A Life Course Approach to Healthy Ageing

  • Diana KuhEmail author
Part of the Practical Issues in Geriatrics book series (PIG)


The life course epidemiological approach extends the WHO healthy ageing initiative by investigating how physical and mental capacities change across life; how they vary by birth cohort, socioeconomic position, gender, and ethnicity; and the extent to which experience and exposures earlier in life have long-term consequences for later life capacities, disability, and chronic diseases. This chapter summarises some of the social and biomedical factors from childhood that have long-term consequences for intrinsic capacities, and how a lower level and/or an accelerated decline in capacities during early and mid-adulthood can identify those at greatest risk of subsequent disability and disease. Promotion of healthy ageing requires preventive strategies that enhance capacities during growth and development, maintain them for as long as possible after maturity, and slow down their rate of decline.


Life course epidemiology Healthy ageing Birth cohort study Intrinsic capacity Midlife prevention 



Thanks to Dr. Rachel Cooper, Professor Rebecca Hardy, Professor Marcus Richards, and Professor Yoav Ben-Shlomo for their helpful comments on an earlier draft of this chapter.


  1. 1.
    World Health Organization (2015) World report on ageing and healthGoogle Scholar
  2. 2.
    Ben-Shlomo Y, Kuh D (2002) A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol 31(2):285–293CrossRefGoogle Scholar
  3. 3.
    Kuh D, Ben-Shlomo Y (2004) A life course approach to chronic disease epidemiology, 2nd edn. Oxford University Press, OxfordCrossRefGoogle Scholar
  4. 4.
    Ben-Shlomo Y, Cooper R, Kuh D (2016) The last two decades of life course epidemiology, and its relevance for research on ageing. Int J Epidemiol 45(4):973–988CrossRefGoogle Scholar
  5. 5.
    Cooper R, Hardy R, Sayers A, Kuh D (2014) A life course approach to physical capability. In: Kuh D, Cooper R, Hardy R, Richards M, Ben-Shlomo Y (eds) A life course approach to healthy ageing, 1st edn. Oxford University Press, Oxford, pp 16–31Google Scholar
  6. 6.
    Gluckman PD, Hanson MA, Bateson P et al (2009) Towards a new developmental synthesis: adaptive developmental plasticity and human disease. Lancet 373(9675):1654–1657CrossRefGoogle Scholar
  7. 7.
    Kuh D, Wong A, Shah I et al (2016) The MRC National Survey of Health and Development reaches age 70: maintaining participation at older ages in a birth cohort study. Eur J Epidemiol 31(11):1135–1147CrossRefGoogle Scholar
  8. 8.
    Kuh D, Karunananthan S, Bergman H, Cooper R (2014) A life-course approach to healthy ageing: maintaining physical capability. Proc Nutr Soc 73(2):237–248CrossRefGoogle Scholar
  9. 9.
    Lara J, Cooper R, Nissan J et al (2015) A proposed panel of biomarkers of healthy ageing. BMC Med 13:222CrossRefGoogle Scholar
  10. 10.
    Dodds RM, Syddall HE, Cooper R et al (2014) Grip strength across the life course: normative data from twelve British studies. PLoS One 9(12):e113637CrossRefGoogle Scholar
  11. 11.
    Dodds RM, Syddall HE, Cooper R, Kuh D, Cooper C, Sayer AA (2016) Global variation in grip strength: a systematic review and meta-analysis of normative data. Age Ageing 45(2):209–216CrossRefGoogle Scholar
  12. 12.
    Davis D, Bendayan R, Muniz G, Hardy R, Richards M, Kuh D (2017) Decline in search speed and verbal memory over 26 years of midlife in a British birth cohort. Neuroepidemiology 49:121–128CrossRefGoogle Scholar
  13. 13.
    Ferrucci L, Cooper R, Shardell M, Simonsick EM, Schrack JA, Kuh D (2016) Age-related change in mobility: perspectives from life course epidemiology and geroscience. J Gerontol A Biol Sci Med Sci 71(9):1184–1194CrossRefGoogle Scholar
  14. 14.
    Case A, Deaton A (2015) Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A 112(49):15078–15083CrossRefGoogle Scholar
  15. 15.
    Hiam L, Harrison D, McKee M, Dorling D (2018) Why is life expectancy in England and Wales ‘stalling’? J Epidemiol Community Health 72:404–408CrossRefGoogle Scholar
  16. 16.
    Kuh D, Shah I, Richards M, Mishra G, Wadsworth M, Hardy R (2009) Do childhood cognitive ability or smoking behaviour explain the influence of lifetime socio-economic conditions on premature adult mortality in a British post war birth cohort? Soc Sci Med 68(9):1565–1573CrossRefGoogle Scholar
  17. 17.
    Galobardes B, Lynch JW, Smith GD (2008) Is the association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review. J Epidemiol Community Health 62(5):387–390CrossRefGoogle Scholar
  18. 18.
    Calvin CM, Deary IJ, Fenton C et al (2011) Intelligence in youth and all-cause-mortality: systematic review with meta-analysis. Int J Epidemiol 40(3):626–644CrossRefGoogle Scholar
  19. 19.
    Cooper R, Strand BH, Hardy R, Patel KV, Kuh D (2014) Physical capability in mid-life and survival over 13 years of follow-up: British birth cohort study. Br Med J 348:g2219CrossRefGoogle Scholar
  20. 20.
    Cooper R, Kuh D, Hardy R (2010) Objectively measured physical capability levels and mortality: systematic review and meta-analysis. Br Med J 341:c4467CrossRefGoogle Scholar
  21. 21.
    Davis D, Cooper R, Terrera GM, Hardy R, Richards M, Kuh D (2016) Verbal memory and search speed in early midlife are associated with mortality over 25 years’ follow-up, independently of health status and early life factors: a British birth cohort study. Int J Epidemiol 45(4):1216–1225PubMedGoogle Scholar
  22. 22.
    Birnie K, Cooper R, Martin RM et al (2011) Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis. PLoS One 6(1):e15564CrossRefGoogle Scholar
  23. 23.
    Dodds R, Denison HJ, Ntani G et al (2012) Birth weight and muscle strength: a systematic review and meta-analysis. J Nutr Health Ageing 16(7):609–615CrossRefGoogle Scholar
  24. 24.
    Cooper R, Richards M, Kuh D (2017) Childhood cognitive ability and age-related changes in physical capability from midlife: findings from a British Birth Cohort Study. Psychosom Med 79(7):785–791CrossRefGoogle Scholar
  25. 25.
    Cooper R, Muniz-Terrera G, Kuh D (2016) Associations of behavioural risk factors and health status with changes in physical capability over 10 years of follow-up: the MRC National Survey of Health and Development. BMJ Open 6(4):e009962CrossRefGoogle Scholar
  26. 26.
    World Health Organization (2010) Global recommendations on physical activity for health. WHO, GenevaGoogle Scholar
  27. 27.
    Anton SD, Woods AJ, Ashizawa T et al (2015) Successful aging: advancing the science of physical independence in older adults. Ageing Res Rev 24(Pt B):304–327CrossRefGoogle Scholar
  28. 28.
    Leshner AI, Landis S, Stroud C, Downey A, Committee on Preventing Dementia and Cognitive Impairment (2017) Preventing cognitive decline and dementia. The National Academies Press, Washington, DCCrossRefGoogle Scholar
  29. 29.
    Livingston G, Sommerlad A, Orgeta V et al (2017) Dementia prevention, intervention, and care. Lancet 390:2673–2734CrossRefGoogle Scholar
  30. 30.
    Wills AK, Lawlor DA, Matthews FE et al (2011) Life course trajectories of systolic blood pressure using longitudinal data from eight UK cohorts. PLoS Med 8(6):e1000440CrossRefGoogle Scholar
  31. 31.
    Hardy R, Lawlor DA, Kuh D (2015) A life course approach to cardiovascular aging. Future Cardiol 11(1):101–113CrossRefGoogle Scholar
  32. 32.
    Lawlor DA, Hardy R (2014) Vascular and metabolic function across the life course. In: Kuh D, Cooper R, Hardy R, Richards M, Ben-Shlomo Y (eds) A life course approach to healthy ageing, 1st edn. Oxford University Press, Oxford, pp 146–161Google Scholar
  33. 33.
    Lange P, Celli B, Agusti A et al (2015) Lung-function trajectories leading to chronic obstructive pulmonary disease. N Engl J Med 373(2):111–122CrossRefGoogle Scholar
  34. 34.
    Colley JRT, Douglas JWB, Reid DD (1973) Respiratory disease in young adults; influence of early childhood lower respiratory tract illness, social class, air pollution, and smoking. Br Med J 3:195–198CrossRefGoogle Scholar
  35. 35.
    Allinson JP, Hardy R, Donaldson GC, Shaheen SO, Kuh D, Wedzicha JA (2017) Combined impact of smoking and early life exposures on adult lung function trajectories. Am J Respir Crit Care Med 196:1021–1030CrossRefGoogle Scholar
  36. 36.
    Allinson JP, Hardy R, Donaldson GC, Shaheen SO, Kuh D, Wedzicha JA (2016) The presence of chronic mucus hypersecretion across adult life in relation to chronic obstructive pulmonary disease development. Am J Respir Crit Care Med 193(6):662–672CrossRefGoogle Scholar
  37. 37.
    Whincup PH, Kaye SJ, Owen CG et al (2008) Birth weight and risk of type 2 diabetes: a systematic review. JAMA 300(24):2886–2897CrossRefGoogle Scholar
  38. 38.
    Galobardes B, Smith GD, Lynch JW (2006) Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood. Ann Epidemiol 16(2):91–104CrossRefGoogle Scholar
  39. 39.
    Hardy R, Kuh D, Langenberg C, Wadsworth M (2003) Birthweight, childhood social class, and change in adult blood pressure in the 1946 British birth cohort. Lancet 362:1178–1183CrossRefGoogle Scholar
  40. 40.
    Ghosh AK, Hardy RJ, Francis DP et al (2014) Midlife blood pressure change and left ventricular mass and remodelling in older age in the 1946 British birth cohort studydagger. Eur Heart J 35:3287–3295CrossRefGoogle Scholar
  41. 41.
    Allen NB, Siddique J, Wilkins JT et al (2014) Blood pressure trajectories in early adulthood and subclinical atherosclerosis in middle age. JAMA 311(5):490–497CrossRefGoogle Scholar
  42. 42.
    Ghosh AK, Hughes AD, Francis D et al (2016) Midlife blood pressure predicts future diastolic dysfunction independently of blood pressure. Heart 102:1380–1387CrossRefGoogle Scholar
  43. 43.
    Hardy R, Cooper R, Sayer AA et al (2013) Body mass index, muscle strength and physical performance in older adults from eight cohort studies: the HALCyon programme. PLoS One 8(2):e56483CrossRefGoogle Scholar
  44. 44.
    Singh-Manoux A, Dugravot A, Shipley M et al (2017) Obesity trajectories and risk of dementia: 28 years of follow-up in the Whitehall II Study. Alzheimers Dement 14:178–186CrossRefGoogle Scholar
  45. 45.
    Senese LC, Almeida ND, Fath AK, Smith BT, Loucks EB (2009) Associations between childhood socioeconomic position and adulthood obesity. Epidemiol Rev 31:21–51CrossRefGoogle Scholar
  46. 46.
    Bann D, Cooper R, Wills AK, Adams J, Kuh D (2014) Socioeconomic position across life and body composition in early old age: findings from a British birth cohort study. J Epidemiol Community Health 68(6):516–523CrossRefGoogle Scholar
  47. 47.
    Bann D, Johnson W, Li L, Kuh D, Hardy R (2017) Socioeconomic inequalities in body mass index across adulthood: coordinated analyses of individual participant data from three British birth cohort studies initiated in 1946, 1958 and 1970. PLoS Med 14(1):e1002214CrossRefGoogle Scholar
  48. 48.
    Johnson W, Li L, Kuh D, Hardy R (2015) How has the age-related process of overweight or obesity development changed over time? Co-ordinated analyses in five United Kingdom birth cohorts. PLoS Med 12(5):e1001828CrossRefGoogle Scholar
  49. 49.
    Bann D, Johnson W, Kuh D, Hardy R (2018) Socioeconomic inequalities in childhood and adolescent body-mass index, weight, and height from 1953 to 2015: an analysis of four longitudinal, observational, British birth cohort studies. Lancet Public Health 3(4):e194–e203CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.MRC National Survey of Health and Development, MRC Unit for Lifelong Health and Ageing at University College LondonLondonUK

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