing populations.

Using Ecological Momentary Assessments to Study How Daily Fluctuations in Psychological States Impact Stress, Well-Being, and Health

Despite great interest in how dynamic fluctuations in psychological states such as mood, social safety, energy, present-focused attention, and burnout impact stress, well-being, and health, most studies examining these constructs use retrospective assessments with relatively long time-lags. Here, we discuss how ecological momentary assessments (EMAs) address methodological issues associated with retrospective reports to help reveal dynamic associations between psychological states at small timescales that are often missed in stress and health research. In addition to helping researchers characterize daily and within-day fluctuations and temporal dynamics between different health-relevant processes, EMAs can elucidate mechanisms through which interventions reduce stress and enhance well-being. EMAs can also be used to identify changes that precede critical health events, which can in turn be used to deliver ecological momentary interventions, or just-in-time interventions, to help prevent such events from occurring. To enable this work, we provide examples of scales and single-item questions used in EMA studies, recommend study designs and statistical approaches that capitalize on EMA data, and discuss limitations of EMA methods. In doing so, we aim to demonstrate how, when used carefully, EMA methods are well poised to greatly advance our understanding of how intrapersonal dynamics affect stress levels, well-being, and human health.

Is Cognitive Reserve a Determinant of Functional and Mental Health in Older People of the Sardinian Blue Zone? A Mediational Approach

The main purpose of this study was to examine the mediating role of cognitive reserve in the relationship between functional health (expressed through the amount and intensity of performed physical activity objectively assessed using wearable accelerometers) and psychological well-being (i.e., assessed in terms of self-reported depressive signs) of older people living in an area of exceptional longevity, the so-called Sardinian Blue Zone. A further goal was to investigate the impact of gender on the cognitive reserve and physical health of our participants, using global cognitive functioning as a covariate. A battery of tests assessing motor efficiency, cognitive reserve, global cognitive functioning, and self-reported depressive symptoms was individually presented to 120 community dwellers (Mage = 82 years, SD = 8.4 years) of the Sardinian Blue Zone. Significant associations were found between cognitive reserve, motor efficiency, and self-reported depressive signs. Moreover, three mediation analyses documented that distinct indexes of cognitive reserve and motor efficiency explain 27.2-31% of the variance in the self-reported depression condition. Following this, it was also found that people with scarce cognitive reserve tended to exhibit significant signs of depression and showed worse motor abilities. In addition, after controlling for the effect of global cognitive functioning, motor efficiency, and cognitive reserve were generally more preserved in males than in females. Overall, these findings suggest that cognitive reserve is a compensatory resource that contributes significantly to the enhancement of health-related quality of life in the last decades of life.