A new study may shift how we define health and aging. Instead of focusing on diseases, researchers looked at 54 health measures to see which factors or clusters of factors had the greatest association with mortality or incapacity. These factors fell into six major health dimensions: diseases, health behaviors, psychological health, sensory function, immunity, and frailty. Six clusters of conditions emerged from this analysis:
The first cluster was, surprisingly, the Robust Obese group. None of these individuals had a normal BMI, but they had the fewest diseases or vulnerabilities. This group had the lowest prevalence of dying or incapacity 5 years later!
The second cluster was One Minor Condition, comprised of individuals of normal weight with a low prevalence of cardiovascular disease and diabetes. As the group’s name suggests, these individuals tended to have one minor condition or disease. While still classified as robust, their prevalence of death five years later was significantly higher than the Robust Obese group, suggesting their “minor” conditions could be early warnings of vulnerability. Individuals in these two clusters had stronger social lives than the general population.
The two intermediate clusters are Broken Bones and Poor Mental Health. Those in the first group had broken a bone past 45 years old—but this group was average or above average in mobility. However, they were five times more likely to be incapacitated by frailty or accidents five years later. And the Poor Mental Health group, characterized primarily by depression, was the only group more likely than average to be incapacitated by alcohol, drug abuse, or suicide attempts.
The most vulnerable clusters were characterized by multiple comorbid diseases, including the Diabetes, Hypertension, and Immobility group. Most vulnerable was the Extensive Comorbidity and Frailty group, which had a high prevalence of 47 of the 54 measures, with an average of 17 vulnerable health measures. Forty-four percent passed away five years later.
This study may help us reconceptualize health and aging. One main finding is that “Health status in older adults does not correspond to chronological age.” And as the authors conclude, “a shift of attention is needed from disease-focused management… to overall health,” so that risks can be more accurately identified and addressed.
McClintock MK, Dale W, Laumann EO, et al. Empirical redefinition of comprehensive health and well-being in the older adults of the United States. Proceedings of the National Academy of Sciences of the United States of America (2016); 113(22): E3071-E3080.