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Ageing Trajectories of Health: Longitudinal Opportunities and Synergies

Periodic Reporting for period 4 - ATHLOS (Ageing Trajectories of Health: Longitudinal Opportunities and Synergies)

Reporting period: 2019-11-01 to 2020-04-30

Understanding the processes and determinants of healthy ageing is important, not merely because we all want to live longer, but because we want our years to be active and healthy. With declining fertility and increasing life expectancy, populations in Europe and elsewhere are ageing rapidly, and at an increasing pace, making it more urgent to understand how to ensure healthy ageing. Ageing is a dynamic process that is highly variable and affected by many determinants. It is convenient to speak of ‘health trajectories’ in order to capture this variation. A health trajectory is a pathway from birth to death defined in terms of length of life (longevity) and health status (the extent of morbidity, disability, or less than optimal health, experienced at a point in time). ATHLOS’ objective is to achieve a better understanding of ageing by identifying patterns of healthy ageing trajectories, the determinants of those patterns, the critical points in time when changes in trajectories are produced, and to propose timely clinical and public health interventions to optimise healthy ageing. Moreover, a new definition of ‘old age’ including not only chronological age but also health status to define an aged person will be used for calculating projections in specific population groups, and guide policy recommendations. To do so, ATHLOS has created a harmonised dataset with over 400,000 individuals collated from existing longitudinal studies of ageing and including information on physical and mental health, life style habits, social environment, and participation, among others. A Healthy Ageing Scale will be developed using Item Response Theory methods with individual items from the surveys. Diverse complex statistical models will be employed to define health trajectories. Specific interventions both at clinical and population level will be designed based on ATHLOS. The impact of these interventions on healthy ageing will be assessed with micro-simulation methods. Stakeholders will participate in the definition of outcomes, the creation of interventions, and dissemination of results. ATHLOS will make its resources available to scientists and stakeholders by providing access to the methodology of harmonisation and to the mega dataset of ageing cohorts. To maximise the policy impact, target audiences will be identified and specific materials disseminated.
The 1st period, activities were dedicated to the creation of the ATHLOS harmonised dataset. The original cohort variables were harmonised into common variables. The ATHLOS Healthy Ageing Scale was tested and a step-by-step approach was conducted to generate a global health scores, using a methodology for the comparison of health scores across ATHLOS studies. A systematic review (92.747 initial articles) for the description of patterns of healthy-ageing trajectories, determinants and inequalities was initiated. Dissemination strategy and data management plans were prepared.

The 2nd period, ATHLOS merged large variable sets from European and International longitudinal studies into the ATHLOS harmonised dataset. The original data and harmonisation codes employed were made publicly available. ATHLOS further developed the Healthy Ageing Scale, allowing to compare health status between populations and to assess healthy-ageing trajectories. The systematic review on determinants of healthy ageing was completed. Specific analyses to identify healthy-ageing determinants were performed. Using the health scores, health-age trajectories of different cohorts were compared, which showed that, at the same chronological age, people in subsequent cohorts are increasingly healthier, encouraging to further explore the determination of ‘old age’ based on characteristics instead of age.

The 3rd period, the healthy-ageing trajectories were studied. The ATHLOS health metric was used to investigate trajectories over time by age and gender, and the association with health determinants. Variation in healthy-ageing trajectories between populations at different socioeconomic development level, and the societal indicators that contribute to such variations were further explored to identify inequalities in healthy ageing. A new definition of “old age” was defined as individual-based, based on the ATHLOS health metric and a threshold health-score for different countries. Based on ATHLOS outcomes and Microsimulation models, recommendations for policymakers were formulated. The results were published in peer-reviewed journals. Stakeholders (e.g. older people’s representatives, health providers, local authorities and researchers) were consulted to discuss the ATHLOS outcomes. Dissemination activities continue.

The 4rd period, the stakeholder consultations were analysed and included, together with other ATHLOS’ findings, in a body of recommendations for health, equity and social policy to achieve optimal healthy ageing. ATHLOS findings were presented during the final conference at the European Parliament.
The most noticeable impact of ATHLOS so far has been its scientific impact. The harmonisation methods used are the state-of-the-art; but the range of data sources (> 19 international studies) is well beyond what has hitherto been attempted and gives a great incentive for further scientific research. The ATHLOS results will be employed for (i) further development of the harmonising procedures and harmonised dataset; (ii) additional analyses based on the harmonised dataset; and (iii) further development and use of the microsimulation model (MSM). So far, 94 scientific publications have derived from ATHLOS and this number will increase as ATHLOS continues to prepare and disseminate information on healthy ageing trajectories in Europe.

ATHLOS’ economic impact should be considered on a long-term, when the results are made publicly available and stakeholders actively incorporate them in their work. The Healthy Ageing Scale and MSM enable the assessment of cost-effectiveness of interventions by accurately comparing and evaluating different options, and their impact on ageing. This allows policy-makers and health service providers to make focused, cost-effective, and timely interventions to improve the ageing trajectory of European citizens, therefore reducing and delaying their need for health services and long-term care. By improving individual functioning, and thereby increasing the proportion of the population who age healthily, the population productivity will increase and the economic burden that comes with general ageing of society in Europe will reduce.

ATHLOS’ societal impact is expected to occur after the end of the project. ATHLOS provides policy-makers the knowledge and tools to make evidence-based decisions regarding all aspects of healthy ageing. Stakeholder were consulted to integrate ATHLOS’ findings into policies and to prioritize areas for policymaking. The Healthy Ageing Scale allows the quantitative descriptions of the impact of determinants on healthy ageing and the MSM helps to describe events and outcomes at population level. The naturalistic approach of the ATHLOS data provides a realistic and population-based assessment, which allows to identify the risks and protective factors that really matter, quantify their impact, and identify interventions that will most effectively optimise healthy ageing.
ATHLOS General Assembly 2017
ATHLOS Extra General Assembly 2018
ATHLOS Harmonisation Workshop 2016
High resolution ATHLOS logotype
ATHLOS WP5 Meeting 2019
ATHLOS General Assembly 2019
ATHLOS General Assembly 2016
ATHLOS General Assembly 2018
ATHLOS kick-off meeting