People are connected, so their health is connected. This means that society affects individual’s healthy ageing, and individual health influences society. For example, an ageing population has consequences for the labor market, the housing market, pensions to be paid, and health care and support to be provided. At the other hand, elderly people have specific needs and demands regarding their housing, (health) care and support, but also regarding their daily activities (voluntary work; taking care of grandchildren; leisure activities).
Identification of important and modifiable societal determinants is beyond the scope of epidemiology. The same is true for the identification of critical factors at later stages of the life course. Selection of friends, changes during adolescence, coping with life events, adequate treatment of chronic diseases and sufficient networks at old age are examples of potential pitfalls for healthy ageing. An example is self-regulation, that is a person’s capacity to plan, guide and monitor her/his own behavior. Elderly persons with higher proactive self-management capacities report higher levels of life satisfaction, positive affect, and well-being . This is strongly affected by context conditions at different levels, such as life events and life style, the embedding in social networks such as family, peers and friends, and in institutions such as health care facilities.Healthy ageing requires physical, mental, and social well-being. These are increasingly affected by the interplay of factors at multiple societal levels:
at the macro level, national institutions regulate access to and quality of prevention, care, and pensions, while population dynamics (e.g. migration) and demographic processes (e.g. declining fertility rates) affect the opportunities and constraints for different institutional solutions.
at the meso level, informal communities and social networks as well as formal organizations can provide crucial resources for social and material support, thus constituting essential elements for prevention and mitigation of health related problems. Also meso level data from living and working conditions should be included like distances to family and health care service, but also the amount of green in the living environment.
at the micro level, individuals do not only differ in their health behavior, physical (e.g. co-morbidity, genetics) and mental predispositions (e.g. self-management ability), but also in disease related risk factors accumulating during their life course. These inter-individual differences, in turn, affect the effectiveness of different preventive measures and interventions.
A key obstacle to successful ageing is misalignment among and across these different levels. Examples for cross-level misalignments are abound: health care routines and structures at meso level are often not equipped to adequately deal with co-morbidity at individual level and changes in age distribution at macro level; macro-level policies building on social support and care for elderly from within their own social network collide with decreasing size and density of personal networks due to labor migration; at meso level, programs for integrated care often fail due to inadequate institutional regulations, resulting in inter-organizational coordination problems and perverse incentives for care providers. Further research is needed to both find determinants and models of this misalignment, as well as identify factors that predict the misalignment, both at individual and societal level.
Until now, the majority of efforts to investigate the conditions for healthy ageing and devise appropriate interventions neglected this interplay between societal levels and the resulting problems of misalignment. Indeed successful ageing research initiatives have a multidisciplinary approach, like the European Research Area in Ageing (http://era-age.group.shef.ac.uk/) and The Behavioral and Social Research Program at the National Institute on Aging (http://agingcenters.org/).