Aging could not be seen as a phase of decline but rather as a vibrant period filled with connections, memories, decision-making, activities, joy, and autonomy. However, due to reduced control of risk factors, the global rose in aging has been associated with increased rates of dementia, which is expected to see its prevalence globally growth by 200% by 2050. The essence of healthy aging and brain health remains a critical question, influenced by both biological and environmental factors. Are its determinants consistent globally? While stable social conditions in developed countries link aging predominantly to unmodifiable elements like age and sex, needs in areas grappling with social and health disparities, such as Latin America, differ significantly.
Previous studies have highlighted the complex interplay among accelerated aging and a group of modifiable factors, including social exclusion, isolation, poverty, reduced access to education, chronic diseases, unhealthy lifestyles, altered sensory perceptual capacities, and mental health problems, including depressive and anxiety symptoms. These factors explain nearly 40% of the prevalence of dementia in global north countries and almost 60% of the prevalence in countries from the global south, including Latin America.
The role of mental health factors in the aging process deserves special attention. Mental health problems face differential prevalence and incidence across the globe. The lifetime prevalence of anxiety in Latin America ranges from 9.3% to 30.3%, and for depression, it is calculated between 11.00% and 14.16%. The 2019 Global Burden of Disease report revealed that these prevalence rates are increased in Caribbean, Tropical, and Andean Latin America, exhibiting higher rates of affective disorders, anxiety, and behavioral disorders compared to high-income countries from the global north.
Mental health problems in Latin America are tied to social disparities, early adversities, access difficulties to social, economic, and educational resources, chronic diseases, and unhealthy habits. Individuals facing social exclusion, increased disparities, and chronic conditions often exhibit altered emotion dysregulation and a high prevalence of mental health issues. Additionally, reduced engagement in healthy lifestyle habits, such as physical activity, and increased alcohol consumption are associated with heightened rates of depression and anxiety.
Previous studies in high-income countries have revealed that individuals with increased symptoms of depression and anxiety may experience accelerated aging. However, to date, the role of mental health problems in aging within Latin America remains an unexplored agenda. Moreover, although complex interactions among all modifiable factors of aging have been separately studied, the impact of mental health issues on aging has traditionally been overlooked in Latin America.
Collaborating with experts from Latin America, the U.S., and Ireland, we analyzed data from 44,394 participants across diverse Latin American and Caribbean countries. We employed machine learning to discern intricate factors influencing healthy aging, primarily focusing on cognitive and functional abilities while also considering social, medical, lifestyle, and mental health problems.
Our analysis revealed the profound influence of modifiable factors, particularly those shaped by social and medical disparities, including poverty, education, cardiometabolic issues, unhealthy habits, and mental health problems. Significantly, mental health conditions, such as depression and anxiety, emerged as critical top predictors across these countries. This was especially evident in low- and middle-income countries (such as Colombia and Ecuador). However, these factors were also highly relevant in high-income Latin American countries like Chile and Uruguay.
The impact of mental health problems in predicting aging was critical, as these factors were even more relevant for aging than classical unmodifiable factors as well as and medical risks, lifestyles, and social disparities. The increased role of mental health problems in aging aligns with other studies from our group (see references 1-6). Our work acknowledges the established connection between mental health, related social and medical disparities, and accelerated aging, emphasizing its amplified impact on aging in regions rife with inequalities. The relationship between aging and mental health can be traced to age-associated challenges, such as the loss of close ties, role transitions, limited mobility, retirement, curtailed social interactions, and healthcare barriers. In areas like many in Latin America, marked by pronounced social exclusion and inequity, these factors intensify mental health challenges and, in turn, influence aging patterns.
The intersection of socioeconomic, health, and mental health disparities in aging and dementia research has been overlooked, particularly in regions marked by pronounced disparities. Our findings prompt a re-evaluation of these relationships and encourage the development of research agendas that seek to understand the interactions, markers, predictors, and potential causative links between mental health, disparities, and aging.
By leveraging region-specific data and grasping the complex interplay among mental health, social and medical disparities, and aging, we can generate fresh regional insights and foster customized interventions. Our research underscores the need for public health policies that address specific risks faced by individuals living in Latin America. Effective strategies should: i) thoroughly implement strategies to reduce the prevalence of mental health problems with improved models of early detection and effective and massive strategies for reducing the presence of undertreated prevalent mental problems; ii) increase resources for diagnosis and reduce the impact of mental health problems across the lifespan with emphasis on aging; iii) implement actions to reduce structural social inequalities, with a focus on brain and mental health; iv) detect and intervene early in chronic diseases that increase risks for mental health problems and lead to altered aging processes; v) launch targeted public health initiatives recognizing regional diversity and addressing prevalent risks and disparities. Regional efforts to track and intervene early in mental health and its related social and medical disparities are critical to promoting healthy aging scenarios.
For a detailed understanding of our findings see:
- Santamaria-Garcia, H., Sainz-Ballesteros, A., Hernandez, H. et al.Factors associated with healthy aging in Latin American populations. Nat Med29, 2248–2258 (2023). https://doi.org/10.1038/s41591-023-02495-1
- Risk factors related to population diversity and disparity determine healthy aging. Nat Med 29, 2183–2184 (2023). https://doi.org/10.1038/s41591-023-02531-0
- Santamaria-Garcia H, Moguilner S, Rodriguez-Villagra OA, et al. (2023). https://doi: 10.1007/s11357-023-00755-z.
- Ibanez, A., & Zimmer, E. R. (2023). Time to synergize mental health with brain health. Nature Mental Health, 1(7), 441-443. https://doi.org/10.1038/s44220-023-00086-0
- Migeot, J., Calivar, M., Granchetti, H., Ibáñez, A., & Fittipaldi, S. (2022). Socioeconomic status impacts cognitive and socioemotional processes in healthy ageing.Scientific reports, 12(1), 6048. https://doi.org/10.1038/s41598-022-09580-4
- Walters, H. Diverse factors shape healthy aging in Latin America. Nat Aging 3, 1175 (2023). https://doi.org/10.1038/s43587-023-00508-9
Note: The attached poster image was designed using a generative artificial intelligence program supervised by Andrés Cifuentes, Hernando Santamaría-Garcia, and Agustín Ibanez.