by Harold L Kennedy, MD, MPH, FACC, FESC, FAHA

To embrace aging and health from a holistic physician’s perspective, I recommend we accept the health literacy definition provided by the National Academy of Medicine and the World Health Organization [1]. Health literacy can be understood as the concept that everyone should have the ability to gain access to, understand, and use information in ways that promote and maintain good health for themselves, their families, and their communities.

This viewpoint consists of three components: 

1) the individual,

2) the community and environment in which they live, and

3) access to healthcare and a health system available to them. 

The following information is contained in an initial primer on optimal aging and health written during COVID-19 to specifically help educate caregivers of the elderly (see below). The text, directed at medical and public health personnel, provides insight into the prevention, surveillance and wellness of the elderly, but also applies to all adults. Specific afflictions and limitations imposed by aging were addressed.

This three-part article aims to call to your attention to excerpts of that text which are germane to all adults seeking knowledge of aging and health.

Life cycle

Aging begins from the moment of birth, and embraces the hereditary risks of our parents, the environment in which we enter, their lifestyle and diet circumstances, their cultural and religious practices, and their healthcare knowledge and access. As shown in the figure we have limited or no personal control during this early origin period of our lives. Thus, our early health is in a non-adaptive phase, and each of us must evaluate the risks and silent co-morbidities (e.g., air particulate matter from fossil fuels leading to increasing asthma) that we encounter.

The other periods of one’s life cycle are shaped by the course of life. For most American adults the patterns of a formative period of education and job interest ensues with limited attention to one’s individual health. This busy period unfortunately results in health being placed at a lower priority for many. 

Thereafter a transition period of middle age evolves in which demands of mandated insurance physical exams, consideration of retirement interests, and emerging maladies  increases the probability of an individual addressing their personal health and aging. 

Subsequently, one merges into the ages of the elderly. This latter period, as we know, is characterized by the onset of adverse health problems and vulnerabilities that occur over time with aging unless (or despite) a program of prevention and wellness has been followed throughout life.

It is remarkable that in 2022, recent data [2] describes the average life expectancy of Americans fell precipitously in 2020 and 2021, the sharpest two-year decline in nearly 100 years. Average life expectancy declined from nearly 79 years to 76 years. Strikingly, the decline in Native Americans and Alaska Natives was down to 65 years, a figure for all Americans last seen in 1944. 

Undoubtedly, the COVID-19 pandemic contributed to this decline, but a focus on the lack of health equity and the social determinants of disease present in society came clearly into view. We should now view the complete life cycle of a patient as an opportunity to establish prevention, surveillance and a healthy lifestyle for long-lasting wellness.

Key takeaways

1. Every patient must be evaluated as to their early origin period to assess their heredity, early healthcare, and knowledge of possible silent co-morbidities (i.e smoking households, fossil fuel exposure, etc.).

2. A formative period from early 20s to 50s is usually characterized by injuries and silent co-morbidities which all too often are not addressed. Such is the case for hereditary atherosclerosis, hypertension and obesity leading to type 2 diabetes. It is during this time that preventive measures against identified risk factors would render the greatest benefit. Surveillance is an important consideration.

3. A transitional period, all too often, is characterized by the onset of medical illnesses, the need for ongoing medical surveillance and treatment of identified risk factors, and re-alignment of lifestyle and other social determinants of disease (e.g., environment or healthcare access).

4. The elderly period can be anticipated to dominate the current decade. All baby boomers will be elderly by 2030 and are estimated to be 73+ million (U.S.) comprising 20% of the population. This global phenomenon will affect all countries.

Our efforts to help patients age in a healthy way requires physicians to remain aware of the changing life cycle stages of a patient’s life, and society factors during those periods. Those factors imposed by work, community, environment and available healthcare systems must guide us in providing effective comprehensive medical care and preventive measures that result in positive outcomes and healthy longevity for our patients. 

Aging and Health for the US Elderly: A Health Primer for Ages 60 to 90 can be found on Amazon or at University of Missouri Press. Follow-up future ResearchGate articles will address Comorbidities and Risk Factors, and Medical Eras and Progress.