Growing older without feeling old


 

Dr Rudi GJ Westendorp, Professor of Medicine at Old Age, University of Copenhagen, Denmark, leaves nothing out in his book, “Growing Older Without Feeling Old: On Vitality and Ageing”(left). He debunks many fad diets and “solutions” to ageing, and examines the attitudes of old people themselves.

Ageless Voice chats with the expert on ageing and the well-being of older people about his book and his perspectives on ageing:

With more people growing old and more are growing older, what does this mean to society and individuals?

Within a period of a hundred years, average life expectancy has doubled from 40 to 80 years. And it keeps going up. There has never been a time that one could foresee such a long and healthy life. The concentration of deaths moved from the youngest to the oldest ages and is accompanied by an unprecedented decrease in fertility rates. It has changed the demographic pyramid of our population drastically. With large increases in survival rates in the last half-century, current cohorts will move up through the population distribution. In 2050, the original pyramid will reach an almost rectangular shape and a skyscraper has erected.

These ‘demographic’ changes are at the heart of political, economic and public debate as the relative number of older adults increases. Governments have responded with measures in family planning, labour, social support and healthcare. I argue that the principle vision behind many of these measures is misguided, and ineffective as a result, as it is based on an (implicit) idealisation of the population pyramid with plenty youngsters to take care of the older population. Instead I suggest an age-independent approach that does not take chronological age – as a criterion for social contribution and (healthcare) consumption – as its basis.

Are governments and society doing enough or not really and what should they be doing?

Let me illustrate this with older people’s views on abuse. At Leyden Academy on Vitality and Ageing we have drawn on our qualitative studies on perspectives on elder abuse involving extensive interviews of more than 100 people in the Netherlands – comprising experts, professionals, and, in particular, people above age 65 years.

When we asked older people, “What do you think of when you hear the word abuse?”, one of the issues recurrently highlighted was inadequate and insufficient care in institutions. One 69-year-old woman who had received hospital treatment told us, “There is no respect for older persons in all these institutions [nursing homes, home care organisations and hospitals]. Older persons are abused in these institutions, abused by the healthcare system. That is what we feel.”

Rather than to blame and shame individuals, older people identified institutional structures as responsible for their experience of abuse and neglect. Research in other countries, particularly in the UK and US, and recurring scandals in care of older people confirm these findings and have led to proposals to reorient institutional abuse to pertain to structural arrangements instead of to individual behaviour or excesses. One way to do this is to introduce the concept of “system abuse” next to the other types of abuse. By system abuse, we mean the organisation and resulting practices in our institutions that are (implicitly) abusive and cause harm or distress to an older person.

System abuse further extends the definition ageism, i.e. the process of systematic stereotyping of and discrimination against people because they are old. By introducing system abuse we can increase awareness of the, at times, implicit disadvantaged position, embedded hostility, and lack of respect older people experience as a result of structuring and financing. This means that accountability is extended from the individual to singular institutions, to overarching sectors, and to local and national governments.

Some countries lament that ageing is a growing problem. What are some assumptions of old age that we should debunk?

First, almost everybody, banks and insurers included, have routinely underestimated the increase in life expectancy because they wrongly believed that there had to be a biologically determined maximum possible age for humans. The current age records are 122 for women and 116 for men. It is only a matter of time before these records are broken too. It is beyond doubt that the first person to live up to 135 is now among us. With technology advancing so quickly, some argue that it could even be the case that the first person to live to 1,000 has already been born.

Second, the ageing process doubles the risk of disease every eight years as we grow older, but due to developments in medical technologies it is getting better every year. Most developed countries have seen the chance of dying from a heart attack fall by 80 percent to 90 percent. UK data show the risk of people developing dementia in old age has dropped 30 percent since 2000. Good education and a high IQ can help to protect you against dementia because you have more ‘reserve capacity’, protecting you against cognitive decline. At age 75, residual life expectancy without impairments in daily life has risen from four to six years in just one generation.

Third, when applying the definition of successful ageing defined by the World Health Organization (WHO) as an optimum state of physical, mental and social functioning, only a sobering 10 percent of the over-85s would qualify. Yet the overwhelming majority of older people feel successful and rate their quality of life with an average seven to eight points out of 10. A large study conducted with over-85 year-olds at Leiden University Medical Centre between 1997 and 2013 found that many participants saw optimum physical functionality as nothing more than a hypothetical idea and the acceptance of functional impairment was an effective way to stay feeling positive.

You talk about healthy ageing in your book called “Growing Older Without Feeling Old”, what does that mean? Can one have healthy ageing even with ailments or even dementia?

There is a great danger in over-diagnosing and over-treating older people; it introduces side effects and also puts too much emphasis on physical health. Under this approach, the elderly are often labeled as sick even if they do not themselves feel impaired.

When older people are unnecessarily told to suffer a suite of medical problems they can withdraw into the role of a sick person and scale back their day-to-day lives, becoming less active, even when activity would have a positive impact on them. Well-meaning family and friends can also begin to treat the person as sick, making the problem worse.

Unlike the approach taken by many doctors, older people do not see the symptoms of age as something to be defeated. The acceptance of functional impairment is a necessary but effective way to stay feeling positive. Many of the oldest old – the over 85-year-olds – actually report an increase in the feeling of well-being, which lasts right up to the year before death. For most older people, successful ageing is about being able to live a socially rewarding live, and to have a say in which medical treatments they decide to undertake.

Several big pharma companies are on a quest to prolong ageing. Can you comment?

I do not have a simple prescription that would prevent, solve, or alleviate the impairments associated with old age. There is no miracle cure, and it is not likely that there ever will be. The causes of the damage that arises due to the ageing process are simply too complex and multifaceted. How different that is from the message we get from the anti-ageing industry. It makes convenient use of what we all want to hear – that the ageing process can be prevented, or at least slowed, by using the product being touted. And to make it very specific – there is no hard proof that ageing is caused by a lack of antioxidants in our food and taking vitamin supplements doesn’t have any advantageous effect.

Should we then just sit around idly, waiting until it is time for our final curtain call? Of course not. We can change our lifestyle at any time if it is negatively affecting our health. It is never too early and never too late to start. It can serve you up to two extra decades of health and an extra decade of life. So why does it go wrong so often? Why are we too fat, why do we drink too much, cycle too little, and stubbornly refuse to give up smoking? Presumably, people underestimate the extent to which the environment has an impact on us.

Interestingly enough, you are part of the European EIT Health consortium (with Danish enterprises) to develop innovative solutions to promote healthy living and active ageing. What are some ideas that have come up? Are there best practices that you have seen in the world?

The mission of EIT Health, as part of the EU Horizon 2020 instrument, is to convey the needs and potential of citizens to entrepreneurial talents creating a world-class innovation ecosystem to address demographic change. It focuses on delivering innovative products, training and services to the market, to overcome society’s main challenges in the fields of healthy living and active ageing, and to keep our healthcare systems sustainable.

EIT Health specifically addresses three cross challenges, i.e. innovation barriers, education and talents, and enabling technologies and data. To tackle these challenges, EIT Health has implemented three instruments that function as a catalyst for innovation – specific health innovations, a business accelerator and an educational campus. These tools utilise research, education and innovation, to turn inventions into products, scholars into entrepreneurs and business ideas into market opportunities.

A prime example of the necessary disruptive innovations is Buurtzorg, a nurse-led, nurse-run organisation of self-managed teams that provide homecare to patients in their neighbourhoods. Championing humanity over bureaucracy, autonomous teams work with primary care providers, community supports, and family resources to bring patients to optimal functioning as quickly as possible.

Buurtzorg was founded in 2006 as an alternative to the bureaucratic way of delivering home care in the Netherlands. Because of the way big homecare organisations are structured and managed, community care has become very fragmented, ineffective and performed by low-educated nurse assistants. Jos de Blok, a former community nurse, thought that it could be possible to use old community care principles again, supporting them with new ideas about how to manage an organisation, and use information technology as a strategic, tactical and practical instrument.

Where do you see us heading in five to 10 years?

Dr Rudi Westendorp, like all, agrees that a sedentary life should be avoided and we should empower seniors to take care of their own health.

Several studies have shown that when the older generation takes responsibility for their own health, it results in better outcomes. Earlier in the Netherlands, we have performed a survey, which shows that 97 percent of people consider it important to be responsible for their own health (www.leydenacademy.nl/Reports/Shades_of_grey_ambitions_of_55). In this group of people aged 55 years and above, older people welcome future availability of innovative options and solutions to improve the control of their own health. The view that people are entitled to a high level of care is held particularly strongly in the older group.

In a similar vein, others have analysed how older people cope with multi-morbidity and revealed that the generally presumed apathy of older individuals is far from evident. Instead, older people aim to preserve their autonomy by opting for pro-active cooperation with medical professionals. These data clearly underline what becomes immediately evident when talking to older people is that they want to be in control of their own health and well-being as long as possible.

We should empower older people and put them in control of their own life by allowing them to self-manage their own health trajectory, rather than only passively accepting care from health professionals.

If you can share one perspective about ageing from your book, what would it be?

If there is one thing that researchers agree on, it is that a sedentary, inactive life should be avoided. Rest rusts. Maintain a mentally and physically active lifestyle at all costs! Therefore, the most important task for the future is to support older people to make their own plans and realise them. It is a moral duty to guarantee frail and dependent old people the right to a proper place in society, just as we have done for young adults and people with disabilities.

 


 

 

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