May 20, 2016
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Comprehensive model reveals half of older population in vulnerable health

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Although the dominant, disease-centered medical model of assessing health asserts that two-thirds of older adults are among the “robust health” classes, a comprehensive model, taking into account mental health, sensory function and past broken bones, among others factors, reveals that one-half belong to less healthy classes, according to researchers at the University of Chicago.

The researchers, working as part of the National Social Life, Health and Aging Project, supported by the NIH National Institute on Aging, also concluded that age itself plays almost no role in accounting for differences in older people’s health and well-being. Their findings are published in Proceedings of the National Academy of Sciences.

“In 1946, the World Health Organization (WHO) defined health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,’” Martha McClintock, PhD, of the Institute for Mind and Biology at the University of Chicago, and colleagues wrote. “In 1977, George Engel built on this definition, calling for a new biopsychosocial model. It integrated traditional medicine with psychosocial factors, which stimulated the field of psychosomatic medicine. These ideas have been honored more as an ideal than in practice.”

To apply this comprehensive definition to the state of health among older adults in the United States, the researchers conducted a longitudinal survey of 3,005 people aged 57 to 85 years. Surveys included a personal interview, a self-administered questionnaire and anthropometric, clinical and physiological measures.

They first applied latent class analysis to model 54 health variables from the National Social Life, health and Aging Project. The researchers then applied the analysis to the medical model, identifying five health classes differentiated largely by having diabetes and hypertension, they wrote. The comprehensive model had a broader range of six health classes, including two new classes — healed broken bones and mental health.

According to the researchers, physiological well-being, sensory function, mobility and health behaviors are essential parts of an overall health profile that better predicts mortality. Additional findings include:

  • Cancer by itself is not related to other conditions that put health at risk;
  • Poor mental health, which affects one in eight older adults, undermines health in ways not previously recognized;
  • Obesity poses little risk to older adults with otherwise excellent physical and mental health;
  • Sensory function and social participation play critical roles in sustaining or undermining health;
  • Having a broken bone since age 45 is a major risk factor for future health issues;
  • Older men and women have different patterns of health and well-being as they age; and
  • Mobility is one of the best markers for well-being.

“In defining health in older adults, medicine traditionally focuses on absence of chronic diseases of major organ systems; those without diabetes, cancer or cardiovascular, kidney liver or pulmonary disease are generally considered healthy,” McClintock and colleagues wrote. “… When applied to the population of older adults in the United States, this standard [medical model] identifies about two-thirds of the older U.S. population as generally healthy, with no diseases of major organ systems. However, a closer look that includes health behaviors, psychological health, sensory function, neuroimmunity and frailty paints a very different picture.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.