Fighting Physical Decline in Aging Women: How Health-Related Factors in Mid-Life Determine Later-Life Frailty

There’s a broad spectrum of how people feel in their bodies upon reaching their 60s. Some may remain spry and strong, while others could start to experience bodily decline that contributes to moving less and aching more. But what if there was some way to predict which camp you’d fall into? A new study published in JAMA Network Open may have cracked the code, offering a crystal ball-like prediction of which women in their late 40s and early 50s will experience physical decline in their 60s and beyond. 

Authored by a collaborative team of researchers primarily based out of Brigham and Women’s Hospital at Harvard Medical School, this study reports which lifestyle variables in mid-life women play a role in accelerating physical dysfunction with older age. With this research, Solomon and colleagues set the stage for creating and using a “mid-life risk score” that could open a window of opportunity for targeting these risk factors before chronic health conditions and physical decline develop.

What Causes Accelerated Physical Decline in Women? 

Due to increases in life expectancy, researchers estimate that the number of adults over age 65 will increase to almost one-quarter of the population by 2050. While we’re all about promoting longer lifespans, it’s imperative that people also have longer healthspans — the years of life lived healthfully and disease-free. 

As people in their 60s and beyond have almost four times as many physical limitations and double the number of disabilities as younger adults, effective strategies to extend both lifespan and healthspan may actually need to begin well before they reach senior status. 

Women are especially susceptible to a decline in physical function, as females’ body compositions are more likely to contain less muscle and more fat mass after menopause. This can reduce physical activity, a loss of independence, and an increased risk of detrimental falls, fractures, or the development of chronic health conditions. While substantial amounts of research have been published regarding the physical decline in adults in their 70s and 80s, fewer studies are available about identifying these risk factors earlier on, before it’s too late.

As the lead author, Daniel H. Solomon, MD, MPH, from the Division of Rheumatology, Inflammation, and Immunity at Brigham and Women’s Hospital, states, “As a clinician and epidemiologist, I often think about the window of opportunity at midlife, when people are vital, engaged, and resilient. If we can identify risk factors and determine who is at risk, we may be able to find interventions that can stave off health declines and help put people on a better health trajectory.”

Certain Health Factors Double the Risk of Physical Decline

In this study, Solomon and colleagues followed over 1,000 women of white, Black, Chinese, or Japanese descent between 42 and 52. They followed them for at least ten years, completing the final assessments between the womens’ 55th and 65th birthdays. The research team used a standardized health questionnaire that delivered a physical component summary (PCS) score, with questions regarding physical activity, ability to perform daily activities, mood, socialization, emotions, bodily pain, energy levels, getting sick, and how well they perceive their health status. 

During this 10-year follow-up period, about 20% of the women experienced a clinically relevant decline in physical health and function, as measured by a drop of 8 points or more on the PCS scale. These women were more likely to be Black, have higher body mass indices (BMIs), were more likely to smoke, less likely to have attended college, and had more comorbidities, including poor heart health, blood sugar dysregulation, joint and cartilage damage, or mood disorders.

Two of the strongest determinants of physical decline were having depressive symptoms and cardiovascular-related health conditions, both of which more than doubled the risk of decline. Other risky variables included currently smoking, which upped the risk by 93%, and having a high BMI, which increased the risk by 7%. 

Finding a Window of Opportunity in a Woman’s Fifth Decade

Some of these factors are not modifiable, like racial background and educational attainment. However, others can be targeted in a woman’s mid-life to protect her physical health in the future, like programs to quit smoking, medications/therapies for depressive symptoms, and more cardiovascular-related protection. 

Additional screening could be done at doctor visits in a woman’s late 40s to early 50s, providing tailored interventions targeted to her high-risk variables. The authors are enthusiastic that a ‘mid-life risk score’ could soon be created to help doctors apply these results in clinical practice and, hopefully, reduce the percentages of women experiencing physical health declines in later life.

As Dr. Solomon concludes, “Age 55 to 65 may be a critical decade. A person’s health and factors may set them on a path for their later adult years. The good news is that a large proportion of women at midlife are very stable and will not experience declines. But, being able to identify women at higher risk could help lead to interventions targeted to them.”

References: 

Milanović Z, Pantelić S, Trajković N, Sporiš G, Kostić R, James N. Age-related decrease in physical activity and functional fitness among elderly men and women. Clin Interv Aging. 2013;8:549-556. doi:10.2147/CIA.S44112

Solomon DH, Colvin A, Lange-Maia BS, et al. Factors Associated With 10-Year Declines in Physical Health and Function Among Women During Midlife. JAMA Netw Open. 2022;5(1):e2142773. doi:10.1001/jamanetworkopen.2021.42773