By: Tara Keck
The world population is ageing. Between 2015 and 2050, the number of people over the age of 65 is projected to increase from 12% to 24% of the total population, due to a combination of decreasing birth rates and increased lifespan (WHO Ageing Factsheet, 2018). In Bosnia and Herzegovina (BiH), this shift towards an aging population has already started. In 2019, 17% of people in BiH were over the age of 65 (https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS?locations=BA), with projections for this percentage to dramatically increase by 2050 (European Health for All Database).
An ageing population comes with a number of medical and social care needs. The risk for a number of diseases and health concerns, such as Alzheimer’s disease, stroke, cancer, hearing loss and vision loss, significantly increase with age. Health and social systems must adapt to support this increasing number of older people. Currently, most research and medical funding are targeted to treating diseases and medical conditions associated with ageing. Preventative approaches for healthy ageing and the social support necessary to help people with age-related heath conditions receive less emphasis, but promoting healthy ageing could potentially reduce the risk for many diseases at once, or at least delay the age of onset. Given the high costs of treating diseases, interventions for healthy ageing could provide a cost-effective way to reduce medical and societal costs and provide an increased quality of life and well-being for older people.
In line with the idea of preventative healthy ageing, the NGO Partnership for Public Health has developed a series of Healthy Ageing Centres (HAC) throughout BiH over the past decade. These HACs are day centres that provide a place for older people to gather, socialize, and partake in organized courses and activities such as exercise, painting, traditional crafts, computer skills, language skills, sports, singing and cooking. There are currently 17 centres in nine municipalities in BiH, with plans to open another centre by the end of 2020. The United Nations Population Fund (UNFPA) has supported these HACs and in recent years has promoted the development of a network of HACs throughout Eastern Europe and Central Asia.
In 2019, a collaboration was formed between the NGO Partnership for Public Health, the UNFPA in BiH and research scientists from University College London (UCL) to determine how often HAC members engaged in different activities that critically affect healthy ageing, including exercise, diet, smoking, alcohol consumption, hearing loss and social engagement and support. The results from HAC members were compared to responses from older people in BiH who do not attend HACs (non-members) but would like to do so, as well as a similar group in the UK(UK BioBank; https://www.ukbiobank.ac.uk/) The data were then used to predict the expected average health outcomes and potential benefits for HAC members.
Three major areas were identified where HAC members had improvements – exercise, eating habits and satisfaction with friendships and familial relationships. There were no areas where HAC members had behaviours that led to a higher risk of poor health outcomes.
First, physical exercise and a healthy diet are known to be preventative against medical problems associated with ageing (Nyberg et al., Lancet Public Health, 2018). Older people who do not exercise are at an increased risk for a number of diseases (Nyberg et al., Lancet Public Health, 2018). Several studies have shown that moderate levels of physical activity have protective effects against cognitive decline associated with ageing (Hamer and Chida, Psychol Med, 2009; Sofi et al., J Intern Med, 2011). For people who already have mild cognitive decline, exercise can improve cognitive outcomes up to 6 to 18 months later (Fiatarone Singh et al., J Am Med Dir Assoc, 2014). In addition to exercise, the consumption of fruits and vegetables is associated with a reduction in the risk of a number of diseases in old age (Nyberg et al., Lancet Public Health, 2018). HAC members had a significant increase in their levels of moderate exercise and healthy diet:
- HAC members were more likely than non-members to undertake any moderate exercise (85% vs 75%),
- HAC members had a 1.4 fold increase in total exercise time per week,
- HAC members consumed a 1.3 fold increase in fruits and vegetables,
- 10% more HAC members consumed the daily recommended fruits and vegetables.
A reduced social network also increases the risk of death in older people, similar to the risk levels from smoking or obesity, and is even more strongly correlated with a decrease in life span than physical inactivity (Holt-Lundstad et al., PLoS Medicine, 2010). Reduced social relationships are also linked to increases in cardiovascular disease (Knox and Uvnas-Modberg, Psychol Bull, 1998; Yang et al., Proc Natl Acad Sci, 2016) and depression (Santini et al., J Affect Disord, 2015), and are a risk factor for dementia (Livingston et al., The Lancet, 2017). In this important risk area, HAC members reported high levels of satisfaction with their personal relationships, which is an indicator of strong social networks:
- HAC members were more likely than non-members to be happy with their friendships (59% vs 44%),
- HAC members were more likely than non-members to be happy with their family relationships (58% vs 30%),
- HAC members were less likely than non-members to report that they often feel lonely (75% vs 88%).
Given the measured differences in health-related activities for HAC members, projections suggest HAC members will have an increased number of healthy or disease-free years in their older age: men will have 1.9 additional disease-free years and women will have 0.8 additional disease-free years after the age of 60. In addition to a reduction in disease risk, HAC members’ lifestyles are associated with a 35-45% increase in survival over the next seven years. Thus, there is a projected benefit in life-span and disease-free years for HAC members, which is largely due to their increase in weekly moderate exercise and stronger social network support.
Overall, HACs are a cost-effective way to provide activities and support that increase the health and well-being of older people, and therefore to extend their healthy life years. In view of this point, together with the demographic trends of increasing numbers of older people in BiH and in the region, governments at all administrative levels throughout the region should:
- Work proactively to expand the number of HACs to serve additional communities and provide the infrastructure necessary to encourage healthy ageing and support the growing older population.
- Administer surveys across the population to determine the current lifestyles of citizens to optimize resources to improve healthy ageing in the population.
- Develop new ways of promoting healthy ageing among citizens that have limited access to healthy ageing services. For example, initiatives related to exercise or other healthy lifestyle activities could be broadcast on national TV and radio programmes. This approach is especially important to reach underserved older populations, including those in rural areas, the vulnerable and those with mobility and access issues who are not able to attend existing HACs in person.
- Fund calls for proposals and develop programmes that promote collaboration between older and younger generations. This will provide social network support for both older and younger people, ensure the exchange of knowledge and experiences, and allow for learning about the importance of healthy ageing at early age.
About the author: Tara Keck is a Professor of Neuroscience and Wellcome Trust Senior Research Fellow in the Department of Neuroscience, Physiology and Pharmacology at University College London. She leads a research team that investigates neuroplasticity – the brain’s ability to adapt, change and learn in response to the changing environment. Her research focuses on understanding the mechanisms underlying neuroplasticity during adulthood and ageing, and how these mechanisms are perturbed in ageing-related diseases.
