Development of a Healthy Aging Score in the Population-Based Rotterdam Study: Evaluating Age and Sex Differences

Objectives: To develop a healthy aging score (HAS), to assess age and sex differences in HAS, and to evaluate the association of the HAS with survival. Design: Prospective population-based cohort. Setting: Inhabitants of Ommoord, Rotterdam, The Netherlands. Participants: A total of 1405 men and 2122 women, mean (standard deviation) age 75.9 (6.4) years. Main measures: We included 7 domains in the total score of HAS: chronic diseases, mental health, cognitive function, physical function, pain, social support, and quality of life; each scored 0, 1, or 2 in each domain. A total score (range 0e14) was constructed and was assessed continuously and in tertiles (13-14: healthy aging, 11-12: intermediate aging, 0-10: poor aging). Sex-specific change in the mean HAS was computed for the age categories of 65-69, 70-74, 75-79, 80-84, and >= 85 years. The association between HAS and mortality was assessed with Cox proportional hazards models. Results: Mean follow-up was 8.6 (3.4) years. Men had poorer scores in the chronic disease domain than women. However, women had poorer mental health, worse physical function, more pain, and lower quality of life compared with men. The prevalence of healthy aging was higher in men (n = 396, 28.2%), than in women (n = 526, 24.8%). The mean (standard deviation) HAS was 11.1 (2.2) in men and 10.7 (2.3) in women. Mean HAS was higher in men than in women for all age categories. The beta for change in mean HAS across the 5 increasing age categories was -0.55 (-0.65 to - 0.45)in men and - 0.65(- 0.73to - 0.57) in women. The age-adjusted hazard ratio per unit increase in HAS with mortality was 0.86 (0.83-0.89) in men, and 0.89 (0.87-0.91) in women. Conclusions: Levels of HAS were lower in women compared with men, in all age categories. The HAS declined with increasing age for both sexes, albeit slightly steeper in women. The HAS was strongly associated with mortality in both sexes. A better understanding of population healthy aging and sex differences in this regard could aid to implement strategies for sustainable healthcare in aging populations. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.