Introductory Chapter: Healthy Aging, Physical Activity, Functional Fitness, Cognitive Function, and Assisted Living Technologies – The Ground for the Sustainability of Health and Quality of Life in Older People

1. Introduction

1.1 Sociodemographic change

Living a long and healthy life is considered the main challenge of societies worldwide. Accompanying a worldwide sociodemographic change, statistical data show an increase in the life expectancy of the most aged segment of the population [1]. Indeed, due to low birth rates, advancements in medical and pharmaceutical technology, health care, nutrition, and sanitation have resulted in lower death rates worldwide [2]. People are living longer, and the population worldwide is growing older. The current increase in the number of older people, combined with the increase in chronic diseases and disabilities associated with age (including limitations in functional fitness components, often due to falls and physical and cognitive alterations, predictors of immobility and dementia), present our societies with global social, economic, and health challenges.

1.2 Healthy aging

The WHO [3] defined healthy aging as the “ongoing process of developing and maintaining the functional ability that enables wellbeing in older age.” Functional ability is a central concept in this approach since it comprises the interaction between physical and mental capacities in a particular environment. Nowadays, it is imperative to develop effective healthy aging strategies because, as previously mentioned, most people expect to live beyond 60 years. By 2050, 1 in 5 people will be 60 or older [1]. This means that more and more people live longer, which poses new challenges and opportunities to the community. However, there seems to be no doubt that a person’s general health is a significant factor to consider among successful aging strategies so that people can benefit from the extra years of life they have achieved, doing what they value.

1.3 Physical activity and functional fitness relationships

Evidence supports that an active and independent lifestyle in old age fundamentally depends on a person’s functional fitness levels, for which balance and cognition are significant [4, 5]. Physical activity (PA) has been considered a key recommendation for developing sustainable policies and action programs for healthy aging. Increasing PA is necessary to maintain functional and cognitive abilities and social activities [4, 6].

Currently, a body of evidence has reported many health and performance-related benefits of engaging in regular PA. It has been shown that certain levels of functional fitness protect the individual from many chronic diseases, promote better performances in daily living activities, and enhance participation in various sports and recreational activities [2, 7]. Strategies to promote PA and functional fitness have been considered priorities for many organizations with worldwide expressions, such as ACSM, WHO, and the Centers for Disease Control and Prevention (CDC). These organizations have developed powerful campaigns centred on promoting exercise and regular physical activity as a means for older people to become healthier, maintain an independent lifestyle, and improve their quality of life and functional capacity.

Research efforts support that the association between PA and functional fitness is reciprocal; functional fitness provides the individual with the capability to engage in physical activities, whereas PA helps to maintain and, in some cases, improve functional fitness [4, 8, 9]. The health and performance-related benefits of regular participation in PA, particularly in older people, are well documented [9, 10]. People who manage to maintain a certain level of functional fitness gain some protection concerning various health conditions (e.g., heart disease, diabetes, obesity, cancers), as well as being able to guarantee the execution of activities of daily living in an independent and safe [11, 12, 13]. Additionally, benefits at the psychological level are also evident, especially concerning emotional well-being, increased cognitive function, and a high perception of quality of life [14].

Although this dose-response relationship between increased levels of PA and the onset of chronic diseases or functional disabilities is relatively well documented [15, 16, 17], only a small percentage of older people engage in regular physical activity. Older people continue to spend more time in sedentary activities (i.e., time sitting), directly affecting many physiological systems, such as cardiorespiratory and musculoskeletal health [18, 19]. Reference literature on the epidemiology of physical activity has reinforced the direct relationship between the increase in sedentary activity associated with morpho-functional limitations related to age and the onset of chronic diseases or disabilities [19]. This is a crucial subject because it is directly related to the loss of autonomy, reduced quality of life, and increased social support and health care costs.

1.4 Assisted living technologies

Assisted living technologies have been given special attention since innovative ICT-based products can make a real difference in people’s physical, mental, and social lives. According to the World Health Organization, in 2019, the following diseases were among the top 10 causes of death in the world: (1) Ischaemic heart disease; (2) stroke; (3) chronic obstructive pulmonary disease; (4) lower respiratory infections; (5) trachea, bronchus, lung cancers; (6) Alzheimer’s disease and other dementias; and (7) Diabetes mellitus. These causes of death have several common denominators, including frailty, physical immobility, and various risk factors associated with cardiovascular, metabolic, respiratory, and cognitive function. Practical actions and making the most of technologies to reverse these problems are priorities. In this context, many health organizations have tried to combat these problems through various disease prevention and control actions (i.e., educational actions, screenings, and wearable health devices) to delay their appearance or lessen their severity. This allows older people to remain a valuable resource in their families, communities, and economies while maintaining high levels of independence and quality of life. Additionally, and no less importantly, this proactive approach reduces the need for institutionalization and significantly contributes to the sustainability of Health Systems. It has been identified as a strategic priority to increase health and social responses to problems arising from demographic aging (such as frequent and prolonged hospitalizations and difficulties in reintegrating into the community after hospital discharge). Assisted living technologies focused on applications in the health area could significantly reduce the number of older people who overuse emergency health services.

Faced with this reality, which is a problem that cuts across many communities around the world, among strategies for the prevention and control of health signs, great attention and investment has been given to the development of Wearable Health Devices, with the function of assisting people in monitoring their health status, providing data with potential for diagnosis and early referral of treatment [20]. Some so-called developed countries have increasingly invested in developing this innovative monitoring system, integrating sensors capable of monitoring deficits and functional mobility, cardiovascular disease, metabolic disease, respiratory disease, and cognitive function, among others. It is for this reason that the revenue of the world wearable health devices market has already reached around 26 billion US dollars, with expectations of reaching 34 billion dollars still in 2019 [21].

Although there is great hope for the potential positive effects of using this type of Assisted Technologies in the monitoring and support of health care, which includes the integration of multimodal signal processing systems for the quantification and evaluation of human activity, physiological, behavioral, emotional and cognitive with real-time feedback, scientific evidence on the validation and effectiveness of the use of these devices is still insufficient for several reasons [20]. Firstly, there still needs to be a consensus regarding the evaluation parameters to be integrated into the monitoring systems and the validation of data collected for diagnosis and early referral in the therapeutic plan. Secondly, only a few wearable health devices have been concerned with integrating information from the user’s interaction with the system, losing an essential source of information in the psychosocial area. Thirdly, most systems available on the market operate in isolation (i.e., in a disintegrated and modular way), and the associated costs are still high for the end user. Finally, fourth place, and not least, it is necessary to break down barriers and resistance to using assisted technology in people’s daily lives. To this end, the extra concern is needed in developing more adapted and ‘friendly’ interfaces for the elderly.

1.5 Final considerations

Considering the multifaceted character of the phenomenon, all these predictors directly impact health-related quality of life. We identified priorities and challenges, boosting research, technological development, and innovation to create solutions in health and well-being adapted to the needs of older people. The future involves research, improving knowledge, and developing therapeutic resources centred on functional skills (mobility and cognitive performance) with positive implications for healthy aging.