A Comprehensive Model of health revealed that 50% of US older adults belong to less healthy classes associated with higher mortality, whereas a traditional Medical Model classified 67% as robust.
Observational
A comprehensive model of health incorporating physical, psychological, functional, and sensory measures identifies vulnerable older adults missed by traditional disease-centered medical models.
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.
McClintock et al. (Mon,) conducted a observational in Health and well-being in older adults. Comprehensive Model (CM) of health vs. Medical Model (MM) was evaluated on Health classes identified via latent class analysis. A Comprehensive Model of health revealed that 50% of US older adults belong to less healthy classes associated with higher mortality, whereas a traditional Medical Model classified 67% as robust.