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REVIEW

Examining Physical Wellness as the Fundamental

Element for Achieving Holistic Well-Being in Older
Persons: Review of Literature and Practical
Application in Daily Life
Sheng-Te Hung 1 , Yi-Chen Cheng 2 , Chieh-Chen Wu 2
, Chun-Hsien Su 1,2

1
Graduate Institute of Sports Coaching Science, College of Kinesiology and Health, Chinese Culture University, Taipei, 111396, Taiwan; 2Department
of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, Taipei, 111396, Taiwan

Correspondence: Chun-Hsien Su, Department of Exercise and Health Promotion, College of Kinesiology and Health, Chinese Culture University, 55,
Hwa-Kang Road, Shilin Distract, Taipei City, 111396, Taiwan, Tel +886-2-28610511 ext.45001, Fax +886-2-28617084, Email [email protected]

Abstract: This review examines the impact of physical activity, nutrition, and sleep evaluations on the physical wellness (PW) and
overall well-being of older individuals. A comprehensive search was conducted in databases like PubMed, Google Scholar, and
EBSCO Information Services. The search spanned from January 2000 to December 2022, resulting in 19,400 articles, out of which 98
review articles met the inclusion criteria. Through the analysis of these articles, key characteristics of the literature were summarized,
and opportunities to enhance the practical application of physical activity (PA), nutrition, and sleep evaluations in the daily lives of
older persons were identified. Regular physical activity is crucial for older persons to maintain their physical, mental, and emotional
well-being and prevent age-related health issues. Older persons have specific nutritional needs, including increased protein, vitamin D,
calcium, and vitamin B12 intake. Poor sleep quality in older persons is associated with negative health outcomes such as cognitive
decline, physical disability, and mortality. This review emphasizes the significance of considering physical wellness as a fundamental
element for achieving holistic well-being in older persons and highlights the importance of physical activity, nutrition, and sleep
evaluations in improving their overall health and well-being. By understanding and implementing these findings, we can enhance the
quality of life and promote healthy aging in older persons.
Keywords: wellness, healthy aging, physical activity, nutrition, sleep

Introduction
Healthy aging involves maintaining functional ability for wellbeing in later age, according to the WHO.1 Chronic
diseases, falls, inactivity, oral health issues, and behavioral problems can impact quality of life. Creating conditions and
opportunities that promote healthy aging can enable older persons to remain independent, secure, and productive.2
The term “wellness” was coined by Dr. Halbert L. Dunn in 1961, and later expanded upon by Dr. Bill Hettler, who
promoted the six-dimension wellness model.3 This model emphasizes the interrelated nature of physical, emotional,
spiritual, intellectual, environmental, and social wellness, and encourages individuals to pursue uplifting ideologies and
meaningful pursuits that incorporate all aspects of their health.4 The promotion of health often involves discussions on
the physical wellness dimension, encompassing aspects such as physical activity, nutrition, and sleep. We have a keen
interest in exploring whether enhancing physical wellness can effectively improve the quality of life for older persons.
Research shows that physical activity and exercise engagement can significantly improve the health of older persons, with
moderate to high intensity exercise for at least five days a week being essential.5,6 Balance exercises can also help prevent falls,
which are a major concern for this population.7 Maintaining a healthy diet and paying attention to nutritional adequacy is
important for all age-related disease states, as proper nutrient intake keeps the body strong.8 Chronic sleep issues can hinder

Journal of Multidisciplinary Healthcare 2023:16 1889–1904 1889

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the ability of older persons to function, but establishing habits that promote quality sleep, such as exercise and avoiding
substances that disrupt sleep, can help. Depression, anxiety, heart disease, diabetes, and pain are common sleep disruptors in
older persons.9 Overall wellness involves taking care of physical, emotional, social, intellectual, environmental, and spiritual
wellness, creating a comprehensive sense of fulfillment in life.10

Methods
Design
This article utilizes the essence of the integrative review method, which involves searching literature and reviewing past
empirical or theoretical studies to provide a more comprehensive understanding of a specific phenomenon.

Literature Search
We searched for empirical research published between January 1, 2000, and January 31, 2022. We consulted the
following databases: PubMed, Google Scholar, and EBSCO Information Services. We used the search terms physical
wellness and older persons, physical activity and older persons, nutrition and older persons and sleep and older persons
for all databases in the fields of title, abstract, keywords, and full text (see Table 1).

Inclusion/Exclusion Criteria and Extraction

After conducting the initial database searches, a focused search was carried out to narrow down the relevant articles. The
inclusion criteria for this phase were studies that focused on physical wellness, physical activity, nutrition, and sleep
evaluations for older persons. The research field of interest was physical wellness (PW) and overall well-being, and the
articles had to be written in English. A screening of titles and abstracts revealed that most hits were not relevant, as many
articles did not investigate the physical wellness for older persons. Our initial search yielded 19,400 articles; after
eliminating irrelevant search matches, 98 articles that met all preliminary criteria remained. The next search steps
included more detailed inclusion criteria to increase the comparability of the studies: studies were selected that
mentioned a theoretical approach for physical activity and older persons, nutrition and older persons, and sleep and
older persons. After a full-text reading, 30 articles were included in this review.

Review and Summary of Literature on Physical Wellness for Older Persons

PW refers to a state of overall health and well-being that is achieved through regular exercise, proper nutrition, adequate
sleep, and avoiding harmful habits. While exercise is an important component of maintaining PW and healthy aging
among older persons, it is necessary to prioritize other factors as well. Healthy eating habits, adequate sleep, and proper
hydration are critical elements that work synergistically to support senior physical fitness and overall health.11
According to the Centers for Disease Control and Prevention (CDC), by the age of 75, one in every three men and one
in every two women are inactive.12 Even if individuals are not currently physically active, research indicates that any
form of exercise can have physical health benefits.12 It is crucial to find an activity that one enjoys and stick with it until
a routine is established, such as walking, stretching, weight training, and balance exercises.

Table 1 Keywords Literature Search

Database Search Terms (Number of Hits)

PubMed Physical wellness and older persons (4657); physical activity and older persons (3041); nutrition and older persons
(1920); sleep and older persons (771)

Google Scholar Physical wellness and older persons (21,000); physical activity and older persons (17,000); nutrition and older persons
(17,800); sleep and older persons (21,800)

EBSCO Information Physical wellness and older persons (1969); physical activity and older persons (1500); nutrition and older persons (385);
Services sleep and older persons (490)

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As individuals age, their metabolism slows down, necessitating fewer calorie intake.13–15 To ensure that they consume
a variety of foods and obtain the necessary nutrients, seniors’ plates should contain a variety of meals. According to the
National Institutes of Health, a well-balanced meal should include lean protein, fruits and vegetables, healthy grains, and
low-fat dairy.16
Sleep is a vital process for individuals of all ages as it can restore energy and repair damage to the body and mind.
Despite the numerous advantages of sleep, many older persons find it difficult to fall or stay asleep, making it
increasingly challenging to obtain adequate sleep as they age. However, as individuals age, various factors combine to
make this more challenging to accomplish. Physical and mental health problems can also cause sleep disturbances.
Health problems such as depression, anxiety, heart disease, diabetes, and diseases that cause discomfort and pain such as
arthritis often interfere with an older person’s ability to sleep.17 Sleep problems can also be induced by adverse drug
reactions, with nearly 40% of people over the age of 65 taking five or more prescription drugs.18
According to a cross-sectional survey, older persons are particularly concerned with healthy eating, health problems
(such as high blood pressure, arthritis, hearing loss, osteoporosis, and diabetes), promoting restful sleep, suggestions for
delaying aging, coping with change, creating a living will, exercise, and dieting.19

Physical Activity for Older Persons

Physical activity (PA) refers to any bodily movement that expends energy and activates skeletal muscles. Physical
function, on the other hand, pertains to an individual’s capacity to perform daily physical tasks. As people age, it is
natural to experience a decline in stamina and agility. However, regular moderate PA, as recommended by the Centers for
Disease Control and Prevention (CDC), can provide numerous benefits for older persons, regardless of sex or underlying
medical conditions.20 PA serves as a preventative measure against noncommunicable diseases such as cardiovascular
disease, stroke, diabetes, and several types of cancer.21 Additionally, engaging in PA has been linked to improved mental
health, a delay in the onset of dementia, enhanced quality of life, and overall well-being.22
Exercise is a subset of PA that is planned, structured, and repetitive and has as a final or an intermediate objective the
improvement or maintenance of physical fitness. The duration, frequency, intensity, and mode of exercise is used to describe the
dose.
Regular exercise has been extensively researched and has consistently demonstrated a positive impact on physical,
mental, and emotional well-being across various age groups. In particular, older persons are at a higher risk of
experiencing age-related health problems, such as bone loss, arthritis pain, and chronic diseases such as cardiovascular
disease, diabetes, and obesity. Regular exercise has been identified as an effective intervention to prevent and manage
these health problems.23,24 PA has been widely recognized as a vital component of a healthy lifestyle. Besides its role in
maintaining physical fitness, recent research has demonstrated that PA also serves as a preventive measure for a range of
chronic diseases. Among the conditions that PA can help reduce the risk of are cardiovascular disease, colon cancer,
diabetes, obesity, and hypertension. Engaging in regular PA has been shown to improve insulin sensitivity, lipid profile,
and blood pressure, all of which are major risk factors for these diseases.25,26
PA is a crucial component of healthy aging and can prevent many of the health issues that often arise with age.27 The CDC
recommends that older persons engage in regular PA to maintain their health. For significant health benefits, the CDC
recommends that older persons engage in at least 150 minutes of moderate-intensity aerobic activity, such as brisk walking,
per week, as well as muscle-strengthening activities on two or more days per week that work all major muscle groups.28
Alternatively, they may perform 75 minutes of vigorous-intensity aerobic activity, such as running or jogging, along with
muscle-strengthening exercises that target all major muscle groups each week. Older persons may also engage in an equivalent
combination of moderate- to vigorous-intensity aerobic activity and muscle-strengthening exercises targeting all major muscle
groups on two or more days per week to achieve the recommended amount of physical activity.28
The objective of this section is to provide an overview of the existing literature on the impact of physical exercise on
the aging process, as well as to identify key areas that should be considered when designing public health policies and
programs. In order to ensure clarity and concision, this article presents a table (Table 2) that summarizes the findings of
the relevant studies.

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Table 2 Summarizes the Study Findings Correlating Physical Activity and Healthy Aging
Study Methodology and Type of the Studies Number of Examined Results
Subjects

Physical activity as a preventative The Health ABC study followed participants 2964 Participation in self-selected exercise
factor for frailty; Peterson et al29 for 5 years, defining frailty based on gait activities is independently associated with
speed and chair rise ability, and explored the delaying the onset and the progression of
impact of physical activity on incident frailty frailty.
and transition to severe frailty. (Longitudinal,
prospective cohort study)
30
(SHARP-P) Study; Legault et al The SHARP-P pilot trial examined physical 73 The interventions produced marked changes
and cognitive training interventions on in cognitive and physical performance
cognitive decline risk in older adults. (RCT) measures and retention rates exceeded 90%.
Four-month improvements in the composite
measure increased with age among
participants assigned to physical activity
training but decreased with age for other
participants.

Australian Longitudinal Study of The study utilized MacArthur criteria to 1403 Lower levels of exercise and physical
Aging (ALSA); Andrews et al31 classify subgroups based on function and performance were linked to lower levels of
compared them across various domains using functioning.
ALSA data. (Observational population study)

Effects of aerobic exercise on This study investigates the impact of aerobic 33 For women, aerobic exercise improved
mild cognitive impairment; Baker exercise on cognition and Alzheimer’s performance on multiple tests of executive
et al32 biomarkers in older adults with mild function, increased glucose disposal during
cognitive impairment, while considering sex the metabolic clamp, and reduced fasting
as a predictive factor. (RCT) plasma levels of insulin, cortisol, and brain-
derived neurotrophic factor.

Physical activity and cognitive This study explored the link between physical 31,464 The results demonstrate the possible
functioning among older Indian activity and cognitive functioning in older beneficial effects of frequent physical activity
adults; Kumar et al33 adults in India, considering potential on cognitive functioning among older
confounders and analyzing gender persons. Regular physical activity can be
differences. Data from the Longitudinal considered as an effective lifestyle factor to
Ageing Study in India (2017–2018) and promote healthy cognitive aging.
propensity score matching were used to
assess cognitive impairment across various
domains.

Physical activity improves verbal In a study, 86 women aged 70–80 with 86 The results demonstrate a significant
and spatial memory in older probable MCI underwent a 6-month training correlation between spatial memory
persons; Nagamatsu et al34 program involving aerobic exercise, resistance performance and overall physical capacity
training, or balance and tone training. MRI after intervention in the aerobic training
scans and memory tests were conducted group.
before and after the program. (RCT)

Self-reported health and leisure The Tromsø Study followed 12,241 12,241 Being sedentary was associated with an
time physical activity on mortality participants aged 25–97 from 1994 to 2015, increased risk of mortality in the ageing
among an ageing population; analyzing the link between physical activity and cohort.
Opdal et al35 self-reported health using a random coefficient Both hard and light physical activity were
model. (Observational population study) positively associated with self-reported
health.

(Continued)

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Table 2 (Continued).

Study Methodology and Type of the Studies Number of Examined Results

Subjects

Effect of physical activity on RBD, In a study involving 667 individuals, both 667 The cognitive flexibility, depressive
depression, and cognitive cross-sectional and longitudinal analyses symptoms, and sleep are all indicators of
flexibility in healthy aged people; were conducted over six years. Participants a potential ongoing neurodegenerative
Lerche et al36 were categorized based on their weekly process and are all positively impacted by
sports activity, and various markers and physical exercise in sports.
parameters were compared to assess
prodromal indicators, cognitive abilities, and
task performance. (Cross-sectional and
a subgroup longitudinal study)

Physical activity and memory A study examined how varying intensity 62 The results demonstrate that an increase in
functions; Ruscheweyh et al37 levels of physical activity impacted episodic physical activity led to improved episodic
memory in healthy elderly individuals memory performance in older person
through a six-month intervention with individuals. To achieve this aim, no high-
medium or low-intensity exercise or control intensity exercise was required.
group, measuring various factors such as
fitness, memory score, neurotrophin, and
catecholamine levels, alongside brain imaging
scans at baseline and post-intervention.
(Longitudinal study)

Adults in their middle and later Fifteen community-based cohort studies 189,192 This meta-analysis discovered that physical
years and successful aging through (189,192 participants aged 43.9–79.0 years) activity helps middle-aged and older persons
physical activity; Lin et al38 were assessed using the Newcastle-Ottawa age well.
Scale for quality, sourced from Pubmed, Web
of Science, and Embase databases.
(Observational population study)

Based on the results of the mentioned studies, the advantages of physical activity for older persons can be
summarized as follows: 1.delaying the onset and progression of frailty, 2. improving cognitive function and reducing
cognitive decline, 3. enhancing overall functioning, 4. positive effects on executive function and Alzheimer’s biomarkers,
5. beneficial effects on cognitive functioning, 6. improving memory, 7. enhanced self-reported health and reduced
mortality risk, 8. positive impact on neurodegenerative indicators, 9. improved episodic memory, 10. successful aging.
Physical activity in older persons has a wide range of advantages, including delaying frailty, improving cognitive
function, enhancing overall functioning, reducing cognitive decline, improving memory, promoting self-reported health,
reducing mortality risk, impacting neurodegenerative indicators positively, and contributing to successful aging.29–38
Regular physical activity, including exercise, is essential for maintaining physical, mental, and emotional well-being,
particularly for older individuals. It has been shown to prevent and manage age-related health problems, chronic diseases,
and reduce the risk of various health conditions. It is crucial for individuals to incorporate regular exercise and physical
activity into their lifestyle to maintain good health and prevent chronic illnesses, particularly as they age.

Physical Activity Improving Strategies

Engaging in exercises with multiple components, moderate intensity exercise, and active living can improve physical
function and prevent falls. Finding enjoyable activities and creating a balanced exercise plan, including cardiovascular,
strength, balance, and flexibility exercises, is crucial for older individuals’ general health and well-being.
Multicomponent PA, such as athletics, dance, and gardening, can enhance physical function and reduce the risk of
harm from falls. Moderate intensity exercise is safe for most individuals, but consultation with a healthcare provider is
essential for those with medical conditions.

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A well-rounded exercise plan should incorporate cardiovascular exercise, strength and power training, balance
exercises, and flexibility exercises.39–42 Cardiovascular exercise, such as walking, stair climbing, swimming, and
dancing, increases endurance and independence for daily activities.43 Strength and power training, involving repetitive
motions using weight or external resistance, builds muscle, prevents bone mass loss, and improves balance.40 Balance
exercises, such as yoga, tai chi, and posture exercises, improve balance and walking quality and lower the risk of
falling.42 Finally, exercises that increase flexibility, like yoga, can increase the range of motion for everyday physical
activities.41

Healthy Eating for Older Persons

Healthy aging involves not only increasing lifespan but also extending healthy, active years. The importance of
consuming adequate nutrition increases as people age, as a healthy diet can impact physical, emotional, and social
wellbeing.44,45 However, both men and women become less active as they age, leading to decreased appetite and lower
caloric intake, which can contribute to the development of vitamin and mineral deficiencies. Moreover, age-related
chronic diseases such as heart disease, diabetes, and osteoporosis can exacerbate dietary inadequacies. A nutritious diet
can reduce the risk of chronic diseases, improve quality of life, and even extend lifespan for older persons.46
As people age, their nutritional needs change. Some important nutritional considerations for older persons include:

1. Decreased Calorie Needs: As people age, they tend to move and exercise less, and the amount of muscle decreases
due to the aging process. Therefore, calorie needs may decrease. If older persons maintain the same calorie intake
as they did when they were young, they may gain more fat, especially around the abdomen.47,48
2. Increased Protein, Vitamin D, Calcium, and Vitamin B12 Needs: Even though older persons require fewer calories
than younger people, they still require more protein, vitamin D, calcium, and vitamins B12 than younger people do.48
3. Muscle Loss: With aging, it is typical to lose strength and muscle. The average adult loses 3–8% of their muscle
mass every decade after the age of 30. Protein-rich diets can help slow muscle loss, increase mass, and build more
muscle.49
4. Constipation: Older persons are more likely to experience constipation than younger people, and women are 2.3
times more likely to have it than males. Adequate fiber intake can help relieve constipation.50
5. Calcium and Vitamin D: Calcium and vitamin D are crucial for maintaining healthy bones. Long-term calcium
insufficiency can encourage bone loss and increase the risk of fractures.51
6. Vitamin B12: Vitamin B12 supports the production of red blood cells and keeps the brain healthy. Older persons may
have difficulty absorbing vitamin B12 from food, and a vegan or vegetarian diet can lead to a greater vitamin B12
shortage.52
7. Other Nutrients: Potassium, omega-3 fatty acids, magnesium, and iron are also beneficial for older persons’
health.53–56
8. Dehydration: Older persons are more prone to dehydration. They should continue to drink enough water each day,
even if they are not thirsty.57
9. Loss of Appetite: Older persons may experience a loss of appetite, which can lead to unintended weight loss,
nutritional inadequacies, and deteriorated health. Eating smaller meals frequently can help.58

The purpose of this section is to provide an overview of the current scientific understanding of how a healthy diet can
impact the aging process. To facilitate comprehension, the article includes tables summarizing the studies mentioned in
the text (Table 3).
Based on the results of the research studies mentioned, the advantages of nutrition or dietary habits for older persons
can be summarized as follows: 1. reduced risk of type 2 diabetes, 2. lower risk of type 2 diabetes through improved diet
quality, 3. fewer depressive symptoms, 4. improved cognitive performance, 5. higher likelihood of healthy aging, 6.
lower risk of physical function impairment, 7. association with longevity, 8. reduced risk of cancer and cardiovascular
disease, 9. weight management, 10. impact on cardiovascular risk factors. Overall, the advantages of nutrition or dietary
habits for older persons include a reduced risk of type 2 diabetes, better mental health, improved cognitive function,

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Table 3 Studies Correlating Healthy Eating and Healthy Aging

Study Type of Study Number of Examined Results
Subjects

Prospective investigation into how often and Baseline questionnaire data on weekly 3747 The majority of participants in the
when older people who live in the community breakfast frequency and daily breakfast time Cardiovascular Health Study (CHS) ate
eat breakfast and their risk of developing type were collected from 3747 older adults (aged breakfast every day (85.5%), and 73% had
2 diabetes; Carew et al59 ≥ 65 y) in the Cardiovascular Health Study. their first meal of the day between 7:00 and
These individuals, without cancer or T2DM, 9:00. These behaviors were linked to higher
were followed for 17.6 years, and hazard socioeconomic status, indicators of
ratios were calculated to assess the a healthier lifestyle, and lower baseline levels
relationship with T2DM. (Prospective study) of cardiometabolic risk indicators.

Changes in Dietary Quality Overall and the Over a span of 20 years, 124,607 124,607 A reduced risk of type 2 diabetes is linked to
Risk of Type 2 Diabetes Subsequently; Ley participants from the Nurses’ Health Study, an improvement in diet quality overall,
et al60 NHS II, and the Health Professionals Follow- whereas a higher risk is linked to a decline.
up Study were examined for diabetes risk, Only a portion of the relationship between
with diet quality evaluated using the AHEI diet quality changes and diabetes risk can be
score every 4 years. (Three prospective attributed to body weight changes.
cohorts)

Greater Healthy Eating Index-2005 scores Nutrition data obtained through dietary 1118 Diet quality and reported depressive
are linked to fewer depressive symptoms in recalls and the Healthy Eating Index were symptoms were substantially correlated.
urban populations; Kuczmarski et al61 used to assess diet quality, while depressive However, compared to food quality,
symptoms were measured using the CES-D education, and sex, income was a noticeably
scale. (Diversity across the life span study) larger predictor of depression.

Healthy Aging findings on the relationship In a study involving 2090 African Americans 2090 The findings show that among those living
between diet quality and cognitive and Whites, researchers analyzed diet below the poverty line, better nutrition
performance in an urban population; Wright quality, race, and poverty’s impact on quality was linked to better performance on
et al62 cognitive performance using baseline data measures of attention and cognitive
from the HANDLS study. (Diversity across flexibility, visuospatial ability, and perceptual
the life span study) quickness.

Intake of dietary flavonoids in women at A study involving 13,818 women from the 13,818 Women who consumed more of many
midlife and healthy aging; Samieri et al63 Nurses’ Health Study examined the flavonoid subclasses in the top quintile at
relationship between midlife flavonoid intake midlife had higher odds of aging healthily
and healthy aging outcomes at age 70, based compared to those in the lowest quintile.
on survival and maintenance of key health Intake of flavonoids, particularly flavones,
domains. (Cohort study) flavanones, anthocyanins, and flavonols, is
higher in midlife and is linked to a higher
likelihood of health and wellbeing in those
who live to older ages.

Physical Function Impairment in Men and A longitudinal cohort study followed 12,658 12,658 Higher consumption of certain foods like
the Alternative Healthy Eating Index; Hagan men from 2008–2012 to investigate the lettuce, broccoli, blueberries, peanuts,
et al64 association between the Alternative Healthy walnuts, and other nuts was linked to
Eating Index-2010 (AHEI) and physical a lower risk of impairment. A reduced
function impairment using multivariable likelihood of physical function impairment
logistic regression models. (Longitudinal was significantly associated with improved
cohort study) overall food quality in this large population
of older men. This may be an especially
compelling public health justification for
older men to change their diets given the
importance of physical fitness to good aging
and quality of life.

(Continued)

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Table 3 (Continued).

Study Type of Study Number of Examined Results

Subjects

Dietary habits of the healthiest older person A study compared the dietary patterns of 122 A western diet, which included French fries,
in the study on healthy aging; Gu et al65 122 super seniors (aged 85+ without major red meat, and processed meat, and
diseases) to 12,626 participants aged 65–86. a nutrient-rich diet, which featured fruits,
Logistic regression analyzed the odds of vegetables, whole grains, nuts, and seeds in
being a super senior based on different addition to other nutritious food options,
dietary patterns. (Cohort study) were both recognized as two distinct
dietary patterns. The likelihood of being
a super-senior was associated with higher
scores for both dietary trends.

Dietary habits in later life affect the risk of This study analyzed data from the Australian 2087 These findings imply that in people who are
developing cancer and cardiovascular Longitudinal Study of Ageing (ALSA) to free of cancer or CVD at age 70 or older,
disease; Nobbs et al66 identify dietary patterns and investigate the development of either condition or
their association with cancer and mortality from either may be independent
cardiovascular disease development and of the majority of dietary patterns.
mortality. (Longitudinal study) Importantly, a correlation between the
pattern of “red meat and protein
alternatives” and cancer growth and death
was found.

Dietary patterns and weight change; A study conducted in 1992 and 2007 1186 Males in the highest tertile of the meat-and-
Arabshahi et al67 examined body weight, socio-demographic fat pattern experienced an average gain in
factors, and lifestyle characteristics, body weight that was more than twice as
identifying two dietary patterns (‘meat-and- high as men in the lowest tertile. Males in
fat’ and ‘fruit-and-vegetable’) using principal the top tertile of the fruit-and-vegetable
component analysis on food frequency pattern experienced average weight
questionnaire data. Multivariable regression increase that was only roughly half that of
models were used, adjusting for changes in men in the lowest tertile. In this cohort,
other variables. (Cohort study) males who followed a diet high in fruit and
vegetables gained less weight than those
who followed a diet heavy in meat and fat.

Ethnicity, dietary habits, alcohol use, and This study utilized cluster analysis to assess 1313 Six distinct, non-overlapping food patterns
cardiovascular risk factors in women aged diet patterns and their correlation with were identified by cluster analysis, including
50 and older; López et al68 major cardiovascular disease risk factors in those for pasta and yellow vegetables,
women aged 50 years and older using sweets, beef, starches, fruits, and milk,
NHANES 2001–2002 data. (Cross-sectional frozen meals, burritos, and pizza, meat
study) dishes, and soft drinks and poultry. The bulk
of the women were placed in the diet plan
for sweets group. There were significant
correlations between food habits and the
main CVD risk variables.

increased chances of healthy aging and longevity, lower risk of physical function impairment, reduced risk of cancer and
cardiovascular disease, weight management, and improved cardiovascular health. These findings highlight the impor­
tance of maintaining a healthy diet in promoting overall well-being and quality of life in older individuals.59–68
Older persons require special attention to their nutritional needs as they age. Decreased calorie needs, increased
protein, vitamin D, calcium, and vitamin B12 needs, muscle loss, constipation, calcium and vitamin D deficiencies,
vitamin B12 deficiency, other beneficial nutrients, dehydration, and loss of appetite are some of the important nutritional
considerations for older persons. A well-balanced diet that meets their unique needs can improve their health and overall
well-being.

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Healthy Eating Improving Strategies

As people age, their dietary needs change, and it is important to adopt a healthy eating pattern that fits their nutritional
requirements. According to the Healthy Eating Index (HEI), older persons have the highest diet quality compared to other
age groups, with an HEI score of 63 out of 100, based on the Dietary Guidelines for Americans.69 However, older people
require fewer calories as they age because their metabolism slows down. As a result, their bodies require more nutrients,
making it important to eat foods that are high in nutrients.47 The Institute of Medicine recommends that adults over 50
should consume at least 30 grams of fiber per day for men and 21 grams for women.70 The USDA has developed Food
Patterns to help people understand different approaches to a balanced diet. Among the food patterns, there are three types
of eating styles: a healthy American-style, a vegetarian-style, and a Mediterranean-style.71 Regular moderate physical
activity can help maintain a healthy weight and lower the risk of heart disease. Choosing vegetables, fruits, whole grains,
high-fiber foods, and lean sources of protein such as fish, while limiting saturated fat and salt intake, is essential.
Additionally, it is important to avoid smoking to promote healthy aging.

Adequate Sleep for Older Persons

Sleep disorders are common among older individuals, with insomnia being the most frequent one.72 Sleep apnea, restless
legs syndrome, periodic limb movement disorder, and rapid eye movement sleep behavior disorder are other disorders
that can affect sleep patterns among the elderly.73 Sleep apnea, if left untreated, can lead to other health issues such as
high blood pressure, stroke, and memory loss.74 Additionally, Alzheimer’s disease can disrupt sleep patterns, with some
patients sleeping excessively and others not getting enough sleep.75 It is imperative to diagnose and manage sleep
disorders to prevent further health complications.
As people age, they often experience changes in their sleep patterns and difficulties with sleep. Older person may
have a harder time falling asleep and staying asleep, and they may spend more time in lighter stages of sleep than in deep
sleep.76 Conditions that commonly affect sleep in older person include depression, anxiety, heart disease, diabetes, and
conditions that cause discomfort and pain, such as arthritis.77 In fact, poor sleep habits and a general lack of sleep can
lead to major health problems in up to 40% of older persons.77 Daytime tiredness, which is when older people feel
exhausted all day but are unable to fall asleep due to their sleepiness, can be the most dangerous side effect of sleep
loss.78,79 This can lead to difficulties with simple activities, as well as anger, depression, memory issues, lack of
concentration, poor energy, a lack of drive, a lack of interest in social interaction, and problems with concentration.80
Lack of sleep has been linked to several major health issues, such as high blood pressure, obesity, substance dependence,
and early death.77,81 Furthermore, research has found a strong link between getting five or fewer hours of sleep and an
increased risk of dementia.82 A restful night’s sleep strengthens memory and attention, enables the body to heal any
daytime cell damage, and revitalizes the immune system, which aids in illness prevention.76 It is important for older
people to prioritize good sleep habits to maintain their overall health and wellbeing.
Table 4 provides a summary of some of the key studies examining the relationship between sleep quality and the
aging process.
Based on the results of the mentioned studies, the advantages of sleep for older persons can be summarized as
follows: 1. subjective sleep quality in noncomplaining elderly subjects, 2. work, eat and sleep, 3. the effects of yoga
compared to active and inactive controls on physical function and health-related quality of life in older adults, 4. sleep
duration and snoring at midlife in relation to healthy aging, 5. sleep duration, snoring habits, and cardiovascular disease
risk factors, 6. daytime sleepiness predicts mortality and cardiovascular disease in older persons, 7. increased risk of heart
failure in women with symptoms of sleep-disordered breathing, 8. sleep disorders and their impacts on healthy,
dependent, and frail older adults, 9. both habitual short sleepers and long sleepers are at greater risk of obesity, 10.
sleep quality, duration, and associated sexual function at older age. The advantages of sleep for older persons include
maintaining consistent sleep quality, promoting physical function, improving quality of life, reducing the risk of chronic
diseases, enhancing cardiovascular health, reducing mortality risk, and supporting sexual function. Adequate sleep
duration and healthy sleep habits are crucial for overall well-being and healthy aging in older individuals.83–92 These
studies have used a variety of methods to assess sleep quality. Sleep disorders are prevalent in older individuals, with

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Table 4 Key Studies Examining the Relationship Between Sleep Quality and the Aging Process
Study Type of Study Number of Examined Results
Subjects

Subjective sleep quality in This study examines sleep quality in 91 According to the findings, sleep quality
noncomplaining elderly subjects; 76. elderly individuals using the PSQI, with does not change systematically over the
Danker-Hopfe et al83 91 subjects participating at baseline and time course of this study.
a follow-up study conducted 16±5
months later (82.4% response rate).
(Investigative study)

Work, eat and sleep: towards a healthy A mixed methods design incorporating 450 The qualitative data analysis revealed the
ageing; Riethmeister et al84 interviews and focus groups was utilized value of healthy working surroundings,
to develop a questionnaire, which was nutrition, and tiredness management. For
then administered to 450 offshore a healthy ageing at work and sustained
workers. Subgroup analyses explored employability program offshore, both
age-related variations in health and work- qualitative and quantitative evaluations
related aspects. (Semi-structured highlighted work, food, and sleep/fatigue
interviews and focus-group) management as the most essential
program objectives.

The effects of yoga compared to active In September 2017, various databases 22 Results indicate that yoga interventions
and inactive controls on physical function were searched for randomized improve multiple physical function and
and health related quality of life in older controlled trials comparing yoga HRQoL outcomes in this population
adults; Sivaramakrishnan et al85 interventions with controls in older compared to both control conditions.
adults, focusing on physical function and This study provides robust evidence for
HRQoL outcomes. (Systematic review promoting yoga in physical activity
and meta-analysis) guidelines for older adults as
a multimodal activity that improves
aspects of fitness like strength, balance
and flexibility, as well as mental wellbeing.

Sleep duration and snoring at midlife in The Nurses’ Health Study analyzed 121,701 The findings show a non-linear
relation to healthy aging; Shi et al86 participants free of major chronic relationship between sleep duration and
diseases in 1986 and aged 70 or older in the likelihood of experiencing good aging.
1995–2001, using logistic regression for Regular snoring was linked to a 31%
odds ratios and confidence intervals in lower likelihood of aging healthily, which
assessing healthy aging. (Prospective was mostly caused by a decreased
cohort study) likelihood of not having any severe
chronic illnesses.

Sleep duration, snoring habits, and A CVD screening program in NYC 371 Sleeping for fewer than six hours each
cardiovascular disease risk factors; Mosca assessed sleep habits and CVD risk night was linked to a number of
et al87 factors among participants (n=371), traditional and psychosocial CVD risk
revealing associations through logistic factors, and snoring was linked to poor
regression. (Investigative study) HDL cholesterol, probably caused by
being overweight or obese.

Daytime sleepiness predicts mortality This study employs an interview- 5888 The findings show that myocardial
and cardiovascular disease in older administered questionnaire to assess infarction, congestive heart failure, acute
persons; Newman et al88 health and sleep habits, while cardiovascular disease morbidity and
continuously monitoring total mortality mortality, and mortality were all
and cardiovascular disease morbidity and associated with daytime sleepiness, the
mortality, including incidents of only sleep disturbance symptom. These
myocardial infarction and congestive results were more prevalent in women
heart failure. (Investigative study) than in men.

(Continued)

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Table 4 (Continued).

Study Type of Study Number of Examined Results

Subjects

Increased risk of heart failure in women The Sleep and Health in Women study 5990 During follow-up, 5.3% of women with
with symptoms of sleep-disordered (SHE) followed 5990 women from 2000 both snoring and excessive daytime
breathing; Ljunggren et al89 to 2011, examining snoring, sleepiness, sleepiness developed heart failure,
and heart failure using Swedish national compared to 0.9% in the control group
registers. (Population-based cohort with neither snoring nor excessive
study) daytime sleepiness. Obstructive sleep
apnea symptoms, which include snoring
and excessive daytime sleepiness, are
linked to an increased risk of developing
heart failure in women.

Sleep disorders and their impacts on A multidisciplinary review task force 106 Sleep disturbances are common in
healthy, dependent, and frail older adults; examined 106 articles from Ovid Medline healthy older adults, with changes in
Cochen et al90 to analyze age-related sleep disorders in sleep architecture and increased
older adults. (Integrative reviews) prevalence of sleep disorders. Sleep
problems worsen in dependent older
adults, including those with Alzheimer’s
disease. Further research is needed to
understand sleep in frail older adults.

Both habitual short sleepers and long A 10-year follow-up study with 4903 4903 In women who were older than 40 at the
sleepers are at greater risk of obesity; participants examined the relationship time of the follow-up, there were no
Theorell-Haglöw et al91 between changes in sleep duration and correlations between variations in sleep
various factors such as obesity, weight patterns and any markers of obesity.
gain, and waist circumference increase Both habitual short sleepers and habitual
using logistic regression analysis. long sleepers exhibited a higher
(Investigative study) prevalence of overall and central obesity
among younger women (aged 40 years)
than habitual normal sleepers.

Sleep Quality, Duration, and Associated This study analyzed data from 2568 men 3944 Moderate sleep quality was linked to an
Sexual Function at Older Age; Smith and 1376 women aged 50 years or older, increased risk of erectile dysfunction in
et al92 assessing the relationship between sleep men. Sleep quality was not associated
quality and sexual function while with difficulty achieving an orgasm in
considering various factors such as age, men, but it was associated with an
ethnicity, and health status. (Longitudinal increased risk of orgasmic difficulty in
Study) women.

insomnia being the most common. Conditions like sleep apnea and Alzheimer’s disease can further disrupt sleep patterns.
Poor sleep habits can lead to health problems and decreased quality of life. Prioritizing good sleep is crucial for
maintaining overall well-being in older persons.

Appropriate Sleep Improving Strategies

Establishing a regular sleep routine is one of the most important strategies for promoting better sleep. Going to bed and
waking up at the same time every day, including weekends, can help regulate the body’s internal clock and promote
better sleep.93 Additionally, including PA in the daily routine can promote better sleep. Regular PA, such as walking or
swimming, can help reduce stress and promote relaxation.93 However, it is important to avoid exercising too close to
bedtime, as this may interfere with sleep.

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Creating a comfortable sleep environment is another essential strategy for promoting better sleep. The bedroom
should be quiet, dark, and cool, and comfortable bedding should be used.94 Additionally, it is important to avoid
stimulants before bedtime. Limiting caffeine, sugar, and alcohol intake, and avoiding eating right before bed can help
promote better sleep.95 Engaging in relaxing activities, such as reading or taking a warm bath, can help promote
relaxation and prepare the mind for sleep.95 It is also important to manage worries and avoid engaging in stimulating
or stressful activities close to bedtime.
Taking short, 20–30-minute naps during the day can help promote wakefulness, but longer naps can interfere with
nighttime sleep.96 Therefore, it is important to avoid long naps during the day. Using relaxation techniques such as deep
breathing, meditation, or progressive muscle relaxation techniques can also help promote relaxation and sleep.96
Managing medical conditions is an important strategy for improving sleep quality. Chronic pain or other medical
conditions can interfere with sleep, so it’s important to manage these conditions with proper medical care.97

Conclusion
Based on the reviewed research studies from the fields of physical activity, nutrition, and sleep for older persons, several
key findings emerge. First and foremost, regular physical activity has been consistently linked to numerous benefits for
older individuals. Engaging in exercise promotes cardiovascular health, improves muscle strength and flexibility,
enhances cognitive function, and reduces the risk of chronic diseases such as diabetes and osteoporosis. Moreover,
exercise has been shown to have a positive impact on mental well-being, including reducing symptoms of anxiety and
depression. Secondly, nutrition plays a crucial role in maintaining optimal health in older adults. The studies highlight the
importance of a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Adequate nutrition
supports the immune system, maintains bone health, and reduces the risk of malnutrition and age-related diseases.
Furthermore, certain nutrients, such as vitamin D and calcium, have been found to be particularly beneficial for older
individuals in promoting bone density and preventing fractures. Lastly, sleep is a vital component of healthy aging. The
research emphasizes the significance of sufficient and quality sleep for older adults’ overall well-being. Poor sleep
patterns and insomnia have been associated with an increased risk of cognitive decline, cardiovascular diseases, and
mood disorders. On the other hand, regular sleep habits, proper sleep hygiene, and the maintenance of a consistent sleep
schedule have been shown to improve cognitive function, immune response, and emotional resilience.
There are several areas that warrant further investigation to enhance our understanding and improve the PW of older
individuals. Firstly, future studies may focus on examining the long-term effects of specific types of physical activity on
various aspects of health in older adults. While the studies in the review highlighted the benefits of regular exercise,
further research could delve deeper into the optimal duration, intensity, and frequency of different exercise modalities,
such as aerobic exercises, strength training, and flexibility exercises. Additionally, investigating the potential benefits of
newer exercise trends, such as high-intensity interval training (HIIT) or mind-body exercises like yoga and tai chi, could
provide valuable insights into their effects on physical wellness for older persons. Secondly, it would be beneficial to
explore the impact of personalized nutrition interventions on the health outcomes of older individuals. Customized
dietary plans that consider an individual’s unique nutritional needs, medical conditions, and preferences could prove
highly effective in promoting optimal health. Future studies could assess the efficacy of personalized nutrition strategies,
such as individualized meal plans or dietary counseling, in improving specific health markers, including immune
function, cognitive health, and cardiovascular health, in older adults. Furthermore, additional research is needed to
understand the interplay between physical activity, nutrition, and sleep in older individuals. Examining the synergistic
effects of these three domains and their cumulative impact on overall health and well-being could provide valuable
insights for developing comprehensive lifestyle interventions.

Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design,
execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically
reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article
has been submitted; and agree to be accountable for all aspects of the work.

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Disclosure
The authors report no conflicts of interest in this work.

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