Successful aging produces gender-independent wellness profiles
Author: John M. Robinson MD, PhD
The Wellzesta Health Research Institute, 100 N. Main St., Ste. 213, Belmont, NC 28012-3104
Historically, seniors (persons age 65+) have been treated as a single group. Today, aging is viewed as a process, with seniors desiring to “age successfully” - though the recipe for successful aging remains elusive. We reasoned that, by remaining independent, residents in independent living at Life Plan Communities are a model for successful aging. Here, we report the results of a cross-sectional observational study of 1093 residents in independent living, ages 65+, at four Life Plan Communities. Using a mobile health software platform, residents accrued points in the eight dimensions of wellness by participating in community-sponsored events, consuming on-demand wellness content, and logging user-initiated activities. The distribution of points in the eight dimensions of wellness (wellness profile) were analyzed to reveal age- and gender-related trends in aging. The wellness profile shows significant gender differences among persons in their late-60s, but not among persons in their early-90’s. Men show less interest in intellectual wellness (47% decrease) and more interest in social wellness (11% increase) and spiritual wellness (186% increase) with age. Women show more interest in social wellness (139% increase) with age. Age-related changes in the wellness profile suggest individual learning during successful aging.
Successful aging results in longevity and quality of life. The minimum criteria for successful aging is a state of health that affords independence, where independence is the ability to perform the instrumental activities of daily living (1). Well-being is a measure of successful aging (2), but it is difficult to quantify.
Life Plan Communities, which cater to persons age 62+, offer a comprehensive solution for aging. Residents who remain in independent living, rather than transitioning into assisted living, memory care, or skilled nursing, are, according to minimum criteria, aging successfully. The characteristics of independent living residents may offer important insights about successful aging.
Surveys have identified the “secrets of long life” (3), reported the preferences and concerns of seniors (4), estimated engagement in whole-person wellness (5), and identified advantages of living at a Life Plan Community (6). Yet surveys suffer from limited memory recall, reporting bias, and limited granularity (to avoid response fatigue). Data within the electronic wellness records of mobile health and wellness software may offer important insights not available from survey data.
We conducted a multi-center cross-sectional study of residents in independent living at four Life Plan Communities in North Carolina and Virginia. Residents received mobile devices (iPad tablets) and subscriptions to and training on Wellzesta Life, a mobile health and wellness platform for communities. In Wellzesta Life, community-sponsored wellness events and on-demand wellness content (articles, videos) were classified according to the International Classification of Wellness (7), which is crafted around the eight dimensions of wellness. In alphabetical order, the dimensions of wellness are emotional, environmental, financial, intellectual, physical, social, spiritual, and vocational. In Wellzesta Life, wellness events are permitted to span up to three dimensions, and points follow the wellness span (see Methods). Study participants accrued points for participating in community-sponsored events, logging user-initiated activities, and consuming on-demand wellness content. The relative points awarded among the eight dimensions of wellness (wellness profile) characterize the individual’s approach to preventative health and wellness.
Study participants were grouped into lustra (periods of five years): early-60s (ages 60-64), late-60s (ages 65-69), early-70s (ages 70-74), late-70s (ages 75-79), early-80s (ages 80-84), late-80s (ages 85-89), early-90s (ages 90-94), and late-90s (ages 95-99). Table S1 summarizes the study demographics. The study population consisted of 1093 residents (390 male, 703 female) in independent living at four Life Plan Communities. Among these, 780 residents (270 males, 510 females) were awarded at least one wellness point in the past six months (Table S2). Points-receiving individuals were analyzed further. Table S3 reports the wellness points statistics for point-receiving individuals. In all age groups, females accumulated more points per individual than males, suggesting that females are more engaged in wellness than age-matched males.
Individuals in their late-90s accumulated significantly less points than the other groups (P = 2E-8 by 1 tailed z-test). The average points per individual in the remaining age groups did not vary significantly. Since the late-90s group contained insufficient total points to resolve the wellness profile, they were excluded from further analysis. In summary, study participants that met two inclusion criteria---age 65-94 and awarded at least one wellness point in the past 6 months---were analyzed further.
For each age group, the wellness profile was calculated from the points awarded during the prior six months. Figure 1 compares the wellness profiles of men and women in their late-60s and early-90s. Significant gender differences are observed for persons in their late-60s, but are not significant for persons in their early-90s.
Figure 1. Bar charts comparing the wellness profiles of men (solid) and women (outlined) in their late-60s (panel a) and early-90s (panel b).
To resolve whether the change between late-60s and early-90s was gradual, sudden, or random, we plotted the individual dimensions of the wellness profile for all groups (Figure 2). For both men and women, and in all wellness dimensions, we observe a progressive approach towards the early-90s profile. Men show less interest in intellectual wellness (47% decrease) and more interest in social wellness (11% increase) and spiritual wellness (186% increase) with age. Women show more interest in social wellness (139% increase) with age.
Figure 2. Evolution of the wellness profile during aging. To better visualize trends, the data (points) were smoothed by fitting to logarithmic decays (dashed lines).
All communities in this study offered more events in physical, social, and intellectual wellness than events in emotional, environmental, financial, spiritual, and vocational wellness. Since the wellness profile is influenced by the availability of community-sponsored wellness programming, the wellness profile observed for the early-90s population may not be the optimal wellness profile for successful aging. Nevertheless, age-related trends in the wellness profile are significant since residents, regardless of age and gender, have equal access to community-sponsored events.
Whereas a longitudinal study would have followed a population initially ages 65-69 over time, in the present cross-sectional study, we have observed seniors in several age groups during a six month period. The six month sampling was not meant to introduce time into the analysis; rather, the six month sampling allowed us to better resolve dimensions of wellness that are underrepresented.
What causes the age-dependent changes in the wellness profile? Age-related differences in the wellness profile may reflect disparate cultural influences between the G.I. generation (currently ages 92-118), the silent generation (currently ages 74-91), and the baby boom generation (currently ages 55-73). We cannot rule out cultural shifts as possible influences on age- and gender-related changes in the wellness profile of seniors. Disparate cultural influences would tend to produce jumps (discontinuities) in the wellness profile from the late-60s to the early-90s. These discontinuities are not observed.
Age-related differences in the wellness profile may reflect learning as part of successful aging. In this view, persons in their late-60s are initiates, or “rookies,” in the process of successful aging. To afford the cost of living in a Life Plan Community, residents in independent living in their late-60s generally led successful professional careers. But the skills developed to lead a successful adolescence or a successful career do not necessarily translate into retirement. Thus, it seems that persons in their late-60s face an entirely new set of challenges and a steep learning curve. In this view, the age-related differences in the wellness profile reflect successful adaptation.
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