Week 3-Healthy ageing

Question 1

Healthy Ageing: What’s the problem? (PHE, 2014)

Answer 1

-In the UK, our life expectancy is expanding rapidly with a greater number of older adults in the population compared to 20 years ago

-There is also a lower birth rate compared to the past decades

-45% of women and 33% of men are not active enough for good health with 19% of men and 26% of women being physically inactive (so typically a physically inactive society using transport over walking)

-Easy access to processed foods

-Both factors impact later life

-It cost 2.6 trillion dollars on healthcare in the US for older adults (higher risk of disease means a greater strain on healthcare)

Question 2

What is Healthy Ageing?

Answer 2

“The process of developing and maintaining
the functional ability that enables wellbeing in older age.” World Health Organization, 2020

Question 3

What is meant by Functional Ability?

Answer 3

Functional ability means an individual can:
*Meet their basic needs
*Learn, grow and make decisions
*Be mobile
*Build and maintain relationships
*Contribute to society (e.g., volunteering-Note: People typically are not hired for jobs as they get older due to their age meaning if they want to improve their skills they are limited to just volunteering)

Question 4

What are the 4 project action areas of the decade built by the UN Decade of Healthy Ageing (2021-2030)?

Answer 4

1. Change how we think, feel and act towards age and aging
2. Ensure that communities foster the abilities of older people
3. Deliver person-centered integrated care and primary health services responsive to older people
4. Provide access to long-term care for older people who need it

-The primary goal of this is to add life to years

Question 5

How can adding life to years be impacted?

Answer 5

-Through environmental influences

Example: Covid-19 pandemic
-Told elderly people to isolate as they were in a high risk group
-So how can they go out and exercise, socialise, or do something meaningful such as volunteering to make their life impactful?
-Social isolation negatively impacted mental health

Other examples: location (lack of shops with healthy food, green spaces to exercise etc.,), socioeconomic status etc.,

Question 6

What’s the link between Physical Health & Healthy Ageing? (The King’s Fund, 2016)

Answer 6

-Older people are likely to suffer from ill PH (50.8% men, 56.7% women aged 80 have a longstanding PH problem)

-2013 ONS survey shows long standing illness increases with age (15% of 16-24 yr olds & 69% of over 75’s)

-If you have two or more chronic physical conditions the risk of depression was over seven times more common.

-Therefore by reducing one e.g., PH, the other will reduce with it e.g., depression

Question 7

What’s the link between Mental Health & Healthy Ageing? (UK Wellbeing Survery, 2013)

Answer 7

 Nearly 1 in 5 people in the UK aged 16 or older showed symptoms of anxiety or depression (higher for females 21.5% than males 14.8%).

Depression affects 4 in 10 people living in care homes (1/3rd of the people using mental health services in the UK are older adults despite the fact they make 18% of the population).

Depression in older adults has links with dementia, frailty, and social isolation

Question 8

What are the 5 factors affecting the mental health & wellbeing of older people? (UK Wellbeing Survey, 2016)

Answer 8

1. Participation in meaningful activities
2. Meaningful relationships
3. Discrimination
4. Physical Health
5. Poverty (inability to pay for the activities, food you want)

Question 9

What’s the link between Nutrition and Healthy Ageing?

Answer 9

-Fasting is linked to delaying the onset of dementia and memory loss, whereas eating processed foods is linked to progressing these risks (BBC Studios, 2013)

Campisi et al. (2019):
-Diet does have an impact us as we age and we have to eat optimally if we want to live long healthy lives (like delaying dementia)
-Themes of healthy eating includes: minimally processed foods, plant-based foods, not much alcohol, not overeating etc.,

Question 10

What did the Annual Review of Public Health (2014) say about Diet and Healthy Ageing?

Answer 10

-There’s not one particular diet proven to health rather the focus should just be on healthy eating (e.g., minimally processed foods, plant-based foods etc.,)

Question 11

What are the benefits of exercise?

Answer 11

Generally considered health protective (reducing/reversing the risk of e.g. cardiovascular disease, type-2 diabetes, obesity, osteoporosis and, some forms of cancer)

A lack of physical activity is a significant factor in non-communicable diseases such as stroke, diabetes, and cancer.

Associated with a significant down-turn in all-cause mortality

Consistently associated with psychological benefits – elevated mood in both clinical and non-clinical populations:
 Reduced anxiety
 Reduced depression**
 Heightened self-esteem and self-image
 Increased levels of pro-social behaviour
 Delayed neuronal degeneration, which underlies cognitive decline in dementia.

Question 12

What are the negative consequences of exercise?

Answer 12

-Excessive reliance on exercise can become compulsive, and may produce dependence.

-Withdrawal effects of guilt and irritability may occur.

-Long-term excessive exercise can lead to muscle wasting and weight loss.

-For previously inactive individuals, dramatic exercise may lead to injury and/or aversion to exercise.

Question 13

What is Physical Activity like throughout the life course? (NHS, 2021)

Answer 13

-72% adults aged 25-44 met the guidelines for aerobic activity

-60% of older adults aged between 65 and 74

-38% of older adults aged 75 and over

Similarly for muscle-strengthening exercise:
-Those aged 75 and over least likely to meet the guidelines (11%) (meaning more likely to fall)

Gluchowski et al. (2022):
-Most older adults aren’t aware of the strength-building guidelines

Question 14

What are the 10 ways Good Physical Health can improve Healthy Ageing?

Answer 14

1. Mobility
2. Muscle Strength
3. Falls
4. Bone Health
5. Emotional wellbeing
6. Enhancement of cognitive function
7. Prevention of cognitive impairment
8. Self-efficacy
9. Physical symptoms
10. Social functioning increases

Question 15

How do we develop interventions for Healthy Ageing? (Skivington et al., 2021)

Answer 15

1. What do we want to change?
   * Define the problem (older people are sedentary with muscles wasting away)
   * Specify the target behaviour
   * Identify the desired change in behaviour
2. What is the mechanism of change?
   * Explore theories of behaviour change
   * Consider behaviour change techniques
   * Consider mode of delivery
3. Implementation
   * Test and refine with a small sample (with a pilot study)
   * Evaluate effectiveness – did it change the target behaviour?

Question 16

What is the ACE Trial? (Stathi et al., 2023)

Answer 16

The Active, Connected, Engaged (ACE) trial is
a multi-centre randomised controlled trial of a peer volunteer led active ageing programme

Question 17

What is the ACE Study?

Answer 17

• A peer-volunteering trial – where a sedentary, isolated older adult aged 65 or over is paired with a more active peer aged 55 or over.
• Cognitive tests were done to check if the individual had dementia + questionnaires assessing their mental health and perceptions on their QoL.
• Goal: to increase the activity of the older adults by encouraging them to get out in the community (to reduce the risk of mobility limitations).
• Random allocation into the intervention or the control group.

Question 18

What are the Hypotheses of the ACE Study?

Answer 18

• Primary: Compared with comparison group, participants allocated to the ACE intervention will have significantly reduced mobility-related limitations, as indicated by SPPB score, at 18 months of follow-up.
• Secondary: Compared with the control group, intervention participants will significantly improve in areas such as physical, mental and social well being, and reductions in areas such as loneliness and utilisation of health and social care.

Question 19

What were the steps in the ACE Study? (Stathi et al., 2023)

Answer 19

1. Baseline Assessment (i.e., checks for disabilities, dementia etc.,) if eligible they are allocated randomly to:

The Comparison Group (just do engaging sessions on healthy eating and nutrition)

OR

The Intervention Group:
1. 1-6 weeks: Meet with your volunteer, Choose an activity to try & Attend activities together
2. 6-12 weeks: Attend activities together, Having telephone support, Attend activities independently
3. 12-24 weeks: Having telephone support, Continue attending independently
-Essentially the volunteer slowly drops off allowing the individual to do this independently

Both have:
Post-intervention (6 months)

Follow-up (12 months)

Follow-up (18 months)

Question 20

What was the Participant Demographic Sample? (ACE, 2023)

Answer 20

Participants:
* 104 current participants
* 42.3% Male, 57.7% Female

Peer-volunteers:
* 47 current peer-volunteers
* 34% Male, 66% Female

-85.10% White
-6.40% Chinese
-4.20% Black/Black British - Caribbean/African
-2.10% Asian/Asian British - Bangladeshi
-2.10% Any other Ethnic Group

Question 21

What was the Aims and Methods of the Scoping Review? (Stathi et al., 2023)

Answer 21

Aim: To explore the motivations of older adults who are peer-volunteers in schemes with some aspect of physical activity

Method:
* Databases: MEDLINE, Embase, APA PsycInfo and CINAHL

• Inclusion criteria: Written in English; Population: aged over 50-years-old, volunteers or have volunteered; Programmes with some option for physical activity; Motivation as an outcome
• Thematic analysis was used to explore the motivation

Question 22

What were the Key Findings of the Scoping Review? (Stathi et al., 2023)

Answer 22

7 studies met the inclusion criteria.

Thematic findings:
* Altruistic motivation: a drive to help others
* Personal motivation: a drive to achieve individual goals e.g. increase physical activity levels
* Past experience: motivated by own experience and wanting to help others overcome barriers

Key takeaways:
* Few papers had a diverse peer-volunteer population
* Previous research suggests that people prefer to be paired with someone with a shared culture, ethnicity and language
* Recruitment from different ethnicities is crucial to reach more ethnic minority participants

Question 23

Give an example of how Qualitative Methods are used to investigate improving interventions for Ethnic Minorities (Stathi et al., 2023)

Answer 23

• Focus groups and interviews with the Bangladeshi and Chinese communities in Greater Manchester
• Explored how they helped others, why they helped others, barriers and facilitators to peer-volunteering, and thoughts on recruitment methods
• Analysed via thematic analysis (focus groups) and interpretative phenomenological analysis (interviews)

Question 24

What was found with Barriers: Health (Stathi et al., 2023)

Answer 24

‘And because I’ve got diabetes, I’ve just got to be mindful and it’s like you say, bringing biscuits and, I don’t normally eat biscuits. And so I don’t want to offend people who
might have sweets. And you know you go and have a cake and I probably will have the cake. But there will things like that that, in my own position and my own health, I understand my own health and so it’s just I don’t want to impede the person’s activities.’ (F65C)

‘Not me. I’m very ill, an old lady. She’s young and she could do it.’ (BFG1)

-Self-fulfilling prophecy where by not reaching out their health gets worse

Question 25

What was found with Facilitators: Mental
health benefits (Stathi et al., 2023)

Answer 25

‘I’m giving more and more time here now. Because it gets me out of the house, being here, talk to people, see people, people come to me for… I’m doing a lot of informal mentoring’ (BFG2)

‘Refreshing your mind and sharing thoughts, exchanging your thoughts it’s reduce your pain as well.’ (F61B)

Question 26

What was found regarding the thoughts on the Recruitment Methods? (Stathi et al., 2023)

Answer 26

‘For me it’s okay because I understand English but some participants, they may not understand English. If they don’t understand, they won’t be interested, it’s as simple as that.’ (M65C)

‘There should be a Chinese photo as more people. If not fully bilingual then at least some Chinese for the main ideas, you know what I mean? [The pictures] don’t look attractive because there’s no Chinese photo’
(M65C).

Question 27

Why does this study matter? (Stathi et al., 2023)

Answer 27

• Important to understand the needs of different communities to be able to tailor recruitment strategies.
• Need to be aware of possible barriers to aid with volunteer retention (e.g., funding, transportation, number of activities to get involved in etc.,).
• We need to think of the entire population and everyone within the population

Question 28

What are the Gender Differences in Physical Fitness?

Answer 28

Clear gender differences in participation
in physical exercise
◦ Profile of active individual - male,
younger, affluent, educated (King et
al., 1992)

◦ Women less likely to participate in
exercise programmes and sport

-Women particularly do not exercise
enough (Vertinsky, 1997)

-Older women do less outdoor activity
than men (Bennett, 1998) (doesn’t mean they are not being physically active however, as they can do physical activity through caregiving or cleaning, or doing it indoors as it is too dark and unsafe for them to go outdoors - therefore it’s just not in the traditional way perhaps)

Question 29

Why Do Fewer Women Than Men Exercise? (Choi, 2000)

Answer 29

◦Interest is in recreational exercise

◦Argues women exercise not for health but for appearance

◦Exercise contributes to reductions in colon cancer, diabetes and promotes reproductive health

◦Figures not hearts

◦Consider ‘bums and tums’ classes - beauty not health

Lancet (2019) suggests it is because of barriers which with time we have become more acceptable of things such as girls football clubs

Question 30

What is the Prevalence of Women’s Health?

Answer 30

-Heart disease is the number one cause of death in women (more than men and twice the number of deaths compared to breast cancer)

-Breast cancer is the 2nd leading cause of death

-Alzheimers is the 5th cause of death with 5% of women above 71 having it compared to men

-34 million people experience osteoarthritis and osteopenia

-18% aged 65+ experience depression

-75% of the 50 million experiencing autoimmune diseases are women

-55% of women aged 65+ are affected by arthritis

Question 31

What is the Transitions of Mental Health and Healthy Ageing? (Marmot & World Health Organisation, 2014)

Answer 31

-Childhood sets up a foundation for the rest of one’s life

-One needs to ensure health is maintained and ensured as childhood is only protective for so long and can be overtaken by other factors such as stress, financial issues etc.,

-Working out and eating healthy can help mitigate this (essentially healthy habits help)

-We must look at wider society to help this such as accessibility e.g., green spaces to exercise

-We must look at the macro-level context i.e., is the government putting enough support in place?

-We must look at the systems too, i.e., how can we preserve equity (equity makes it fair, equality makes it the same)? are we maintaining universal access to healthcare?

Question 32

What is the impact of Exercise on Mental Health?

Answer 32

-Older adults with mental health conditions can benefit from taking part in regular exercise. This helps increase their fitness & confidence, reduces their fall risk, encourages social inclusion & maintains
independence.

-Systematic review found that aerobic exercise performed 30-40 mins x3 p/w improved MH outcomes in people with Schizophrenia & Schizoaffective disorder. (Stanton & Happell, 2014).

-Exercise found to be effective in reducing the risk of developing a mood or anxiety disorder over the following three years (Have et al., 2011).

-Similar findings reflected in populations of older adults, particularly during the COVID-19 pandemic (Callow et al., 2020; Carmona-Torres et al., 2021).

-Also, of course, alongside other interventions such as CBT, medication, peer support, arts, nutrition, exercise, mindfulness are beneficial

Question 33

What is TREAD (TREAtment of Depression
with physical activity) study (Chalder et al., 2012)?

Answer 33

-Looked at individuals who were diagnosed and currently treated for depression

-Found that adding a physical activity intervention didn’t benefit these individuals much

Question 34

What are Critiques of the TREAD Trial?

Answer 34

So the most obvious conclusion is “PA has no effect on depression in clinical populations?”

Not necessarily: TREAD usual care could have included antidepressants, counselling, referral to exercise on prescription schemes…Pts already received high-quality care….57% on AD at recruitment.

1. It may have been difficult to make any positive difference to this ‘usual care’.
2. 25% of Pts were already meeting UK Gov Guidelines on PA at baseline (the target level for the intervention) & could have feasibly been already gaining the results of PA
3. everyone should be encouraged to exercise. There are other benefits