Leader: Giulia Cappellaro (BOCCONI); Other collaborator(s): Andreea Piriu (BOCCONI), Maria Vittoria Bufali (BOCCONI), Amelia Compagni (BOCCONI), Aleksandra Torbica (BOCCONI)
Task 1 initially conducts a comprehensive conceptual and empirical exploration of the ‘healthy ageing’ (HA) construct to eventually advance a multi-dimensional assessment framework that transcends disciplines, settings and levels of analysis, with the ultimate goal of understanding the different needs of the older population segments and providing scope for effective intervention.
Brief description of the activities and of the intermediate results
The review aimed to comprehensively understand the concept of Healthy Aging (HA) by systematically identifying and evaluating studies focusing on multidimensional HA frameworks. Using PRISMA guidelines, the analysis resulted in a three-domain framework: Intrinsic Capacity (IC), Functional Ability (FA), and Environment (ENV). These domains were further divided into sub-domains and analyzed across 55 studies, predominantly utilizing quantitative methods.
The analysis highlighted a significant focus on FA and IC, with less attention given to ENV, particularly in relation to age-related illness and frailty. While 45% of studies solely examined IC and FA, only 8% considered ENV alongside IC or FA. Commonly studied sub-domains included 'Locomotion' and 'Psychological' for IC, and 'Meet their basic needs' and 'Build and maintain relationships' for FA.
ENV factors were categorized into five sub-domains: 'Communication, information and technology', 'Economic', 'Health and social care', 'Physical', and 'Socio-cultural'. However, the physical environment received the most attention. These sub-domains were further divided into 24 second-order themes.
Regarding assessment tools, the review found a lack of standardization, particularly in assessing ENV, with few established scales or approaches. This highlights a need for further research and standardization efforts in multidimensional HA frameworks, aiming for a holistic understanding of aging that incorporates both objective and subjective components across various levels of analysis.
Main policy, industrial and scientific implications
Considering the need for standardised multi-dimensional HA models, our work lays the ground for future harmonisation efforts, providing not only conceptual basis but also suggestions on measurement tools and instruments for further assessments looking to enhance exhaustiveness and comparability across settings and populations.
Some strengths of the current contribution to the literature can be summarised as follows: The HA assessment model emerging from this literature review can provide structure to future territorial efforts to respond to the needs of ageing adults, allowing for specificities across different territories via its multi-layer, evidence-based design capturing both objective and subjective components of ageing at various levels of analysis and across settings. Following the 2020 European Commission Strategic Foresight Report introducing resilience as a new compass to how key policy challenges are approached, applying resilience thinking to holistic healthy ageing models of care is of central importance. This entails moving from disease-centred models of care to capability approaches, which is why both subjective and objective aspects of the ageing process are essential requisites in holistic biopsychosocial models of care catering to the needs of older adults. Via the conceptual and empirical considerations applied in the design of this framework, we identify how various HA dimensions are understood at an operational level and thus contribute to the worldwide policy debate on translating theoretical HA constructs into measurable variables for the effective identification of care needs across older individuals with different ageing trajectories.
Informing standardized measurement: we contribute to the literature on the standardized HA measurement instruments and assessment tools, enhancing consistency and comparability across studies, thus helping further research to tailor interventions to the specific needs and characteristics of older adults.
Brief description of the activities and of the intermediate results
The review had undergone several rounds of internal verification. Its results were presented during the 2024 Age-It General Meeting in Venice (20-22 May 2024). This ultimately allowed to further anchor the work into a systematic review of the evidence on the operationalisation of healthy ageing in the scientific literature. The review identifies conceptual, empirical and methodological gaps in HA research to guide future integration efforts. Specifically, we: (1) systematically identify and critically appraise studies that operationalise the multidimensional concept of HA; (2) derive and cross-validate main themes, grouping the evidence into discrete conceptual categories operating under the HA paradigm; (3) analyse, expand and organise knowledge of the environmental determinants of HA, suggesting a multi-layer categorisation of this latter domain. In doing so, this systematic review of literature addresses conspicuous knowledge gaps in current HA measurement and suggests methodological improvements compared to prior research.
In a nutshell, the analysis reveals that some intrinsic capacity and functional ability components benefit from well-established measurement approaches, whereas environmental factors influencing ageing lack frequent and consistent measurement, as well as validated standardised measurement approaches. This uneven progress reflects varying focus and complexity levels across different aspects of healthy ageing. The methodological challenges in the ENV domain necessitate innovative approaches to capture its multifaceted nature. Addressing these gaps requires interdisciplinary efforts to develop robust, standardised tools, enhancing our understanding and measurement of environmental factors.
Main policy, industrial and scientific implications
Findings in this review distinctly encourage healthy life course promotion, advancing a multidimensional approach that considers, from an objective and subjective perspective, both intrinsic (e.g. individual-specific) and contextual physical and psycho-social factors determining how populations age. The review provides evidence for a more detailed classification of the environmental domain while systematising the evidence on the operationalisation of healthy ageing, with a clear account of the concepts it covers and the measurement instruments used in practice. In doing so, we stress the importance of preventing previously dominant and currently affirming paradigms of well-being in older age from drifting towards an exclusive focus on (individual responsibility of) intrinsic capacity and functional ability. Instead, results in this review provide conceptual and methodological basis to tackle ageing based on more complete notions that include the structural and environmental bases of well-being.
Brief description of the activities and of the intermediate results
A manuscript based on results from this analysis is currently under review with a leading journal in the social sciences and biomedicine field. Herewith, we argue for the potential of HA as an approach to promote and sustain well-being in older age through an organised knowledge of the capabilities residing within the contexts or environments in which individuals live. Overall, results in this review provide conceptual and methodological basis to advocate for the policy recognition of structural environmental supports mediating the complex interaction of biological and psychosocial factors.
Main policy, industrial and scientific implications
Some current methodological challenges can hinder the operationalisation of HA into an integrated framework, due to varying cultural perspectives and disciplinary approaches that emphasise different HA dimensions or employ different measurement tools. The economic value stemming from maintaining healthy engagement among older adults can be greatly enhanced by involving institutions in the age vs. health mix, thereby creating opportunities that might otherwise be overlooked. The analysis contributes to efforts towards models that take a resilience-thinking and holistic approach to understanding the determinants of well-being during the ageing process. This, indeed, represents an essential step to ensure that the two guiding principles which drove the rise of the theoretical construct of HA take shape in practice. These include moving from disease- or deficit-centred views to capability-based approaches and fully recognising the substantial contribution of environmental supports to health and well-being. Omitting such considerations not only underestimates the broader economic impact of healthy ageing but also risks missing out on strategic interventions that could foster this value.
The review constitutes a clear synthesis and analysis of the current state of research into healthy ageing. It provides well-differentiated findings of the what (the dimensions of healthy ageing and their associated constructs) and the how (the type of instrumentation used) of published research on healthy ageing. Additionally, and in terms of our analysis of empirical measurements of the IC, FA and ENV domains and their sub-domains of HA, we usefully address degrees of relative objectivity of instruments and of methodological advancement in the constructs measured across. This provides a useful critique that should alert researchers to the potential strengths and weaknesses of tools that they may employ in their research. In this regard, we have met our overarching goal to identify conceptual, empirical and methodological gaps in HA research and thereby guide future integration efforts.
Brief description of the activities/intermediate results and main policy implications
The manuscript consisting in the systematic review mentioned above is currently under revision for resubmission after an R&R decision. In accomplishing the revisions, we have boosted the discourse on the ongoing paradigm change from disease-based models of ageing to a healthy ageing, calling for standardisation across fragmented frameworks based on the conceptual, empirical and methodological gaps identified. Given its rich potential for policy and practice, we trust that this research work, already peer-reviewed and welcomed with notable appeal, will help to guide other works in HA measurement and standardisation.