Methods
The analysis is performed based on the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 4 (2010–2011). The SHARE is a multidisciplinary and cross-national panel database of micro data on health, socio-economic status as well as social and family networks of more than 80,000 individuals from 20 European countries (+Israel) aged 50 or over. There had already been 5 waves of the study that run from 2004 to 2015. The SHARE main questionnaire consists of 20 modules on health, socio-economics and social networks. All data are collected by face-to-face computer-aided personal interviews (CAPI). The databases of the SHARE are publicly accessible for research use, and are the only databases with such access from the large studies including all dimensions of health and health determinants. The wave 4th is the newest full survey from the study (Wave 5- SHARELIFE has other objectives). The methodology, compliance and databases were described previously [
66‐
68]. In this study, the data from 6 selected European countries are used. These countries represent different welfare policies, traditions and behavioral patterns: Netherlands and Germany represent Western Europe, Italy and Spain represent Southern Europe, Poland and Hungary represent Eastern -Central Europe. The analysis covers 5139 men and 5909 women from the six selected countries. The data are representative for the respective country populations.
Healthy ageing assessment
The dependent variable of healthy ageing is constructed as a binary variable with a reference to three dimensions that have been identified in the overview of healthy ageing definitions: health status self-assessment, functional capacity and assessment of the perceived meaning of life. The healthy ageing is assessed as reporting good or better than good health status (self-assessed health – SAH), having no limitations in the Activities of Daily Living (ADL) and reporting that at least sometimes (sometimes or often) life has a meaning. The list of ADL included the following items: walking 100 m; sitting for two hours; getting up from a chair after sitting for a long period; climbing several flights of stairs without resting; climbing one flight of stairs without resting; stooping, kneeling, or crouching; reaching or extending arms above shoulder level; pulling or pushing large objects, such as a living room chair; lifting or carrying weights over 10 lb (5 kg), such as a heavy bag of groceries; and picking up a small coin from the table. The self-perceived meaning of life is a measure of psychological capabilities. Earlier studies point that the will to live and the perceived meaningfulness of life are associated with the longevity of older adults and their well-being [
69].
The healthy ageing indicator composed of the three above listed measures is well rooted in previous (see above) research. Most of the healthy ageing definitions refer to some sort of subjective health measure, functional or independence assessment and psychological construct. Several definitions use healthy ageing measures similar to the indicator presented in this study. Castro-Lieonard [
70] used an indicator based on two components: well-being and self-assessed health, Cerning [
71] created an indicator of physical functioning, cognitive functioning and self-assessed health, Lopez et al. [
72] used physical functioning, life satisfaction and self-assessed health together with cognitive functioning and activity, Dionigi et al. [
73] used an indicator including functional independence, happiness and self-assessed health together with social engagement.
Healthy lifestyle and psychosocial indexes
The behavioral analysis uses two indexes of healthy lifestyle indicators and psychosocial indicators. The healthy lifestyle indicator refers to the domains of smoking, physical activity (moderate or vigorous and nutrition (consumption of fruits and vegetables per week, drinks per day and regular consumption of more than 3 meals per day). Each domain was valued with a score from 0 to 2, depending on its potential health effect as identified in the literature. The index follows the WHO guidelines on the selected domains [
74,
75], though in a simple manner as the SHARE database provides only information on the types and frequencies of selected behaviors, not accounting for their quality (i.e. the calories intake of specific types of food, time spend on specific physical activities). The index was created as a sum of the points for each of the domains (Table
1).
Table 1
Characteristics of the sample by sex
Age groups | 60–67 | 1976 | 38.5 | 2324 | 39.3 | |
68–79 | 2399 | 46.7 | 2546 | 43.1 |
> = 80 | 764 | 14.9 | 1039 | 17.6 |
Education | Elementary | 2529 | 51.2 | 3782 | 65.4 |
Secondary | 1535 | 31.1 | 1394 | 24.1 |
University | 876 | 17.7 | 609 | 10.5 |
Country group | Western Europe | 1445 | 28.1 | 1589 | 26.9 |
Southern Europe | 2301 | 44.8 | 2598 | 44 |
Central-Eastern Europe | 1393 | 27.1 | 1722 | 29.1 |
Healthy ageing | Worse than good SAH. functional limitations. perception that life has no meaning | 2717 | 52.9 | 3484 | 59 |
At least good SAH. no functional limitations. perception of life meaningfulness | 2422 | 47.1 | 2425 | 41 |
Current job situation | Non-working (retired. unemployed. homemaker. permanently sick or disabled. rentier. student. etc.) | 4632 | 91.2 | 5594 | 95.7 | 0 | Psychosocial index |
Working (employed or self-employed) | 449 | 8.8 | 253 | 4.3 | 1 |
Activity in last 12 months | No activities | 1284 | 25.5 | 1504 | 25.9 | 0 |
Activities at home (read books. magazines. did word or number games. chess. cards) | 1773 | 35.2 | 1916 | 33 | 1 |
Activities outside of house (voluntary or charity work. educational course. sport. social club. taking part in religious. community organizations. | 1982 | 39.3 | 2379 | 41 | 2 |
Network satisfaction (scale from 0 to 10 where 0 means completely dissatisfied and 10 means completely satisfied) | 0–5 points | 43 | 0.9 | 48 | 0.9 | 0 |
6–10 points | 4728 | 99.1 | 5479 | 99.1 | 1 |
Life satisfaction (scale from 0 to 10 where 0 means completely dissatisfied and 10 means completely satisfied) | 0–5 points | 778 | 15.2 | 1170 | 19.9 | 0 |
6–10 points | 4329 | 84.8 | 4721 | 80.1 | 1 |
Smoking status | Current smoking | 922 | 21.2 | 589 | 14.2 | 0 | Life style index |
No smoking currently | 3428 | 78.8 | 3573 | 85.8 | 1 |
Vigorous physical activity | Less than once a week | 2979 | 58.5 | 3956 | 67.7 | 0 |
Once a week | 611 | 12 | 619 | 10.6 | 1 |
More than once a week sports or activities that are vigorous | 1498 | 29.4 | 1271 | 21.7 | 2 |
Moderate physical activity | Once a week or less | 1836 | 36.1 | 2544 | 43.5 | 0 |
More than once a week activities requiring a moderate level of energy | 3252 | 63.9 | 3302 | 56.5 | 1 |
Vegetables consumption | Less than 3–6 times a week | 411 | 8 | 355 | 6.1 | 0 |
3–6 times a week | 903 | 17.6 | 888 | 15.2 | 1 |
Every day serving of fruits or vegetables | 3776 | 73.5 | 4604 | 78.7 | 2 |
Drinks consumption | 6 cups of more a day drinks of tea. coffee. water. milk. fruit. soft drinks | 374 | 7.3 | 439 | 7.5 | 0 |
3–5 cups | 1534 | 30.1 | 1989 | 34 | 1 |
1–2 cups | 3183 | 62.5 | 3418 | 58.5 | 2 |
Regular meals | Meals not regular | 569 | 11.1 | 595 | 10.1 | 0 |
Regular meals | 4570 | 88.9 | 5314 | 89.9 | 1 |
| | N | mean (SD) | N | mean (SD) | |
Lifestyle index | | 4717 | 6.26 (1.70) | 5475 | 6.20 (1.65) |
Psychosocial index | | 4347 | 3.12 (0.98) | 4156 | 3.03 (0.99) |
The psychosocial index includes domains of participation in the labor market (employment or self-employment), participation in organized activities of social character (volunteering, learning, sports, clubs, religious and community organizations), undertaking leisure activities at home (reading, playing games or chess, doing crosswords), satisfaction from the social network and life satisfaction. Again, a coding was applied to each type of activity (from 0 to 2 points) and the index was created as a sum of the points for each dimension, separately for the lifestyle and psychosocial index (Table
1). For the index calculation, only the data is used where the status of all components was known.
The descriptive statistics include the frequency distribution for all categorical variables as well as the mean and standard deviation (SD) for the continuous variables. For comparing of the health status for country and education groups, chi square test was used and for lifestyle and psychological indexes, t-test was used (normal distribution of indexes was estimated based on skewness parameter). The multivariable analysis of association between health and potential predictors analysis used a logistic regression model with health status as a dependent variable and a set of independent explanatory variables. The core independent variables are the healthy lifestyle index and psychosocial index based on the behaviors that have been identified in the literature as important for the healthy ageing process (see above). As confounding variables education (all models), income (log transformed), age group, country group (where applicable) are used. Three age groups have been distinguished: 60–67 years of age, 68–79 years of age and the group above 80 years of age. The grouping is based on the assumption that behaviors and health needs of older population might change depending on their involvement in the outside activities, especially labor market. The first group includes people that are still potentially labor market active. The upper age limit for this group is equal to the retirement age which is foreseen to increase to 67 years of age in most of the analyzed countries in the years to come. In Germany, the retirement age is gradually increasing from 65 to 67 by 2027; in the Netherlands, it is increasing from 65 to 67 by 2024; in Italy, it equals 66 years of age for men and 64 for women; in Spain, it is gradually increasing from 65 to 67 by 2027; in Poland, it is gradually increasing from 65 to 67 by 2020 for men and from 60 to 67 by 2040 for women; in Hungary, it is gradually increasing from 62 to 65 by 2022. The second age group (68–79) is represented by people who have reached retirement age, but still have a great potential of active ageing and involvement in social activities. The third group consists of the oldest old (80+), for whom the potential of activity is lower while care needs increase in line with health deterioration. Education is assessed based on the ISCED-97 scale as a set of binary variables of primary, secondary and higher education. Financial situation is assessed based on the reported income (continuous variable). Regression models are run separately for the three age groups: 60-67/68-79/80+ and for the above mentioned three groups of countries. All analyses are carried out separately for men and women. The analysis is done using SPSS v. 23, for the statistical significance p < 0,05 is used.
Results
There is a great disproportion of older people (60+) reporting healthy ageing (i.e. being healthy) across countries. In the countries of Western Europe (Netherlands, Germany), almost 60 % of older people (60+) report being in good health, having no functional limitations and finding a meaning in life. In Western Europe, not only older people have higher propensity for healthy ageing, but there are almost no differences observable between sexes. In the countries of Southern Europe, the share of individuals reporting healthy ageing is lower and the differences between men and women are large (accounting to 10 pp.) with 48 % of men and 38 % of females reporting healthy ageing. In the countries of Central-Eastern Europe, the picture is quite different with only 33 % of men and 29 % of women aged 60+ reporting healthy ageing (Table
2).
Table 2
Percentage of person with good health status by country, education groups and sex
Country group | Western Europe | 849 | 58.8 % | 937 | 59.0 % |
Southern Europe | 1109 | 48.2 % | 986 | 38.0 % |
Central-Eastern Europe | 464 | 33.3 % | 502 | 29.2 % |
p value | <0.001 | <0.001 |
(difference between health and country groups |
Education | Primary | 1057 | 41.8 % | 1313 | 34.7 % |
Secondary | 738 | 48.1 % | 693 | 49.7 % |
University | 534 | 61.0 % | 365 | 59.9 % |
p value | <0.001 | <0.001 |
(difference between health and education groups |
On average in the six selected European countries, men are found to have higher propensity for healthy ageing (i.e. being healthy) than women as 47 % of men and 41 % of women respond positively to health-related items that contribute to healthy ageing. There are however no sound sex differences in the lifestyle undertaken by older men and women that might be of importance for healthy ageing. On average, men have the score of the healthy lifestyle index at the level of 6.26 and women at the level of 6.2 out of the maximum of 9 points. The average level of the psychosocial index accounts to 3.12 for men and 3.03 for women out of the maximum of 5 points (Table
1). At the same time both indexes are found to be related to healthy ageing. The average score of the lifestyle index is higher on average by 1 point for men and 1.1 point for women ageing healthy (i.e. being healthy) than for men and women with poorer health. Also the average score of the psychosocial index is higher for individuals with propensity to better health – on average by 0.6 point for men and by 0.7 for women (Table
3).
Table 3
Mean (SD) of psychosocial and lifestyle index value in groups of health and by sex
Lifestyle index | Health status good | 2076 | 6.83 (1.6) | 1837 | 6.79 (1.6) |
Health status not good | 2271 | 5.73 (1.6) | 2319 | 5.72 (1.6) |
p value | <0.001 | <0.001 |
(Difference between health groups |
Psychosocial index | Health status good | 2301 | 3.42 (0.9) | 2317 | 3.41 (0.9) |
Health status not good | 2416 | 2.83 (1.0) | 3158 | 2.76 (1.0) |
p value | <0.001 | <0.001 |
(Difference between health groups |
The results of the multidimensional analysis of healthy ageing predictors in different age groups point to the importance of both indexes: lifestyle and psychosocial (Table
4). The odd ratios of being healthy in older age increase with each point of the lifestyle index by 32.5 % for males and 18.7 % for females aged 60–67; 32.6 % for males and 28 % for females aged 68–79 and 53.5 % for males and 36.9 % for females aged 80+. Social participation, networking and life satisfaction are also of great importance, with the odds ratios of healthy ageing increasing with each point of the psychosocial index by 55.2 % for males and 61.3 % for females aged 60–67; 73.5 % for males and 71.9 % for females aged 68–79 and 76.2 % for males and 45.4 % for males aged 80 +.
Table 4
Multidimensional analysis of health ageing predictors by age groups – logistic regression results
Male | Income (log.) | 0.957 | 0.866 | 1.059 | .396 | 1.082 | 0.958 | 1.222 | 0.204 | 0.981 | 0.736 | 1.308 | 0.896 |
Elementary educ. | 1 | | | | 1 | | | | 1 | | | |
Secondary educ. | 1.664 | 1.242 | 2.229 | 0.001 | 1.020 | 0.784 | 1.327 | 0.883 | 0.617 | 0.341 | 1.116 | 0.110 |
University educ. | 2.214 | 1.546 | 3.172 | 0.000 | 1.359 | 0.985 | 1.875 | 0.062 | 0.660 | 0.347 | 1.252 | 0.203 |
Index lifestyle | 1.325 | 1.232 | 1.424 | 0.000 | 1.326 | 1.242 | 1.417 | 0.000 | 1.824 | 1.533 | 2.170 | 0.000 |
Index psychosocial | 1.552 | 1.362 | 1.767 | 0.000 | 1.735 | 1.531 | 1.967 | 0.000 | 1.762 | 1.366 | 2.273 | 0.000 |
Central Europe | 1 | | | | 1 | | | | 1 | | | |
Western Europe | 2.259 | 1.635 | 3.119 | 0.000 | 1.532 | 1.115 | 2.106 | 0.009 | 1.440 | 0.721 | 2.878 | 0.302 |
Southern Europe | 2.969 | 2.149 | 4.102 | 0.000 | 2.376 | 1.753 | 3.220 | 0.000 | 1.485 | 0.770 | 2.867 | 0.238 |
Female | Income (log.) | 1.130 | 1.008 | 1.268 | 0.036 | 1.117 | 0.995 | 1.253 | 0.060 | 0.954 | 0.833 | 1.093 | 0.499 |
Elementary educ. | 1 | | | | 1 | | | | 1 | | | |
Secondary educ. | 1.202 | 0.929 | 1.555 | 0.161 | 1.264 | 0.961 | 1.662 | 0.093 | 1.274 | 0.717 | 2.264 | 0.409 |
University educ. | 1.204 | 0.862 | 1.680 | 0.276 | 1.129 | 0.763 | 1.671 | 0.545 | 2.742 | 1.109 | 6.778 | 0.029 |
Index lifestyle | 1.187 | 1.105 | 1.275 | 0.000 | 1.280 | 1.178 | 1.392 | 0.000 | 1.648 | 1.369 | 1.983 | 0.000 |
Index psychosocial | 1.613 | 1.416 | 1.837 | 0.000 | 1.719 | 1.499 | 1.971 | 0.000 | 1.454 | 1.123 | 1.882 | 0.004 |
Central-Eastern Europe | 1 | | | | 1 | | | | 1 | | | |
Western Europe | 1.519 | 1.111 | 2.077 | .009 | 2.298 | 1.578 | 3.347 | 0.000 | 2.179 | 1.053 | 4.510 | 0.036 |
Southern Europe | 1.778 | 1.325 | 2.385 | .000 | 1.701 | 1.197 | 2.417 | 0.003 | 1.311 | 0.634 | 2.710 | 0.465 |
The results of the analysis of healthy ageing predictors across the groups of selected European countries point to the importance of the lifestyle and psychosocial index in all countries (Table
5). In Western Europe the odds of being healthy at old age increase by 34 % with each point of the lifestyle index for males and 35.4 % for females; in Southern Europe by 43.6 % for males and 24.4 % for females and in Central-Eastern Europe by 27.7 % for males and 13.9 % for females. Again, the psychosocial index of social activities, networking and life satisfaction is found to be very important, increasing the likelihood of healthy ageing by 74 % per each index point for males and 68.8 % for females in Western European countries, 68.7 % for males and 63.4 % for females in Southern European countries, and 53 % for males and 52.7 % for females in Central-Eastern European countries.
Table 5
Multidimensional analysis of health ageing predictors by country groups – logistic regression results
Male | 60–67 | 1 | | | | 1 | | | | 1 | | | |
68–79 | 0.630 | 0.478 | 0.831 | 0.001 | 0.840 | 0.660 | 1.068 | 0.155 | 0.710 | 0.519 | 0.973 | 0.033 |
> = 80 | 0.425 | 0.288 | 0.627 | 0.000 | 0.466 | 0.330 | 0.658 | 0.000 | 0.451 | 0.263 | 0.773 | 0.004 |
Income (log) | 0.980 | 0.868 | 1.106 | 0.741 | 0.992 | 0.896 | 1.099 | 0.883 | 1.088 | 0.858 | 1.378 | 0.487 |
Elementary educ. | 1 | | | | 1 | | | | 1 | | | |
Secondary educ. | 0.972 | 0.715 | 1.321 | 0.856 | 1.680 | 1.213 | 2.326 | 0.002 | 0.929 | 0.650 | 1.327 | 0.684 |
University educ. | 1.240 | 0.893 | 1.723 | 0.200 | 2.015 | 1.290 | 3.147 | 0.002 | 1.251 | 0.788 | 1.984 | 0.342 |
Index lifestyle | 1.340 | 1.232 | 1.457 | 0.000 | 1.436 | 1.336 | 1.544 | 0.000 | 1.277 | 1.163 | 1.402 | 0.000 |
Index psychosocial | 1.741 | 1.458 | 2.079 | 0.000 | 1.687 | 1.494 | 1.904 | 0.000 | 1.530 | 1.301 | 1.799 | 0.000 |
Female | 60–67 | 1 | | | | 1 | | | | 1 | | | |
68–79 | 0.710 | 0.662 | 1.122 | 0.269 | 0.478 | 0.377 | 0.607 | 0.000 | 0.474 | 0.331 | 0.679 | 0.000 |
> = 80 | 0.451 | 0.403 | 0.851 | 0.005 | 0.248 | 0.169 | 0.362 | 0.000 | 0.270 | 0.142 | 0.514 | 0.000 |
Income (log) | 1.260 | 1.079 | 1.472 | 0.003 | 1.033 | 0.942 | 1.133 | 0.492 | 0.971 | 0.819 | 1.151 | 0.736 |
Elementary educ. | 1 | | | | 1 | | | | 1 | | | |
Secondary educ. | 0.969 | 0.742 | 1.266 | 0.818 | 1.677 | 1.188 | 2.367 | 0.003 | 1.473 | 1.038 | 2.089 | 0.030 |
University educ. | 0.909 | 0.654 | 1.263 | 0.571 | 1.587 | 0.968 | 2.601 | 0.067 | 1.930 | 1.089 | 3.419 | 0.024 |
Index lifestyle | 1.354 | 1.237 | 1.482 | 0.000 | 1.244 | 1.147 | 1.350 | 0.000 | 1.139 | 1.027 | 1.264 | 0.014 |
Index psychosocial | 1.688 | 1.411 | 2.020 | 0.000 | 1.634 | 1.443 | 1.850 | 0.000 | 1.527 | 1.274 | 1.830 | 0.000 |
Discussion
In this study, the relation between healthy ageing (i.e. being healthy at older age) and three groups of factors: lifestyle index, psychosocial index and socio-demographics is analyzed. The definition of healthy ageing used in this study refers to subjective multi-dimensional indicators of being healthy, i.e. self-reported by older people health status, functional abilities and a psychosocial construct like positive meaning of life. Functional ability associated with the level of independence in everyday activity could significantly influence not only self-assessment of health status, but also the chances and abilities to participate in social life, especially out of home activities. It could also influence the general psychological well-being. The last dimension of the definition is strongly related to psychological well-being and social relations in older age.
Differences in the subjective assessment of healthy ageing that are found reflect variations in the health status of older Europeans reported in other studies as well. According to the WHO [
76] and Eurostat [
77] data life expectancy of older Europeans (65+) is higher in Southern and Western European than in Central-Eastern Europe and reversely the prevalence of chronic conditions is higher in Central-Eastern Europe than in other regions, especially in Western Europe. Objective indicators coming from the epidemiological studies (mortality, LE) well document differences in health status across European countries.
Presented analysis points to the differences in healthy ageing (i.e. being healthy at older age) assessed by a multi-dimensional, subjective measure. Variations in healthy ageing could be attributable to health and social inequalities in older age, but also to factors developed and accumulated throughout lives. Similarly to studies pointing to educational inequalities in health [
27,
47], there is an educational gradient in healthy ageing observable in this study as the proportion of individuals being healthy at older age increases with the educational level. Usually the role of education is analyzed in relation to the level and potential for health education, health beliefs, and awareness of the risk factors in several health conditions as well as better understanding of individual susceptibility to specific diseases. This could be also attributed to various factors related to social position, including healthier lifestyle throughout life [
45] and better access to information and care. At the population level, the observed differences can be related to historical developments and different life experiences as well as life choices of younger and-especially-older populations between different European regions (i.e. access to education or employment status of men and women). In Poland and Hungary, a lower share of people ageing healthily might be attributable to poor social and economic conditions in their younger years of the communist era and during the economic and political transition period.
The results of the health predictors by age groups confirm that undertaking physical activity, healthy diet based on high consumption of vegetables and fruits, high consumption of liquids and regular meals are crucial and positively related to health outcomes, fitness and well-being in older age, as also reported by others [
1]. It is necessary to point to earlier findings of Robinson et al. [
40] that healthy lifestyle is important for each age group – even the oldest old. At the same time, presented results confirm earlier findings that participation in social activities and social networking might decrease the risk of morbidity, functional decline and mental illness [
59‐
61] adding that the results are important for all age groups and for both sexes. It should be noted that even after controlling for life-style, social participation and networking, educational gradient in healthy ageing is found for males below the age of 68 with higher probability of healthy ageing for males with a secondary education or an university degree. This is partly in line with earlier findings of various European studies [
27,
32] pointing to the differences in health status in older age between educational groups. The positive relation between education and healthy ageing of men might be related to their prolonged outside activity, especially on the labor market, which is more common among people with higher education degree. This relation is not observed however for women. For them it is not education but income that increases the probability of healthy ageing in the group of the youngest old (below the age of 68) while. Such results would suggest that for women, economic standing is more adequate social status indicator than education and could be a better predictor of healthy ageing, this however would require further studies. The relation between healthy ageing and education or income is insignificant for individuals above the age of 68. These might confirm earlier finding that inequalities in health tend to diminish with age [
27].
Cross-country analysis points that in countries with higher economic inequalities and higher health inequalities [
78] of Southern and Central-Eastern Europe, education plays a role for females as the probability of healthy ageing increases with education, even if lifestyle, psychosocial factors and age are controlled for. In post-communist countries, like Hungary and Poland, this might point to the theory of decomposition of the social status observed in the 1980s where education was found to be more important predictor of social status than income. Still in the studies from 1990s, the correlation between education and income was higher in the Western European countries than in Southern or Central-Eastern European countries [
79]. For the older population, the decomposition might have led to differences in social status and health behaviors throughout life that result in better propensity for healthy ageing in people with secondary and higher education, and in greater importance of education than income with respect to health outcomes and well-being. In Western European countries, education is not among the important predictors of healthy ageing, but income is still found to be significantly related to health. These results might partly point to the existence of socio-economic inequalities in health among older people [
27], but rather among females than males. The differences between men and women would need further studies.
Overall, it should be noted that while differentiating between age groups and countries, the study points to the homogeneity of positive correlates of healthy ageing (i.e. being healthy at older age) with healthy lifestyle characterized by undertaking physical activity, adequate nutrition and non-smoking as well as social activities, including leisure and social networking. The psycho-social characteristics related to participation in outside activities, being rooted in social networks and life satisfaction are of similar importance for the health status as undertaking healthy behaviors by older people. The study adds to the previous research that these correlates are important in all age groups, and points that even the oldest old might benefit from the healthy lifestyle and social participation and networking. From the public health policy point of view, it is an important finding that investments in healthy diet and physical activity as well as stimulation of social networks and activities are related to positive self-perception of health status, high level of functional abilities and perceived meaning of life in older age, even for the oldest old. The study also points that in order to increase the healthy ageing potential in the European countries (and increase healthy life expectancy by 2 years, what is a public health goal for 2020), public health policy should also aim at investments in the health promotion programs and initiatives targeted to the older population, stimulating physical health via adequate nutrition in line with the WHO recommendations, physical exercises and non-smoking policies, accompanied by stimulation of social networks and active ageing measures oriented at social participation.
The strength of the presented study is in assessing healthy ageing predictors for several countries characterized not only by different cultural and socio-economic environment, but also by different social positions of older people in society and variations in policy measures addressing health. In presented countries, social policy focused on the health status of older people varies due to differences in priorities, economic and social resources involved as well as management. According to Raphael [
80], countries of continental and southern Europe less frequently directly address public health issues, incorporating health measures into general social policies, than Anglo-Saxon countries. This is even less frequent in Central-Eastern European countries where the awareness of the social and health policy towards ageing is only raising. Thus, results of presented analyses can be used to improve social and public health policy depending on the country-specific circumstances.
The study however has some limitations related to the definition of healthy ageing. Presented definition is based on the three individual level indicators, however the authors are aware that there are various definitions of healthy status in older age and healthy aging might be adopted. The selection of the three domains was based on the literature review and the database review. The literature review pointed to numerous definitions of healthy ageing [
2], which are briefly discussed above with the three element: self-assessed heath, functional abilities and psychological well-being or capabilities present in many of them. The definition adopted in this study is found by the authors as the best suited definition representing all three domains in the SHARE study. The SHARE survey of the years 2010–2011 was selected as the best database providing individual level information on health status in the three domains identified, life-style patterns, social networks and activity as well as demographic and socio-economic information. Other available databases (with public access) included specific dimensions of health, however with narrower scope (European Social Survey, International Social Survey Programme, etc.). The study is of preliminary character, pointing to the need for further studies that would allow to identify more country specific features of healthy ageing, using country specific definitions that could be addressed by policies at the national level. Furthermore, a dynamic approach to the analysis of healthy aging could be adopted in future research.
Conclusions
Presented study identifies the set of predictors related to healthy ageing (i.e. being healthy at older ager) as defined by three domains: good health status self-assessment, functional abilities and perception of meaning in life. The study allows for identification and discussion of factors that are of importance for well-defined and targeted public health policy, and especially health promotion programs oriented towards healthy ageing.
Policy conclusions that can be drawn from the research point that the main concern for public health policy oriented towards health and high quality of life in older age include stimulation of healthy lifestyle characterized by vigorous or moderate physical activity of older people, high consumption of vegetables and fruits, regular nutrition and high consumption of liquids. These behavioral patterns are found to be positively related in all countries covered with the study, for men and women and for all age groups. Importantly, even for the oldest age group (80+), the healthy lifestyle is beneficial. The patterns identified are similar for men and women.
Whilst social participation and social networking are not within the scope of public health actions, they are also of importance for healthy ageing. Social participation, as defined in the study includes labor market participation of the labor market active age people as well as involvement in outdoor and indoor leisure activities, which older people might engage in. Next to social participation, also social networking and satisfaction are important predictors of healthy ageing because they facilitate the feeling of belonging and being a part of society, and significantly influence the social integration of older people together with younger generations. The meaning of life, strongly associated with the will to live, usually is created by positive emotions and present and future life plans. It might be important to encourage older people to participate and network also via the health promotion tools.
The idea of health promotion among older people has been developed relatively recently in European countries, especially in the Central-Eastern Europe. There had been a long-lasting belief that supporting health promotion in younger generations will result in improved health outcomes measured by a decrease in morbidity and mortality, and improvement in health-related quality of life. Presented data show that healthy lifestyle and satisfactory psychosocial functioning are significantly related to better quality of life in older age, even above 80 years of age. Challenges in front of the health promoters include achieving better results in healthy lifestyle promotion among older people and developing positive attitudes towards health promotion in older age by showing benefits of healthy ageing.
Acknowledgments
This publication arises from the project Pro-Health 65+ which has received funding from the European Union, in the framework of the Health Programme (2008–2013). The content of this publication represents the views of the authors and it is their sole responsibility; it can in no way be taken to reflect the views of the European Commission and/or the Executive Agency for Health and Consumers or any other body of the European Union. The European Commission and/or the Executive Agency do(es) not accept responsibility for any use that may be made of the information it contains.
Publication co-financed from funds for science in the years 2015–2017 allocated for implementation of an international co-financed project.