Stress biology and metabolic ageing in older adults during prolonged crises: Ukraine as an example.

Prolonged crises expose older adults to chronic psychological and social stress, irregular nutrition, reduced physical activity, reduced access to health care, and interruptions in treatment of chronic disease. Together, these factors can compound age-related vulnerabilities and increase the risk of metabolic deterioration, multimorbidity and functional decline. This Perspective argues that prolonged crises should be viewed not only as social or psychological events, but also as conditions that may affect stress-related and ageing-related biological pathways. Severe or prolonged stress, however, can make these responses maladaptive and contribute to physiological dysregulation. Under prolonged crisis conditions, such maladaptive stress responses may be linked to abdominal obesity, sarcopenic obesity, physical frailty, and functional decline through chronic activation of the hypothalamic-pituitary-adrenal axis, altered glucocorticoid signalling, sleep disturbance, inflammation, cellular senescence and senescence-associated secretory phenotype, immunometabolic dysregulation, adipose tissue inflammation, insulin resistance, mitochondrial dysfunction and anabolic resistance in skeletal muscle. Ukraine is a timely example of this broader problem, as prolonged war, population ageing, non-communicable diseases, displacement, mental health needs, and new screening initiatives now intersect. Thus, a biologically informed framework for healthy ageing needs to incorporate mental health assessment, metabolic screening, nutritional assessment, muscle function and rehabilitation rather than address these in isolation. Functional ability reflects the combined effects of psychological stress, metabolic ageing, muscle loss, multimorbidity, and changes in the living environment. It should be considered a key indicator for older adults during and after prolonged crises.