Measuring Active and Healthy Ageing (AHA): Characteristics of the Bern Cohort Study 2014 (BeCS-14)
Introduction
According to the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA), health is a multi-dimensional concept, capturing how people feel and function. However, current research on AHA is limited by distinguishing the least healthy individuals rather than identifying those in best health or discriminating the full spectrum of function or activity. This implies a challenge to develop reference values of both, best health (“health strengths”) and least health (“health resources”) across all age stages within the human life course. The aim of the Bern Cohort Study 2014 (BeCS-14) was to validly measure individual capability, wellbeing and bio-functional age (BFA) using a comprehensive functional approach in accordance with the ICF across all non-pediatric and non-geriatric age stages (i.e. 18 – 70 years).
Methods
Single-centre, cross-sectional, observational, non-interventional trial (Cantonal Ethics Committee Bern approval, Ref.-Nr. KEK-BE: 023112). All participants followed a defined, standardized battery of assessments consisting of bio-functional status (BFS) and bio-functional age (BFA) among others. The overall primary endpoints of the study were to 1) compare the BFA of BeCS-14 with LeCS-84, a previous randomized trial from Germany in 1984 (Leipzig cohort study, LeCS-84), and 2) analyse the qualitative differences between the two populations. Furthermore, we intend to adjust and adapt the evaluation algorithm for BFS and BFA assessment in the future. In the present publication we focus on BFA in contrast to chronological age, present data on the BFS subdomains cardiovascular performance and social stress exposition and fit BFS and BFA into a complex AHA assessment model incorporating the ICF concept. The analysis includes the female BeCS-14 population only. Statistics: Descriptive analysis (means and standard deviations) and linear regression analysis.
Results
In total, 462 women were recruited (73.3% of BeCS-14 cohort). In respect to cardiovascular performance, there was a significant difference for all age groups but the youngest when comparing the BeCS-14 cohort with the LeCS-84 cohort, indicating a significantly better cardiovascular performance in Swiss women aged 30+ compared to German women assessed 30 years ago. Furthermore, there was a significant age-related effect, meaning the younger the better cardiovascular performance. In respect to stress exposition, there was a significantly higher stress exposition level in the German women assessed 30 years ago compared to Swiss women nowadays. Furthermore, there was a decreasing level of social stress exposition in aging women. The measured mean BFA agreed with the chronological age in the LeCS-84 cohort (regression coefficient 0.86, communality age 76%). In contrast, the measured mean BFA was lower than the chronological age within the BeCS-14 cohort (regression coefficient 0.58). In detail, within the decades 35-45 years and 55-65 years the gradient of BFA increase (aging rate) was similar in both cohorts (decade 35-45 years: LeCS-84 4.08 ± 1.03 year equivalents and BeCS-14 4.78 ± 1.67 year equivalents; decade 55-65 years: LeCS-84 6.21 ± 1.29 year equivalents and BeCS-14 5.25 ± 1.18 year equivalents). Remarkably, within the LeCS-84 cohort the mean aging rate within the decade 45-55 years was significantly different from all other aging rates in both cohorts: 13.02 ± 1.05 year equivalents. However, within the BeCS-14 cohort the corresponding value was 4.83 ± 1.02 year equivalents thus indicating a continuous aging process across the adult life course. Finally, the BFS and BFA assessment tool, proved in LeCS-84 and Be-CS-14, was fitted into a theoretical model incorporating the ICF and AHA concept. Therefore, each BFS/BFA item was translated to the corresponding ICF/AHA domain resulting in a complex AHA assessment diagnostic tool.
Conclusions
The BFS/BFA assessment tool follows EIP-AHA requirements. It can be used on an individual as well as on a population level. However, it remains to be developed how the assessed health strengths/health resources-profile may be integrated into change management.