Rethinking Ageing Research: From Lifespan to Healthspan

Karen A. Mather; Mary Revelas

doi:10.53941/alr.2025.100006

Abstract

Lifespan refers to the total number of years lived until death while healthspan denotes the period of time spent in good health, free of overt disease and disability. While global life expectancy has dramatically improved over time, healthspan lags behind. The World Health Organization estimated in 2020 that the global healthspan-lifespan gap was approximately 9.6 years, highlighting the growing disparity between longevity and years lived in good health. This healthspan-lifespan gap continues to persist despite improvements in the standard of living across most of the world. Indeed, in some countries the gap is even growing, with chronic age-related diseases being the main contributor. The personal, socioeconomic and healthcare cost of this gap is significant, and its impact will only increase as our population ages. Multidisciplinary efforts to improve healthspan are required to address this imbalance, which will provide benefits to all and enable older adults to continue to contribute positively to the community and to age well. Here, we discuss the healthspan-lifespan gap and argue that extending healthspan rather than lifespan should be a priority. We also discuss its many determinants, methodological approaches and challenges, potential strategies and interventions to improve healthspan and future research directions. Noting that different strategies may be required across populations and countries to address this imbalance. Given the varied efforts to investigate this question from multiple perspectives and the different strategies proposed, there can be optimism that in the foreseeable future we will increase healthspan and reduce the healthspan-lifespan gap.

References

1.
Dattani, S.; Rodes-Guirao, L.; Richie, H.; et al. Life Expectancy. Available online: https://ourworldindata.org/life-expectancy (accessed on 1 July 2025).
2.
Ankrah, P.K.; Mensah, E.D.; Dabie, K.; et al. Harnessing Genetics to Extend Lifespan and Healthspan: Current Progress and Future Directions. Cureus 2024, 16, e55495.
3.
Garmany, A.; Terzic, A. Global Healthspan-Lifespan Gaps Among 183 World Health Organization Member States. JAMA Netw. Open 2024, 7, e2450241.
4.
Xiong, B.; Chen, Y.; Chen, N. Does living longer mean living healthier? A comprehensive analysis of 204 countries and regions from 1990 to 2019. BMC Public Health 2024, 24, 3368.
5.
World Health Organization WHO’s Work on the UN Decade of Healthy Ageing (2021–2030). Available online: https://www.who.int/initiatives/decade-of-healthy-ageing (accessed on 1 July 2025).
6.
National Academy of Medicine. Global Roadmap for Healthy Longevity; National Academies Press: Washington, DC, USA, 2022.
7.
Scott, A.J.; Ellison, M.; Sinclair, D.A. The economic value of targeting aging. Nat Aging 2021, 1, 616–623.
8.
DeBacker, J.M.; Evans, R.W.; Romanni, R. The Macroeconomics of improving aging. SSRN 2024. http://dx.doi.org/10.2139/ssrn.5067690.
9.
Nandi, A.; Counts, N.; Broker, J.; et al. Cost of care for Alzheimer’s disease and related dementias in the United States: 2016 to 2060. NPJ Aging 2024, 10, 13.
10.
Zissimopoulos, J.; Crimmins, E.; St Clair, P. The Value of Delaying Alzheimer’s Disease Onset. Forum Health Econ. Policy 2014, 18, 25–39.
11.
Jagger, C.; Van Oyen, H.; Robine, J.-M. Health Expectancy Calculation by the Sullivan Method: A Practical Guide, 4th ed.; University of Newcastle, Institute of Aging: Newcastle, UK, 1994.
12.
Garmany, A.; Terzic, A. Healthspan-lifespan gap differs in magnitude and disease contribution across world regions. Commun. Med. 2025, 5, 381.
13.
Kaeberlein, M. How healthy is the healthspan concept? Geroscience 2018, 40, 361–364.
14.
Masfiah, S.; Kurnialandi, A.; Meij, J.J.; et al. Definitions of healthspan: A systematic review. Ageing Res. Rev. 2025, 111, 102806.
15.
Sanchez-Niubo, A.; Forero, C.G.; Wu, Y.T.; et al. Development of a common scale for measuring healthy ageing across the world: Results from the ATHLOS consortium. Int. J. Epidemiol. 2021, 50, 880–892.
16.
Fries, J.F. Aging, natural death, and the compression of morbidity. N. Engl. J. Med. 1980, 303, 130–135.
17.
Zhang, Y.; Murata, S.; Schmidt-Mende, K.; et al. Do people reach 100 by surviving, delaying, or avoiding diseases? A life course comparison of centenarians and non-centenarians from the same birth cohorts. Geroscience 2025, 47, 3539–3549.
18.
Rajpal, S.; Joe, W.; Ronanki, S.; et al. Centenarians and near-centenarians in India: Empirical insights on health and well-being characteristics. Geroscience 2025, 47, 6941–695
19.
Andersen, S.L.; Sebastiani, P.; Dworkis, D.A.; et al. Health span approximates life span among many supercentenarians: Compression of morbidity at the approximate limit of life span. J. Gerontol. A Biol. Sci. Med. Sci. 2012, 67, 395–405.
20.
Willcox, D.C.; Willcox, B.J.; Wang, N.C.; et al. Life at the extreme limit: Phenotypic characteristics of supercentenarians in Okinawa. J. Gerontol. A Biol. Sci. Med. Sci. 2008, 63, 1201–1208.
21.
Irandoust, K.; Daroudi, R.; Tajvar, M.; et al. Global and regional impact of health determinants on life expectancy and health-adjusted life expectancy, 2000–2018: An econometric analysis based on the Global Burden of Disease study 2019. Front. Public Health 2025, 13, 1566469.
22.
Argentieri, M.A.; Amin, N.; Nevado-Holgado, A.J.; et al. Integrating the environmental and genetic architectures of aging and mortality. Nat. Med. 2025, 31, 1016–1025.
23.
Shiels, P.; Neytchev, O.; Borland, G.; et al. Ignoring the planet: A critical blind spot for research on ageing. J. Intern. Med. 2025, 298, 578–590.
24.
Hernandez, H.; Santamaria-Garcia, H.; Moguilner, S.; et al. The exposome of healthy and accelerated aging across 40 countries. Nat. Med. 2025, 31, 3089–3100.
25.
Castruita, P.A.; Pina-Escudero, S.D.; Renteria, M.E.; et al. Genetic, Social, and Lifestyle Drivers of Healthy Aging and Longevity. Curr. Genet. Med. Rep. 2022, 10, 25–34.
26.
Guan, Y.; Yan, Z. Molecular Mechanisms of Exercise and Healthspan. Cells 2022, 11, 872.
27.
Abud, T.; Kounidas, G.; Martin, K.R.; et al. Determinants of healthy ageing: A systematic review of contemporary literature. Aging Clin. Exp. Res. 2022, 34, 1215–1223.
28.
Herbert, C.; House, M.; Dietzman, R.; et al. Blue Zones: Centenarian Modes of Physical Activity:A Scoping Review. J. Popul. Ageing 2025, 18, 5–41.
29.
Bauman, A. Commentary on Izquierdo (2024): Where next for exercise recommendations for healthy longevity in older adults? J. Nutr. Health Aging 2025, 29, 100421.
30.
Izquierdo, M.; de Souto Barreto, P.; Arai, H.; et al. Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR). J. Nutr. Health Aging 2025, 29, 100401.
31.
Najafi, P.; Mohammadi, M. Redefining Age-Friendly Neighbourhoods: Translating the Promises of Blue Zones for Contemporary Urban Environments. Int. J. Environ. Res. Public Health 2024, 21, 365.
32.
Aliberti, S.M.; Capunzo, M.; Galimberti, D.; et al. Ageing Trajectories: Exposome-Driven Pathobiological Mechanisms and Implications for Prevention from Blue Zones and Italian Longevity Hotspots Such as Cilento and Sicilian Mountain Villages. Int. J. Mol. Sci. 2025, 26, 4796.
33.
Figueiredo, T.; Midao, L.; Rocha, P.; et al. The interplay between climate change and ageing: A systematic review of health indicators. PLoS ONE 2024, 19, e0297116.
34.
Caruso, C.; Candore, G. Climate Change, Socio-Economic Status, and Life Expectancy. Ageing Longev. Res. 2025, 1, 2504000438.
35.
Siraji, M.A.; Kalavally, V.; Schaefer, A.; et al. Effects of Daytime Electric Light Exposure on Human Alertness and Higher Cognitive Functions: A Systematic Review. Front. Psychol. 2021, 12, 765750.
36.
Siraji, M.A.; Spitschan, M.; Kalavally, V.; et al. Light exposure behaviors predict mood, memory and sleep quality. Sci. Rep. 2023, 13, 12425.
37.
Karimi, B.; Samadi, S. Long-term exposure to air pollution on cardio-respiratory, and lung cancer mortality: A systematic review and meta-analysis. J. Environ. Health Sci. Eng. 2024, 22, 75–95.
38.
Mayntz, S.P.; Rosenbech, K.E.; Mohamed, R.A.; et al. Impact of air pollution and noise exposure on cardiovascular disease incidence and mortality: A systematic review. Heliyon 2024, 10, e39844.
39.
Kadyan, S.; Park, G.; Singh, T.P.; et al. Microbiome-based therapeutics towards healthier aging and longevity. Genome Med. 2025, 17, 75.
40.
Sato, Y.; Atarashi, K.; Plichta, D.R.; et al. Novel bile acid biosynthetic pathways are enriched in the microbiome of centenarians. Nature 2021, 599, 458–464.
41.
Pang, S.; Chen, X.; Lu, Z.; et al. Longevity of centenarians is reflected by the gut microbiome with youth-associated signatures. Nat. Aging 2023, 3, 436–449.
42.
Ma, Y.; Liang, L.; Zheng, F.; et al. Association Between Sleep Duration and Cognitive Decline. JAMA Netw. Open 2020, 3, e2013573.
43.
Ibrahim, A.; Högl, B.; Stefani, A. The Bidirectional Relationship between Sleep and Neurodegeneration: Actionability to Improve Brain Health. Clin. Transl. Neurosci. 2024, 8, 11.
44.
Ramasubbu, K.; Ramanathan, G.; Venkatraman, G.; et al. Sleep-associated insulin resistance promotes neurodegeneration. Mol. Biol. Rep. 2023, 50, 8665–8681.
45.
Mir, F.A.; Lark, A.R.S.; Nehs, C.J. Unraveling the interplay between sleep, redox metabolism, and aging: Implications for brain health and longevity. Front. Aging 2025, 6, 1605070.
46.
Sambou, M.L.; Zhao, X.; Hong, T.; et al. Associations between sleep-behavioral traits and healthspan: A one-sample Mendelian randomization study based on 388,909 participants of the UK-Biobank. J. Affect. Disord. 2024, 350, 854–862.
47.
Dominguez, L.J.; Veronese, N.; Baiamonte, E.; et al. Healthy Aging and Dietary Patterns. Nutrients 2022, 14, 889.
48.
Park, S.H.; Lee, D.H.; Lee, D.H.; et al. Scientific evidence of foods that improve the lifespan and healthspan of different organisms. Nutr. Res. Rev. 2024, 37, 169–178.
49.
Fatima, G.; Dalmadi, I.; Sullos, G.; et al. Dietary Patterns for Health-Span and Longevity: A Comprehensive Review of Nutritional Strategies Promoting Lifelong Wellness. Appl. Sci. 2025, 15, 12013.
50.
Tessier, A.J.; Wang, F.; Korat, A.A.; et al. Optimal dietary patterns for healthy aging. Nat. Med. 2025, 31, 1644–1652.
51.
Sambou, M.L.; Wang, Y.; Xu, F.; et al. Associations of sleep, lifestyle, and physiological markers with healthspan termination: A prospective cohort analysis. Sleep Breath. 2025, 30, 2.
52.
Vila, J. Social Support and Longevity: Meta-Analysis-Based Evidence and Psychobiological Mechanisms. Front. Psychol. 2021, 12, 717164.
53.
Kreouzi, M.; Theodorakis, N.; Constantinou, C. Lessons Learned From Blue Zones, Lifestyle Medicine Pillars and Beyond: An Update on the Contributions of Behavior and Genetics to Wellbeing and Longevity. Am. J. Lifestyle Med. 2024, 18, 750–765.
54.
Aliberti, S.M.; Capunzo, M.; Funk, R.H.W. Systems and Molecular Biology of Longevity and Preventive Medicine: Brain-Energy-Microbiome-Exposome Synergies in Blue Zones and the Cilento Case. Int. J. Mol. Sci. 2025, 26, 7887.
55.
Aliberti, S.M.; Capunzo, M. The Power of Environment: A Comprehensive Review of the Exposome’s Role in Healthy Aging, Longevity, and Preventive Medicine-Lessons from Blue Zones and Cilento. Nutrients 2025, 17, 722.
56.
Zenin, A.; Tsepilov, Y.; Sharapov, S.;et al. Identification of 12 genetic loci associated with human healthspan. Commun. Biol. 2019, 2, 41.
57.
Ying, K.; Liu, H.; Tarkhov, A.E.; et al. Causality-enriched epigenetic age uncouples damage and adaptation. Nat. Aging 2024, 4, 231–246.
58.
Levine, M.E.; Lu, A.T.; Quach, A.; et al. An epigenetic biomarker of aging for lifespan and healthspan. Aging 2018, 10, 573–591.
59.
Kuo, C.L.; Liu, P.; Drouard, G.; et al. A proteomic signature of healthspan. Proc. Natl. Acad. Sci. USA 2025, 122, e2414086122
60.
Kroemer, G.; Maier, A.B.; Cuervo, A.M.; et al. From geroscience to precision geromedicine: Understanding and managing aging. Cell 2025, 188, 2043–2062
61.
Singapore Ministry of Health Healthier SG. Available online: https://www.healthiersg.gov.sg/ (accessed on 1 July 2025).
62.
Chen, S.Q.; Cao, Y.; Ma, J.J.; et al. Construction and evaluation of a practical model for measuring health-adjusted life expectancy (HALE) in China. BMC Public Health 2024, 24, 1667.
63.
Tsuji, I. Epidemiologic Research on Healthy Life Expectancy and Proposal for Its Extension: A Revised English Version of Japanese in the Journal of the Japan Medical Association 2019;148(9):1781-4. JMA J. 2020, 3, 149–153.
64.
Bonnes, S.L.R.; Strauss, T.; Palmer, A.K.; et al. Establishing healthy longevity clinics in publicly funded hospitals. Geroscience 2024, 46, 4217–4223.
65.
Rowe, J.W.; Kahn, R.L. Successful aging. Gerontologist 1997, 37, 433–440.
66.
Australian Government Department of Health Disability and Ageing. About the New Rights-Based Aged Care Act. Online, 2024. Available online: https://www.health.gov.au/our-work/aged-care-act/about (accessed on 1 July 2025).
67.
Crane, P.A.; Wilkinson, G.; Teare, H. Healthspan versus lifespan: New medicines to close the gap. Nat Aging 2022, 2, 984–988.
68.
Barzilai, N.; Crandall, J.P.; Kritchevsky, S.B.; et al. Metformin as a Tool to Target Aging. Cell Metab. 2016, 23, 1060–1065.
69.
Harinath, G.; Nyquist, A.; Wouters, M.; et al. Low-Dose Naltrexone as a Potential Healthspan-Enhancing Intervention in a Normative Aging Cohort: Changes in Quality of Life and Immune Health Metrics. Aging Biol. 2024, 2, e20240032.
70.
Saliev, T.; Singh, P.B. Targeting Senescence: A Review of Senolytics and Senomorphics in Anti-Aging Interventions. Biomolecules 2025, 15, 860.
71.
de Magalhaes, J.P. Senolytics under scrutiny in the quest to slow aging. Nat. Biotechnol. 2025, 43, 1413–1415.
72.
Cesari, M.; Sumi, Y.; Han, Z.A.; et al. Implementing care for healthy ageing. BMJ Glob. Health 2022, 7, e007778.

Scilight Press

Author Information

Abstract

Keywords

References

About Scilight

Journals

Publishing Policies

Contact Us