Envejecimiento saludable: la mirada del curso de vida en el adulto mayor. Impacto en el adulto mayor

The life course approach is a conceptual framework used in public health, epidemiology, and the social sciences that analyzes how biological, behavioral, social, economic, and environmental factors interact over time to influence people's health and disease. It is based on the premise that health is not a static phenomenon or the result of isolated events, but rather the consequence of a cumulative trajectory of exposures and experiences that begin even before birth and continue throughout life. Favorable or unfavorable exposures can accumulate and modify the risk of disease or well-being in later stages. In pathologies such as diabetes, obesity, or cardiovascular disease, this approach allows us to understand how early factors (fetal nutrition, childhood growth, family habits, socioeconomic context) can influence metabolic and clinical risk in adulthood. Diabetes is a very common chronic disease in older adults, affecting more than 25% of people over 65 years of age [1]. Most older adults with diabetes also have other chronic conditions [2]. In addition, they may experience geriatric syndromes and multifactorial conditions, such as urinary incontinence and cognitive impairment [3]. They may also rely on support from family or friends to assist with diabetes-related self-care activities. Therefore, older adults with diabetes require a different approach to care than younger adults. Care should be individualized based on functional status, coexisting chronic conditions, and life expectancy, and patient-centered care planning should be based on a comprehensive geriatric assessment. The importance of cardiometabolic risk factors, such as obesity, hypertension, smoking, and sedentary lifestyle, which develop in middle age, suggests that preventive approaches are needed well before these patients develop conditions such as dementia. In addition to genetics, the family's emotional and educational environment, as well as the general environment, interact significantly from the earliest days of life. Other factors, such as socioeconomic status, education, and whether schooling takes place in urban or rural areas, also significantly influence the differential acquisition of health knowledge. This determines adherence (or lack thereof) to healthy lifestyles, the prevention of risky behaviors and substance use, as well as compliance with hygiene standards and adherence to vaccinations and treatments. All of these factors are extremely important for reaching adulthood in the best possible condition.