title: Empirical redefinition of comprehensive health and well-being in the older adults of the United States.
abstract: The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Despite general acceptance of this comprehensive definition, there has been little rigorous scientific attempt to use it to measure and assess population health. Instead, the dominant model of health is a disease-centered Medical Model (MM), which actively ignores many relevant domains. In contrast to the MM, we approach this issue through a Comprehensive Model (CM) of health consistent with the WHO definition, giving statistically equal consideration to multiple health domains, including medical, physical, psychological, functional, and sensory measures. We apply a data-driven latent class analysis (LCA) to model 54 specific health variables from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of US community-dwelling older adults. We first apply the LCA to the MM, identifying five health classes differentiated primarily by having diabetes and hypertension. The CM identifies a broader range of six health classes, including two "emergent" classes completely obscured by the MM. We find that specific medical diagnoses (cancer and hypertension) and health behaviors (smoking) are far less important than mental health (loneliness), sensory function (hearing), mobility, and bone fractures in defining vulnerable health classes. Although the MM places two-thirds of the US population into "robust health" classes, the CM reveals that one-half belong to less healthy classes, independently associated with higher mortality. This reconceptualization has important implications for medical care delivery, preventive health practices, and resource allocation.
authors.affiliation: Departments of Psychology and Comparative Human Development and the Institute for Mind and Biology, The University of Chicago, Chicago, IL 60637; mkm1@uchicago.edu.
authors.forename: Martha K
authors.initials: MK
authors.lastname: McClintock
authors.affiliation: Section of Geriatrics and Palliative Medicine, Department of Medicine, The University of Chicago, Chicago, IL 60637;
authors.forename: William
authors.initials: W
authors.lastname: Dale
authors.affiliation: Department of Sociology, The University of Chicago, Chicago, IL 60637; NORC, The University of Chicago, Chicago, IL 60637.
authors.forename: Edward O
authors.initials: EO
authors.lastname: Laumann
authors.affiliation: Department of Sociology, The University of Chicago, Chicago, IL 60637; NORC, The University of Chicago, Chicago, IL 60637.
authors.forename: Linda
authors.initials: L
authors.lastname: Waite
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008132:Loneliness; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D012677:Sensation / Q000502:physiology*; D014481:United States
keywords: aging; comprehensive health; disease; health policy; well-being