Your health span: how to live a long and healthy life
Published: 29/07/2024 | Author: Julie Gunn
Progress in living standards and modern medicine mean that we live increasingly long lives. But at the same time, issues like more sedentary lifestyles and poor dietary choices mean that those later years may not be spent in good health – as many as 8 out of 10 older adults globally live with chronic disease as a result. Learn why your health span matters, and some of the actions you can take to extend yours – to live not just a long life, but to be healthy and active in your old age.
A greying population
There has been much discussion in recent decades about the demographic change termed the "greying population" in reference to the increasing proportion of older adults in society. The number of people aged 60 years and older currently outnumber children under 5 years old, and by around 2050, the number of people aged 65 years and older will increase by up to 25%, and outnumber those aged 25 years and younger. This demographic change is primarily due to declining birth rates and longer life expectancies.
While living longer intuitively seems to be a good thing, if these extra years are lived in poor health, there are obvious negative impacts on the individual’s quality of life, as well as broader societal impacts including increased demand for healthcare services, pension systems, and geriatric care.
Health span vs. lifespan
Ideally, we should aim to extend health span in parallel with extending lifespan. Health span is broadly defined as the period of life spent in good health, free from the chronic diseases and disabilities of ageing In popular culture, this distinction between health span and lifespan is now often stated as a desire to “add life to our years rather than years to our lives”.
An unfortunate reality is that many older adults live with a chronic disease such as cardiovascular disease, diabetes, cancer, arthritis and dementia, among others. Estimates vary from country to country, but typically 8 out of 10 older adults live with at least one of these conditions, and as many as half of older adults live with two or more.
The healthy ageing concept
Consequently, promoting healthy ageing has become a major focus of research, practice and policy around the world. The World Health Organisation defines healthy ageing as the process of developing and maintaining the functional ability that enables wellbeing in older age. In other words, healthy ageing is a lifelong process that begins early in life.
A practical and dynamic definition of health also includes an individual's ability to adapt and self-manage in the face of social, physical, and emotional challenges, and shifts the focus to how individuals can maintain quality of life despite health issues, acknowledging the strengths and capabilities of those living with chronic conditions.
The influence of lifestyle on healthy ageing
There is little doubt about the importance of lifestyle choices in preventing chronic diseases and supporting healthy ageing. Many lifestyle-related chronic diseases are arguably preventable, or at least their onset can be delayed (i.e. extending health span) through good practices around diet, physical activity, sleep, stress management, and social connections. These practices can be thought of as both those that support healthy ageing from early life, and those that can be changed later in life to address the changing needs of the older adult.
Dietary habits to support healthy ageing
Dietary patterns can vary from region to region, and there appears to be much controversy in the public conversation about diet. Yet on the whole, most authorities agree that an eating pattern that includes a variety of vegetables, fruits, whole grains, dairy, seafood, poultry, meat, eggs, nuts, and seeds, and that limits processed meats and added sugars, is associated with good health.
Dietary advice for older adults tends to focus on protein intake, given established patterns linking inadequate protein intake and a decline in muscle health with advancing age. Consequently, the daily quantity of protein recommended for older adults is 1.2 grams of protein per kilogram of body weight, which is 50% more than the typical recommended daily allowance (RDA) or dietary reference values (DRVs) for the average adult.
An emerging area of interest is the role of dietary fibre in mitigating declines in muscle health with advancing age. In fact, independent of participation in physical activity or higher dietary protein intake, a daily fibre intake of close to 30 grams is associated with higher muscle mass and function in older adults.
Physical activity habits to support healthy aging
Physical activity guidelines suggest at least 150 minutes of moderate-intensity aerobic physical activity throughout the week (or at least 75 minutes of vigorous-intensity aerobic physical activity, or an equivalent combination thereof), and muscle-strengthening activities involving major muscle groups on 2 or more days a week. Movement throughout the day is also emphasised so that long periods of sitting are avoided.
In older adults, the emphasis for physical activity is very much on strength training as a means to slow the rate of loss of muscle mass and function that occurs with advancing ageing, while also helping to reduce the risk of falls and associated negative outcomes in this age group.
The importance of both aerobic fitness and strength is highlighted by almost every metric of fitness (e.g. aerobic fitness, handgrip strength, leg or chest press strength, walking speed, chair rise test) having an inverse relationship with risk of death. In other words, being fitter in any aspect of fitness is associated with a reduced risk of death, compared to being less fit.
Adding life to our years
Extending health span is an ambitious yet achievable goal that we can all aim for. Good practices around diet and physical activity are central to this goal, but very much supported by a holistic approach that includes good sleep, stress management, and social connections, while also changing with changing needs across the life course to support healthy ageing.
References
• Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet. 2014;384(9937):45-52. doi:10.1016/S0140-6736(14)60648-6
• Brito LB, Ricardo DR, Araújo DS, Ramos PS, Myers J, Araújo CG. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2014;21(7):892-898. doi:10.1177/2047487312471759
• Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi:10.1093/ageing/afy169
• Deutz NE, Bauer JM, Barazzoni R, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929-936. doi:10.1016/j.clnu.2014.04.007
• European Commission Health Promotion and Disease Prevention Knowledge Gateway (2021) Physical activity recommendations for adults (18-64 years old) as described by health-related organisations. url: https://knowledge4policy.ec.europa.eu/health-promotion-knowledge-gateway/physical-activity-sedentary-behaviour-table-2b_en
• Frampton J, Murphy KG, Frost G, Chambers ES. Higher dietary fibre intake is associated with increased skeletal muscle mass and strength in adults aged 40 years and older. J Cachexia Sarcopenia Muscle. 2021;12(6):2134-2144. doi:10.1002/jcsm.12820
• Huber M, Knottnerus JA, Green L, et al. How should we define health? BMJ. 2011;343:d4163. doi:10.1136/bmj.d4163
• Kaeberlein M. How healthy is the healthspan concept?. Geroscience. 2018;40(4):361-364. doi:10.1007/s11357-018-0036-9
• Katz DL, Frates EP, Bonnet JP, Gupta SK, Vartiainen E, Carmona RH. Lifestyle as Medicine: The Case for a True Health Initiative. Am J Health Promot. 2018;32(6):1452-1458. doi:10.1177/0890117117705949
• Katz DL, Meller S. Can we say what diet is best for health?. Annu Rev Public Health. 2014;35:83-103. doi:10.1146/annurev-publhealth-032013-182351
• Kokkinos P, Faselis C, Samuel IBH, et al. Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J Am Coll Cardiol. 2022;80(6):598-609. doi:10.1016/j.jacc.2022.05.031
• Michel JP, Sadana R. "Healthy Aging" Concepts and Measures. J Am Med Dir Assoc. 2017;18(6):460-464. doi:10.1016/j.jamda.2017.03.008
• Montiel-Rojas D, Nilsson A, Santoro A, et al. Dietary Fibre May Mitigate Sarcopenia Risk: Findings from the NU-AGE Cohort of Older European Adults. Nutrients. 2020;12(4):1075. doi:10.3390/nu12041075
• Organisation for Economic Co-operation and Development (OECD)/European Union (2022), Health at a Glance: Europe 2022: State of Health in the EU Cycle. OECD Publishing, Paris. doi: 10.1787/507433b0-en
• Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337(7661):a439. doi:10.1136/bmj.a439
• Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50-58. doi:10.1001/jama.2010.1923
• World Health Organisation (2022) Fact sheet: Ageing and health. url: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
