Developmental aspects of a life course approach to healthy ageing

Abstract

We examine the mechanistic basis and wider implications of adopting a developmental perspective on human ageing. Previous models of ageing have concentrated on its genetic basis, or the detrimental effects of accumulated damage, but also have raised issues about whether ageing can be viewed as adaptive itself, or is a consequence of other adaptive processes, for example if maintenance and repair processes in the period up to reproduction are traded off against later decline in function. A life course model places ageing in the context of the attainment of peak capacity for a body system, starting in early development when plasticity permits changes in structure and function induced by a range of environmental stimuli, followed by a period of decline, the rate of which depends on the peak attained as well as the later life conditions. Such path dependency in the rate of ageing may offer new insights into its modification. Focusing on musculoskeletal and cardiovascular function, we discuss this model and the possible underlying mechanisms, including endothelial function, oxidative stress, stem cells and nutritional factors such as vitamin D status. Epigenetic changes induced during developmental plasticity, and immune function may provide a common mechanistic process underlying a life course model of ageing. The life course trajectory differs in high and low resource settings. New insights into the developmental components of the life course model of ageing may lead to the design of biomarkers of later chronic disease risk and to new interventions to promote healthy ageing, with important implications for public health.

Developmental Origins of Health and Disease: A Lifecourse Approach to the Prevention of Non-Communicable Diseases

“…Pregnancy at a young age, and early marriage, not only affect the health and human rights of girls but also disrupts their education and development of skills and social networks, all of these undermining their future health and wellbeing, along with the health of their children [39]. Adolescent pregnancy is associated with higher risk of adverse outcomes for both mother and child than pregnancies occurring when women are aged 20–30 years; stillbirths, neonatal deaths, preterm births, low birth weight and postnatal depression are all more common in adolescent pregnancies [40,41]. Pregnancies occurring at a younger age are often unplanned and so risk factors for adverse pregnancy outcome, such as low folic acid intake and alcohol use, are more likely.…”

The inheritance of cardiovascular disease risk

“…This approach has been particularly applied to ageing, separating health into various domains in which cardiometabolic function relates to the ability to be mobile and viewing health as a combination of intrinsic capacity (defined as the composite of all the physical and mental capacities that an individual can draw on) and functional ability (defined as the health‐related attributes that enable people to be and to do what they what they have reason to value). This model has applied to cardiovascular function in relation to endothelial function, the effects of oxidative stress, nutrition and stem cell capacities .…”

What are the public health implications of the life course perspective?

“…Risks for a large number of public health problems, including non-communicable diseases (NCDs), accumulate not only throughout an individual's life from the embryo stage onwards, but can also be passed from one generation to the next [3][4][5][6].…”