Knowledge of lifespan and healthspan and interest in Healthy Longevity Medicine among the general population in Singapore: The Singapore HEalthy LOngevity (HELO) survey

Knowledge of lifespan and healthspan and interest in Healthy Longevity Medicine among the general population in Singapore: The Singapore HEalthy LOngevity (HELO) survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Knowledge of lifespan and healthspan and interest in Healthy Longevity Medicine among the general population in Singapore: The Singapore HEalthy LOngevity (HELO) survey Jonas Amalaraj, Belinda Wang, Anna Szucs, Louis Island, Laureen Wang, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6694270/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Given the growing global interest in Healthy Longevity Medicine (HLM), the field lacks understanding about public knowledge and interest, which are crucial to consider for any public health intervention relying on HLM. This study presents findings from the Healthy Longevity (HELO) survey conducted in Singapore, assessing public knowledge regarding lifespan, healthspan, and interest in HLM. This nationwide cross-sectional survey, conducted between June and August 2024, involved 3,034 participants. Main domains including questions on demographics, living arrangements, medical information, health behaviours, income and financial status were tested for associations with knowledge about lifespan and healthspan, and interest in HLM clinics using binary logistic regression. While 82·3% of 46 years old [IQR: 34 – 59] participants correctly defined lifespan, 41·3% accurately defined healthspan and 55·5% expressed interest in HLM clinics. Younger age, male gender, Chinese ethnicity, higher education and income, full-time employment, lower body mass index, supplement use, moderate (vs. no) alcohol consumption, high exercise frequency, and enrolment in (self-paid) annual health screenings were associated with better knowledge and stronger interest in HLM clinics. These findings highlight the need for targeted education to enhance understanding of healthspan and implement evidence-based preventive health programs, supporting the clinical translation of geroscience into Precision Geromedicine through HLM clinics. Scientific community and society/Scientific community/Research data Health sciences/Medical research aging healthspan knowledge lifespan longevity motivation Figures Figure 1 Figure 2 1. Introduction The shift toward ageing populations globally has placed unprecedented pressure on healthcare systems. 1 As the older demographic grows, healthcare costs are expected to increase, raising significant concerns about long-term sustainability. 2 In Singapore, where the proportion of individuals aged 65 years and older is projected to exceed 25% by 2030, this demographic shift has also been accompanied by a growing prevalence of ageing related diseases. 3 These trends, coupled with rising old-age dependency ratios and declining birth rates, 4 pose challenges to healthcare systems to deliver quality and sustainable care. Healthy Longevity Medicine (HLM), also referred to as Precision Geromedicine for scientific and medical audiences, is an emerging medical speciality and offers promising solutions to address the challenges posed by ageing populations. 5 Rooted in geroscience, Precision Geromedicine seeks to optimise health and healthspan by targeting the biological processes of ageing. 5 By focusing on prevention and delaying the onset ageing related diseases, the field offers a paradigm shift from reactive to proactive healthcare. 6 Despite its promise, public opinions on HLM remains insufficiently understood, with surveys revealing diverse preferences as well as socio-demographic and ethical considerations, highlighting the complexity of perspectives on health and healthspan. 7 , 8 To address this gap, the HEalthy LOngevity (HELO) consortium was established to examine public awareness, knowledge, and motivations towards healthy longevity. 9 The HELO conceptual framework was developed to explore factors shaping views and intentions towards healthy longevity, which formed the basis for the global HELO population survey, first developed and deployed in Singapore. 10 Understanding public knowledge and interest in Singapore is particularly timely, given its large-scale national efforts to ramp up preventive healthcare 5 and its population’s general receptiveness to public health campaigns 11 making it a promising target for general public health initiatives involving HLM. A preliminary qualitative study conducted with the Singaporean population during the development of the HELO survey highlighted mixed reactions to the notion of HLM clinics, with both enthusiasm about their potential to extend healthspan but also reservations regarding the extent of lifestyle changes required to reach positive results. 12 However, this study could not inform on the representativeness of these different perspectives in the Singaporean population given its qualitative nature. A population survey is hence warranted to obtain national population estimates and quantify their variation with individual characteristics. The present study focused on results from the HELO population survey in Singapore and aimed to measure knowledge of lifespan and healthspan, and interests in attending HLM clinics among the general population in Singapore and identify associated factors. 2. Method Ethics approval for the study was obtained from the Institutional Review Board at the National University of Singapore (NUS-IRB-2023-672). Written or electronic informed consent was obtained from all participants prior to data collection. 2.1 Study design and sampling A nationwide cross-sectional design was utilised to assess public knowledge and interests in HLM through the HELO survey in Singapore. 10, 12 The HELO survey explored public awareness, knowledge, and factors underlying motivation towards lifespan, healthspan, and HLM. The HELO survey comprised 149 questions across multiple sections, designed to capture a comprehensive understanding of participants' demographics, knowledge, behaviours, and attitudes towards HLM: Section A: Demographic data (37 questions). Section B: Knowledge of lifespan and healthspan (20 questions). Section C: Interest in HLM Clinics and health-related concerns (17 questions). Section D: Health behaviours, social support, personality, and aspirations (75 questions). The survey was available in the official languages of Singapore, namely English, Chinese, Malay, and Tamil. All translations followed the Translation, Review, Adjudication, Pretest, and Documentation approach (TRAPD) 13 to ensure culturally and contextually appropriate adaptations. The survey was administered door-to-door in Singapore from June 24 to August 11, 2024, targeting a sample size of up to n= 2,500 participants. For door-to-door data collection, multistage cluster sampling was used to randomly select postal codes from households and public places across five major regions of Singapore (Central, East, West, North, and Northeast), as defined by the Urban Redevelopment Authority Singapore. 14 The “last birthday” method 15 was used for within-household sampling to select household members who were currently at home, aged 21 years old or older (as defined by the local age of majority), and had the most recent birthday. Surveys were conducted daily between 9am and 9pm, and participants had the option to complete the survey digitally via a QR code ( n =1614), or using a pen-and-paper format ( n =389). For online data collection, surveys were administered via the Qualtrics platform, which recruited participants residing in Singapore. A total of n = 1,000 participants were recruited through Qualtrics from July 8 to August 20, 2024. Stratified random sampling was applied to ensure demographic representativeness across age, gender, and ethnicity. The median time (seconds) taken to complete the surveys were 1,546 [IQR: 993–2,221] for the door-to-door survey and 971 [IQR: 743–1,506] for the online survey. 2.2 Participants Eligible participants were adults aged 21 years and older residing in Singapore. Door-to-door participants received a S$20 reimbursement for their time and effort. Online panel participants were remunerated based on the incentives scheme of the panel provider, which offered rewards in the form of points, cash, gift cards, or vouchers. Exclusion criteria included non-residency in Singapore or an inability to provide consent due to physical or cognitive impairment. 2.3 Measures 2.3.1 Outcome measures Knowledge of lifespan was assessed by asking participants, “Do you know what lifespan is?” and requiring that they selected the correct definition as “the number of years a person is alive”, which participants needed to select among four response options, with the incorrect options being “the number of years spent as an adult”, “the number of years in retirement”, and “the distance between your two arms when you extend them”. Knowledge of healthspan was similarly measured by asking, “Do you know what healthspan is?” with an accurate definition as “the number of years a person spends in good health”, and incorrect options being "the budget a government can allocate to healthcare", "the number of years a person spends with chronic disease", and "the number of years a person lives" After providing an introduction to HLM clinics – “A Healthy Longevity Medicine clinic offers a comprehensive assessment (2 hours) of biological, physical, cognitive, and mental measures, which is followed by advice from a doctor and other healthcare professionals to optimise health via personalised lifestyle changes (e.g., diet, exercise, sleep), supplements, and medication, interest in them was assessed through a binary (yes/no) survey question evaluating participants’ willingness to engage with or utilise the clinic’s services. 2.3.2 Sociodemographic Age was collected as self-reported chronological age and perceived age, both measured in years. Chronological age was defined as the participant's actual age, while perceived age captured the number in years answered to the question “how old do you feel?”. Gender was categorised as female, male, or other based on participant self-identification. Ethnicity was grouped into Singapore’s four officially recognised categories: Chinese, Indian, Malay, and others. Residency status was classified as citizen, permanent resident, or non-resident/foreigner. Work status was defined as full-time, part-time or casual work, retired and working, retired, or unemployed. Educational attainment was categorised into six levels: postgraduate degree, undergraduate degree, diploma or certificate, secondary school or equivalent, primary school or equivalent, and no formal education. Religion was categorized as Buddhism, Christianity, Islam, Hinduism, Taoism, no religion, or other religions. Marital status was defined as married, single (never married), divorced, widowed, or separated. Family structure included two variables: whether participants had children (yes or no) and whether they had grandchildren (yes or no). Monthly household income was grouped into seven ranges, from “$500 or below” to “$10,001 or more,” with an additional category for “refused to answer.” Monthly individual income was classified into the same categories with the inclusion of a “no income” category. Housing type was categorised as Housing Development Board (HDB) 5-room or executive, HDB 4-room, HDB 3-room, HDB 1-room or 2-room, condominium or other apartment, and landed property or others. The Housing and Development Board (HDB) is Singapore's public housing authority, responsible for planning and developing estates. With over 80% of residents living in public housing under a tiered subsidy scheme, HDB flat size serves as a proxy for socioeconomic status (SES), as smaller (1–2 room) flats have income eligibility caps. 16 2.3.3 Health and lifestyle Body mass index (BMI) was calculated using height in metres(m) and weight (kg). Chronic disease status was defined as the absence or presence of any chronic medical conditions. Medication use and supplement use were each classified as yes or no. Alcohol consumption was categorised as no alcohol consumption, 1 to 7 drinks per week, 8 to 14 drinks per week, or 15 or more drinks per week. Smoking status was classified as never smoked, used to smoke regularly, or currently smoking. Exercise frequency was measured in number of days per week, from 0 to 7. Enrolment in HealthierSG, a 2023 national initiative encouraging Singapore citizens to register with a family doctor for primary and preventive care was also assessed, with responses categorised as “yes,” “no,” or “not qualified to enrol”. 17, 18 Completion of any annual health screening was recorded as “yes” or “no.” 2.4 Data analysis 2.4.1 Quality check A minimum completion rate threshold of 43% was established, requiring respondents to answer all questions in Section A and at least up to Question 5 in Section B. Responses falling below this threshold were excluded, as they lacked essential knowledge-based questions on lifespan and healthspan, which were necessary for a clinically meaningful analysis of the data. 2.4.2 Analyses Three separate analyses were performed to determine the association between socio-demographic characteristics and: (1) knowledge of lifespan, (2) knowledge of healthspan, and (3) interest in engaging HLM clinics services. Crude and age-adjusted logistic regression were employed to assess determinants of knowledge regarding lifespan and healthspan, as well as interest in HLM clinics, which are presented as odds ratios (OR) with 95% confidence intervals (CI). The statistical significance level was set at α = 0·05. All analyses were conducted using SPSS version 27. 3. Results 3.1. Sample characteristics The HELO cohort consists of 3,034 participants of which 2,003 were enrolled via door-to-door data collection and 1,031 via online collection. This sample size was achieved after exclusion of ( n=289 ) participants. Table 1 outlines the demographic and health profiles of the participants. The median age of the total cohort was 46 years [IQR: 34–59], while the median perceived age was 41 years [IQR: 32-56]. The majority were female (54·1%), Chinese (71·0%), and Singapore citizens (83·4%). Nearly half of the participants were highly educated (proportion with postgraduate degrees: 14·6%, and undergraduate degrees: 31·1%). The largest groups earned between SGD 5,001–10,000 (26·9%) or above (26·6%) monthly, while 13·3% declined to disclose their income. Most participants were Singapore citizens (83.4%), with permanent residents comprising 10.1% and non-residents or foreigners comprising 6.4% of the sample. A majority were married (63.9%), followed by those who were single and never married (28.2%), divorced (4.0%), widowed (3.2%), and separated (0.7%). Additionally, 60.9% of participants reported having children. Most participants (77·6%) also reported no chronic diseases and not taking medications (67·6%), while 50·1% reporting using supplements. Approximately half of the participants (47·3%) were enrolled in the HealthierSG initiative, while 53·9% had undergone annual health screenings. Lifestyle behaviours indicated that 69·1% reported they did not consume alcohol and that 80·5% had never smoked. A total of 19.1% of respondents reported no physical exercise. Among those who exercised, 13.7% did so once per week, 16.5% exercised twice per week, and 18.8% exercised three times per week. Characteristics of the cohort stratified according to the sampling methodology are given in Supplementary Table S1. 3.2 Knowledge about lifespan and healthspan and interest in attending Healthy Longevity Medicine clinics Figure 1 illustrates the distribution of participants’ understanding of the definitions for lifespan and healthspan, as well as their interest in the services offered at a HLM clinic. Most participants accurately identified the correct definition of lifespan (82·3%), while about half as many were able to identify the correct definition of healthspan (41·3%). Overall, 55·5% of the participants indicated interest in HLM clinics. 3.3 Demographic associations with knowledge regarding lifespan, healthspan, and interest in attending Healthy Longevity Medicine clinics Table 2 summarizes the association between demographic characteristics and participants' knowledge of lifespan and healthspan, and interest in HLM clinics. Lower chronological age (Figure 2) and male gender was statistically significantly associated with better knowledge of lifespan and higher interest in attending a HLM clinic. Chinese participants had better knowledge of lifespan compared to other ethnicities. Christianity was consistently associated with better knowledge and more interest in HLM clinics compared to other religions. 3.4 Age-adjusted demographic associations with knowledge regarding lifespan, healthspan, and interest in attending Healthy Longevity Medicine clinics Table 3 depicts the age-adjusted demographic characteristics and their association with knowledge of lifespan and healthspan and interest in HLM clinics. Having no grandchildren was statistically significantly associated with better knowledge of lifespan and stronger interest in attending a HLM clinic, while those having family members aged 90 years or older had better knowledge of healthspan. Higher education was consistently associated with better knowledge of lifespan, healthspan, and interest in HLM clinics. Those with a full-time employment had better knowledge of lifespan than those unemployed, as well as better knowledge of healthspan and interest in HLM clinics than those who were retired or unemployed. When compared to those earning less than $500 per month, a household income of $2,501 and more was associated with better knowledge of lifespan and interest in HLM clinics, while those with income of more than $5,001 had better knowledge of healthspan and interest in HLM clinics. Additionally, those residing in a condominium demonstrated better knowledge of lifespan and expressed more interest in HLM clinics. 3.5 Age-adjusted health associations with knowledge regarding lifespan, healthspan, and interest in attending Healthy Longevity Medicine clinics Table 4 shows the associations between health characteristics with knowledge and interest in HLM clinics, adjusting for chronological age. A lower body mass index (BMI) was associated with better knowledge of lifespan and interest in HLM clinics. Additionally, taking supplements was associated with knowledge of lifespan, healthspan, and interest in HLM clinics. Those consuming 1–7 drinks of alcohol per week, compared to nil drinks, had better knowledge of lifespan and healthspan and interest in HLM clinics. Regular exercise was associated with better outcomes, with those exercising for 2 days or more per week reporting better scores in knowledge of healthspan and interest in HLM clinics. Having government health insurance and being enrolled in HealthierSG were both associated with better knowledge of lifespan and healthspan and interest in HLM clinics. Participants who underwent annual health screening and who paid out-of-pocket had higher odds of knowing the definition of healthspan and being interested in attending HLM clinics. Discussion The HELO survey revealed strong public knowledge of lifespan and less widespread understanding of healthspan in the general population of Singapore. More than half of the population expressed interest in HLM clinics. Younger chronological age, male gender, Chinese ethnicity, Christianity, higher education, full-time employment, and higher income were positively associated with knowledge and interest in HLM clinics. Having no grandchildren was linked to better knowledge of lifespan and interest in HLM clinics, while family members living past 90 years were associated with better healthspan knowledge. Health determinants included lower BMI, taking supplements, moderate (vs. no) alcoholic intake, regular exercise, having government health insurance, enrolment in HealthierSG, and completing annual (self-paid) health screenings, all of which were associated with better knowledge and interest in HLM clinics. The factors with the largest effect sizes for both knowledge of lifespan and healthspan, as well as interest in HLM clinics, included having government health insurance and basic education. Additionally, an income above SGD 2,501 and paying out-of-pocket for health screenings were associated with greater interest in visiting HLM clinics. The observed disparity between public knowledge of lifespan and healthspan highlights a weaker understanding of the concept of healthy longevity. The United Nations Decade of Healthy Ageing seeks to address the needs of an ageing population by integrating social, biological, economic, and environmental determinants of healthy ageing across the lifespan, and by promoting interventions to extend healthspan. 19 The limited understanding of healthy longevity is echoed by the Hevolution Foundation survey, which found only 30% of 4,000 citizens self-reported their familiarity with the concept. 20 Defining lifespan and healthspan requires consensus and standardization to effectively disseminate these concepts to the public and develop targeted strategies for healthy ageing policies within global healthcare systems. 21 Despite this, more than half of the participants expressed interest in HLM clinics, suggesting a recognised need and willingness to improve their healthspan. This enthusiasm reflects a growing demand for personalised and preventative healthcare solutions, particularly in Singapore, with the rising prevalence of ageing related diseases and an increasing older-age population which have prompted national initiatives such as HealthierSG. 18, 22 The present finding aligns with insights from a previous focus group study, where Singaporean residents expressed optimism for HLM’s potential in extending healthspan, raised concerns about the challenges of adopting necessary lifestyle changes, and discussed the importance of perceived autonomy over their way of living. 12 Education The findings carry several implications for public health and policy. The disparity between knowledge of lifespan and healthspan underscores the need for targeted educational campaigns to enhance awareness and promote evidence-based preventive health, facilitating the clinical translation of geroscience into Precision Geromedicine through HLM clinics. Enhancing health literacy on healthspan, including awareness of the healthspan-lifespan gap and misconceptions, is crucial for shifting the focus from lifespan extension to the number of healthy years in life. Effective health interventions should be designed and communicated with a clear understanding of population needs, particularly among disengaged groups at higher risk for chronic diseases. Establishing Healthy Longevity Medicine The high levels of knowledge and interest in HLM clinics observed in this study may be attributed to Singapore’s proactive approach to geroscience and preventive health, including the establishment of a healthy longevity research clinic. 23 The HealthierSG initiative, launched in 2023, is a key driver in promoting preventive health by integrating general practitioners, community partners, and public hospitals to encourage early screening and lifestyle interventions. 5, 18 Complementing this, the NUS Academy for Healthy Longevity plays a pivotal role in education and capacity building, offering standardized training programs to equip healthcare professionals with expertise in Precision Geromedicine. 24 Through targeted education and public health initiatives, Singapore is actively bridging the gap between geroscience research and clinical application, fostering a healthcare ecosystem that prioritizes healthspan extension and evidence-based preventive care. Study strength and limitations To the authors’ knowledge, the HELO survey is the first large-scale initiative to investigate public knowledge and interest in HLM, addressing a critical gap in the literature. A key limitation of this study is its reliance on self-reported data, which may be subject to recall bias and social desirability bias, as participants may not remember certain health-related information well or could have overestimated their interest in attending HLM clinics to align with perceived societal expectations. This could lead to inflated estimates of interest, potentially overestimating the population's openness to HLM clinics. Secondly, the study assessed public knowledge of lifespan and healthspan, but variations in individual interpretations of these terms could have influenced responses. As the correct definition needed to be selected between four options, we cannot exclude that some participants responded accurately by chance or by deducing which one was the most probable answer without having prior knowledge about the term itself. Further, without a universally accepted and standardized definition of healthspan 22 , participants may have conceptualized the term differently, leading to inconsistencies in self-reported knowledge. Standardizing definitions across various cultural contexts can help assess conceptual understanding and accuracy of future research on public awareness of lifespan and healthspan. Furthermore, the findings may not be fully generalizable to other populations with different healthcare systems, cultural attitudes, and levels of exposure to geroscience, necessitating initiatives such as the global rollout of HELO 9 . As the study’s cross-sectional design captures associations at a single point in time, it did not make it possible to capture longitudinal or causal relationships. Longitudinal studies are needed to assess changes in awareness and engagement over time and to evaluate whether targeted interventions lead to sustained improvements in knowledge and interest in HLM clinics. In conclusion, the HELO survey in Singapore highlights the urgent need for improved public education about key concepts of healthy longevity, such as healthspan, and equitable access to HLM as a proactive response to the challenges of ageing populations. HLM offers a key opportunity to optimize healthspan through education, health literacy, and the establishment of HLM clinics. This approach could alleviate the strain on healthcare systems, advancing more sustainable and proactive care models worldwide. Further efforts are needed to refine strategies, build consensus on concepts such as healthspan, and ensure the effective implementation of this field of medicine to meet the complex needs of an ageing population. Abbreviations IQR Interquartile range HDB Housing Development Board BMI Body mass index References Scott A, Ellison M, Sinclair D. The economic value of targeting aging. Nature Aging. 2021;1:1-8. Speech by Mr Ong Ye Kung, Minister for Health, at the Motion debate on supporting healthcare: 10 May 2023 [press release]. Singapore, 10 May 2023 2023. Institute for Health Metrics and Evaluation (IHME). Global Burden of Diseases 2019 Results. Global Health Data Exchange. Seattle, Washington 2020. Department of Statistics Singapore. Population and Population Structure 2023 [Available from: https://www.singstat.gov.sg/find-data/search-by-theme/population/population-and-population-structure/latest-data. Amalaraj JJP, Island L, Ong JYY, Wang L, Valderas JM, Dunn M, et al. Towards Precision Geromedicine in Singapore. The Lancet Regional Health – Western Pacific (Submitted). 2024. Kroemer G, Maier AB, Cuervo AM, Gladyshev VN, Ferrucci L, Gorbunova V, et al. From geroscience to precision geromedicine: Understanding and managing aging. Cell. 2025;188(8):2043-62. Donner Y, Fortney K, Calimport SRG, Pfleger K, Shah M, Betts-LaCroix J. Great Desire for Extended Life and Health amongst the American Public. Frontiers in Genetics. 2016;6. McKinsey Health Insititute. Age is just a number: How older adults view healthy aging. 2023. Wang Belinda, al. e. Attitudes toward Lifespan, Healthspan, and Healthy Longevity Medicine: The HELO Conceptual Framework. Journal of the American Medical Directors Association (Submitted). 2024. Wang B, Szücs A, Sandalova E, Horberg EJ, O’Keefe PA, Island L, et al. Attitudes toward lifespan, healthspan, and Healthy Longevity Medicine: the HELO conceptual framework. Journal of the American Medical Directors Association (Submitted). 2024. Khow YZ, Lim TLY, Ng JSP, Wu J, Tan CS, Chia KS, et al. Behavioral impact of national health campaigns on healthy lifestyle practices among young adults in Singapore: a cross-sectional study. BMC Public Health. 2021;21(1):1601. Wang B, Szücs A, Sandalova E, Horberg EJ, O’Keefe PA, Island L, et al. Public views towards lifespan, healthspan, and Healthy Longevity Medicine in Singapore: a qualitative study from the HEalthy LOngevity (HELO) initiatives. The Journals of Gerontology Series A (Submitted). 2024. Walde P, Völlm BA. The TRAPD approach as a method for questionnaire translation. Front Psychiatry. 2023;14:1199989. Urban Redevelopment Authority Singapore. Regional Highlights Singapore2024 [Available from: https://www.ura.gov.sg/Corporate/Planning/Master-Plan/Master-Plan-2019/Regional-Highlights. Salmon CT, Nichols JS. The next-birthday method of respondent selection. Public Opinion Quarterly. 1983;47(2):270-6. Lim DYZ, Wong TH, Feng M, Ong MEH, Ho AFW. Leveraging open data to reconstruct the Singapore Housing Index and other building-level markers of socioeconomic status for health services research. International Journal for Equity in Health. 2021;20:1-9. Milton K, Bull FC, Bauman A. Reliability and validity testing of a single-item physical activity measure. Br J Sports Med. 2011;45(3):203-8. Ministry of Health Singapore. White paper on Healthier SG. Singapore 2022. p. 39. United Nations. United Nations Decade of Healthy Ageing: Plan of Action 2021-2030. New York: United Nations,; 2021. Hevolution. The Global Healthspan Report. Hevolution; 2024. Masfiah S, Kurnialandi A, Meij JJ, Maier AB. Definition of healthspan: A systematic review. Aging Research Reviews (Submitted for publication). 2024. The Lancet Regional Health – Western P. Healthier SG: for a healthier Singapore and beyond. The Lancet Regional Health – Western Pacific. 2023;37. Bonnes SLR, Strauss T, Palmer AK, Hurt RT, Island L, Goshen A, et al. Establishing healthy longevity clinics in publicly funded hospitals. GeroScience. 2024. National University of Singapore. NUS Academy for Healthy Longevity, Singapore: National University of Singapore; 2024 [Available from: https://longevityacademy.sg/. Tables Tables 1 to 4 are available in the Supplementary Files section Additional Declarations There is NO Competing Interest. Supplementary Files HELOCommentaryVer10SUPPLEMENTARY1.docx Supplementary Table S1. Characteristics of participants stratified according to data collection format. HELOCommentaryVer10TABLES1.docx Table 1, Table 2, Table 3, Table 4 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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J. Horberg","email":"","orcid":"","institution":"University of Exeter","correspondingAuthor":false,"prefix":"","firstName":"E.","middleName":"J.","lastName":"Horberg","suffix":""},{"id":490914626,"identity":"a4479527-0fea-4e68-ad12-1048aadf25bb","order_by":6,"name":"Paul O'KEEFE","email":"","orcid":"https://orcid.org/0000-0003-3751-7655","institution":"University of Exeter","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"O'KEEFE","suffix":""},{"id":490914627,"identity":"1d118862-c031-4343-9f8a-eb1c1ed0dee2","order_by":7,"name":"Sonny ROSENTHAL","email":"","orcid":"https://orcid.org/0000-0003-4928-4916","institution":"Singapore Management University","correspondingAuthor":false,"prefix":"","firstName":"Sonny","middleName":"","lastName":"ROSENTHAL","suffix":""},{"id":490914628,"identity":"a6ae9f79-11fc-454a-8c69-f6594f5bed38","order_by":8,"name":"Yap-Seng CHONG","email":"","orcid":"","institution":"National University of Singapore","correspondingAuthor":false,"prefix":"","firstName":"Yap-Seng","middleName":"","lastName":"CHONG","suffix":""},{"id":490914629,"identity":"aa0d7a75-dd51-406d-ac77-e51763124c46","order_by":9,"name":"Johannes J. MEIJ","email":"","orcid":"","institution":"Amsterdam University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Johannes","middleName":"J.","lastName":"MEIJ","suffix":""},{"id":490914619,"identity":"06d18562-cc15-44da-be4c-b3510e0823b0","order_by":10,"name":"Andrea Maier","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYFACHhAhwcDA3gBiWJCihecAlEGkFpDiBCK18DfwHmC6UWMhZz7zjZkE4w4itEgc4EtgzjkmYSxzOweo5QwxDjvAY8CcwyaROEM6LU2CsY0ILfJgLf8k6mdIHiNSiwFIS26bRIKEBPMx4rQYHuZLOJzbJ2E4gyf5sEUiMVrkjvcefJzzrU5egv1g442PbTaEtTAwA0MAzkkgQsMoGAWjYBSMAiIAAC0DLHIRzOzeAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-7206-1724","institution":"Vrije Universiteit Amsterdam","correspondingAuthor":true,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Maier","suffix":""}],"badges":[],"createdAt":"2025-05-19 02:10:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6694270/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6694270/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87817097,"identity":"0e33b5ba-032e-4906-8967-677dfc4cacbe","added_by":"auto","created_at":"2025-07-29 10:21:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52851,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge of lifespan and healthspan and interest in a Healthy Longevity Medicine clinic.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote: Data are presented as n [%].\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6694270/v1/a7942c0cb43127e42b98143f.png"},{"id":87816679,"identity":"751d84bb-3bc5-4c9e-8a1f-42f6a5fe9183","added_by":"auto","created_at":"2025-07-29 10:13:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":61328,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of accurate answers regarding lifespan and healthspan definitions and interest in attending Healthy Longevity Medicine clinics, stratified by age groups.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6694270/v1/caf8b14931a97bc5881367c6.png"},{"id":91729228,"identity":"b8d9efb2-8222-46b5-b434-8f2923673d3f","added_by":"auto","created_at":"2025-09-19 15:39:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":746015,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6694270/v1/a6ebfe1a-714f-453f-a14b-ea30434c6336.pdf"},{"id":87816680,"identity":"3ef70941-9818-4377-81ef-b89e7ceeac8b","added_by":"auto","created_at":"2025-07-29 10:13:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":77029,"visible":true,"origin":"","legend":"Supplementary Table S1. Characteristics of participants stratified according to data collection format.","description":"","filename":"HELOCommentaryVer10SUPPLEMENTARY1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6694270/v1/e4cf7ce0e96773061db6b6c1.docx"},{"id":87817099,"identity":"fa2c5aa7-44a3-460f-9efc-23bf3176d4e8","added_by":"auto","created_at":"2025-07-29 10:21:23","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":142173,"visible":true,"origin":"","legend":"Table 1, Table 2, Table 3, Table 4","description":"","filename":"HELOCommentaryVer10TABLES1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6694270/v1/4d6eb1456b093e20c180feb5.docx"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e Competing Interest.","formattedTitle":"Knowledge of lifespan and healthspan and interest in Healthy Longevity Medicine among the general population in Singapore: The Singapore HEalthy LOngevity (HELO) survey","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe shift toward ageing populations globally has placed unprecedented pressure on healthcare systems.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e As the older demographic grows, healthcare costs are expected to increase, raising significant concerns about long-term sustainability.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e In Singapore, where the proportion of individuals aged 65 years and older is projected to exceed 25% by 2030, this demographic shift has also been accompanied by a growing prevalence of ageing related diseases.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e These trends, coupled with rising old-age dependency ratios and declining birth rates,\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e pose challenges to healthcare systems to deliver quality and sustainable care. Healthy Longevity Medicine (HLM), also referred to as Precision Geromedicine for scientific and medical audiences, is an emerging medical speciality and offers promising solutions to address the challenges posed by ageing populations.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Rooted in geroscience, Precision Geromedicine seeks to optimise health and healthspan by targeting the biological processes of ageing.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e By focusing on prevention and delaying the onset ageing related diseases, the field offers a paradigm shift from reactive to proactive healthcare.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDespite its promise, public opinions on HLM remains insufficiently understood, with surveys revealing diverse preferences as well as socio-demographic and ethical considerations, highlighting the complexity of perspectives on health and healthspan.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e To address this gap, the HEalthy LOngevity (HELO) consortium was established to examine public awareness, knowledge, and motivations towards healthy longevity.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The HELO conceptual framework was developed to explore factors shaping views and intentions towards healthy longevity, which formed the basis for the global HELO population survey, first developed and deployed in Singapore.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Understanding public knowledge and interest in Singapore is particularly timely, given its large-scale national efforts to ramp up preventive healthcare\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e and its population\u0026rsquo;s general receptiveness to public health campaigns\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e making it a promising target for general public health initiatives involving HLM. A preliminary qualitative study conducted with the Singaporean population during the development of the HELO survey highlighted mixed reactions to the notion of HLM clinics, with both enthusiasm about their potential to extend healthspan but also reservations regarding the extent of lifestyle changes required to reach positive results.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e However, this study could not inform on the representativeness of these different perspectives in the Singaporean population given its qualitative nature. A population survey is hence warranted to obtain national population estimates and quantify their variation with individual characteristics.\u003c/p\u003e\u003cp\u003eThe present study focused on results from the HELO population survey in Singapore and aimed to measure knowledge of lifespan and healthspan, and interests in attending HLM clinics among the general population in Singapore and identify associated factors.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"2. Method","content":"\u003cp\u003eEthics approval for the study was obtained from the Institutional Review Board at the National University of Singapore (NUS-IRB-2023-672). Written or electronic informed consent was obtained from all participants prior to data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Study design and sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA nationwide cross-sectional design was utilised to assess public knowledge and interests in HLM through the HELO survey in Singapore.\u003csup\u003e10, 12\u003c/sup\u003e The HELO survey explored public awareness, knowledge, and factors underlying motivation towards lifespan, healthspan, and HLM. The HELO survey comprised 149 questions across multiple sections, designed to capture a comprehensive understanding of participants' demographics, knowledge, behaviours, and attitudes towards HLM:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSection A: Demographic data (37 questions).\u003c/li\u003e\n \u003cli\u003eSection B: Knowledge of lifespan and healthspan (20 questions).\u003c/li\u003e\n \u003cli\u003eSection C: Interest in HLM Clinics and health-related concerns (17 questions).\u003c/li\u003e\n \u003cli\u003eSection D: Health behaviours, social support, personality, and aspirations (75 questions).\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe survey was available in the official languages of Singapore, namely English, Chinese, Malay, and Tamil. All translations followed the Translation, Review, Adjudication, Pretest, and Documentation approach (TRAPD)\u003csup\u003e13\u003c/sup\u003e to ensure culturally and contextually appropriate adaptations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe survey was administered door-to-door in Singapore from June 24 to August 11, 2024, targeting a sample size of up to \u003cem\u003en=\u003c/em\u003e2,500 participants. For door-to-door data collection, multistage cluster sampling was used to randomly select postal codes from households and public places across five major regions of Singapore (Central, East, West, North, and Northeast), as defined by the Urban Redevelopment Authority Singapore.\u003csup\u003e14\u003c/sup\u003e The “last birthday” method\u003csup\u003e15\u003c/sup\u003e was used for within-household sampling to select household members who were currently at home, aged 21 years old or older (as defined by the local age of majority), and had the most recent birthday. Surveys were conducted daily between 9am and 9pm, and participants had the option to complete the survey digitally via a QR code (\u003cem\u003en\u003c/em\u003e=1614), or using a pen-and-paper format (\u003cem\u003en\u003c/em\u003e=389). For online data collection, surveys were administered via the Qualtrics platform, which recruited participants residing in Singapore. A total of \u003cem\u003en\u003c/em\u003e = 1,000 participants were recruited through Qualtrics from July 8 to August 20, 2024. Stratified random sampling was applied to ensure demographic representativeness across age, gender, and ethnicity.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe median time (seconds) taken to complete the surveys were 1,546 [IQR: 993–2,221] for the door-to-door survey and 971 [IQR: 743–1,506] for the online survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEligible participants were adults aged 21 years and older residing in Singapore. Door-to-door participants received a S$20 reimbursement for their time and effort. Online panel participants were remunerated based on the incentives scheme of the panel provider, which offered rewards in the form of points, cash, gift cards, or vouchers. Exclusion criteria included non-residency in Singapore or an inability to provide consent due to physical or cognitive impairment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3.1 Outcome measures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKnowledge of lifespan was assessed by asking participants, “Do you know what lifespan is?” and requiring that they selected the correct definition as “the number of years a person is alive”, which participants needed to select among four response options, with the incorrect options being “the number of years spent as an adult”, “the number of years in retirement”, and “the distance between your two arms when you extend them”. Knowledge of healthspan was similarly measured by asking, “Do you know what healthspan is?” with an accurate definition as “the number of years a person spends in good health”, and incorrect options being \"the budget a government can allocate to healthcare\", \"the number of years a person spends with chronic disease\", and \"the number of years a person lives\"\u003c/p\u003e\n\u003cp\u003eAfter providing an introduction to\u0026nbsp;HLM clinics\u0026nbsp;– “A Healthy Longevity Medicine clinic offers a comprehensive assessment (2 hours) of biological, physical, cognitive, and mental measures, which is followed by advice from a doctor and other healthcare professionals to optimise health via personalised lifestyle changes (e.g., diet, exercise, sleep), supplements, and medication, interest in them was assessed through a binary (yes/no) survey question evaluating participants’ willingness to engage with or utilise the clinic’s services.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3.2 Sociodemographic\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAge was collected as self-reported chronological age and perceived age, both measured in years. Chronological age was defined as the participant's actual age, while perceived age captured the number in years answered to the question “how old do you feel?”. Gender was categorised as female, male, or other based on participant self-identification. Ethnicity was grouped into Singapore’s four officially recognised categories: Chinese, Indian, Malay, and others. Residency status was classified as citizen, permanent resident, or non-resident/foreigner. Work status was defined as full-time, part-time or casual work, retired and working, retired, or unemployed. Educational attainment was categorised into six levels: postgraduate degree, undergraduate degree, diploma or certificate, secondary school or equivalent, primary school or equivalent, and no formal education. Religion was categorized as Buddhism, Christianity, Islam, Hinduism, Taoism, no religion, or other religions. Marital status was defined as married, single (never married), divorced, widowed, or separated. Family structure included two variables: whether participants had children (yes or no) and whether they had grandchildren (yes or no). Monthly household income was grouped into seven ranges, from “$500 or below” to “$10,001 or more,” with an additional category for “refused to answer.” Monthly individual income was classified into the same categories with the inclusion of a “no income” category. Housing type was categorised as Housing Development Board (HDB) 5-room or executive, HDB 4-room, HDB 3-room, HDB 1-room or 2-room, condominium or other apartment, and landed property or others.\u0026nbsp;The Housing and Development Board (HDB) is Singapore's public housing authority, responsible for planning and developing estates. With over 80% of residents living in public housing under a tiered subsidy scheme, HDB flat size serves as a proxy for socioeconomic status (SES), as smaller (1–2 room) flats have income eligibility caps.\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3.3 Health and lifestyle\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBody mass index (BMI) was calculated using height in metres(m) and weight (kg). Chronic disease status was defined as the absence or presence of any chronic medical conditions. Medication use and supplement use were each classified as yes or no. Alcohol consumption was categorised as no alcohol consumption, 1 to 7 drinks per week, 8 to 14 drinks per week, or 15 or more drinks per week. Smoking status was classified as never smoked, used to smoke regularly, or currently smoking. Exercise frequency was measured in number of days per week, from 0 to 7. Enrolment in HealthierSG, a 2023 national initiative encouraging Singapore citizens to register with a family doctor for primary and preventive care was also assessed, with responses categorised as “yes,” “no,” or “not qualified to enrol”.\u003csup\u003e17, 18\u003c/sup\u003e Completion of any annual health screening was recorded as “yes” or “no.”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.4.1 Quality check\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA minimum completion rate threshold of 43% was established, requiring respondents to answer all questions in Section A and at least up to Question 5 in Section B. Responses falling below this threshold were excluded, as they lacked essential knowledge-based questions on lifespan and healthspan, which were necessary for a clinically meaningful analysis of the data.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.4.2 Analyses\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThree separate analyses were performed to determine the association between socio-demographic characteristics and: (1) knowledge of lifespan, (2) knowledge of healthspan, and (3) interest in engaging HLM clinics services. Crude and age-adjusted logistic regression were employed to assess determinants of knowledge regarding lifespan and healthspan, as well as interest in HLM clinics, which are presented as odds ratios (OR) with 95% confidence intervals (CI). The statistical significance level was set at α = 0·05. All analyses were conducted using SPSS version 27.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Sample characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe HELO cohort consists of 3,034 participants of which 2,003 were enrolled via door-to-door data collection and 1,031 via online collection. This sample size was achieved after exclusion of (\u003cem\u003en=289\u003c/em\u003e) participants.\u003c/p\u003e\n\u003cp\u003eTable 1 outlines the demographic and health profiles of the participants. The median age of the total cohort was 46 years [IQR: 34–59], while the median perceived age was 41 years [IQR: 32-56]. The majority were female (54·1%), Chinese (71·0%), and Singapore citizens (83·4%). Nearly half of the participants were highly educated (proportion with postgraduate degrees: 14·6%, and undergraduate degrees: 31·1%). The largest groups earned between SGD 5,001–10,000 (26·9%) or above (26·6%) monthly, while 13·3% declined to disclose their income. Most participants were Singapore citizens (83.4%), with permanent residents comprising 10.1% and non-residents or foreigners comprising 6.4% of the sample. A majority were married (63.9%), followed by those who were single and never married (28.2%), divorced (4.0%), widowed (3.2%), and separated (0.7%). Additionally, 60.9% of participants reported having children. Most participants (77·6%) also reported no chronic diseases and not taking medications (67·6%), while 50·1% reporting using supplements. Approximately half of the participants (47·3%) were enrolled in the HealthierSG initiative, while 53·9% had undergone annual health screenings. Lifestyle behaviours indicated that 69·1% reported they did not consume alcohol and that 80·5% had never smoked. A total of 19.1% of respondents reported no physical exercise. Among those who exercised, 13.7% did so once per week, 16.5% exercised twice per week, and 18.8% exercised three times per week.\u0026nbsp;Characteristics of the cohort stratified according to the sampling methodology are given in Supplementary Table S1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Knowledge about lifespan and healthspan and interest in attending Healthy Longevity Medicine clinics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 illustrates the distribution of participants’ understanding of the definitions for lifespan and healthspan, as well as their interest in the services offered at a HLM clinic. Most participants accurately identified the correct definition of lifespan (82·3%), while about half as many were able to identify the correct definition of healthspan (41·3%). Overall, 55·5% of the participants indicated interest in\u0026nbsp;HLM clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Demographic associations with knowledge regarding lifespan, healthspan, and interest in attending Healthy Longevity Medicine clinics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 summarizes the association between demographic characteristics and participants' knowledge of lifespan and healthspan, and interest in\u0026nbsp;HLM clinics. Lower chronological age (Figure 2) and male gender was statistically significantly associated with better knowledge of lifespan and higher interest in attending a\u0026nbsp;HLM clinic.\u0026nbsp;Chinese participants had better knowledge of lifespan compared to other ethnicities. Christianity was consistently associated with better knowledge and more interest in\u0026nbsp;HLM clinics\u0026nbsp;compared to other religions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Age-adjusted demographic associations with knowledge regarding lifespan, healthspan, and interest in attending Healthy Longevity Medicine clinics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 depicts the age-adjusted demographic characteristics and their association with knowledge of lifespan and healthspan and interest in\u0026nbsp;HLM clinics. Having no grandchildren was statistically significantly associated with better knowledge of lifespan and stronger interest in attending a HLM clinic, while those having family members aged 90 years or older had better knowledge of healthspan. Higher education was consistently associated with better knowledge of lifespan, healthspan, and interest in\u0026nbsp;HLM clinics. Those with a full-time employment had better knowledge of lifespan than those unemployed, as well as better knowledge of healthspan and interest in\u0026nbsp;HLM clinics\u0026nbsp;than those who were retired or unemployed. When compared to those earning less than $500 per month, a household income of $2,501 and more was associated with better knowledge of lifespan and interest in\u0026nbsp;HLM clinics, while those with income of more than $5,001 had better knowledge of healthspan and interest in\u0026nbsp;HLM clinics. Additionally, those residing in a condominium demonstrated better knowledge of lifespan and expressed more interest in\u0026nbsp;HLM clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Age-adjusted health associations with knowledge regarding lifespan, healthspan, and interest in attending Healthy Longevity Medicine clinics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 shows the associations between health characteristics with knowledge and interest in\u0026nbsp;HLM clinics, adjusting for chronological age. A lower body mass index (BMI) was associated with better knowledge of lifespan and interest in\u0026nbsp;HLM clinics. Additionally, taking supplements was associated with knowledge of lifespan, healthspan, and interest in\u0026nbsp;HLM clinics. Those consuming 1–7 drinks of alcohol per week, compared to nil drinks, had better knowledge of lifespan and healthspan and interest in\u0026nbsp;HLM clinics. Regular exercise was associated with better outcomes, with those exercising for 2 days or more per week reporting better scores in knowledge of healthspan and interest in\u0026nbsp;HLM clinics. Having government health insurance and being enrolled in HealthierSG were both associated with better knowledge of lifespan and healthspan and interest in\u0026nbsp;HLM clinics. Participants who underwent annual health screening and who paid out-of-pocket had higher odds of knowing the definition of healthspan and being interested in attending\u0026nbsp;HLM clinics.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe HELO survey revealed strong public knowledge of lifespan and less widespread understanding of healthspan in the general population of Singapore. More than half of the population expressed interest in HLM clinics. Younger chronological age, male gender, Chinese ethnicity, Christianity, higher education, full-time employment, and higher income were positively associated with knowledge and interest in HLM clinics. Having no grandchildren was linked to better knowledge of lifespan and interest in\u0026nbsp;HLM clinics, while family members living past 90 years were associated with better healthspan knowledge. Health determinants included lower BMI, taking supplements, moderate (vs. no) alcoholic intake, regular exercise, having government health insurance, enrolment in HealthierSG, and completing annual (self-paid) health screenings, all of which were associated with better knowledge and interest in HLM clinics. The factors with the largest effect sizes for both knowledge of lifespan and healthspan, as well as interest in HLM clinics, included having government health insurance and basic education. Additionally, an income above SGD 2,501 and paying out-of-pocket for health screenings were associated with greater interest in visiting HLM clinics.\u003c/p\u003e\n\u003cp\u003eThe observed disparity between public knowledge of lifespan and healthspan highlights a weaker understanding of the concept of healthy longevity. The United Nations Decade of Healthy Ageing seeks to address the needs of an ageing population by integrating social, biological, economic, and environmental determinants of healthy ageing across the lifespan, and by promoting interventions to extend healthspan.\u003csup\u003e19\u003c/sup\u003e The limited understanding of healthy longevity is echoed by the Hevolution Foundation survey, which found only 30% of 4,000 citizens self-reported their familiarity with the concept.\u003csup\u003e20\u003c/sup\u003e Defining lifespan and healthspan requires consensus and standardization to effectively disseminate these concepts to the public and develop targeted strategies for healthy ageing policies within global healthcare systems.\u003csup\u003e21\u003c/sup\u003e Despite this, more than half of the participants expressed interest in HLM clinics, suggesting a recognised need and willingness to improve their healthspan. This enthusiasm reflects a growing demand for personalised and preventative healthcare solutions, particularly in Singapore, with the rising prevalence of ageing related diseases and an increasing older-age population which have prompted national initiatives such as HealthierSG.\u003csup\u003e18, 22\u003c/sup\u003e The present finding aligns with insights from a previous focus group study, where Singaporean residents expressed optimism for HLM\u0026rsquo;s potential in extending healthspan, raised concerns about the challenges of adopting necessary lifestyle changes, and discussed the importance of perceived autonomy over their way of living.\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEducation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe findings carry several implications for public health and policy. The disparity between knowledge of lifespan and healthspan underscores the need for targeted educational campaigns to enhance awareness and promote evidence-based preventive health, facilitating the clinical translation of geroscience into Precision Geromedicine through HLM clinics. Enhancing health literacy on healthspan, including awareness of the healthspan-lifespan gap and misconceptions, is crucial for shifting the focus from lifespan extension to the number of healthy years in life. Effective health interventions should be designed and communicated with a clear understanding of population needs, particularly among disengaged groups at higher risk for chronic diseases.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEstablishing Healthy Longevity Medicine\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe high levels of knowledge and interest in HLM clinics observed in this study may be attributed to Singapore\u0026rsquo;s proactive approach to geroscience and preventive health, including the establishment of a healthy longevity research clinic.\u003csup\u003e23\u003c/sup\u003e The HealthierSG initiative, launched in 2023, is a key driver in promoting preventive health by integrating general practitioners, community partners, and public hospitals to encourage early screening and lifestyle interventions.\u003csup\u003e5, 18\u003c/sup\u003e Complementing this, the NUS Academy for Healthy Longevity plays a pivotal role in education and capacity building, offering standardized training programs to equip healthcare professionals with expertise in Precision Geromedicine.\u003csup\u003e24\u003c/sup\u003e Through targeted education and public health initiatives, Singapore is actively bridging the gap between geroscience research and clinical application, fostering a healthcare ecosystem that prioritizes healthspan extension and evidence-based preventive care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy strength and limitations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo the authors\u0026rsquo; knowledge, the HELO survey is the first large-scale initiative to investigate public knowledge and interest in HLM, addressing a critical gap in the literature. A key limitation of this study is its reliance on self-reported data, which may be subject to recall bias and social desirability bias, as participants may not remember certain health-related information well or could have overestimated their interest in attending HLM clinics to align with perceived societal expectations. This could lead to inflated estimates of interest, potentially overestimating the population\u0026apos;s openness to HLM clinics. Secondly, the study assessed public knowledge of lifespan and healthspan, but variations in individual interpretations of these terms could have influenced responses. As the correct definition needed to be selected between four options, we cannot exclude that some participants responded accurately by chance or by deducing which one was the most probable answer without having prior knowledge about the term itself. Further, without a universally accepted and standardized definition of healthspan\u003csup\u003e22\u003c/sup\u003e, participants may have conceptualized the term differently, leading to inconsistencies in self-reported knowledge. Standardizing definitions across various cultural contexts can help assess conceptual understanding and accuracy of future research on public awareness of lifespan and healthspan. Furthermore, the findings may not be fully generalizable to other populations with different healthcare systems, cultural attitudes, and levels of exposure to geroscience, necessitating initiatives such as the global rollout of HELO\u003csup\u003e9\u003c/sup\u003e. As the study\u0026rsquo;s cross-sectional design captures associations at a single point in time, it did not make it possible to capture longitudinal or causal relationships. Longitudinal studies are needed to assess changes in awareness and engagement over time and to evaluate whether targeted interventions lead to sustained improvements in knowledge and interest in HLM clinics. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn conclusion, the HELO survey in Singapore highlights the urgent need for improved public education about key concepts of healthy longevity, such as healthspan, and equitable access to HLM as a proactive response to the challenges of ageing populations. HLM offers a key opportunity to optimize healthspan through education, health literacy, and the establishment of HLM clinics. This approach could alleviate the strain on healthcare systems, advancing more sustainable and proactive care models worldwide. Further efforts are needed to refine strategies, build consensus on concepts such as healthspan, and ensure the effective implementation of this field of medicine to meet the complex needs of an ageing population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003eIQR\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cem\u003eInterquartile range\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003eHDB\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cem\u003eHousing Development Board\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cem\u003eBMI\u003c/em\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e\u003cem\u003eBody mass index\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eScott A, Ellison M, Sinclair D. The economic value of targeting aging. Nature Aging. 2021;1:1-8.\u003c/li\u003e\n\u003cli\u003eSpeech by Mr Ong Ye Kung, Minister for Health, at the Motion debate on supporting healthcare: 10 May 2023 [press release]. Singapore, 10 May 2023 2023.\u003c/li\u003e\n\u003cli\u003eInstitute for Health Metrics and Evaluation (IHME). Global Burden of Diseases 2019 Results. Global Health Data Exchange. Seattle, Washington 2020.\u003c/li\u003e\n\u003cli\u003eDepartment of Statistics Singapore. Population and Population Structure 2023 [Available from: https://www.singstat.gov.sg/find-data/search-by-theme/population/population-and-population-structure/latest-data.\u003c/li\u003e\n\u003cli\u003eAmalaraj JJP, Island L, Ong JYY, Wang L, Valderas JM, Dunn M, et al. Towards Precision Geromedicine in Singapore. The Lancet Regional Health \u0026ndash; Western Pacific (Submitted). 2024.\u003c/li\u003e\n\u003cli\u003eKroemer G, Maier AB, Cuervo AM, Gladyshev VN, Ferrucci L, Gorbunova V, et al. From geroscience to precision geromedicine: Understanding and managing aging. Cell. 2025;188(8):2043-62.\u003c/li\u003e\n\u003cli\u003eDonner Y, Fortney K, Calimport SRG, Pfleger K, Shah M, Betts-LaCroix J. Great Desire for Extended Life and Health amongst the American Public. Frontiers in Genetics. 2016;6.\u003c/li\u003e\n\u003cli\u003eMcKinsey Health Insititute. Age is just a number: How older adults view healthy aging. 2023.\u003c/li\u003e\n\u003cli\u003eWang Belinda, al. e. Attitudes toward Lifespan, Healthspan, and Healthy Longevity Medicine: The HELO Conceptual Framework. Journal of the American Medical Directors Association (Submitted). 2024.\u003c/li\u003e\n\u003cli\u003eWang B, Sz\u0026uuml;cs A, Sandalova E, Horberg EJ, O\u0026rsquo;Keefe PA, Island L, et al. Attitudes toward lifespan, healthspan, and Healthy Longevity Medicine: the HELO conceptual framework. Journal of the American Medical Directors Association (Submitted). 2024.\u003c/li\u003e\n\u003cli\u003eKhow YZ, Lim TLY, Ng JSP, Wu J, Tan CS, Chia KS, et al. Behavioral impact of national health campaigns on healthy lifestyle practices among young adults in Singapore: a cross-sectional study. BMC Public Health. 2021;21(1):1601.\u003c/li\u003e\n\u003cli\u003eWang B, Sz\u0026uuml;cs A, Sandalova E, Horberg EJ, O\u0026rsquo;Keefe PA, Island L, et al. Public views towards lifespan, healthspan, and Healthy Longevity Medicine in Singapore: a qualitative study from the HEalthy LOngevity (HELO) initiatives. The Journals of Gerontology Series A (Submitted). 2024.\u003c/li\u003e\n\u003cli\u003eWalde P, V\u0026ouml;llm BA. The TRAPD approach as a method for questionnaire translation. Front Psychiatry. 2023;14:1199989.\u003c/li\u003e\n\u003cli\u003eUrban Redevelopment Authority Singapore. Regional Highlights Singapore2024 [Available from: https://www.ura.gov.sg/Corporate/Planning/Master-Plan/Master-Plan-2019/Regional-Highlights.\u003c/li\u003e\n\u003cli\u003eSalmon CT, Nichols JS. The next-birthday method of respondent selection. Public Opinion Quarterly. 1983;47(2):270-6.\u003c/li\u003e\n\u003cli\u003eLim DYZ, Wong TH, Feng M, Ong MEH, Ho AFW. Leveraging open data to reconstruct the Singapore Housing Index and other building-level markers of socioeconomic status for health services research. International Journal for Equity in Health. 2021;20:1-9.\u003c/li\u003e\n\u003cli\u003eMilton K, Bull FC, Bauman A. Reliability and validity testing of a single-item physical activity measure. Br J Sports Med. 2011;45(3):203-8.\u003c/li\u003e\n\u003cli\u003eMinistry of Health Singapore. White paper on Healthier SG. Singapore 2022. p. 39.\u003c/li\u003e\n\u003cli\u003eUnited Nations. United Nations Decade of Healthy Ageing: Plan of Action 2021-2030. New York: United Nations,; 2021.\u003c/li\u003e\n\u003cli\u003eHevolution. The Global Healthspan Report. Hevolution; 2024.\u003c/li\u003e\n\u003cli\u003eMasfiah S, Kurnialandi A, Meij JJ, Maier AB. Definition of healthspan: A systematic review. Aging Research Reviews (Submitted for publication). 2024.\u003c/li\u003e\n\u003cli\u003eThe Lancet Regional Health \u0026ndash; Western P. Healthier SG: for a healthier Singapore and beyond. The Lancet Regional Health \u0026ndash; Western Pacific. 2023;37.\u003c/li\u003e\n\u003cli\u003eBonnes SLR, Strauss T, Palmer AK, Hurt RT, Island L, Goshen A, et al. Establishing healthy longevity clinics in publicly funded hospitals. GeroScience. 2024.\u003c/li\u003e\n\u003cli\u003eNational University of Singapore. NUS Academy for Healthy Longevity, Singapore: National University of Singapore; 2024 [Available from: https://longevityacademy.sg/.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"aging, healthspan, knowledge, lifespan, longevity, motivation","lastPublishedDoi":"10.21203/rs.3.rs-6694270/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6694270/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eGiven the growing global interest in Healthy Longevity Medicine (HLM), the field lacks understanding about public knowledge and interest, which are crucial to consider for any public health intervention relying on HLM. This study presents findings from the Healthy Longevity (HELO) survey conducted in Singapore, assessing public knowledge regarding lifespan, healthspan, and interest in HLM. This nationwide cross-sectional survey, conducted between June and August 2024, involved 3,034 participants. Main domains including questions on demographics, living arrangements, medical information, health behaviours, income and financial status were tested for associations with knowledge about lifespan and healthspan, and interest in HLM clinics using binary logistic regression. While 82·3% of 46 years old [IQR: 34 – 59] participants correctly defined lifespan, 41·3% accurately defined healthspan and 55·5% expressed interest in HLM clinics. Younger age, male gender, Chinese ethnicity, higher education and income, full-time employment, lower body mass index, supplement use, moderate (vs. no) alcohol consumption, high exercise frequency, and enrolment in (self-paid) annual health screenings were associated with better knowledge and stronger interest in HLM clinics. These findings highlight the need for targeted education to enhance understanding of healthspan and implement evidence-based preventive health programs, supporting the clinical translation of geroscience into Precision Geromedicine through HLM clinics.\u003c/p\u003e","manuscriptTitle":"Knowledge of lifespan and healthspan and interest in Healthy Longevity Medicine among the general population in Singapore: The Singapore HEalthy LOngevity (HELO) survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-29 10:13:18","doi":"10.21203/rs.3.rs-6694270/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e9cfc4fa-4dd0-4255-a779-e53800dcabce","owner":[],"postedDate":"July 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52128599,"name":"Scientific community and society/Scientific community/Research data"},{"id":52128600,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-09-19T15:31:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-29 10:13:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6694270","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6694270","identity":"rs-6694270","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}