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Redefining health and well-being in older adults

Health is more than just the absence of disease. Health also includes physical, psychological, and social well-being. Many traditional models of health, however, focus mostly on conditions such as diabetes, cancer, and heart disease.

A team led by Dr. Martha McClintock at the University of Chicago set out to classify the health of older adults by using a more comprehensive approach. The research was supported in part by NIH's National Institute on Aging (NIA). Results were published on May 31 in Proceedings of the National Academy of Sciences.

The researchers interviewed a sample of more than 3,000 American adults, ages 57 to 85. The sample was designed to represent all older adults nationwide who live at home, regardless of their health status. The team administered questionnaires that covered 54 diverse health variables. Participants were contacted again after five years and either re-interviewed or noted as unable to participate due to incapacity or death.

A traditional "medical model" used 19 of the variables. These addressed medical issues and organ function, including heart disease, cancer, lung disease, stroke, diabetes, kidney disease, and liver disease. A "comprehensive model" included 35 measures covering other aspects of health and well-being. These included health behaviors (such as sleeping, drinking, and smoking); psychological health (such as stress, depression, loneliness, and self-esteem); sensory function (such as taste, vision, and hearing); and frailty (such as gait speed, bone fracture, anemia, and urinary incontinence).

The researchers found that about half of the people classified as healthy based on the medical model had vulnerabilities revealed by the comprehensive model that affected the chances that they would die or become incapacitated within five years. Conversely, some people with chronic diseases had many strengths that reclassified them as healthy in the comprehensive model. For example, older adults who were obese but otherwise physically and mentally healthy had the lowest risk of dying or becoming incapacitated.

Analysis of the full comprehensive model of health and well-being revealed several unique variables that predicted mortality and incapacity. Poor mental health, poor sensory function and social engagement and having a broken bone any time after age 45 were all strong markers for future health problems. Conversely, greater mobility predicted 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," McClintock says.

-by Carol Torgan, Ph.D.

--From the National Institute of Health

For further information on this and other health topics, visit the web site of the National Institute of Health at

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