Living longer does not necessarily mean living longer in good health. This distinction lies at the heart of the concept of healthspan, a term increasingly used in ageing research to describe the years spent in good physical and mental health, while maintaining independence and quality of life.
The goal is not simply to increase life expectancy, but to preserve, as far as possible, the abilities that allow people to carry out everyday activities, maintain social relationships and navigate the different stages of ageing with a good level of well-being.
But what exactly does healthspan mean? How is the length of time spent in good health measured, and which factors can influence it? To answer these questions, it is useful to start with the scientific definitions and distinguish between the indicators used to study population health and those employed to assess individuals.
What is healthspan?
Healthspan is the period of life spent in good health, with a level of physical and cognitive functioning that allows people to maintain independence and quality of life.
Unlike a concept of health based exclusively on the absence of disease, healthspan also considers the ability to move, think, make decisions and carry out everyday activities.
This means that being in good health does not necessarily imply being free from every medical condition. A person with a well-managed chronic condition, for example, may still maintain a good level of independence and a satisfactory quality of life.
The concept is closely linked to healthy ageing, a key topic for the World Health Organization (WHO). According to the WHO, healthy ageing involves developing and maintaining the functional abilities that enable well-being in older age.
The focus therefore shifts from the length of life alone to the ability to preserve its quality for as long as possible.
What is the difference between healthspan, lifespan and longevity?
Healthspan, lifespan and longevity are related concepts, but they do not mean the same thing.
- Lifespan: the total length of an individual's life, from birth to death.
- Healthspan: the period of life spent in good health, taking into account physical and cognitive functioning and the degree of independence.
- Longevity: the ability to live for a long time; in scientific contexts, it includes the study of lifespan and the factors associated with ageing.
The distinction between healthspan and lifespan is particularly important.
Two people may reach a similar age but experience very different conditions during their final years: one may maintain good mobility and independence, while the other may experience functional limitations, frailty or disability.
For this reason, one of the goals of ageing research is to understand how to reduce the gap between the total number of years lived and the number of years lived in good health.
This approach does not mean viewing illness or disability as conditions that can always be avoided. Rather, it recognises that lifespan alone does not fully describe the health of a population.
How is healthspan measured?
Healthspan cannot be measured using a single blood test, genetic test or universal value.
Its assessment depends on the indicators used, the research context and the aspect of health being analysed.
It is important to distinguish between two levels: the statistical estimate of the years lived in good health across a population and the clinical assessment of an individual's health.
1. Healthy life expectancy (HALE)
One of the most important indicators is Healthy Life Expectancy (HALE), used by the WHO.
HALE estimates the average number of years a person can expect to live in full health, taking into account not only mortality but also the years lived with illness or disability and their severity.
Unlike life expectancy alone, this indicator also considers the impact of conditions that affect health throughout a person's life.
HALE can be calculated at birth or at a specific age, such as 60. Estimates are based on demographic and epidemiological data, including mortality and the loss of health associated with different conditions.
It is essential to remember that HALE is a statistical average for a population, not an individual prediction. It cannot determine how many years a particular person will live in good health.
2. Functional ability
To assess an individual's health, it is also necessary to consider what that person can actually do in everyday life.
The WHO uses the concept of functional ability, which depends on the interaction between a person's physical and mental capacities and the environment in which they live.
Relevant aspects include:
- Mobility: the ability to walk, maintain balance and move around independently.
- Strength and muscle function: the ability to carry out everyday activities, lift objects and get up from a chair.
- Cognitive function: memory, attention, orientation and decision-making.
- Independence: the ability to manage activities such as getting dressed, preparing meals and personal care.
- Psychological and social well-being: the ability to maintain relationships, participate in social life and manage everyday activities.
These aspects can be assessed through clinical interviews, validated questionnaires and functional tests, selected according to the person's age, medical history and needs.
3. Clinical and metabolic indicators
Certain clinical parameters also help describe health status and the risk factors associated with chronic diseases.
Depending on the individual's circumstances, a doctor may consider:
- blood pressure;
- blood glucose and other indicators of glucose metabolism;
- lipid profile, including cholesterol and triglycerides;
- body composition and nutritional status;
- muscle strength and cardiorespiratory fitness;
- the presence of chronic conditions and how well they are managed.
These parameters can provide important information about cardiovascular, metabolic and functional health. However, none of them can measure healthspan on its own.
Biomarkers of biological ageing, including those based on epigenetic analyses, are also being studied. They can contribute to research into biological processes associated with age, but they are not a definitive, universally validated measure of the years a person will live in good health.
In short, assessing healthspan requires a multidimensional perspective: clinical data must be interpreted alongside functional abilities, the person's medical history and their living environment.
Which factors influence healthspan?
The length of time spent in good health is influenced by the interaction of genetic, biological, environmental, social and behavioural factors. No single intervention can determine on its own how many years a person will live in good health.
However, research into prevention and ageing has identified several important areas for supporting health over time.
A balanced diet and overall diet quality
Nutrition contributes to maintaining cardiovascular and metabolic health, providing essential nutrients and preserving muscle mass.
A balanced, varied diet that meets individual needs can support a healthier profile over the long term.
The Mediterranean diet, for example, has been widely studied for its associations with cardiovascular health and several ageing-related outcomes.
Key components of this dietary pattern include vegetables, fruit, legumes, whole grains, nuts and extra virgin olive oil, alongside fish and other protein sources in amounts suited to individual needs.
Rather than focusing on a single food or nutrient, it is important to consider the overall quality of the diet and whether it can be sustained over time.
Physical activity and maintaining muscle mass
Regular movement supports cardiovascular health, insulin sensitivity, balance and the preservation of functional abilities.
As people get older, maintaining muscle strength and mass becomes particularly important because it can help preserve mobility and independence.
For adults, international guidelines generally recommend at least 150 minutes of moderate-intensity aerobic activity per week, or an equivalent amount of activity, alongside muscle-strengthening exercises on at least two days a week. The amount and type of exercise should be adapted to individual circumstances.
There is no need to start with demanding programmes: reducing sedentary time and gradually increasing movement can be a useful first step.
Sleep and recovery
Sleep plays a role in regulating numerous physiological processes, including metabolism, cognitive function and the immune response.
Insufficient or poor-quality sleep, particularly when it becomes persistent, may be associated with a higher risk of metabolic and cardiovascular problems, as well as difficulties with concentration and managing everyday activities.
Keeping regular sleep schedules, creating an environment conducive to rest and seeking professional advice for persistent sleep problems are useful ways to protect health.
Prevention and management of risk factors
Prevention helps identify and manage conditions that may compromise health over time.
Monitoring blood pressure, assessing cardiovascular risk, following screening recommendations based on age and personal history, and properly managing any chronic conditions are all important steps.
Avoiding smoking and limiting alcohol consumption are also part of preventive strategies.
These measures cannot guarantee that illness will be avoided or that a person will reach a particular age in good health, but they can help reduce modifiable risks.
Social relationships and psychological well-being
Healthspan is not just about how the body functions. Social relationships, community involvement and psychological well-being also contribute to quality of life.
Social isolation and loneliness are associated with several adverse health outcomes, although the causal relationships may vary according to individual circumstances and context.
Maintaining meaningful connections, pursuing interests and taking part in activities suited to one's abilities can support well-being throughout ageing.
Healthspan and biological ageing: what is the connection?
Biological ageing refers to the changes that occur in the body over time. It does not necessarily correspond to chronological age, meaning the number of years since birth.
Biological age is a concept used to describe aspects of the body's physiological state through various indicators, some of which are still being studied and validated.
Healthspan is connected to these processes, but it is a broader concept: it is not concerned solely with biological changes, but also with how they relate to a person's health, functional abilities and independence.
For example, two people of the same chronological age may have different levels of muscle strength, cardiorespiratory fitness and metabolic risk. These differences may contribute to different health trajectories over the years.
However, it is not appropriate to infer a person's future healthspan from a single biomarker or biological age test. Research is continuing to investigate how well these tools can predict clinically relevant outcomes and help guide effective interventions.
Nutrition and healthspan: what does the research say?
Nutrition is one of the most widely studied areas in understanding how to support health during ageing. It helps prevent nutritional deficiencies, supports metabolic and cardiovascular health and, an often overlooked aspect, helps maintain muscle mass and function.
As we age, muscle strength and mass tend to decline. When this loss becomes significant and impairs physical function, it is known as sarcopenia, a condition associated with an increased risk of falls, frailty and loss of independence. This is why muscle is one of the most direct links between nutrition and healthspan.
Adequate protein intake is one of the nutritional factors that help preserve muscle. However, requirements vary from person to person and, in some circumstances, such as certain forms of kidney disease, protein intake may need to be restricted. For this reason, recommendations should be tailored to individual needs.
In older adults, the more common issue is not excessive protein intake but insufficient intake, which may be linked to factors such as poor appetite, difficulty chewing or a lack of variety in meals.
Distributing protein across main meals rather than concentrating it in just one may be beneficial, although the evidence on this point is still being debated.
Nutrition alone is not enough: protein has its greatest effect on muscle when combined with strength training.
When reading studies on nutrition and ageing, it is important to distinguish between observational findings, clinical studies and biological hypotheses.
An association between a dietary habit and better health does not prove that the habit increases the number of years lived in good health by a measurable amount.
The same applies to interventions investigating calorie restriction, fasting and specific dietary patterns.
Results depend on the protocol, the population studied, the duration of the study and the outcomes measured.
The Fasting Mimicking Diet, for example, is being researched for its potential effects on certain metabolic markers and other health parameters.
This evidence must be interpreted in light of the limitations of the available studies: an improvement in a biomarker does not, in itself, demonstrate an extension of healthspan.
There is currently no nutritional strategy that guarantees a specific increase in the number of years an individual will live in good health.
The most prudent approach is to consider nutrition as part of an overall lifestyle and a preventive health plan tailored to individual circumstances.
Can healthspan be increased?
It is not possible to predict with certainty how many years a person will live in good health, or to guarantee that a specific intervention will extend an individual's healthspan.
However, it is possible to address several modifiable factors that influence the risk of chronic diseases and the preservation of functional abilities.
An approach focused on long-term health may include:
- following a balanced diet that meets individual needs;
- engaging in regular physical activity, including strength exercises where appropriate;
- getting enough sleep and addressing any persistent sleep problems;
- avoiding smoking and limiting alcohol consumption;
- attending preventive health checks and managing chronic conditions;
- maintaining social relationships and taking part in activities that support psychological well-being.
Personalisation is essential: age, medical conditions, medications, physical activity levels and nutritional requirements can all affect which recommendations are most appropriate.
The goal is not to chase an ideal biological age value or a predetermined number of years, but to support health and functional ability through choices that are consistent with scientific evidence and individual circumstances.
Healthspan broadens the way we think about longevity: beyond the number of years lived, it considers health, independence and the ability to maintain a good quality of life.
Assessing it requires different tools, from statistical indicators such as HALE to the clinical and functional measures used to understand an individual's health. No single test or biomarker is sufficient to describe it fully.
A balanced diet, physical activity, sleep, prevention and psychological well-being are all important areas for supporting health over time.
Research continues to clarify how these factors interact with the ageing process and which interventions may make a meaningful contribution to preserving functional ability.
Sources
World Health Organization, Healthy life expectancy (HALE).
World Health Organization, Healthy life expectancy: indicator and data.
World Health Organization, Decade of Healthy Ageing.
Centers for Disease Control and Prevention, Physical Activity Guidelines for Adults.
