The HEALTH Framework: H Is for Health Systems in Aging

HEALTH Framework

H – Health Systems in Aging

I wrote a blog post introducing the HEALTH framework, which focuses on healthspan rather than lifespan. In this post, I want to expand on the H, health systems in aging, or How we age?

Before we talk about how to extend healthspan, we have to understand what actually changes in the body as we age.

Aging is not a single disease, and it does not begin at retirement. It is a continuous biological process that affects every organ system, gradually reducing resilience, slowing recovery, and narrowing the body’s margin for error. These changes begin decades before symptoms appear, often during the years when most people are busy building careers, raising families, and postponing attention to their own health.

Many people think of aging as something that happens later in life. In reality, aging is already underway in our thirties, forties, and fifties, at the cellular and systems level. The choices we make during those years quietly shape future strength, balance, memory, energy, and independence.

Aging does not appear as a single problem, but as systems changing together.

The heart stiffens, and blood vessels lose elasticity. The lungs exchange oxygen less efficiently. The brain becomes more sensitive to stress and medications, with gradual shifts in processing speed and emotional regulation. Metabolism changes as insulin signaling becomes less efficient and cholesterol handling shifts. Muscle mass declines, bones weaken, balance worsens, and recovery from illness or injury takes longer. Sensory systems such as vision and hearing become less reliable, affecting safety, connection, and quality of life.

These changes explain why the risk of chronic disease rises with age. Conditions such as heart disease, diabetes, dementia, and frailty are not sudden events. They develop slowly as biological systems lose reserves and repeated stress accumulates. Read the GeriAcademy blog What Happens When We Age to learn more about organ systems and aging.

But biology is only part of the story.

To understand how aging actually shows up in real people, geriatric medicine uses a systems-based approach often described through the Five Ms: Mind, Mobility, Medications, Multi-complexity, and What Matters. Learn more about the 5Ms.

• Mind reflects changes in cognition, mood, and emotional resilience.

  
  

• Mobility includes strength, balance, endurance, and fall risk.

  
  

• Medications matter because aging bodies process drugs differently, and medication burden can quietly contribute to fatigue, confusion, and instability.

  
  

• Multi-complexity acknowledges that people rarely age with a single condition; multiple issues interact and influence one another.

  
  

• What Matters anchors all of this in personal goals, values, relationships, and desired independence.

This approach shifts the focus from isolated diagnoses to function and lived experience.

Underneath these clinical realities is the biology of aging itself. Over time, inflammation increases, cellular stress accumulates, energy production becomes less efficient, and repair mechanisms slow. These processes are shaped by genetics, environment, behavior, and cumulative lifetime exposures.

Aging is not a failure of the body. It is a biological process shaped by time and experience.

Importantly, many of these systems respond to behavior. Physical activity, nutrition, sleep, stress regulation, social connection, and avoidance of harmful substances directly influence how quickly these changes progress and how well the body recovers from stress.

This is why healthspan is not built later; it is built gradually, long before illness appears.

The H in the HEALTH framework asks a foundational question:

What is actually happening in the aging body, and how do we understand it without oversimplifying or panicking?

Everything else in the HEALTH framework builds on this understanding.