Healthy Ageing in a disadvantaged neighborhood

Annemiek Bielderman

Research and Innovation Group in Health Care and Nursing

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Contents

• Ageing and Healthy Ageing

• Healthy Ageing and Lifestyle

• Ageing in disadvantaged neighborhoods

• Delfgoud project

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Ageing of the population

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Percentage younger (0-14 years) and older people (65+ years) in various European countries, 1850-2050.

(Netherlands Interdisciplinary Demographic

Institute)

Ontwikkeling

grijze druk

2010-2025

The ageing in the

Netherlands

2010-2025

The number of

adults (>65)

related to adults

(20-64)

Healthy Ageing

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Stephen Hawking

69 years old

Healthy ageing

Development and maintenance of optimalphysical, mental and social well-being and

function in older adults. (West Virginia Rural Healthy Ageing Network; Hansen-Kyle et al., 2005)

Multi-dimensional

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A healthy lifestyle is a prerequisitefor healthy ageing

Loss in yearsLoss in healthy

years (HALE)

Smoking

Obesitas

Physical inactivity

Overweight

Excessive alcohol use

Health Adjusted Life Expectancy (HALE) The number of years that a person can expect to live in good health

Health gap indicator = Disability-Adjusted Life-Years (DALY)

Number of years spent in ill health and the number of years lost due to premature mortality.

A = time lived in good healthC = time lost due to premature mortalityLife expectancy = A + BHealth expectancy indicators (e.g. healthy life expectancy and HALE) = A + f(B)Health gaps indicators (e.g. DALYs) = C + g(B)

Health Adjusted Life Years

Effect healthy lifestyle on

HALE

Health promotion and disease prevention does work for older adults

• Longer life

• Reduced disability– Later onset

– Fewer years of disability prior to death

– Fewer falls

• Improved mental health– Positive effect on depressive symptoms,

social connectedness

– Delays in loss of cognitive function

• Lower health care costs

Salutogenesis as a model of health promotion

Salutogenesis focusing on: - relationships between

health and well-being.- Coping recourses that

are crucial for health in difficult situations.

Aaron Antonovsky (1923 – 1994)

Studies suggest elderly who have positive perceptions of ageing slow down frailty in late life

Disadvantaged neighborhoods

• Socio economic status (SES):

– Based on income, education, and occupation (Winkleby et al., 1992)

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Disadvantaged neighborhoods

• SES is a strong predictor of physical and mental health status

Socioeconomic health differences

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Disadvantaged neighborhoods

• Socioeconomic health differences

= systematic differences in health and mortalitybetween people with a high and a low socioeconomic status (Verweij, 2010)

1. Life expectancy

2. Health-Adjusted Life Expectancy (HALE)

3. Risk factors for diseaseLife style factors

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Socioeconomic health differences

1. Life expectancy is lower in low SES persons:

– 7.3 years in men

– 6.4 years in women

• Stays present at older age (>65 years)

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(Verweij & van der Lucht, 2010; van der Lucht et al., 2010; Pappas et al., 1993; Winkleby et al., 1992)

men women

Life expectancy (years)

Socioeconomic health differences

1. Life expectancy lower in low SES persons:

2. Health Adjusted Life Expectancy (HALE):

Less years in good perceived health( 19.2 years; 20.6 years)

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(Verweij & van der Lucht, 2010; Bruggink et al., 2010)

Socioeconomic health differences

1. Life expectancy lower in low SES persons

2. Health Adjusted Life Expectancy (HALE)

3. More risk factors for disease in low SES:

– Unhealthy life style: Smoking, overweight, lessphysical exercise, alcohol use

– More chronic diseases

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(Bruggink et al., 2010; Verweij & van der Lucht, 2010; Pappas et al., 1993)

Ageing and low SES

• Elderly people with lower SES:

– Higher mortality (Huisman et al., 2004)

– More functional limitations (Knesebeck et al., 2003)

– Poor self-rated health (Knesebeck et al., 2003)

– Lower health-related quality of life (Robert et al., 2009)

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Ageing and low SES

• Diminish the health differences between low and high SES elderly people

Improve the health of elderly people

with a low SES

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Delfzijl

Utrecht

Amsterdam

Groningen

Assen

23Geografische verschillen in gezondheid. VTV-2006, Bilthoven: RIVM.www.rivm.nl

Regional differences in Social Economic Status in the Netherlands

Elderly people in Delfzijl North

• Very low SES area in the Netherlands

• Multi-dimensional health problems:

– Anxiety and/or depressive symptoms (45%)

– Low social competence (43%)

• Social and/or emotional loneliness

– Problems with self-reliance (18%)

– Unhealthy lifestyle:

• obesity, smoking, physical inactivity

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Improve the health of elderly with a low SES

How can we improve the health of these elders?

• Multi-factorial intervention:

– Directed at more dimensions:

• Physical function, psychological function, lifestyle factors

• Setting directed method:

– Adjusted to the wishes and needs of the target group

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DELFGOUD project

• Aim of the study:• To improve the quality of life in older adults with

a low socioeconomic status.

– To promote a healthy life style– Stimulating physical activity and improving eating

pattern

– To improve social skills

– Learn to get on with anxiety and depressivesymptoms.

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Research question

• Main question:

– What is the effect of the DELFGOUD program on health related quality of life in older adults (> 65 year) with a low socioeconomic status?

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Theoretical principles of the DELFGOUD project

Resilience theory

Salutogenesis paradigm

Reserve Capacity Model

Healthy lifestyleinterventions

Enhancement of healthy ageing

Decrease in disabilityand increase in quality of life

Coping with age related stress due to chronic diseases, anxiety,

depression and loneliness

Resilience is a factor in coping with (pre) frailty

Enhancement of sense of coherence is a prerequisite for

healthy ageing

Multi-factorial interventions are effective

Enhancement of healthy lifestyle in deprived older adults

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DELFGOUD project

• DELFGOUD: multi-factorial intervention program

• The interventions:

– Physical activity

– Social skills training

– Depression intervention

– Healthy eating intervention program

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Interventions of DELFGOUD project

• Physical exercise:– Exercise program

– Promoting physical activity

• Social skills:– Influencing loneliness and social anxiety

• Depression:

– Learn to get on with depressive symptoms in daily life

• Healthy nutrition:

– Promoting healthy nutrition and a balanced eating pattern

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• How does the program look like?

(1) Depression/ Nutrition

(2) Nutrition / Social skills

(3) Social skills / Depression

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Physical activity

DELFGOUD project planning

6 months0 months 12 months 18 months

Study design and sample

• Sample of older adults (> 65 year) in Delfzijl North : n=240

• Randomized Controlled Trial (RCT) design: – Randomization into the experimental group (n=180) and control group

(n=60)

• Three experimental conditions:a) Depression + Nutritionb) Nutrition + Social skillsc) Social skills + Depression

• Inclusion criteria: – Low SES, sedentary, depressive symptoms, loneliness

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Measurements

• Outcome measures:

– Quality of life

– Physical fitness

– Loneliness

– Social contacts

– Depression and anxiety

– Eating pattern

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Key points DELFGOUD project

• To improve the quality of life in low SES elderly people with a multi-factorial intervention program

• Support a healthy lifestyle:

– More physical activity in daily life

– Healthy diet

– Learn to handle anxiety, depression and loneliness

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Take home message Life expectancy is still rising in oursociety.

A healthy lifestyle is a prerequisitefor healthy ageing.

The salutogenesis theory is a theoretical framework for healthy ageing interventions

A multi-factorial lifestyle interventionis an effective way to enhance a healthy lifestyle in deprived olderadults.

Annemiek Bieldermanj.h.bielderman@pl.hanze.nl

Netwerk Ouderenzorg Regio Noord

Partners

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