A life-course approach to healthy ageing: maintaining physical capability

Abstract

Research on healthy ageing lacks an agreed conceptual framework and has not adequately taken into account the growing evidence that social and biological factors from early life onwards affect later health. We conceptualise healthy ageing within a life-course framework, separating healthy biological ageing (in terms of optimal physical and cognitive functioning, delaying the onset of chronic diseases, and extending length of life for as long as possible) from changes in psychological and social wellbeing. We summarise the findings of a review of healthy ageing indicators, focusing on objective measures of physical capability, such as tests of grip strength, walking speed, chair rises and standing balance, which aim to capture physical functioning at the individual level, assessing the capacity to undertake the physical tasks of daily living. There is robust evidence that higher scores on these measures are associated with lower rates of mortality, and more limited evidence of lower risk of morbidity, and of age-related patterns of change. Drawing on a research collaboration of UK cohort studies, we summarise what is known about the influences on physical capability in terms of lifetime socioeconomic position, body size and lifestyle, and underlying physiology and genetics; the evidence to date supports a broad set of factors already identified as risk factors for chronic diseases. We identify a need for larger longitudinal studies to investigate age-related change and ethnic diversity in these objective measures, the dynamic relationships between them, and how they relate to other component measures of healthy ageing. Robust evidence across cohort studies, using standardised measures within a clear conceptual framework, will benefit policy and practice to promote healthy ageing.

Fig. 1.

Life-course functional trajectories. A, normal development and decline; B, sub-optimal development resulting in reduced functional reserve at maturity; C, accelerated age-related decline; D, a combination of trajectories B and C.

Fig. 2.

Mean chair rise speed (stands/min) at ages 53 and 60–64 years by response status in the Medical Research Council National Survey of Health and Development.

Fig. 3.

Patterns of association between common clinical disorders and chair rise performance at 60–64 years in the Medical Research Council National Survey of Health and Development. ECG, electrocardiogram; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.

Fig. 4.

Differences in mean functional ageing score by number of clinical disorders in the Medical Research Council National Survey of Health and Development at age 60–64 years (sex adjusted).