Redefining Health and Well-being in America’s Aging Population
Research at the University of Chicago provides new perspectives on how to define the health and well-being of aging Americans and presents a sharp departure from the traditional biomedical model’s reliance on a checklist of infirmities centered on heart disease, cancer, diabetes, high blood pressure, and cholesterol levels.
The work, part of the National Social Life, Health, and Aging Project (NSHAP), supported by the National Institute on Aging of the National Institutes of Health is a major longitudinal survey of a representative sample of 3,000 people aged 57 to 85 done by the independent research organization NORC at the University of Chicago.The study yielded comprehensive new data about the experience of aging in America that formed the underpinning of the research and its conclusions.
Using what they call a “comprehensive model” of health and aging, the team has shown how other factors such psychological well-being, sensory function, mobility and health behaviors are essential parts of an overall health profile that better predicts mortality.
The research concludes that many people currently classified as healthy under the biomedical model in fact are not, and many seen as unhealthy are in much better shape when the additional factors in the comprehensive model are included. The comprehensive model reflects a definition of health long advanced, but little studied, by the World Health Organization that considers health to include psychological, social, and physical factors in addition to the diseases that are the basis for the current medical model of health.
The newly published research may well have an impact on everything from the nature of older people’s conversations with their doctors to health policy, researchers said. It is based on the results of a major longitudinal study of aging Americans, funded by the National Institute on Aging, that is the first of its kind to collect this sort of information from a scientifically-selected group of people chosen randomly to represent aging among the entire older U.S. population. Noteworthy is the finding that chronological age itself plays almost no role in accounting for differences in older people’s health and well-being.
Instead of looking only at chronic diseases, such as heart disease and other organ decline in aging, the comprehensive model includes many other dimensions, that collectively yield six new classes of well-being for judging the health of older individuals. The results appear in “An Empirical Redefinition of Comprehensive Health and Well-being in the Older Adults of the US” published in the current issue of the Proceedings of the National Academy of Sciences.
The multidisciplinary UChicago team includes the lead author and biopsychologist Martha McClintock, the David Lee Shillinglaw Distinguished Service Professor in Psychology; geriatrician William Dale, Associate Professor of Medicine, Chief, Section of Geriatrics & Palliative Medicine at University of Chicago Medicine; sociologist Edward Laumann, the George Herbert Mead Distinguished Service Professor in Sociology; and demographer Linda Waite, the Lucy Flower Professor in Urban Sociology.
Highlights of the research include:
- Cancer by itself is not related to other conditions that undermine health.
- Chronological age itself plays little or no role in accounting for differences among older people’s health status.
- Poor mental health, which afflicts one in eight older adults, undermines health in ways not previously recognized.
- Obesity in older adults with excellent physical and mental health, seems to pose very little risk.
- Sensory function and social participation play critical roles in sustaining or undermining health.
- Having broken a bone since age 45 is a major marker for future health issues in people’s lives.
- Older men and women have different patterns of health and well-being during aging.
- Mobility issues are one of the best markers of well-being.
“The new comprehensive model of health identifies constellations of health completely hidden by the medical model and reclassifies about half of the people seen as healthy as having significant vulnerabilities that affect the chances that they may die or become incapacitated within five years,” said McClintock.
“At the same time, some people with chronic disease are revealed as having many strengths that lead to their reclassification as quite healthy, with low risks of death and incapacity,” Waite added.
Six new ways of looking at aging
The comprehensive model’s first category had the highest levels of measured and personally assessed physical and mental health compared to all other groups, and represented 22% of older Americans. This group was typified by higher obesity and blood pressure, but had fewer organ system diseases, better mobility, sensory function, and psychological health. They had the lowest prevalence of dying or becoming incapacitated (six percent) five years into the study.
A second category had normal weight, low prevalence of cardiovascular disease and diabetes, but had one minor disease such as thyroid disease, peptic ulcers, or anemia. Although not causes of death, the conditions could be harbingers of danger that require more attention. People in this group were more than twice as likely to have died or become incapacitated five years after the initial survey than people in category one.
Two emerging vulnerable classes of health traits, completely overlooked by the medical model, included 28 percent of the older population. One group included people who had broken a bone after age 45. A second new class had mental health problems, in addition to poor sleep patterns, engaged in heavy drinking, had a poor sense of smell and walked slowly, all of which correlate with depression. Both groups had moderate risks of dying or becoming incapacitated within five years of the initial survey.
The most vulnerable older people were in two classes, one characterized by immobility and uncontrolled diabetes and hypertension. This group was more likely to have morbid obesity, cardiac, lung, and liver disease, but only moderate risk (19%) of dying or being incapacitated within five years. The most vulnerable class had multiple illnesses and many other problems, were quite frail, and fully 44% either died or became incapacitated by the time of the second interview. A majority of people in each of these categories were women, who tend to outlive men.
Implications for seniors—or older adults
The study points for a need for revising the nature of patient/doctor conversations during yearly medical checkups, the authors note. “From a health system perspective, a shift of attention is needed from disease-focused management, such as medications for hypertension or high cholesterol, to overall well-being across many areas,” said Dale.
“Instead of policies focused on reducing obesity as a much lamented health condition, greater support for reducing loneliness among isolated older adults or restoring sensory functions would be more effective in enhancing health and well-being in the older population,” said Laumann.
Important new survey provides better look at aging
Unlike studies that look at groups of people with similar medical conditions, the research is the first of its size and scope to look at a group of people scientifically selected to represent the entire population of older Americans with the intent to characterize their overall health and well-being.
In conducting the study, NORC gathered data from individuals who were tested not only for medical conditions, such as high blood pressure, but also 35 different aspects of their health behaviors, psychological well-being and physical functioning not covered by the medical model. The people were first interviewed in 2005, were interviewed again in 2010, and are currently undergoing a third round of interviews.
The research team used its data to study the traditional medical model and found that it overestimates the influence of some factors, such as obesity, which is not a particularly dangerous condition among people who are healthy, active and socially connected, the team found. It also highlights diabetes and hypertension as the diseases best discriminating types of aging patterns, rather than cancer.
The new approach, which takes medical, psychological, functional abilities and lifestyle factors into account, yields a more accurate view of health among aging Americans. The size of the research sample and the depth of the data enables this new look at an age-old question. “Taking a broad definition of health seriously, and empirically identifying specific constellations of health and comorbidities in the US population, provides a new way of assessing health and risk in older adults living in their homes, and thereby may ultimately inform health policy,” the authors write.
Research reported in this news release was supported by the National Institute on Aging of the National Institutes of Health under award number R01AG021487; R37 AG030481;R01AG033903. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health."
About NORC at the University of Chicago
NORC at the University of Chicago conducts research and analysis that decision-makers trust. As a nonpartisan research organization and a pioneer in measuring and understanding the world, we have studied almost every aspect of the human experience and every major news event for more than eight decades. Today, we partner with government, corporate, and nonprofit clients around the world to provide the objectivity and expertise necessary to inform the critical decisions facing society.
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