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Ageing trajectories of health—longitudinal opportunities and synergies (ATHLOS) Healthy Ageing Scale in adults from 16 international cohorts representing 38 countries worldwide
  1. Elena Critselis1,2,
  2. Dimitris Panaretos1,
  3. Albert Sánchez-Niubò3,4,
  4. Iago Giné-Vázquez3,
  5. José Luis Ayuso-Mateos4,5,6,
  6. Francisco Felix Caballero7,8,
  7. Javier de la Fuente5,6,
  8. Josep Maria Haro4,
  9. Demosthenes Panagiotakos1,9
  1. 1 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
  2. 2 Proteomics Facility, Center for Systems Biology, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
  3. 3 Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan De Deu, Sant Boi De Llobregat, Spain
  4. 4 Centro De Investigación Biomédica En Red De Salud Mental (CIBERSAM), Instituto De Salud Carlos III, Madrid, Spain
  5. 5 Department of Psychiatry, Universidad Autonoma De Madrid, Madrid, Spain
  6. 6 Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
  7. 7 Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain
  8. 8 Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
  9. 9 Faculty of Health, University of Canberra, Canberra, Australia
  1. Correspondence to Demosthenes Panagiotakos, Department of Nutrition and Dietetics, Harokopio University, Athens 17671, Greece; dbpanag{at}


Background Uniform international measurement tools for assessing healthy ageing are currently lacking.

Objectives The study assessed the novel comprehensive global Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) Healthy Ageing Scale, using an Item Response Theory approach, for evaluating healthy ageing across populations.

Design Pooled analysis of 16 international longitudinal studies.

Setting 38 countries in five continents.

Subjects International cohort (n=355 314), including 44.4% (n=153 597) males, aged (mean±SD) 61.7±11.5 years old.

Methods The ATHLOS Healthy Ageing Scale (including 41 items related to intrinsic capacity and functional ability) was evaluated in a pooled international cohort (n=355 314 from 16 studies) according to gender, country of residence and age group. It was also assessed in a subset of eight cohorts with ≥3 waves of follow-up assessment. The independent samples t-test and Mann–Whitney test were applied for comparing normally and skewed continuous variables between groups, respectively.

Results The ATHLOS Scale (range: 12.49–68.84) had a mean (±SD) value of 50.2±10.0, with males and individuals >65 years old exhibiting higher and lower mean scores, respectively. Highest mean scores were detected in Switzerland, Japan and Denmark, while lowest in Ghana, India and Russia. When the ATHLOS Scale was evaluated in a subset of cohorts with ≥3 study waves, mean scores were significantly higher than those of the baseline cohort (mean scores in ≥3 study waves vs baseline: 51.6±9.4 vs 50.2±10.0; p<0.01).

Conclusions The ATHLOS Healthy Ageing Scale may be adequately applied for assessing healthy ageing across populations.

  • Ageing
  • epidemiology of ageing
  • public health
  • research methods
  • screening

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  • Contributors Conception and design: JMH and DP. Acquisition of data: EC, JLAM, FFC, JDLF, JMH and DP. Analysis of data: EC, DP, ASN, JMH, DP. Interpretation of data: EC, DP, ASN, IG-V, JLAM, FFC, JDLF, JMH, DP. Drafting of manuscript: EC, DP, DP. Critical revision of manuscript: ASN, IG-V, JLAM, FFC, JDLF, JMH. Final approval: All authors.

  • Funding This work was conducted within the context of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project (European Union’s Horizon 2020 research and innovation programme, grant agreement no. 635316).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.