Successful ageing, what is it?

 Welcome to the Successful Ageing blog

Örebro University’s strategic initiative on Successful Ageing currently consists of two graduate research schools focusing on interdisciplinary research. The PhD students spend four years on their own research while being part of the strategic initiative.

At the research school on Successful Ageing, research is being carried out on ageing and the opportunities offered by successful ageing. We are developing theories on successful ageing and relating them to a contemporary Nordic perspective. The graduate school is international with 18 doctoral students from several different countries.

The Newbreed PhD programme is partly financed by the EU Horizon 2020 programme, Marie Skłodowska-Curie Actions, Co-funding of Regional, National and International Programmes (MSCA COFUND). During 2018, 16 international doctoral students were recruited from 14 different countries, each working on a project of their own choice within four thematic areas.

Living Longer, Living Harder: Ageing in Extreme Poverty in Bangladesh

by Owasim Akram

Demographic projections suggest that global ageing is gradually shifting to the South. Although older persons are rapidly becoming the majority among the extreme poor populations in developing countries, little is known about their life context.

In Bangladesh, around 14 million people are over the age of 60. Despite the demographic projections, the country is not yet prepared for an ageing society. Both the intensity and the persistence of poverty being experienced at old age have been thoroughly underestimated in research. On the other hand, conventional discussions on ageing and poverty have mostly stressed on economic and resource deprivation. This approach grossly ignores the fact that living with dignity, care and attention matter a lot to the older persons than anything else. This hardly receives any attention in the academic domain specially in poverty and ageing research. Furthermore, extreme poor older persons are not only asset poor but also significantly relations and dignity poor, which further deepen their vulnerability and marginality. At the same time, there is no clear agreement on what constitutes extreme poverty. All these suggest that it is crucial to consider the temporal as well as intergenerational aspects to understand better the relations between ageing and extreme poverty. The process can be further explained using the Capability Approach through a lifecycle-based interdisciplinary framework.

With this brief background in mind, the PhD research seeks to answer the following questions:

  1. How is ageing experienced in a shrinking social space with extreme poverty conditions?
  2. What are the patterns of relations, bargains/trade-offs, household and societal dynamics, costs and opportunities associated with the older extreme poor?
  3. What are the (social & public) policy directions the findings referring to?

The research relies on different qualitative tools to generate a detailed understanding of the lived context of ageing. First, primary data has been collected from 37 older persons through life history interviews. Respondents are persons aged from 60 and upwards from a mixed background of single, married, male, female, living alone, living with children, living without children, widowed, living in old age homes etc. The participants are selected from different extreme poverty pockets of Bangladesh. Second, the research is relying on a secondary qualitative panel dataset conducted as part of a larger extreme poverty graduate programme in Bangladesh to generate further nuanced understanding. This dataset consists of 72 households, which have been followed over five years. To understand the policy process and to arrive at a critical policy narrative, the research aims to carry out a number of elite interviews with selected high-level public officials, elected representatives, law makers and practitioners.

Muscle-strengthening activities and physical activity in the elderly

by Jort Veen

The global population aged over 60 years has increased from 382 million in 1980 to 962 million in 2017, and is expected to increase to nearly 2.1 billion in 2050. By 2030, older adults will outnumber children under the age of 10. This population ageing is not without challenges. As the average population age rises, governments and major health organisations need to address the interests of older adults.

One of those interests is independency and quality of life. In order to carry out daily life tasks, a healthy muscle strength and muscle mass are needed. Older adults invariably experience a progressive decline in muscle strength, skeletal muscle mass and physical performance. The official term for this condition is sarcopenia, which is now classified as a muscle disease that can eventually lead to frailty. The current prevalence of sarcopenia in people over 60 years old is about 10%; it is estimated that in 2050 approximately 500 million older adults will be diagnosed with sarcopenia.

To prevent the social and economic impact of health conditions like sarcopenia, major public health organisations have issued physical activity (PA) guidelines. The current PA guidelines recommend that older adults accumulate a minimum of 150 minutes of moderate to vigorous physical activity (MVPA) per week and also engage in muscle-strengthening activities (MSA) at least twice a week or more. However, little is known about how MSA and adherence to 150 minutes of MVPA affect the risk of developing sarcopenia. In a cross-sectional study, we aimed to determine whether engagement in MSA is linked to sarcopenia risk in older adults who already meet the PA guidelines of 150 min of MVPA per week.

We recruited 193 community-dwelling men and women (65–70 years) in Örebro county (Sweden). They were assessed for handgrip strength (HG), how fast they could rise and sit five times from a chair (5STS) and for muscle mass. Based on these measurements, a sarcopenia risk score (SRS) was developed. Adherence to PA was assessed using an accelerometer; engagement in MSA was assessed by using a validated questionnaire.

We found that adherence to the MSA recommendations twice a week or more as well as fulfilling the 150 minutes of MVPA was related to a significantly (p < 0.05) lower SRS compared to older adults who did not meet the MSA recommendations. This finding was still significant (p < 0.05) after adjusting for protein intake, abdominal obesity, medication and tobacco use. Similar significant results (p < 0.05) were observed for the individual variables muscle mass and 5STS but not for HG.

It would seem that, in our studied population, adherence to the MSA guideline is related to a lower risk of sarcopenia in older adults who already meet the 150 weekly minutes of MVPA. Our results reinforce the promotion of the full PA guidelines to decrease sarcopenia progression in older populations.

 

Reference

Veen J, Montiel-Rojas D, Nilsson A, Kadi F. Engagement in Muscle-Strengthening Activities Lowers Sarcopenia Risk in Older Adults Already Adhering to the Aerobic Physical Activity Guidelines. International Journal of Environmental Research and Public Health. 2021; 18(3):989. https://doi.org/10.3390/ijerph18030989

 

Is orienteering the key to healthy ageing?

by Frida Fart, PhD student

Orienteering is an endurance-running sport involving navigation in diverse terrain with the help of a map and a magnetic compass, demanding considerable cognitive skills and physical endurance of its practitioners. From a healthy-ageing perspective the sport is interesting as several seniors practising the sport have reached a high age. The oldest individual we interviewed was 94 years old and was still competing. Moreover, the sport involves physical activity, a cognitive challenge and a social network – three components that have been found to be particularly important for healthy-ageing. Indeed, in an earlier paper it was shown that senior orienteering athletes do rate their health and well-being higher compared to the general older population. They were also found to suffer from less gut problems and less signs of anxiety and depression. We therefore decided to follow up these results and in the study that was published earlier this fall we investigated the gut flora in relation to several health parameters and diet.

In the study we found that senior orienteering athletes had a higher level of a bacteria called Faecalibacterium prausnitzii in their gut flora. This bacterium has in experimental studies been proposed to be important for intestinal barrier function, the ability of the intestine to act as a barrier towards foreign substances that we are exposed to through the food. This particular bacterium is important for the production of butyrate, one of the major sources of nutrients for the colonic cells in the intestine. The increased level of this particular bacteria might potentially correspond to a higher level of butyrate. However, this cannot be concluded in this study as butyrate is almost impossible to measure. We did also observe that older individuals that practise orienteering had lower levels of two strains that has been associated with poor gut health. In addition, our observations seemed to be independent of diet and more dependent on lifestyle, such as physical activity. Hence, our data support previous findings proposing that physical activity on its own can affect the composition of the gut flora. Even though this is an exciting finding it is important to note that this is an observational study and we only investigate one time point in the long life of the senior orienteers. To be able to draw the conclusion that our findings are independent of diet we need to repeat these findings in a larger cohort and follow these individuals over time. It is also important to remember that a large part of the composition of the gut flora is still unknown and the characteristics of what constitutes a healthy gut microbiome needs to be defined. Thus, it is impossible to clarify what our findings mean for the ageing process, but it is evident that senior orienteers are an exciting model to further study healthy-ageing.

 

Towards development of Internet of things based solutions to fulfil older adult’s needs

by Gomathi Thangavel 

According to a Swedish study [1], older people prefer to stay at their own home because they feel

  • Home means safety and security – familiar neighbourhood, planned building according to one´s own need, having
  • Home means freedom – Independence, Governing daily

Internet of Things (IoT) connects machines, devices, sensors and people. Our everyday appliances are getting “smart”, sensors are getting cheaper, and IoT solutions which links them are being developing at a rapid phase. These devices will be part of a future homes. So it is intuitive to study how IoT solutions can be used to improve older adults quality of life and help them age. Previous study which reviewed IoT in the context of ageing mostly revolves around two main perspectives; technical perspective and human perspective. Technical mainly focus on physiological needs (i.e., Health) like assisted living, medicine, safety and monitoring. Whereas human perspective focus on user social needs. Also the review suggested to have a focus on areas where the two themes converge and empower users to be independent, socially active and have more control over their lives [2]. So the main aim of this study is to develop an IoT solution for older adult’s everyday needs including physiological and social.

Study will be carried out in 3 phases. Initially, a pilot study will be carried out through focus group interview with 5 older adults above 65+ (both healthy and specific chronically ill users) to first understand their views and needs, and then design scenarios accordingly. Secondly, specific case studies will be conducted with a large group of older adults above 65+ based on the identified scenarios to finalise the requirements. Finally, based on the requirements, a prototype IoT solution will be designed and evaluated.

Acknowledgement

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska -Curie grant agreement No 754285

References:

  1. Haak, M., Fänge, A., Iwarsson, S., & Dahlin Ivanoff, S. (2007). Home as a signification of independence and autonomy: experiences among very old Swedish people. Scandinavian Journal of Occupational Therapy, 14(1), 16-24.
  2. Soro, A., Ambe, A. H., & Brereton, M. (2017). Minding the Gap: Reconciling Human and Technical Perspectives on the IoT for Healthy Ageing. Wireless Communications and Mobile Computing,

Evidence-Based Design and Ageing

by Vasiliki Kondyli

 As the demographic landscape of our cities is changing fast, the cities are growing and the population is aging. How do designers and architects respond to this challenge? Which is the knowledge and the technical assets to tackle the new needs in design?

With ageing, the experience we have of the environment is reshaped by both physical, sensory, and cognitive changes. People move slower, lose their visual acuity,  have less confidence to cross the street, or to learn new shortcuts for the path to the market. The environment, in terms of architecture and the sensory or cognitive stimulation provided, can shape cognitive processes and be more or less supportive of independent living in older age.

To define the best design practices that can lead to a stimulating but also comfortable environment for older adults, we need to know which are the characteristics of the environment that influence the experience and how to manipulate them through everyday design practice. The answer is inspired by the tradition of healthcare design. Known as Evidence-Based Design, this design approach bases its design decisions on credible research and on existing projects’ evaluation. By collecting evidence through behavioral studies in the built environment as well as in research labs, the designer can enrich his knowledge and better anticipate how people will behave in a newly designed space. For instance, taking into consideration the age-related loss of visual quality; the use of patterns and textures in carpeting should be avoided as empirical studies show that they can greatly diminish depth perception at stairs and contribute to an increased rate of fall-related accidents.

Towards this direction, new developments in design-assistive tools aim at embedding this empirical knowledge to design systems in order to facilitate design decision-making by the architects. However, despite the fact that collecting evidence about people’s behavior in space and past design experience is useful for constructing new principles for the design practice, the role of the designer or the architect has always been and will be defined by a process of discovery, and creativity. Consequently, a question for the future will be: Upon what do designers base their critical view and their creativity? An Evidence-Based Design approach is not linear or static, nor does it provide a ready-made suite of answers, it simply means that the designer has the opportunity to look beyond the limitations of his own knowledge about human behavior especially for particular groups of users such as the older adults, and to apply his critical view upon a combination of creativity and reliable information in order to better shape the environment.

Secondment in Leuven: practicing the art of performing science

Returning to places where you lived before is a special and meaningful experience. This February I spent almost three weeks on my Newbreed secondment in Leuven, Belgium, at the university where I previously studied as a master’s student. Founded in 1425, KU Leuven is now among top 50 universities in the world, a university with a dynamic and inspiring research atmosphere. Holding a research master’s degree from KU Leuven (2018) and returning there now as a visiting researcher makes it twice special for me.

For my secondment, I joined the Meaning and Religion research lab. Being in the familiar research environment was an advantage for my experience, especially since well-being in advanced age is a common theme for my doctoral project and for the visited lab. My current study focusses on feelings of unsafety and well-being of older adults, and I presented research questions, hypotheses, and preliminary results in two lab brainstorm meetings. Thanks to these discussions, individual meetings with my secondment supervisor, Jessie Dezutter, and regular contact with my supervisors from Örebro University the study was significantly enriched, theoretically and methodologically. I am grateful to all the lab members for giving me this time and space for discussion, for their questions, remarks and overall interest in the 65+ and Safe Study we are currently working on in Örebro (supervisors Henrik Andershed, Karin Hellfeldt, and Katja Boersma). It was also very interesting to explore the existential foundations of feeling unsafe in discussions with a professor in clinical psychology, Siebrecht Vanhooren. In addition, attending weekly research meetings in the department contributed a lot to my further understanding of different research designs.

Apart from the main research activities, participating in a rich cultural life in Leuven was an experience by itself. During these weeks, Leuven hosted a festival “Alone together” that combined art and science events addressing the theme of loneliness and togetherness. For instance, an evening lecture on loneliness given by two university professors attracted a full 800-person auditorium of listeners. An exhibition “Alone together” with art works conveyed different shades of being with yourself and with others by immersion in visual, audial and even full body experience, (being able to understand Dutch allowed me to participate in these events). Feeling lonely, feeling unsafe… there was a lot to reflect on concerning possible parallels of these experiences. And, by the way, thanks to a welcoming group of other PhD students my feeling in Leuven was much more “together” than “alone”!

Secondment experience can also be a time to reflect on your professional identity. The question of how you define yourself will be answered slightly differently at different career stages (in my case, a researcher? a psychologist? an observing journalist? or all of that at the same time?). Nevertheless, there is also a common thread that connects various experiences throughout one’s life. I can confidently say that collaborating with colleagues from KU Leuven and being able to discuss aspects of the existential dimension, both in Leuven and in Örebro, gives me a good sense of continuity of my professional track.

Nadezhda Golovchanova
February 25, 2020

Who’s Afraid of the Big Bad Stereotypes? A Diversified Understanding of Successful Ageing

By Merve Tuncer, PhD Candidate, Sociology

One can argue that there is so much stigma around being an older adult in the 21st century, especially in a Western context. So many people imagine (and consider) older people as senile, rigid, old-fashioned, unhealthy, conservative or ignorant and simply see them as a burden. But where are these perceptions originating from? If we look closer, we can see that many of these negative old age stereotypes centralize around productivity. And unfortunately we live in a stratified capitalistic society where your status is interwoven to the fabric of your class position. What this means is that one’s perceived position in a given society is closely linked to one’s socio-economic conditions, and as we all know, older people usually do not engage in paid-labour in Western societies due to the established old age pension system.

What this welfare regime provides for older adults is a relatively secure and stabilized later life in terms of well-being. But this very system also cannot stop highlighting the economic ‘burden’ created by older adults. This understanding simply de-values everything that have no economic value. Therefore, it disregards everything that is produced and fostered outside the realm of economic productivity. For instance, it overlooks the unpaid and/or voluntary work performed by older adults, it devalues the accumulated knowledge of older adults, and it puts the heavy weight of structural problems on older adults themselves. If we look closer to the policies of most ageing models, we can see that their main concern is to keep older people in the work force as long as possible. In a similar vein, nowadays we can see the pension systems are shrinking or being replaced with different retirement schemas. The problem with these prescribed ageing models is two folded; a) they contribute to the construction of negative old age stereotypes and in return increase ageism, b) they often overlook the other experiences of ageing that can be considered productive, healthy or successful.

My PhD project focuses on the intersectional aspect of later life experiences. Because of this, I am trying to explore a more diversified understanding of old age and make the other polars of the ageing spectrum more visible. I particularly focus on migrant women who are now ageing in Sweden. I am researching both the structural and the agency-oriented aspect of this experience. I am trying to understand their relation to the apparatuses of the welfare regime (i.e. their relation to the health care system, social services, pension etc.) and their experiences with regard to gender roles, migrant status and later life. On the more agency-oriented level, I am looking into their relation to their family and acquaintances; how they mobilize their social capital, how they manage their daily tasks and so on. The way they organize their everyday lives, their resistance practices and the decision-making processes on allocation, adaptation, coping and rejecting are my prior interest with regards to their experiences. My intention in doing this is to explore the experiences that are excluded or disregarded by most of the mainstream ageing models and to broaden our perspective on what successful, productive or healthy can look like in different contexts. My project aims to make the resistance practices and coping mechanisms of older adults more visible and to contribute to the development of useful tools to overcome the ageist stereotypes.

 

Active and healthy ageing – how do we make it possible? — Aktivt och hälsosamt åldrande – hur blir det möjligt?

By Ida Schoultz, Associate Professor, School of Medical Sciences at Örebro University

On December 5th, the MultiHelix Think Tank (MTT) organised a seminar in Lund, Sweden, on the theme of healthy ageing. Short presentations by several experts in different fields were followed by extended discussions. I participated by presenting, among other things, the “Successful Ageing” strategic initiative and how the work within the two research schools (Successful Ageing and Newbreed) are structured.

MTT is a stand-alone think tank where representatives from academia, civil society, the private sector and other stakeholders meet to discuss and exchange ideas on how future challenges in the broad area of Life Science should be addressed.

The Think Think on healthy ageing offered a number of extremely interesting presentations and discussions. In his presentation, Greger Bengtsson from the Swedish Association of Local Authorities and Regions (skr.se) highlighted the needs and challenges of society as regards the ageing population. In order to promote active and healthy ageing, we must be better at preventative actions and coordinating care activities. We also listened to Alexander Dozet from Region Skåne who discussed the health-economic aspects of the ageing population.

In Hörby Municipality, free training activities for people over 75 years have been offered. Eva Klang Vänerklint presented the initiative, which produced very good results. A large number of residents in the municipality were interested in taking part in the initiative and a number of health benefits were also seen by those who participated. At Kristianstad University, a project is also on-going where a research group is evaluating preventative home visits to elderly persons at their homes. These visits have taken place in several different municipalities. By taking time to listen to such persons, one can gain an increased understanding of what efforts are needed. It also provides an opportunity to identify older people who are lonely or have a malnutrition problem.

Professor Susanne Iwarsson from Lund University presented a summary of the research that is ongoing within “CASE – Centre for Ageing and Supportive Environments”. Several exciting projects are underway within the research centre, focussing on supportive environments for an ageing population.

Örebro University’s Successful Ageing initiative stands out by taking a holistic perspective on ageing, something that several of the participants at the Think Tank recognised as very positive.


Den 5 december anordnandes en Think Tank av tankesmedjan Mulithelix i Lund med temat hälsosamt åldrande. Här kombinerades kortare presentationer med efterföljande diskussion. Till mötet hade flera experter bjudits in, jag deltog för att bland annat presentera den strategiska satsningen ”Successful Ageing” samt hur det övergripande arbetet inom forskarskolorna ”Succesful Ageing” och ”Newbreed” är strukturerat.

MultiHelix Think Tank är en fristående tankesmedja där parter från akademin, civilsamhället, den privata sektorn och andra aktörer möts för att utbyta idéer för att möjliggöra lösningar på framtidens utmaningar inom det breda området Life Science.

Think Tanken bjöd på flera oerhört intressanta presentationer och diskussioner. Greger Bengtsson, Sveriges kommuner och landsting, lyfte i sin presentation samhällets behov och utmaningar när det gäller den åldrande befolkningen. För att främja aktivt och hälsosamt åldrande måste vi bli bättre på förebyggande insatser, men också att koppla ihop vård och omsorg. Vi fick även höra Alexander Dozet från region Skåne diskutera de hälsoekonomiska aspekterna av den ökade äldre befolkningen.

Mycket intressant var också att ta del av Hörbys kommuns satsning på gratis träning för personer över 75 år. Eva Klang Vänerklint, presenterade initiativet som gett mycket goda resultat. Oerhört många av kommunens invånare var intresserade av att ta del av erbjudandet och man såg även flera hälsovinster hos de som deltog. Vid Högskolan Kristianstad pågår också ett projekt där man utvärderar preventiva hembesök hos äldre som skett i flera olika kommuner. Genom att lyssna in den äldre personen får man en ökad förståelse för vilka insatser som behövs, dessutom ger det en möjlighet att fånga upp äldre personer som är ensamma eller har en undernäringsproblematik.

Professor Susanne Iwarsson från Lund universitet presenterade också översiktligt den forskning som pågår inom ”CASE- Center for ageing and supportive environments”. Inom forskningscentret pågår flera spännande projekt som har fokus på stödjande miljöer för en åldrande befolkning.

Satsningen ”Succesful Ageing” och Newbreed utmärker sig på sätt att de tar ett helhetsperspektiv på åldrande, vilket flera som deltog i Think Tanken såg mycket positivt på och de ser framemot att följa forskningen inom forskarskolorna vidare.

 

Early detection of dementia stage transition through habit recognition

by Gibson Chimamiwa

Older individuals prefer to age in their home environments despite their vulnerability to chronic diseases and frailty. To make it easier for individuals suffering from dementia to live in their own homes for as long as possible, new smart home solutions are needed. Due to their cognitive decline, they are prone to frequent habit changes at various dementia stages, and hence they need particular support to manage these situations.

In order to meet the care needs of the patients at different stages of the cognitive impairment, smart home solutions need to know and reason upon the activities and habits of the patients and also be able to recognise habit changes in real time. The changes in habits indicate the transition of the patient from one stage of dementia to the other. Early recognition of such stage transitions could assist caregivers in providing treatment or other interventions to slow the progression to late-stage dementia.

The state-of-the-art in smart homes for dementia have focused on activity recognition. However, dementia patients experience changes in habits and therefore there is need to extend activity recognition to habit recognition. In habit recognition, the aim is to capture one or more activities that are performed in a regular and repeated way such as detecting that the user usually sleeps for 8 hours per day. Observed deviations from the habits could indicate that the patient is moving from one stage of dementia to another.

Overall, while smart home solutions based on activity recognition for dementia patients exist, they are insufficient to support patients with changing habits such as dementia patients. Our ambition is to extend activity recognition to habit recognition system in order to detect habit changes and determine dementia stage transition. The habit recognition system could eventually be implemented in patients’ homes to assist caregivers to slow the progression to late-stage dementia through treatment or other interventions. These interventions will also enable patients to remain longer in their preferred environments thereby reducing societal costs.

Is Attention Deficit/Hyperactivity Disorder (ADHD) only a problem in childhood? A case for older age ADHD and its relationship with age-related disorders

By Maja Dobrosavljevic

With the growing population of older individuals, age-related disorders receive increasing attention as both an individual and public health concern. ADHD is usually associated with younger age; however, in approximately 60% of children and adolescents with ADHD, significant problems with attention and everyday functioning can persist to middle and older age. Although an increasing number of older adults has started seeking help in relation to ADHD symptoms, we still do not know what proportion of older population can be classified as having ADHD. This is because previous studies have been mostly conducted in children, adolescents and adults younger than 50.

Available research has shown that ADHD is linked to higher mortality rates and to a wide range of physical health problems, such as cardiovascular diseases and diabetes, as well as to mental health and behavioral problems. Additionally, recent studies have indicated that ADHD might be a risk factor for dementia. However, the available scientific literature has provided only sparse and inconclusive insights in how ADHD is manifesting in older individuals in relation to their health.

Having in mind the striking knowledge gap in what we know about ADHD in older adults, our first step is to conduct a systematic review of available literature. This will help us to identify more precisely the proportion of the older age population with ADHD, as well as to gain better understanding of manifestation of ADHD in this age group. In the next step, we aim to investigate a potential association between ADHD and age-related disorders, by using large-scale Swedish population registries.

Our findings can be applied in shifting the focus of health providers and research community to this, mostly unrecognized, population. Also, age-specific prevention programs could be developed that might help older people with ADHD to prevent certain health issues by employing small changes in their eating habits or physical activity. Finally, viewing ADHD as a life-long, chronic condition, rather than a developmental condition, can provide new insights into neuropsychological aspects of ageing.