Do you consider yourself healthy because you’re not that old, have few or no chronic conditions and haven’t gained too much weight as you’ve aged? We’ve got news: You may be among the 50 percent of seniors who should be reclassified as having significant health vulnerabilities. And your obese neighbor who’s ten years older and a cancer survivor may actually be healthier than you (or she) thinks.
The traditional medical model that’s been used to evaluate health—a model that checks off the number of diseases you have and deems you healthy or not — isn’t a good barometer, says a team of University of Chicago researchers. Nor is age.
The team recently published a paper redefining “health” in older adults, based on findings from a major, first-of-its-kind longitudinal survey.
A comprehensive model of health that takes into account not only medical conditions, but also many other factors including social connections and state of mind, is a more accurate indicator of how healthy you are and more clearly predicts how you’ll fare over the next few years. The model isn’t entirely new — the World Health Organization has been using it for some time — but it does run counter to the model that the U.S. medical establishment has been using.
Redefining “Health” in Older Adults
“I think the key thing is that these functional factors — things such as mental health, social relationships, mobility, sensory function, cognition — all of these things aren’t just ancillary aspects of health, they are a fundamental part of health,” says Martha McClintock, PhD, the David Lee Shillinglaw Distinguished Professor of Psychology at the university, who led the study.
McClintock’s team gathered information on 3,000 men and women ages 57 to 85. Five years later, they looked to see which factors were most important in predicting who would become incapacitated or die.
Among the findings, some surprised even McClintock’s team:
- Obesity by itself did not make older adults unhealthy if they had otherwise excellent mental and physical health.
- Having a broken bone since age 45 predicted future health issues.
- Sensory functioning—good eyesight, hearing, sense of taste—were critical for staying healthy. That doesn’t mean you have to maintain perfect sight or hearing, McClintock says. It means you can’t be in denial — you must be willing to use a hearing aid or eyeglasses.
- Mental health status is even more important to your general health than previously thought. Not just depression,but also loneliness and poor self-esteem are strong predictors of health problems.
- Mobility — being able to get out and about and connect with others — is one of the best predictors of ongoing health and well being.
- Cancer by itself does not predict whether you will be healthy or not in other aspects of health.
McClintock can’t explain all the findings with certainty. While osteoporosis can also lead to fractures, she says that having a broken bone later in life might reflect existing problems with the nervous system or muscles. Or — another hypothesis — since cytokines, which are an important part of the immune system, are involved in bone processes such as remodeling, the bone break may be a signal of existing immune system issues. If something’s awry with the ongoing bone remodeling process, that may up your risk of fractures, McClintock says.
As for cancer, since a history of the disease was not associated with people having other diseases or mental health problems, a cancer history didn’t automatically put people in an unhealthy category.
Mobility was found to be one of the best predictors of good health, and that’s no surprise, she says. ”You need it to live your life, to go shopping, to go out with friends for the evening, to get together with your walking group.”
Being Fat Isn’t So Bad for Your Health After All
As for obesity by itself not being a major predictor of disability or death for those in otherwise good health, she believes that health pluses— being socially connected and mentally healthy — may offset the ill effects of the obesity.
In fact, the healthiest group of people in the Chicago study were more likely to be overweight and have high blood pressure, but they had less incidence of heart, liver and other organ system diseases, were more mobile, had better sensory function and were psychologically healthier.
From a policy standpoint, this means our health system might do its job better if it spent less money on helping us lose weight, and more on reducing loneliness and covering hearing aids.
Is the Comprehensive Model Catching On?
Not quickly enough, in McClintock’s view. But you can find a doctor who doesn’t just look at your age and list of diseases, she says. A geriatrician may be most likely to be trained to treat multiple diseases while also realizing the importance of the other factors, she says.
If no geriatrician is available, she suggests looking for doctors from different specialties who are comfortable working as a team — an arrangement that’s becoming more common, she says.
A Personal Action Plan
Based on her research, McClintock offers this advice to maintain optimal health with age:
- Maintain a good social life
- Correct sensory problems such as hearing loss as quickly and as much as possible
- Take mental health issues such as depression and anxiety seriously and get help
- Maintain muscle mass as well as you can
- Don’t focus on your diseases. Keep them under control, but realize that other factors can offset the ill effects of your conditions.
The study was published online May 16 in the Proceedings of the National Academy of Sciences.
Given this comprehensive model, how’s your health?