Ageing is often perceived as a process confined to later life, but the truth is that the trajectory of our health in old age is shaped by experiences and choices made throughout our entire lives. The risk of age-related diseases such as dementia, frailty, and multimorbidity (the presence of multiple chronic conditions) increases with age, but many of these risks can be mitigated through interventions at various stages of life. This is the essence of the life course approach to healthy ageing—a perspective that emphasizes the importance of addressing modifiable risk factors early and consistently across the lifespan.
In this article, we’ll explore how adopting a life course approach can set the stage for healthy ageing, reduce the risk of age-related diseases, and promote longevity. We’ll also discuss the critical role of policy in addressing socioeconomic disparities that influence health outcomes across generations.
The Rising Burden of Dementia in India
Dementia is one of the most feared age-related conditions, but its risk can be influenced by factors at every stage of life. The Dementia prevention, intervention, and care: 2020 report of the Lancet Commission highlights the importance of a life course approach in understanding and mitigating dementia risk. The report identifies modifiable risk factors that appear in early life, midlife, and later life:
- Early life: Education plays a crucial role in cognitive development. Higher levels of education in childhood and adolescence are associated with a reduced risk of dementia in later life.
- Midlife: Conditions such as hypertension, obesity, and physical inactivity are strong risk factors for dementia. Interventions during this period, such as maintaining a healthy diet and regular exercise, can significantly lower the risk.
- Later life: Depression and social isolation in older adults are linked to an increased risk of dementia. Addressing mental health and fostering social connections can help mitigate this risk.
A Personal View published in The Lancet Healthy Longevity further emphasizes the importance of young adulthood as a critical window for early intervention. Promoting brain health through continued education, regular physical activity, and healthy nutrition during this period can have far-reaching effects on cognitive health in later life.
Beyond Dementia: Frailty and Multimorbidity
The life course approach is not limited to dementia prevention. It is equally relevant for other age-related conditions, such as frailty and multimorbidity. Frailty, characterized by reduced physical strength and increased vulnerability to adverse health outcomes, is often rooted in early life experiences. For example, socioeconomic disadvantage and undernutrition in childhood have been shown to increase the risk of frailty in later life.
Similarly, childhood and adolescence are critical periods for skeletal development. Diets rich in calcium, vitamin D, and protein during these stages can have protective effects against fractures and osteoporosis in old age. Early life also plays a significant role in multimorbidity risk. Factors such as younger maternal age, higher maternal BMI, and low socioeconomic status in childhood are predictive of a faster accumulation of chronic diseases in adulthood.
The Importance of Timing: When to Intervene?
Identifying modifiable risk factors is only part of the equation. Equally important is understanding the life stages during which these factors are most potent. For example, midlife is a sensitive period for interventions targeting obesity and high blood pressure, both of which are strong risk factors for dementia and coronary heart disease. However, this does not mean that interventions should be limited to midlife. Risk factors span across the life course, and preventative efforts at any stage can have far-reaching health benefits.
It’s also important to recognize that while early life and midlife play a significant role in shaping risk trajectories, these trajectories are not set in stone. Risk profiles remain malleable throughout life, and interventions in later life can still make a meaningful difference.
A Broader Reframing of Ageing
To promote healthy longevity, we need to reframe how we think about ageing. The misconception that age-related diseases are inevitable and can only be addressed in late adulthood must be countered. The foundations of healthy ageing are laid over the course of our lives, and prevention strategies must begin early.
However, the responsibility for healthy ageing should not fall solely on individuals. Policymakers have a critical role to play in addressing the socioeconomic disparities that underpin risk inequalities. For example, differences in access to childhood education can have long-term effects on health outcomes. Policies aimed at improving access to and the quality of education can help level the playing field and reduce health disparities across generations.
Conclusion: Setting the Stage for Healthy Longevity
Ageing does not have to mean declining health. By adopting a life course approach, we can set the stage for a path of healthy longevity. This means recognizing the importance of early interventions, understanding the interplay between risk factors across different life stages, and implementing policies that address the root causes of health inequalities.
The life course approach reminds us that healthy ageing is a lifelong journey. By taking proactive steps at every stage of life, we can reduce the risk of age-related diseases and promote a healthier, more vibrant old age.
References
- Articles: Predictors of multimorbidity across the life course. The Lancet Healthy Longevity, 2024. Link
- Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 2024. Link
- Personal View: Promoting brain health in young adulthood to prevent Alzheimer’s disease and related dementias. The Lancet Healthy Longevity, 2024. Link
- Series: Frailty risk factors over the life course. The Lancet, 2019. Link
