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Being “in good health” is often understood to mean not suffering from chronic diseases. But a new study finds that in older adults, factors such as psychosocial well-being and frailty are actually better predictors of death than typical measures like having diabetes or high blood pressure.

Why it matters:

The disease-centered focus of modern medicine often ignores the elements of health outside of illness. This is the first study of its kind to use a more comprehensive definition of well-being to analyze population health.

The nitty gritty:

Researches took a closer look at the data gathered by the National Social Life, Health, and Aging Project (NSHAP) a longitudinal, population-based study of older Americans who live at home. By interviewing and examining over 3,000 adults between 57 and 85 years of age, they found that half of the people classified as healthy by the traditional medical models actually had hidden risk factors for death and incapacity within five years.


The researchers created a statistical model to recategorize the study population into six tiers, from “robust” to “at-risk.” This model found that factors including loneliness, sense of hearing, mobility, and bone fractures significantly impacted mortality but were not included in traditional disease models. The authors found it more accurately reflected whether individuals would become incapacitated or die within five years than the prevailing medical model, which focuses on distinct diseases.

The healthiest class of people were obese and robust. Obesity in an older adult who was otherwise healthy posed little risk for mortality.


“Our data shows that there are distinct clusters, or classes of health,” said lead investigator Martha K. McClintock, professor of psychology at the University of Chicago. The study was published in Proceedings of the National Academy of Sciences.

You’ll want to know:

Two previously unrecognized factors with twice the mortality and incapacity risk included people with healed broken bones and people with poor mental health.

What they’re saying:

“What surprised me was the importance of broken bones,” said John Haaga, who heads a division of the National Institute on Aging, which funded the research. That risk was known in older people, but “other broken bones earlier in life, in late middle age, being such a signal is interesting and worth following up,” he explained.

This empirical data confirms the idea that there is no health without mental health, said Dr. Maria A. Oquendo, professor of psychiatry at Columbia University and New York State Psychiatric Institute.

But keep in mind:

While mental health has been historically shortchanged in medicine, the profession is increasingly recognizing that psychosocial well-being matters.

“What they are considering the traditional medical model is really outdated,” said Dr. Joseph Ladapo, an assistant professor of population health and medicine at New York University Langone Medical Center.  “I don’t think it’s quite a fair comparison.”

The study also concluded that certain health behaviors, like smoking, carry little weight in defining vulnerable health classes.

“I think one has to pause and look at the bigger  picture and really do a gut check on that kind of finding,” said Ladapo.  For many major illnesses like heart disease, stroke, and kidney disease, smoking is a major risk factor, and “it’s an enormous limitation [of the study]. … There is no doubt that smoking imparts an enormous burden on health and wellness.”

The bottom line:

Though a more inclusive definition of health isn’t a brand-new idea, this study adds evidence that overlooked health factors may be important indicators of health in older adults.