In this paper (https://doi.org/10.1016/s2468-2667(20)30093-1), which is a comment on the article “Education and wealth inequalities in healthy ageing in eight harmonised cohorts in the ATHLOS consortium: a population-based study” (https://doi.org/10.1016/s2468-2667(20)30077-3), we highlight several points and recommendations related to future research on health inequalities in ageing, as described below:
- Efforts must focus on harmonising longitudinal studies of ageing and establishing a minimum subset of health measures to increase the robustness of cross-population comparisons. In this regard, a shift is needed towards multidimensional and longitudinal measures of health, rather than focusing on single diseases and specific time-windows.
- Appropriate methods ought to be applied to account for the varying nature of health measures. Indicators of disease and function are diverse in terms of the applied scale (i.e., natural, such as grip strength vs normative-clinical, such as chronic condition count), potential floor and ceiling effects (e.g., Mini Mental State Examination score), and skewness (e.g., basic and instrumental activities of daily living).
- A nuanced approach to the study of health changes in later life requires an improved discernment between diverse health trajectories in terms of rate and pattern of change, beyond the usual and successful ageing pathways. This will enable better capturing of interpersonal differences in intrapersonal change over time.
- Studying the impact of different life-long social determinants on longitudinal health changes in old age, beyond their effect on measures of diseases of survival, is a necessary step to improve our understanding of the great heterogeneity across ageing-related health phenotypes.
- The effect of the social determinants of health should be understood and examined from a complementary rather than exclusionary perspective, given that social factors tend to influence each other, beyond their simultaneous effect on health.
- Only by achieving a full understanding of the social determinants of ageing trajectories of health and considering the multiple and intertwined paths through which poverty and social disadvantage affect health and ageing will we be able to inform interventions aimed at boosting wellbeing in later life.
Amaia Calderón-Larrañaga, MPHD PhD
Assistant Professor at the Aging Research Center, Karolinska Institutet, Sweden
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