Interventions for Healthy Ageing

WHO defines healthy ageing as the process of developing and maintaining the functional ability that enables wellbeing in older age.

"Functional ability — retaining autonomy and independence as people age — is the cornerstone of healthy ageing."

Intrinsic capacity is the composite of all of an individual's physical and mental capacities and is the key determinant of functional ability. Domains: cognition, psychological state, sensory function (vision and hearing), vitality/nutrition and locomotion.

Healthspan = duration of life in good health. Fries described compression of morbidity — medicine rectangularises the survival curve, delaying death closer to maximum lifespan without changing maximum lifespan itself.

Key conceptual point: "healthy ageing" and "successful ageing" are biologically vague as descriptions. Their proper function is prescriptive — a norm of intervention: "keep as many people as possible as healthy as possible for as long as possible."

Frailty is the clinical counterpart — loss of in-built capacity across multiple systems with reduced physiological reserve and resilience. The focus in older patients should be on functionality rather than disease diagnosis.

Physical function is proposed as the biomarker of healthy ageing — aerobic capacity, gait speed, balance, mobility and muscle strength — predicting adverse events, disability and mortality.

Gait speed predicts mortality in older adults better than chronic diseases such as hypertension.

Older adults with handgrip strength above the weakness thresholds had lower odds of adverse events across most intrinsic capacity domains and lower hospitalisation rates.

Multimorbidity is NOT the most important factor modulating intrinsic capacity domains — function matters more than disease count.

Habitual physical activity increases average life expectancy by about two years and prevents most of the body-composition changes of ageing.

Exercise prevents/treats obesity, cardiovascular disease, type 2 diabetes, hypertension, osteoarthritis, osteoporosis, stroke, peripheral vascular disease, renal failure, dementia and depression.

Multicomponent exercise (resistance + balance + gait retraining) improves all the hallmarks of frailty. VIVIFRAIL gives individualised "prescription passports" based on SPPB and gait speed.

High-intensity and explosive (power) resistance training is the optimal prescription for sarcopenia, and also improves balance and cognition (particularly in MCI).

Sequence in the frail follows the physiology of mobility: strength/power to stand → balance to stay upright → endurance to walk.

Aerobic exercise alone does not improve strength or balance. Walking-based falls programmes are inferior to strength-and-balance programmes and have been associated with increased fracture rates in those at risk.

Screen for the anorexia of ageing and malnutrition using SNAQ or MNA whenever weight falls more than 5 lb (2.3 kg) per year; diagnose using GLIM criteria (phenotypic + aetiologic).

Oral nutritional supplements produce 1–3 kg weight gain over 1–3 months, but have not shown mortality or functional benefit in the general elderly population — benefit is confined to those who are frail, malnourished or recently ill.

Mediterranean diet promotes epigenetic rejuvenation (NU-AGE); adequate protein and vitamin D 800–2000 IU/day support muscle and bone. Pillar 3 — Preventive Geriatrics (Stratify by Prognosis)

The Health Maintenance Clinical Glidepath stratifies every intervention into four categories: Robust — life expectancy over 5 years, functionally independent Frail — life expectancy under 5 years or significant functional impairment Moderately demented — life expectancy 2–10 years End of life — life expectancy under 2 years, functionally dependent

At EVERY visit, for all categories: blood pressure including orthostatics, weight, pain assessment, medication review including OTC and herbal, awareness of elder abuse, and Rapid Geriatric Assessment. Lifestyle education at each visit for the robust and frail.

Yearly: ADLs and IADLs, urinary incontinence, ADAM screen for hypogonadism in men; consider annual visual acuity and auditory testing.

Immunisation: influenza yearly in all four categories; pneumococcal; tetanus booster every 10 years with at least one dose as Tdap; zoster — Shingrix 90% protective versus Zostavax 30%.

Screening tied to life expectancy: osteoporosis by DXA plus FRAX; one-time AAA ultrasound in male ever-smokers aged 65–75; sleep apnoea (Epworth); targeted lipid and TSH screening; cancer screening only if life expectancy is 10 years or more; smoking cessation must be prioritised at every encounter.

Plasticity is retained into old age — cognitive training, physical training and even neurogenesis are demonstrable. Longitudinal cohorts show that good vision, volunteer or paid work, physical activity and IADL independence independently predict continued functional independence over 7 years. Address the transitions of ageing — retirement, bereavement, loss of driving, sensory loss — and support social connectedness and home environment modification.

WHO ICOPE Handbook, 2nd edition (2024) — the operational tool for healthy ageing. It supports health and care workers to put evidence-based recommendations into practice in primary care and community settings, describing pathways to detect declines in intrinsic capacity, identify social care and support needs, and develop a personalised care plan; an interactive App generates a printable summary. The pathway is designed for general practitioners and trained non-experts such as community health workers or nurses, without requiring specialised geriatric expertise — usable from urban clinics to rural outreach. Pilot programmes in India, Mexico and Vietnam demonstrated feasibility in resource-constrained environments with improved functional outcomes and reduced healthcare utilisation. In France, the INSPIRE ICOPE-CARE programme had over 3000 individuals actively followed by October 2024, with high adherence and evidence of delayed functional loss. (European Geriatric Medicine 2026)

ICOPE Step 1 screening — what it actually finds. In a Singapore feasibility study of 367 community-dwelling older adults (mean age 71.8), ICOPE Step 1 screening found 284 (77.4%) with signs of intrinsic capacity decline — commonest being visual impairment (42.0%), hearing loss (33.5%) and cognitive deterioration (31.3%), followed by limited mobility (24.3%), malnutrition (16.1%) and depressive symptoms (16.1%). Clinical message: sensory impairment is the commonest reversible threat to intrinsic capacity — screen vision and hearing first.

Lancet Commission 2024 — dementia prevention as healthy ageing. The 2024 report adds untreated vision loss and high LDL cholesterol; around 45% of dementia cases are potentially preventable by addressing 14 modifiable risk factors across the life course: low education in early life; hearing loss, hypertension, obesity, excessive alcohol, traumatic brain injury, high LDL cholesterol, depression, physical inactivity, diabetes and smoking in mid-life; and social isolation, air pollution and visual impairment in late life.

Multidomain interventions have come of age. Five multidomain trials published 2015–2019 including FINGER did not show consistent cognitive improvement — but in the 2020s, seven of ten trials reported beneficial effects of multidomain interventions on cognitive outcomes, with additional benefits on physical function, reduced multimorbidity and healthcare resource use. (Geriatrics & Gerontology International 2025)

Biological proof that lifestyle slows ageing. CALERIE showed a lifestyle intervention slowed the pace of ageing by DunedinPACE — roughly 3% slowing, associated with 15% lower risk of death. (Nature Aging 2023)