Defining Healthy Ageing: The Role of Ethnicity and Lifestyle Factors

Menassa, Marilyne (2023). Defining Healthy Ageing: The Role of Ethnicity and Lifestyle Factors (Unpublished). (Dissertation, University of Bern, the Faculty of Medicine and the Faculty of Human Sciences)

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Abstract

Background Healthy ageing is a heterogeneous concept that requires clarification on, first, its defining characteristics and, second, how factors such as ethnicity, sociodemographics, and lifestyle affect it. Over the past two decades, healthy ageing has become the focus of research and policy as the world demographically shifts into an older population. This dissertation has three aims: 1) to provide a conceptual overview and analysis of healthy ageing and explore if a monistic definition is possible; 2) to describe healthy ageing multidimensionally in a multiethnic population and explore the factors associated with it; and 3) to explore how long-term mental health as one domain of healthy ageing is associated with lifestyle patterns.

Methods For aim 1, a systematic review and concept analysis based on the PRISMA and Walker and Avant methods were conducted. The concept attributes, antecedents, consequences, and dimensions were described, and the included conceptualizations were classified into types based on their characteristics. For aim 2, healthy ageing was operationalized using the Healthy Ageing Score (HAS) constituting of seven biopsychosocial domains in the Healthy Life in an Urban Setting Cohort Study (HELIUS) including Surinamese, Ghanaians, Turkish, Moroccans, and Dutch residents of Amsterdam. Logistic regression was used to explore the associations between ethnicity, age group, and sex, as well as ethnic differences in the HAS domains. For aim 3, pre-defined long-term mental health patterns were described in adults of Dutch origin in the Doetinchem Cohort Study (DCS). Logistic regression was used to explore the associations between mental health and lifestyle patterns for sleep, smoking, BMI, alcohol intake, and physical activity and to investigate the role of sociodemographic factors in these associations.

Results The first study showed that conceptualizations of healthy ageing were mostly from high-income countries with “successful” and “healthy” as the main terms used. Healthy ageing was characterised by life-long adaptations through person-environment interactions across objective and subjective dimensions, mainly cognitive, psychological, physical, and social. Three types of definitions were found based on health-state outcomes, adaptations, or a combination of both, with some definitions also emphasizing person-environment congruence and health promotion. The second study showed that ethnic minorities aged less healthily than adults from Dutch origin according to the HAS. Ageing poorly was associated with sex (worse in females), marital status, educational, and occupational levels and was also observed in the younger age category (≤ 45 years). The third study found that over a 20-year period persistent good and changing mental health patterns were more common than poor patterns in Dutch adults, while persistent poor and changing patterns were associated with unhealthy sleep and smoking over the same period.

Conclusions Healthy ageing is a multidimensional concept, determined by person-environment interactions over the life course, and cannot be monistically defined. It is disproportionately manifested between ethnic groups, is less healthy among minorities compared to the host population, is less healthy in females, and is observed at a young age in adulthood. Long-term unhealthy lifestyle could lead to suboptimal mental health in adults.

Implications Bridging the gap between conceptual and operational definitions of healthy ageing and promoting interdisciplinarity in healthy ageing research that accounts for multidimensionality, context, and ethnicity would improve the evidence and its application in practice and policy. Promoting a healthy lifestyle early in adulthood might help improve mental health, and potentially other dimensions and domains of healthy ageing where further investigations in different ethnicities are warranted.

Item Type:	Thesis (Dissertation)
Division/Institute:	04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
Graduate School:	Graduate School for Health Sciences (GHS)
UniBE Contributor:	Menassa, Marilyne, Franco Duran, Oscar Horacio
Subjects:	600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services
Language:	English
Submitter:	Beatrice Minder Wyssmann
Date Deposited:	28 Aug 2023 15:08
Last Modified:	28 Aug 2023 15:21
Additional Information:	PhD in Health Sciences (Public Health)
URI:	https://boris.unibe.ch/id/eprint/185800