Health and Aging Unifying Concepts Scores Biomarkers

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Fuellen G et al Health and Aging Unifying Concepts. aging and we place these into a consistent systematic which are potential targets of interventions in order to. framework Our aim in presenting these definitions is to increase healthspan on the other hand Our definitions are. support empirical studies in particular in health and aging designed to apply to most animal species although the. research and to facilitate the comparability of results For literature we surveyed and thus the operationalization of. this reason we aim for a coherent set of definitions that health we suggest is specifically targeted to human and. are practical in the sense that they can be used in actual the model organisms C elegans and mouse Overall we. research contexts This requires that the definitions can be arrive at a framework of definitions covering states time. operationalized that they are based on a sufficient periods associated processes and predictors of future. consensus in the research communities and are states as given in Table 1 We suggest that this generic. sufficiently robust to be applied to different experimental framework of simple and threshold free definitions of. and clinical settings covering molecular as well as higher common terms places these into context while still. level phenotypic phenomena common for a variety of preserving to a maximum degree their intuitive meaning. biological species in particular human and model In this paper we will first present a framework for the. organisms such as C elegans and mouse different kinds of terminological categories states time. Specifically we dissect health into a hierarchical periods processes predictors We then define the key. system of its various aspects allowing to analyze its term health and closely related terms such as healthspan. features in detail and to identify the biomarkers We define the term survival contrast its meaning with. molecular pathways and corresponding supportive health and propose to integrate both terms under the. interventions for the various aspects of health While integrative concept of wellbeing Often used indicators of. beyond the scope of the present paper the inter related health such as quality of life activities of daily living lack. aspects of health that we describe can in principle be of frailty or self reported health in case of human and. scored and weighted and thus provide a way for the indices such as the Healthy Aging Index can then be. overall measurement and comparison of the health of viewed as projections or surrogates of wellbeing We. different individuals Defining health based on disease further define aging as the set of all processes in an. and dysfunction we follow a consensus approach by individual that reduce its wellbeing that is its health or. means of a literature survey For disease we employ the survival or both Regarding predictors we define the term. World Health Organization WHO International biomarker for features of health survival or wellbeing. Statistical Classification of Diseases and Related Health as generically as possible as a predictor for these features. Problems and for dysfunction we start with the WHO that is better than chronological age Such a biomarker is. International classification of functioning disability and a feature itself and as any feature it may be composed of. health The latter will then be utilized as background for more elementary features We discuss various classes of. the review of pertinent papers from health and healthspan biomarkers of aging considering for example causality. research to systematize our findings From this of various kinds We define healthspan pathways as. consensus we then derive appropriate definitions of molecular features of health that relate to each other. healthspan healthspan enhancing processes and specifically by belonging to the same molecular pathway. biomarkers of health as well as wellbeing aging and Precise definitions of other standard concepts such as. biological age In order to allow the step from prediction biological age follow naturally. to enhancement we finally distinguish between, correlative features on the one hand and causal features. Table 1 Framework of definitions, S tate Time period Underlying biological processes Predictor of future state. health healthspan healthspan enhancing processes health biomarkers. concepts survival lifespan lifespan enhancing processes survival biomarkers. Integrative,wellbeing wellspan wellspan enhancing processes. biological age,illbeing illspan aging processes, baseline organismal state chronological time average biological processes chronological age. Frequently used terminology that we can fit into our framework is marked in boldface T he terms in the last row and specifically the term average. biological processes refer to a specifically selected reference population. Aging and Disease Volume 10 Number 4 August 2019 884. Fuellen G et al Health and Aging Unifying Concepts. How to Define Health with Respect to a Reference been formulated to be applied to humans but it uses very. generic terms that apply to most species of course. Therapeutic interventions affecting aging and health may mental and social well being can hardly be applied to. have different goals Often the emphasis of preventive as species like jellyfish or sponges This definition is also. well as curative interventions was on the extension of simple and threshold free but it is not very practical. lifespan But for most people the mere extension of life is First what exactly does well being refer to Second. not desirable if it were possible to live for several any deviation from complete well being would be a. hundred years in a vigilant coma hardly anyone would deviation from health Whoever loses their job or misses. prefer such a long enduring vegetative state to a normal their spouse or whose kids are not doing well at school. human life with a much shorter lifespan For this and other is not in a complete state of well being Third it is not. reasons emphasis has shifted to increasing healthspan clear whether a state of complete well being is. i e the time period that an individual spends in a state of attainable at all In practice the question arises which of. health Lifespan is relatively easy to be operationalized many possible deviations from complete well being is. While from a theoretical perspective life is both the lesser evil This question does not have a general. intensionally and extensionally vague at its borders 5 answer because preferences will vary from person to. this does not matter much in the context of medical person A photographer might prefer to retain sight over. research For practical purposes being alive that is hearing while a composer might opt the other way. survival can be modelled as a binary state any individual around Different people will assign different w eights to. as a whole is either alive or it is not We consider only certain aspects of well being. the survival of an individual as a whole not the life status These problems of the WHO definition motivate an. of body parts like organs tissues or single cells The time approach in which the severity of any deviation from. period of an individual spent alive is its lifespan Death is health is weighted on an individual basis taking into. the irreversible end of biological life account that goals may change with time and. In contrast it is much more difficult to operationalize circumstances This also holds for the time period in. health and healthspan For one the definition of health which health is desired Possibly some individuals such. itself is contested Is it an intrinsic property of an as athletes may want to trade better physical function in. individual or is it the extrinsic statistical property of the short term for worse health in the long term Thus. instantiating certain features better than the average of a there may be trade offs between different features of. relevant reference group Is it a subjective value health as well as between the intensity and the extension. judgement or is it ascribed to individuals in a socio of health given that both cannot necessarily be optimized. constructive way 6 7 We will argue that an operational at the same time We will introduce the concept of. definition of health needs to incorporate elements from all wellbeing different from the WHO term well being. these approaches Second as one may expect the features featuring in the WHO definition of health in order to. of health turn out to be quite different in humans and integrate health healthspan and survival lifespan. model organisms like C elegans or mouse Third it is not according to the subjective weighting of individuals As. clear whether there is an irreversible end of healthspan our operationalizations of health and wellbeing make use. other than death Often the healthspan of an individual is of more features than one these features have to be. assumed to begin with conception or birth and end at some weighted in order to be integrated into a single score Such. later time But individuals can have diseases or weighting is necessarily subjective and different weights. dysfunctions during their life and then recover they may may reflect different preferences of different people In. even be born with a disease or a dysfunction and then have case of non human animals weighting is implicitly or. their health re gained We thus do not define healthspan explicitly carried out by the researcher here the. as a single coherent time interval but allow it to stretch subjective view of the researcher replaces the preferences. over unconnected intervals and simply define healthspan of the individual. as the time an individual spends in a state of health where Our definition of health will thus contain a subjective. health is in turn operationalized as described below element with respect to certain weighting factors but the. This allows us to stay uncommitted to the question very features that are weighted comprise objectively. whether it is possible in principle to re gain the state of measurable aspects Thus we will not advertise a. health subjective definition of health 6 Subjective theories of. Probably the most famous definition of health is the health define health in subjective terms Individuals are. one programmatically formulated by the WHO in 1948 healthy according to these theories if they feel healthy or. The WHO defines health as the state of complete report to be healthy Feeling healthy is usually considered. physical mental and social well being and not merely the a necessary aspect of health and self reports are often. absence of disease or infirmity 8 This definition has used to operationalize health However subjective aspects. Aging and Disease Volume 10 Number 4 August 2019 885. Fuellen G et al Health and Aging Unifying Concepts. cannot be the whole story Individuals can feel healthy consensus Starting from the ICF classification we. although they have diseases or dysfunctions still unknown reviewed pertinent papers from health and healthspan. to them or ignored by them In addition coping strategies research with respect to how they operationalize health. and compensation as well as a change in goals and values systematizing our findings according to the ICF. may influence the subjective assessment of one s health classification In some cases our review gave us reason to. Moreover subjective theories are not feasible for other modify the default presented by the ICF classification. species like worm or mouse even if worms or mice had a Once the different features have been selected and. subjective self conception of being healthy they would measured we can compare the values measured for these. not be able to self report their health status at an interview with the reference values that are the average in a. In contrast to a subjective approach to defining health reference population For example we can compare the. we will define health as a state of an individual based on grip strength of a 60 year old individual with the average. specific objective features namely the absence of disease grip strength of 60 year olds in the reference population. and dysfunction As most of these features can be realized Depending on whether the value measured is below or. in a gradual manner the question arises where exactly to above average optionally considering the variability of. put the threshold We need to introduce thresholds in values in the reference population we can assign a score. order to distinguish between healthy and unhealthy to this feature and we can consider this individual to be. individuals In order not to have to introduce arbitrary in bad or good health with respect to this feature E g a. thresholds we will refer to the average realization of the very simple and often inadequate scoring would assign. features in a certain reference population Thus our 1 to values below average and 0 to values above average. approach is threshold free in the sense that we do not set Using some subjective weighting we can then. any thresholds a priori we only provide a recipe for integrate the scores for all features into one overall health. setting these in a generic way score This would be done in a standardized way which. Furthermore in view of the controversial discussion reflects the different aspects of health Such an approach. found in the literature we refrain from starting top down mirrors the use of qualifiers in the ICF The simplest. We further define aging as the aggregate of all processes in an individual that reduce its wellbeing that is its health or survival or both We define biomarkers of health by their attribute of predicting future health better than chronological age We define healthspan pathways as molecular

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