Monitoring individuals’ health status while they are aging is extremely important to know how they are doing and feel here and now, and to forecast future medical and care needs. The goal for individuals and societies would be to postpone as much as possible disability and frailty. However, aging is a complex phenomenon and different factors impact in different ways on how we age. While time passes at the same rate for all individuals, the accumulation of diseases and disabilities occurs at different speeds for different persons. This means that there are people that get “biologically older” earlier than others, and individuals that “stay young” for many more years than their peers. For example, while some 80-year-olds may enjoy good physical and mental functioning, others may be frail, suffer from a high disease burden, and require significant support in their daily life. This is common experience. Moreover, older people with equal health status at earlier ages may experience different health changes over time, and their needs of medical and social care may diverge from what would be expected. Consequently, the health of the older population can be viewed as a continuous and dynamic process that needs to be assessed regularly over time – paying attention to any changes.
Researchers working at the Aging Research Center of Karolinska Institutet have developed a tool to measure and monitor over time the global health status of an individual. It is called HAT (Health Assessment Tool) and is based on the assessment of five parameters: chronic diseases, gait speed, cognitive function, disability in basic and instrumental activities of daily living. In a recent study (1), a group of researchers from KI, led by dr. Amaia Calderón-Larrañaga and dr. Davide Vetrano, have recently used HAT to identify the most common health trajectories in a sample of more than 3,000 individuals older than 60, participating in the SNAC-K study (Swedish National Study on Aging and Care in Kungsholmen). Three mainstream trajectories have been identified. The first trajectory (green line in the figure) – the healthiest – was displayed by 78% of the population and was characterized by a slow health decline until the age of 80 and a faster decline afterwards. The second health trajectory (yellow line) encompassed 18% of the population and was characterized by a faster decline across the decades. Finally, a third trajectory (red line), characterized by a steep health decline, was displayed by 4% of the population. When subjects in the worst and middle trajectories were compared with those in the best trajectory, researchers found that people in the worst trajectories became disable 12 years earlier than the others, and that died on average 4 years earlier. In other words, older adults developing diseases and functional impairments faster will experience a earlier reduction in both the duration and quality of life.
Researchers went on and explored which socioeconomic, psychosocial and behavioral factors were associated with the three identified health trajectories. They found that subjects in the two worst health trajectories had more frequently financial difficulties and a low education attainment. Moreover, they had poorer social interactions and presented more frequently with obesity, sedentary behaviors and smoking habit. Interestingly, all these health determinants are somewhat modifiable and, whenever improved, they might change the health status of older people, making them experiencing more longer and healthier lives. Based on available data, researcher estimated that by improving physical activity levels about one third of the individuals belonging to the worst trajectories would move to the best trajectory. Similarly, improving the education level of those in the worst trajectories would make 20% of them experiencing a better health. Finally, preventing individuals from social isolation would increase the health status of 15% of those belonging to the worst health trajectories.
As suggested by more and more scientific studies, and by the observation of the health trends of the last decades, poor health is not an inevitable consequence of survival to older ages. As shown by this study, a number of factors linked to individuals’ health-related behaviors and social context, such as physical activity, financial strain, social participation, education, social connections, and obesity lead to important variations in older peoples’ health trajectories. By intervening on all these factors throughout life, seven out of ten people in the poorest health trajectories could be steered towards a healthier ageing. Addressing the social determinants of health in its broadest sense, complementarily considering life-long factors belonging to the socioeconomic, psychosocial, and behavioral dimensions, should be central to any public health strategy aimed at fostering health in older age.
Figure (to see the original at: https://www.aging-us.com/article/203407/text)
Health trajectories identified in the SNAC-K population by observing 3,363 subjects for 12 years. The green line represents the healthiest trajectory, the yellow line represents the declining health trajectory and the red line represents the fast declining health trajectory.
(1) Referred article
- Calderón-Larrañaga A, Hu X, Haaksma M, Rizzuto D, Fratiglioni L, Vetrano DL. Health trajectories after age 60: the role of individual behaviors and the social context. Aging (Albany NY). 2021 Aug 12;13(undefined). doi: 10.18632/aging.203407. Epub ahead of print. PMID: 34383709. https://www.aging-us.com/article/203407/text
By Amaia Calderón-Larrañaga, MPHD PhD
Assistant Professor at the Aging Research Center, Karolinska Institutet, Sweden
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