Health and well-being are more than just physical

Lone anonymous middle aged man suffering depression or anxiety.  Looking sad, worried, frustrated, in pain or desperate with hands on head leaning against an empty white wall. (Gareth Price)

Mental health factors like loneliness, and sensory factors like hearing loss, can matter more to someone's well-being and risk of death than traditional measures like cancer and high blood pressure, a new study suggests.

Particularly in caring for older adults, doctors should consider more than just physical health, the researchers say.

"We're a mosaic of all of these traits," said lead author Martha McClintock, of The University of Chicago. "In order to see the picture of health, you need to look at them together."

Traditionally, health and well-being is measured with the so-called medical model, which is based on physical health and the absence of disease.

McClintock and her colleagues adapted the medical model to create what they call the comprehensive model, which includes medical, physical, psychological, functional and sensory factors.

To compare the two models, they used 2005-2006 data from the U.S. National Social Life, Health and Aging Project on a nationally representative sample of people ages 57 to 85.

According to the medical model, about two-thirds of the U.S. population in that age group is generally healthy. But in the comprehensive model, half of that population has health problems that increases their risk of death or incapacitation over the next five years.

The comprehensive model also identified two groups left out of the medical model: people with poor mental health, and those with healed bones that were broken after age 45. Between 14 and 19 percent of people in those classes would likely be dead within five years, compared to 6 to 16 percent of people in generally good health.

These two health classes "comprised a quarter of the U.S. population of people this age that were not predicted by the medical model at all," McClintock told Reuters Health.

The newer model also showed a complex relationship between obesity and old age. For example, obesity in older people without other health issues appears to confer little risk, but that's not true for people with other conditions like diabetes and poor mental health.

The researchers also report in the Proceedings of the National Academy of Science that diagnoses like cancer and high blood pressure, and behaviors like smoking, might not always have as big an impact as some mental health and sensory issues.

This doesn't mean that cancer, high blood pressure and smoking aren't important, said McClintock, but factors like loneliness and poor hearing were better predictors of being dead or incapacitated within five years.

She said the findings challenge the idea of chronological aging, when people progress from stage 1 to stage 2 and so on. Instead, she said, aging is more like a water system.

"I think of it as we're going down a river as we age," said McClintock. "When we're young adults or middle aged, we're pretty much in the same boat, but then with aging the stream splits up (and) we start zigging and zagging on different pathways."

Her team is working to confirm these findings among Baby Boomers, who would have grown up in a different era than the people in this study.

In the meantime, she said, older people can use this knowledge to find a healthcare team trained to think of health as constellations of conditions. They should tell their doctors about more than just their physical health, she advises, and should visit an audiologist and get a home safety study done. They can also become more socially active by joining community groups.