Healthy ageing phenotypes and four-year health outcomes: findings from a prospective cohort study

Global aging presents major public health challenges. Promoting Healthy Aging (HA) is a priority for organizations such as WHO and the American Geriatrics Society. However, inconsistent HA definitions hinder research and policy. This study examines the associations of two clinical phenotypes of healthy aging with healthcare utilization, care needs, and patient-reported outcomes using longitudinal data from a community-based population from 12 European countries. In this prospective cohort study, we analyzed data from 15,122 community-dwelling adults aged 65 + from waves 5 and 7 of SHARE (45.7% male; mean age 73.2 years, SD = 6.2). HA status was classified using biomedical and biopsychosocial criteria. Multivariate regression models assessed associations between HA and healthcare use, self-reported health, quality of life, and mortality, adjusting for sociodemographic factors. According to the biomedical phenotype, 16.8% ( n = 2,546) met HA criteria, while 34.1% ( n = 5,151) met the biopsychosocial phenotype criteria. Both showed an association with lower healthcare utilization, with the biomedical phenotype showing a stronger association. HA status correlated with better self-reported health and quality of life, with the biopsychosocial phenotype demonstrating a more robust associative relationship. Mortality rates do not differ significantly between phenotypes. Both HA phenotypes predict health outcomes in older adults. The biopsychosocial phenotype shows a stronger association with quality of life, underscoring the importance of psychosocial and environmental determinants. Integrative strategies addressing both biomedical and psychosocial dimensions are crucial for promoting healthy aging. Future research should investigate long-term HA trajectories to inform personalized intervention models.