A research framework for the United Nations Decade of Healthy Ageing (2021–2030)

The mission of UN Decade of Healthy Ageing (2020–2030) is to improve the lives of older people, their families and their communities. In this paper, we create a conceptual framework and research agenda for researchers to knowledge to address the Decade action items. The framework builds on the main components of healthy ageing: Environments (highlighting society and community) across life courses (of work and family) toward wellbeing (of individuals, family members and communities). Knowledge gaps are identified within each area as priority research actions. Within societal environments, interrogating beliefs about ageism and about familism are proposed as a way to illustrate how macro approaches to older people influence their experiences. We need to interrogate the extent to which communities are good places to grow old; and whether they have sufficient resources to be supportive to older residents. Further articulation of trajectories and turning points across the full span of work and of family life courses is proposed to better understand their diversities and the extent to which they lead to adequate financial and social resources in later life. Components of wellbeing are proposed to monitor improvement in the lives of older people, their families and communities. Researcher priorities can be informed by regional and national strategies reflecting Decade actions.

Co-Inference of Data Mislabelings Reveals Improved Models in Genomics and Breast Cancer Diagnostics

Mislabeling of cases as well as controls in case–control studies is a frequent source of strong bias in prognostic and diagnostic tests and algorithms. Common data processing methods available to the researchers in the biomedical community do not allow for consistent and robust treatment of labeled data in the situations where both, the case and the control groups, contain a non-negligible proportion of mislabeled data instances. This is an especially prominent issue in studies regarding late-onset conditions, where individuals who may convert to cases may populate the control group, and for screening studies that often have high false-positive/-negative rates. To address this problem, we propose a method for a simultaneous robust inference of Lasso reduced discriminative models and of latent group-specific mislabeling risks, not requiring any exactly labeled data. We apply it to a standard breast cancer imaging dataset and infer the mislabeling probabilities (being rates of false-negative and false-positive core-needle biopsies) together with a small set of simple diagnostic rules, outperforming the state-of-the-art BI-RADS diagnostics on these data. The inferred mislabeling rates for breast cancer biopsies agree with the published purely empirical studies. Applying the method to human genomic data from a healthy-ageing cohort reveals a previously unreported compact combination of single-nucleotide polymorphisms that are strongly associated with a healthy-ageing phenotype for Caucasians. It determines that 7.5% of Caucasians in the 1000 Genomes dataset (selected as a control group) carry a pattern characteristic of healthy ageing.

Cardiovascular risk factors, living and ageing in Halle: the CARLA study

The CARLA study (Cardiovascular Disease, Living and Ageing in Halle) is a longitudinal population-based cohort study of the general population of the city of Halle (Saale), Germany. The primary aim of the cohort was to investigate risk factors for cardiovascular diseases based on comprehensive cardiological phenotyping of study participants and was extended to study factors associated with healthy ageing. In total, 1779 probands (812 women and 967 men, aged 45–83 years) were examined at baseline (2002–2005), with a first and second follow-up performed 4 and 8 years later. The response proportion at baseline was 64.1% and the reparticipation proportion for the first and second follow-up was 86% and 77% respectively. Sixty-four percent of the study participants were in retirement while 25% were full- or partially-employed and 11% were unemployed at the time of the baseline examination. The currently running third follow-up focuses on the assessment of physical and mental health, with an intensive 4 h examination program, including measurement of cardiovascular, neurocognitive, balance and gait parameters. The data collected in the CARLA Study resulted in answering various research questions in over 80 publications, of which two thirds were pooled analyses with other similar population-based studies. Due to the extensiveness of information on risk factors, subclinical conditions and evident diseases, the biobanking concept for the biosamples, the cohort representativeness of an elderly population, and the high level of quality assurance, the CARLA cohort offers a unique platform for further research on important indicators for healthy ageing.

Comparison of intrinsic capacity factors in older individuals before and during COVID-19 in the context of healthy ageing in Baltic Countries

The COVID-19 in the context of healthy ageing is associated with decline in body functional abilities and serious illness in older individuals. Regular assessment of ageing processes, including intrinsic capacity factors, provides an opportunity for better understanding of the individual’s functional abilities and vulnerabilities. Based on the data (2017–2020) from two waves (7 and 8) of the Survey of Health, Ageing and Retirement in Europe (SHARE), an evaluation and comparison of the intrinsic capacity factors of older individuals (50+ years) before and during COVID-19 was conducted, including data from 4422 individuals in Baltic countries (from Latvia – 648, Lithuania – 1079 and Estonia – 2695). Excellent or very good health status before the outbreak reported 35.3% respondents in Latvia, 54.9% in Lithuania and 45.3% in Estonia (p < 0.001). On worsened health status since the outbreak reported 7% respondents in Latvia, 13.8% in Lithuania and 5.9% in Estonia (p < 0.001). Feeling of nervousness, depression and loneliness during COVID-19 outbreak increased among all respondents, regardless of nationality and severity of symptoms before outbreak (p < 0.001). The results indicate that during COVID-19 outbreak respondents were experiencing deterioration in cognitive and psychological health. To maintain the level of individual’s functional abilities during situations like COVID-19 outbreak preventive actions are needed by promoting physical activities and social networks, especially for older individuals.

Older People, Sense of Coherence and Community

In this chapter, the authors consider the meanings of the concepts of healthy ageing, ageing well, salutogenic ageing and reciprocity between the sense of coherence (SOC) and ageing processes. They discuss how the community can provide resources to strengthen older adults’ SOC, perceived well-being and quality of life. Quoting ‘It’s not how old we are; it’s how we are old’, the authors illuminate critical differences in understanding healthy ageing by professionals, researchers and older people themselves.

Investigating Potential Dose–Response Relationships between Vitamin D Status and Cognitive Performance: A Cross-Sectional Analysis in Middle- to Older-Aged Adults in the Busselton Healthy Ageing Study

Low vitamin D status has been linked to adverse cognitive outcomes in older adults. However, relationships at higher levels remain uncertain. We aimed to clarify patterns of association between vitamin D status and cognitive performance, using flexible regression methods, in 4872 middle- to older-aged adults (2678 females) from the Busselton Healthy Ageing Study. Cross-sectional associations of serum levels of 25-hydroxyvitamin D (25OHD) and performance in cognitive domains were modelled using linear regression and restricted cubic splines, controlling for demographic, lifestyle, and health factors. Mean ± SD serum 25OHD levels were 78 ± 24 nM/L for women and 85 ± 25 nM/L for men. Increasing levels in women were associated with better global cognition (linear trend, p = 0.023) and attention accuracy (continuity of attention), with improvement in the latter plateauing around levels of 80 nM/L (nonlinear trend, p = 0.035). In men, increasing levels of serum 25OHD were associated with better attention accuracy (linear trend, p = 0.022), but poorer semantic verbal fluency (linear trend, p = 0.025) and global cognition (nonlinear trend, p = 0.015). We identified patterns of association between serum 25OHD levels and cognitive performance that may reflect early dose–response relationships, particularly in women. Longitudinal analyses extending through to older ages may help to clarify the nature, strength, and temporality of these relationships.