9/11: Healthy Aging 

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Happy September! Happy National Healthy Aging Month!

Healthy Aging

The United States is an aging country, and healthy aging is a national priority to help older adults live longer and healthier. (Office of Disease Prevention and Health Promotion, 2023) September is National Healthy Aging Month. Healthy Aging Month is an annual observance month designed to focus global attention on the positive aspects of growing old. The mission of Healthy Aging Month is to encourage local Healthy Aging events that promote taking personal responsibility for one’s health (physical, social, mental, or financial). (Office of Disease Prevention and Health Promotion, 2022)

This week, we will learn why healthy aging matters, the definition of healthy aging and its domains, and how we can be well as we age.

Why Healthy Aging Matters

The older population is increasing fast all over the world. Today, 10% of people worldwide are 65 and over. (Statista Research Department, 2022) According to the United Nations (UN) standards, if the population of people over 65 is more than 7% of the whole population in a region/country, it is considered an aging society.

As previously stated, United States is an aging country. In 2021, 16.8% of people were aged 65 and over. Number of Americans over the age 65 is projected to nearly double from 52 million in 2018 to 95 million by 2060, and the 65 and older age group’s share of the total population will rise from 16% to 23%. For the first time, in 2034 the population of older adults will outnumber children in U.S. history. (United States Census Bureau, 2018)

California is projected to be one of the fastest growing states in the nation in total population. The population over 60 will have an overall increase of 166% from 2010 to 2060. More than half of the counties will have over a 100% increase in this age group. Twenty-four of these counties will have growth rates of over 150%. These counties are located throughout the central and southern areas of the state. Influence of the 60 and over age group on California is expected to emerge most strongly between 2010 to 2030. (California Department of Aging, 2023)

As the older adult population increases, they will face many health issues. For example:

●     In 2018, among 52 million older adults, 36 million of them experienced falls, and 8 million had some injuries.

●     It is estimated that in 2030, the population of older adults will be 74 million, and more than half of them (52 million) will experience falls, and 12 million will report injuries, such as hip fractures, if we do not have a program to promote their health. (National Center for Injury Prevention and Control, 2016)

The infographic below shows facts about falls.  Source:  CDC/Falls

The increase in the older adult population and related health issues will impact the costs of healthcare. Annual costs of falls and Alzheimer’s disease were $50B and $214B per year in 2014 respectively. If we cannot stem the rate of increase in falls, Alzheimer’s, or any other disease, it is projected that the costs will increase. In fact, the lives of all on an individual and community level will be influenced worldwide including the U.S. (Florence et al., 2018), (Alzheimer's Association, 2014)

2014 Alzheimer's disease facts (source)

Thus, improving the lives of older people, their families, and the communities in which they live is important, and global collaboration is necessary. The United Nations Decade of Healthy Aging (2021-2030) is a global collaboration to bring together governments, civil societies, international agencies, professionals, academia, the media, and the private sector to promote healthy aging globally. (World Health Organization, 2021)

World Health Organization (WHO) is the leading authority for health within the United Nations and responsible for providing leadership on global health matters. WHO’s justification to act on aging and health is the human right. Older people have the right to the highest attainable standard of health to fulfill a healthy life. The right to health is an inclusive right to access timely and appropriate health care, access to the underlying determinants of health, such as food and nutrition, housing, safe and potable water and adequate sanitation, safe and healthy working conditions, and a healthy environment. High quality and sufficient quantity of effective public health and healthcare facilities, goods, and services should be available and accessible for older people without any discrimination to improve the quality of life and support independent living. Also, fostering sustainable development and minimizing the expenditures associated with the older population are the key justifications for acting on aging and health. (Beard & Sadana, 2015)

Aligned with WHO, Equity in Aging Resource Center of the California Department of Aging works to provide all Californians access to opportunities and services to age well regardless of age, disability, race, ethnicity, immigration status, religion/faith, income, geography, sexual orientation, gender identity, language, or family status. (Equity in Aging Resource Center, 2023)

Video: A look at the Decade of Healthy Aging 2021-2030 in the Americas by Pan American Health Organization (PAHO)

Video: A look at the United Nations Decade of Healthy Aging (2021-2030) 

What Is Healthy Aging?

Having the opportunity to live long and healthy is a right for all people in the world. Living longer does not always mean a healthy life in old age. We want to live long in good health without activity limitations. The World Health Organization (WHO) defines healthy aging as “the process of developing and maintaining the functional ability that enables wellbeing in older age.” Functional ability, which is the key term in this definition, is about having the capabilities that enable all people to be and do what they have reason to value. This includes a person’s ability to:

● meet their basic needs.

● learn, grow, and make decisions.

● be mobile.

● build and maintain relationships.

●     contribute to society.

Functional Ability:  

The definition highlights that functional ability is more important than just focusing on the absence of diseases. It is shifting from disease-centered to function-centered. In other words, being free of diseases is not required for healthy aging, as many older adults have one or more health conditions. In fact, as long as they are able to control their health conditions well with little influence on their overall well-being, they have the capabilities to be and do what they have reason to value. (World Health Organization, 2020)

Functional ability is determined by three components: intrinsic capacity, environmental factors, and the interactions between them. 

1. Intrinsic capacity is defined by WHO as “all physical and mental capacities that people can draw on at any point in time”. It consists of cognitive, psychological, mobility, vitality, and sensory capacities. 

a. Cognitive capacity refers to the ability to perform mental functions such as learning, thinking, reasoning, remembering, problem solving, decision making, and attention. 

b. Psychological capacity refers to emotional and affective functions such as feeling, sensation, and intuition, with emphasis placed on depression. 

c. Mobility refers to the ability to move freely and easily. It's a foundation for living healthy and independently. 

d. Vitality refers to an individual's energy and equilibrium, and nutrition is a key factor for its maintenance. It is considered the underlying physiological determinant of intrinsic capacity and identified by energy metabolism, neuromuscular function, immune and stress function. (Ashikali et al., 20230) (Bautmans et al., 2022). 

e. Sensory capacity refers to the ability to receive stimuli, respond to it, and interact with the environment through the five senses of hearing, vision, taste, smell, and touch. (Nurse Key, 2017) Sensory function is the ability of an older person to do daily activities, participate in important physiologic and social functions such as personal interaction (hearing and vision), nutrition (smell and taste), and mobility (vision, touch, and balance), (Pinto, et al., 2014), (Cesari et al., 2018)


WHO focuses on the concept of functional ability as the center of healthy aging rather than the absence of disease. 

In this holistic approach, healthcare providers do the comprehensive assessment of different domains of intrinsic capacity of individuals to do early intervention and enhance their functional ability. Individuals have supporting behavioral modifications toward a healthy lifestyle to achieve the peak of their physical and mental capacities and higher quality of life. (Cesari et al., 2018), (Abud et al., 20220)

 

Video:  Learn more about Intrinsic Capacity

Five domains of intrinsic capacity:

The five domains (i.e., locomotion or mobility, sensory, cognition, psychological, vitality) constitute the intrinsic capacity construct. Examples of possible subdomains are also provided. (Cesari et al., 2018)

How We Can Be Well as We Age

As previously discussed, the older population is growing due to increasing life expectancy. Life expectancy is defined by WHO as "the average number of years that a newborn could expect to live, if he or she were to pass through life exposed to the sex and age specific death rates prevailing at the time of his or her birth, for a specific year, in a given country, territory, or geographic area". (World Health Organization, 2023) This simply means how long an individual can expect to live. Life expectancy has increased around the world because of declining premature death rates due to better health. You can see global life expectancy increases in the chart below. It shows life expectancy doubled around the world from 1770 to 2019:

● In Oceania from 35 to 79 years

● In Europe from 34 to 79 years

● In the Americas from 35 to 77 years

● In Asia from 27.5 to 73.6 years

●     In Africa from 26 years to 63 years (Roser et al., 2013)

The United States of America is ranked 47th among the countries in the world by life expectancy in 2023. The average life expectancy for both sexes in 1955 was 69.5 years, and by 2023 it increased to 79.74 years. (Wordometer, 2023)

Higher life expectancy means people are living longer. Living longer can be viewed in two ways:

● Adding years to life means increasing life expectancy.

●     Adding life to years means HEALTHY life expectancy which leads to aging well.

Healthy Life Expectancy

Healthy life expectancy is the years of life in good health for a person at any given age. WHO reported that between 2000-2019 life expectancy has increased six years from 66.8 years to 73.4 years globally, and in the United States of America, it has improved 1.8 years from 76.7 years to 78.5 years. While healthy life expectancy has increased 8% from 58.3 to 63.7 worldwide, in the U.S., it has improved 0.318 years from 65.8 years to 66.1 years. Data shows that the increase in healthy life expectancy is lower than the increase in life expectancy. The reason for the lower increase in healthy life expectancy is decreasing death rates due to better hygiene and lower risk of infectious disease and increasing risks of age-related losses such as seeing, hearing, and moving and developing Non-Communicable Chronic Diseases (NCDs) such as diabetes, heart disease, stroke, chronic respiratory disorders, cancers, falls, osteoarthritis, dementia which negatively affect the functional ability to live healthy with age.

Non-Communicable Chronic Diseases, Risk Factors, and Prevention Strategies


As we learned, healthy aging does not mean living in the absence of diseases. Instead, healthy aging focuses on living well and enhancing functional ability even in the presence of diseases. Thus, improving physical and mental capacities through strategies to reduce risk factors and provide high-quality health services to prevent and manage NCDs and age-related changes is essential for health at older ages. (Budreviciute et al., 2020) Picture below shows the list of NCDs.

Classifying NCD Risk Factors

NCDs risk factors can be classified in two different ways:  Classifying into five categories OR Classified as non-modifiable and modifiable

Classifying into five categories

Five categories of risk factors:

o   Self-management

 o   Genetic 

o   Environmental 

o   Medical conditions 

o   Socio-demographic


Best prevention management strategies for these categories include:


1. Individual (lifestyle management)

2. Societal (awareness management)

3. National (health policy decisions)

4. Global (health strategy)


Lifestyle management is the most effective strategy in which individuals can make healthy choices in all aspects of their lives and develop healthy behaviors to maintain and optimize their intrinsic capacities and functional abilities which benefit preventing, postponing, or managing chronic conditions. (Budreviciute et al., 2020) 

Picture below shows five risk factors of NCDs.

Classifying as non-modifiable or modifiable

Modifiable vs non-modifiable:


 Non-modifiable risk factors such as age, gender, race, and family history are non-changeable. 

 Modifiable or personal behavioral risk factors that can be changed or controlled in everyday lifestyle include insufficient physical activity, unhealthy diet, tobacco use, and harmful use of alcohol. Also, behavioral risk factors can lead to other four metabolic/physiological risk factors: raised blood pressure and total cholesterol, elevated glucose, overweight, and obesity. (World Health Organization,2023)


Therefore, lifestyle management and personal behavior modifications are crucial to prevent NCDs. In other words, having a healthy lifestyle maintains intrinsic capacities and functional ability and reduces the risk of diseases. 

Picture below shows the four modifiable or personal behavior factors for NCDs.

World Health Organization’s Program for Healthy Aging


WHO is responsible for setting norms and standards and offers Integrated Care for Older People (ICOPE). ICOPE is an older person centered and integrated community settings program to prevent or delay the onset of losses in intrinsic capacity by modifying risk factors. ICOPE guidelines provide interventions to prevent visual and hearing loss, mobility loss, malnutrition, cognitive impairment, and depressive symptoms. For example, highly intensive strength training is the key intervention necessary to prevent and reverse mobility impairments, but it also indirectly protects the brain against depression and cognitive impairment and prevents falls. Nutrition enhances the effects of exercise and has a direct impact on increasing muscle mass and strength. (World Health Organization, 2017)

Video:  A look at the WHO ICOPE program

Review of Literature Related to Lifestyle Changes and Healthy Aging


A systematic review and meta-analysis aimed to analyze preventive interventions for older adults using the WHO framework (ICOPE). The analysis of studies that met the inclusion criteria showed international recommendations on interventions to maintain and prevent declines in sensory, mobility, cognitive, vital, and psychological capacities. According to the results, the recommended intervention for sensory capacities was routine screening for vision and hearing to provide comprehensive eye care for visual impairment and hearing aids for management of hearing loss. A wide range of physical activities such as water-based physical exercises, mind–body and multimodal exercises, dance, exercise via video games, home visits, and interventions aiming to reduce sedentary behavior was recommended for maintaining mobility capacity. Interventions for cognitive capacity included physical exercise programs such as resistance training, yoga, and aquatic exercises, mind-stimulating activities such as intergenerational communication, playing instruments, and meditation. Recommendation for maintaining vital capacity was a healthy diet. Music and singing, continued education and learning, and cognitive behavioral therapy were effective interventions for psychological capacity. Researchers concluded that choosing a healthy lifestyle by older adults and providing a wide range of accessible activities by the community are crucial for healthy aging. (Ashikali et al., 2023)

Results of a 36-year prospective cohort study among 85,346 people from 1984-2020 in the U.S. showed that the participants who maintained a normal body mass index, never smoked, ate a healthy diet, and had physical activity levels and alcohol consumption that met public health recommendations, achieved maximum longevity with no diagnosis of cardiovascular disease, type 2 diabetes, or cancer. (Ding et al., 2021)

A longitudinal study aimed to determine the effect of healthy lifestyle factors on the average number of years lived with and without heart failure (HF) among older men and women. In conclusion, they found that total life expectancy and years lived without HF have increased by eating healthy, being physically active, not smoking, having a healthy weight, and having low alcohol use. (Limpens et al., 2022)

The objective of a prospective cohort study among 2,449 men and women aged 65 years and older was to determine the impact of lifestyle factors on life expectancy lived with and without Alzheimer’s dementia. Results showed that older adults with healthy lifestyles including diet for brain health, moderate or vigorous physical activity (≥150 min/week), cognitive activities, no smoking, and light to moderate alcohol consumption (women 1-15 g/day; men 1-30 g/day) had longer expectancy and lived a larger part of their remaining years without Alzheimer’s dementia. (Dhana et al., 2022)

The graph below shows the overall life expectancy and life expectancy with and without Alzheimer’s dementia according to categories of lifestyle score in women and men. A behavior was classified as low risk or healthy if it met several criteria: Mediterranean-DASH Diet Intervention for Neurodegenerative Delay—MIND score (without alcohol) >7.5, corresponding to upper 40% of cohort distribution; cognitive activity score >3.43, corresponding to upper 40% of cohort distribution; not being a current smoker; moderate or vigorous exercise for ≥150 min/week; and light to moderate alcohol consumption (1-15 g/day for women and 1-30 g/day for men).


Results of a retrospective cohort study in Japan showed that changes in health-related lifestyle habits including exercise, diet, sleep, and rest improve purpose in life. Researchers concluded that a higher sense of purpose in life is achievable through positive lifestyle changes. (Kinoshita et al., 2020)

Tips for Healthy Aging

Many factors can influence healthy aging. As we learned some of these factors are unchangeable, such as genetics. While we can control some of them by lifestyle modification. Studies show that even small changes in personal health behaviors help us live longer and better.

Some tips to boost your health as you age:

● Exercise regularly.

● Sleep well.

● Get regular checkup for vision and hearing.

●     Stay in touch with family and friends.

● Maintain a positive attitude and manage stress.

● Keep your curiosity alive.

● Talk to your health care provider if you feel depressed.

● Don’t smoke (University of California San Francisco, 2023).

●     Limit alcohol (all adults aged 65 and older: no more than 1 drink a day and no more than 7 drinks per week) (National Center for Health Promotion and Disease Prevention, 2023).

You will be successful in changing your lifestyle if you start with small changes, focus on one behavior at a time and get support from others. (American Psychological Association, 2023)

Summary

We are living longer due to increasing life expectancy. We want to live healthy with age. Healthy aging is a right for all of us. Maintaining and improving physical and mental health, independence, and quality of life in later stages of life means healthy aging. Everybody can experience healthy aging as long as their functional ability enables them to be and do what they have reason to value. Healthy lifestyle is the key to healthy aging. In other words, lifestyle management and personal behavior modifications are crucial to maintain functional ability, reduce risk of non-communicable chronic diseases, and live healthy and independently with age.

 

We are living longer. We need to practice healthy aging by regularly exercising, eating healthy foods, getting regular health screenings, and participating in social activities. 

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