Measuring Active and Healthy Ageing: Applying a generic interdisciplinary assessment model incorporating ICF



In this study we compared the chronological and bio-functional age between two German speaking cohorts 30 years apart applying a comprehensive and generic Active and Healthy Aging (AHA) assessment model incorporating ICF.


Single-centre, cross-sectional, observational, non-interventional, non-randomized trial at an University based women’s hospital, division of Gynecological Endocrinology and Reproductive Medicine. All participants followed a standardized, holistic battery of biopsychosocial assessments consisting of bio-functional status (BFS), bio-functional age (BFA) and additional validated psychometric questionnaires.


462 non-pediatric, non-geriatric females were in the BeCS-14 cohort. The measured mean BFA was lower than the chronological age within the BeCS-14 cohort (regression coefficient 0.58) and comparable in the female LeCS-84 subcohort (regression coefficient age 0.85, communality age 76%). In detail, within the decades 35-45 years and 55-65 years the gradient of BFA increase (aging rate) was similar in both cohorts (decade 35-45 years: LeCS-84 4.08 ± 1.03 year equivalents and BeCS-14 4.78 ± 1.67 year equivalents; decade 55-65 years: LeCS-84 6.21 ± 1.29 year equivalents and BeCS-14 5.25 ± 1.18 year equivalents). Remarkably, within the LeCS-84 cohort the mean aging rate within the decade 45-55 years was significantly different from all other aging rates in both cohorts: 13.02 ± 1.05 year equivalents. However, within the BeCS-14 cohort the corresponding value was 4.83 ± 1.02 year equivalents thus indicating a continuous aging process across the adult life course. In BeCS-14, there was a significant age-related effect for cardiovascular performance and social stress exposition and younger age was associated with better cardiovascular performance while level of social stress exposition decreased in aging women.


When comparing BeCS-14 and LeCS-84, the aging process seemed to be accelerated in women in LeCS-84 between 45 and 54 years of age. We can only speculate on the reasons, such as differences in the health care, political and social system. However, the differences observed support the use of our BFS/BFA assessment tool not only on an individual level (strengths/ resources) but also population level following EIP-AHA requirements. Yet, it remains to be developed how the assessed health strengths/resources-profile may be integrated into AHA management.

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  1. 1.

    Bousquet J, Michel J, Standberg T, Crooks G, Iakovidis I, Gomez M. The European Innovation Partnership on Active and Healthy Ageing: The European Geriatric Medicine introduces the EIP on AHA Column. Eur Geriatr Med 2014;5(6): 361–362

    Article  Google Scholar 

  2. 2.

    Bousquet J, Malva J, Nogues M, Manas LR, Vellas B, Farrell J, Group MR. Operational Definition of Active and Healthy Aging (AHA): The European Innovation Partnership (EIP) on AHA Reference Site Questionnaire: Montpellier October 20-21, 2014, Lisbon July 2, 2015. Journal of the American Medical Directors Association. 2015;doi:10.1016/j.jamda.2015.09.004

  3. 3.

    Bousquet J, Kuh D, Bewick M, Standberg T, Farrell J, Pengelly R, Joel ME, Rodriguez Manas L, Mercier J, Bringer J, Camuzat T, Bourret R, Bedbrook A, Kowalski ML, Samolinski B, Bonini S, Brayne C, Michel JP, Venne J, Viriot- Durandal P, Alonso J, Avignon A, Ben-Shlomo Y, Bousquet PJ, Combe B, Cooper R, Hardy R, Iaccarino G, Keil T, Kesse-Guyot E, Momas I, Ritchie K, Robine JM, Thijs C, Tischer C, Vellas B, Zaidi A, Alonso F, Andersen Ranberg K, Andreeva V, Ankri J, Arnavielhe S, Arshad H, Auge P, Berr C, Bertone P, Blain H, Blasimme A, Buijs GJ, Caimmi D, Carriazo A, Cesario A, Coletta J, Cosco T, Criton M, Cuisinier F, Demoly P, Fernandez-Nocelo S, Fougere B, Garcia-Aymerich J, Goldberg M, Guldemond N, Gutter Z, Harman D, Hendry A, Heve D, Illario M, Jeandel C, Krauss-Etschmann S, Krys O, Kula D, Laune D, Lehmann S, Maier D, Malva J, Matignon P, Melen E, Mercier G, Moda G, Nizinkska A, Nogues M, O’Neill M, Pelissier JY, Poethig D, Porta D, Postma D, Puisieux F, Richards M, Robalo-Cordeiro C, Romano V, Roubille F, Schulz H, Scott A, Senesse P, Slagter S, Smit HA, Somekh D, Stafford M, Suanzes J, Todo-Bom A, Touchon J, Traver-Salcedo V, Van Beurden M, Varraso R, Vergara I, Villalba-Mora E, Wilson N, Wouters E, Zins M. Operational Definition of Active and Healthy Ageing (AHA): A Conceptual Framework. J Nutr Health Aging 2015;19(9): 955–960. doi:10.1007/s12603-015-0589-6

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Bousquet J, Bourquin C, Augé P, Domy P, Bringer J, Camuzat T. MACVIA-LR Reference Site of the European Innovation Partnership on Active and Healthy Ageing. Eur Geriatr Med 2014;5(6): 406–415

    Article  Google Scholar 

  5. 5.

    Bousquet J, Kuh D, Bewick M, Strandberg T, Farrell J, Pengelly R. Operational definition of active and healthy ageing (AHA): Report of the meeting held in Montpellier October 2015;21,22–2012. Eur Geriatr Med 7:in press

  6. 6.

    Kuh D, Cooper R, Hardy R, Richards M, Ben-Shlomo YAlcathao. A life course approach to healthy ageing. Oxford, 2014

    Google Scholar 

  7. 7.

    Organization WH. Healthy ageing requires a life-course approach. doi:, 2015

  8. 8.

    von Bertalanffy K. An outline of General System Theory. Br J Philos Sci 1950;1:134–165

    Article  Google Scholar 

  9. 9.

    Buerger M. Biomorphosis-The life change theory of human organism and its functions (dt.). Ärztl Fortbild 1956;5:409–423

    Google Scholar 

  10. 10.

    Beier W. The human life course from a theoretical point (dt.). Z Ges Inn Med 1976;31:90–93

    CAS  PubMed  Google Scholar 

  11. 11.

    Strehler B. Time, cells and aging. Academic Press, London, 1977

  12. 12.

    Beier W, Poethig D. Tradition with important potential for the future -About Measuring Vitality, Age and Aging (dt.). Bewegungstherapie und Gesundheitssport 2013;29:6–10

    Article  Google Scholar 

  13. 13.

    Hochschild R. Can an index of aging be constructed for evaluating treatments to retard aging rates? A 2,462-person study. Journal of gerontology 1990;45 (6):B187-214

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Lehtisalo J., Lindström J., Ngandu T., Kivipelto M., Ahtiluoto S., Ilanne-Parikka P., Keinänen-Kiukaanniemi S., Eriksson J.G., Uusitupa M., Tuomilehto J.J.L, Study FDP. Association of Long-Term Dietary Fat Intake, Exercise, and Weight with Later Cognitive Function in the Finnish Diabetes Prevention Study. J Nutr Health Aging 2016;20(2): 146–154. doi:10.1007/s12603-015-0565-1

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Hau C., Reid K. F., Wong K. F., Chin R. J., Botto T. J., Eliasziw M., Bermudez O. I.R.A. F. Collaborative Evaluation of the Healthy Habits Program: An Effective Community Intervention to Improve Mobility and Cognition of Chinese Older Adults Living in the U.S. J Nutr Health Aging 2016;20(4): 391–397. doi:10.1007/s12603-015-0623-8

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Poethig D. Experimental development of a clinical diagnostic model objectifying bio-functional age(ing) of human being. Habilitation thesis (dt.). German National Library Leipzig, 1984

    Google Scholar 

  17. 17.

    Ries W, Poethig D (1984) Chronological and biological age -A new method to measure healthy aging. Exp Gerontol 1984.19 (3):211–216

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Dean W. Biological aging measurement: Clinical applications. The German test battery, University Leipzig, 175-87. The Center for Bio Gerontology Los Angeles. 1988

    Google Scholar 

  19. 19.

    Grotkamp S, Cibis W, Nuechtern E, von Mittelstaedt G, Seger W. Personal Factors in the International Classification of Functioning, Disability and Health: Prospective Evidence. Australian Journal of Rehabilitation Counselling 2012.18 (1):1-24

    Article  Google Scholar 

  20. 20.

    Viol M. Bio-psychosocial aging -Positioning of the vitality concept in the ICF (dt.). Bewegungstherapie und Gesundheitssport 2011.27:74-79

    Article  Google Scholar 

  21. 21.

    Hamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 1960.23:56-62

    Google Scholar 

  22. 22.

    Bullinger M, Kirchberger I, Ware J. Der deutsche SF-36 Health Survey. Übersetzung und psychometrische Testung eines krankheitsübergreifenden Instrumentes zur Erfassung der gesundheitsbezogenen Lebensqualität. Zeitschrift fuer Gesundheitswissenschaften 1995;1:21-36

    Google Scholar 

  23. 23.

    Schulz P, Schlotz W, Becker P. Trierer Inventar zum chronischen Stress (TICS). Hogrefe, Göttingen. 2004

    Google Scholar 

  24. 24.

    Ardelt-Gattinger E, Meindl M. AD-EVA. Interdisziplinäres Testsystem zur Diagnostik und Evaluation bei Adipositas und anderen durch Ess-und Bewegungsverhalten beeinflussbaren Krankheiten. Huber, Bern. 2010

    Google Scholar 

  25. 25.

    Zenz H, Bischoff C, Hrabal V. Patiententheorienfragebogen (PATEF). Handanweisung. Hogrefe, Göttingen. 1996

    Google Scholar 

  26. 26.

    Molnar M, Haiden C., Geißler-Gruber B. IMPULS-Broschüre und IMPULS-Test. Betriebliche Analyse der Arbeitsbedingungen. AUVA, AK, ÖGB, WKÖ (Hg.) Wien. 2012

    Google Scholar 

  27. 27.

    Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology; Circulation 1996;93(5): 1043–1065

  28. 28.

    Kalbe E, Baller G, Brand M, Kessler J; Das Inventar zur Gedächtnisdiagnostik: Vorstellung der endgültigen Version. vol 33 Akt Neurol 2006;. doi:10.1055/s-2006-953127

    Google Scholar 

  29. 29.

    Meissner-Poethig D, Michalak U. Vitalitaet und aerztliche Intervention. Vitalitaetsdiagnostik: Grundlagen-Angebote-Konsequenzen. Hippokrates-Verlag, 1997

    Google Scholar 

  30. 30.

    Beckmann D, Brähler E, Richter H-E. Der Gießen-Test (GT), vol 4. erweiterte und überarbeitete Auflage mit Neustandardisierung 1990. Huber, Bern. 1991

  31. 31.

  32. 32. lebenserwartung_geburt_erreichbares_alter65_o_geschlecht_ab1958. html?nn=3214682.2015. Accessed 10.11.2015

  33. 33.

    Pfeifer K, Huber G, Baldus A, Poethig D, Schule K. [Resource management: ICF-oriented exercise programs for patients with diabetes mellitus type 2. Chronic illnesses and biopsychosocial status]. Zeitschrift fur Gerontologie und Geriatrie 2012;45(2): 119–127. doi:10.1007/s00391-011-0276-0

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Europe WHOROf. Strategy and action plan for healthy aging in Europe, 2012-2020. Paper presented at the Regional committee for Europe, sixty-second session, Malta

  35. 35.

    Poethig D, Gerdes W, Viol M, Wagner P, Simm A. [Biofunctional age diagnosis in humans. Potentials and limits]. Zeitschrift fur Gerontologie und Geriatrie 2011;44(3): 198–204. doi:10.1007/s00391-011-0171-8

    Article  Google Scholar 

  36. 36.

    Stute P, Meissner F, Sudeck G. Natural health resource use, vitality analysis and vitalisation in practice: The Bern Model. B&G–Bewegungstherapie und Gesundheitssport 2011;27(2): 80–85. doi:10.1055/s-0031-1271376

    Article  Google Scholar 

  37. 37.

    GmbH DI. Das B.I.A.-Kompendium 3. Ausgabe, 2005.

  38. 38.

    Schumacher J, Wilz G, Gunzelmann T, Brahler E. [The Antonovsky Sense of Coherence Scale. Test statistical evaluation of a representative population sample and construction of a brief scale]. Psychotherapie, Psychosomatik, medizinische Psychologie 2000;50(12): 472–482. doi:10.1055/s-2000-9207

    CAS  PubMed  Google Scholar 

  39. 39.

    Poethig D, Ries W. Sex differences of biological aging -Experimental study outcomes. Z Alternsforsch 1985;40(4): 235–244

    Google Scholar 

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Stute, P., Bitterlich, N., Bousquet, J. et al. Measuring Active and Healthy Ageing: Applying a generic interdisciplinary assessment model incorporating ICF. J Nutr Health Aging 21, 1002–1009 (2017).

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  • European Innovation Partnership on Active and Healthy Ageing EIP-AHA
  • bio-functional status
  • bio-functional age
  • health resources
  • Bern Cohort Study 2014
  • International Classification of Functioning
  • Disability and Health (ICF)