Who are the oldest old?: narrative insights from european nonagenarian siblings

Ninety year olds are the fastest growing group in Western Europe. 15% of 90 year olds age slowly, combining long ‘lifespan’ and ‘health span’ and often clustering in families. Nonagenarian families are reservoirs of genetic, life-style and behavioural information, which may help us dissect out how to live longer, and better. This research combined narrative interviews and photographic images as we asked ninety year old siblings about their insights into important factors in their longevity. The subject group was a purposeful sample of nonagenarian sibling pairs or trios, 5 from each of 4 of the European countries associated with the EU Genetics of Healthy Ageing (GeHA) study-Italy, Finland, Poland and Northern Ireland, who answered structured questions about common family background, lifestyles. Overall, 17% of nonagenarian siblings thought genes or long-living family members were important; 19% reported good health all their lives; 30% said that ‘keeping going’ with a positive attitude and good social networks were very important. With respect to life-style, 32% reported that hard work was related to their longevity, while 19% considered good simple food as important. Across Europe there were differences; Irish siblings ranked genes, health and food as most important. In Italy hard work was the main stay of a long life with health being equally important. In Finland and Poland, a positive joyful attitude was considered intrinsic to longevity, with hard work a close second. All valued good social networks. The combined narrative and photographic images provided powerful visual and auditory in digital stories used of nonagenarian siblings, a group about whom little is known and provide an important educational tool to improve understanding about ageing well strategies.info:eu-repo/semantics/publishedVersio

Age and Age-related Diseases: Role of Inflammation Triggers and Cytokines

Cytokine dysregulation is believed to play a key role in the remodeling of the immune system at older age, with evidence pointing to an inability to fine-control systemic inflammation, which seems to be a marker of unsuccessful aging. This reshaping of cytokine expression pattern, with a progressive tendency toward a pro-inflammatory phenotype has been called “inflamm-aging.” Despite research there is no clear understanding about the causes of “inflamm-aging” that underpin most major age-related diseases, including atherosclerosis, diabetes, Alzheimer’s disease, rheumatoid arthritis, cancer, and aging itself. While inflammation is part of the normal repair response for healing, and essential in keeping us safe from bacterial and viral infections and noxious environmental agents, not all inflammation is good. When inflammation becomes prolonged and persists, it can become damaging and destructive. Several common molecular pathways have been identified that are associated with both aging and low-grade inflammation. The age-related change in redox balance, the increase in age-related senescent cells, the senescence-associated secretory phenotype (SASP) and the decline in effective autophagy that can trigger the inflammasome, suggest that it may be possible to delay age-related diseases and aging itself by suppressing pro-inflammatory molecular mechanisms or improving the timely resolution of inflammation. Conversely there may be learning from molecular or genetic pathways from long-lived cohorts who exemplify good quality aging. Here, we will discuss some of the current ideas and highlight molecular pathways that appear to contribute to the immune imbalance and the cytokine dysregulation, which is associated with “inflammageing” or parainflammation. Evidence of these findings will be drawn from research in cardiovascular disease, cancer, neurological inflammation and rheumatoid arthritis

Insights Into Sibling Relationships and Longevity From Genetics of Healthy Ageing Nonagenarians: The Importance of Optimisation, Resilience and Social Networks

Understanding how to “Age Longer and Age Well” is a priority for people personally, for populations and for government policy. Approximately ten percent of nonagenarians reach 90 years and beyond in good condition and seem to have a combination of both age-span and health-span. However, the factors which contribute to human longevity remain challenging. Culture is a shared system of learning ideas, feelings, and survival strategies. It has a strong influence on each person’s psychological development, behavior, values and beliefs. Nonagenarians have rich life experiences that can teach us much about aging well; they are rich reservoirs of genetic, lifestyle and psychological information which can help understanding about how to live longer and better. Sibling or trio nonagenarians are important sources of family beliefs and behaviors upon which individual personalities may have been built. Their personal family histories and narratives are powerful tools that help to determine familial traits, beliefs and social behaviors which may help establish factors important in the siblings’ longevity. Using purposefully selected subjects, recruited to the Genetics of Healthy Ageing (GeHA) project in four European countries, this research used the simple life story and qualitative research methods to analyze contrasting and distinctive questions about the interface between the psychological and social worlds as presented in the nonagenarian siblings’ insights about their longevity. Their stories aimed to give better understanding about which psychological aspects of their common life journey and the degree of emotional support in their sibling relationships may have supported their paths to longevity. The most universal finding in each of the four European countries was that nonagenarians demonstrated high positivity, resilience and coping skills and were supported in social networks. Around this theme, nonagenarians reported “being happy,” “always cheerful,” “never melancholy” and having a contentment with a “rich life” and family relationships which fits with accumulating evidence that life satisfaction comes from a perceived self-efficacy and optimism. Most sibling relationships in this study, when analyzed according to the Gold classification, fit the “congenial” or “loyal” relationship type – demonstrating a healthy respect for the others’ opinion without overt dependence, which may help individual coping and survival mechanisms

Killer immunoglobulin-like Receptors (KIR) haplogroups A and B track with Natural Killer Cells and Cytokine Profile in Aged Subjects: Observations from Octo/Nonagenarians in the Belfast Elderly Longitudinal Free-living Aging STudy (BELFAST)

BACKGROUND: Natural Killer Cells (NK) play an important role in detection and elimination of virus-infected, damaged or cancer cells. NK cell function is guided by expression of Killer Immunoglobulin-like Receptors (KIRs) and contributed to by the cytokine milieu. KIR molecules are grouped on NK cells into stimulatory and inhibitory KIR haplotypes A and B, through which NKs sense and tolerate HLA self-antigens or up-regulate the NK-cytotoxic response to cells with altered HLA self-antigens, damaged by viruses or tumours. We have previously described increased numbers of NK and NK-related subsets in association with sIL-2R cytokine serum levels in BELFAST octo/nonagenarians. We hypothesised that changes in KIR A and B haplotype gene frequencies could explain the increased cytokine profiles and NK compartments previously described in Belfast Elderly Longitudinal Free-living Aging STudy (BELFAST) octo/nonagenarians, who show evidence of ageing well. RESULTS: In the BELFAST study, 24% of octo/nonagenarians carried the KIR A haplotype and 76% KIR B haplotype with no differences for KIR A haplogroup frequency between male or female subjects (23% v 24%; p=0.88) or for KIR B haplogroup (77% v 76%; p=0.99). Octo/nonagenarian KIR A haplotype carriers showed increased NK numbers and percentage compared to Group B KIR subjects (p=0.003; p=0.016 respectively). There were no KIR A/ B haplogroup-associated changes for related CD57+CD8 ((high or low)) subsets. Using logistic regression, KIR B carriers were predicted to have higher IL-12 cytokine levels compared to KIR A carriers by about 3% (OR 1.03, confidence limits CI 0.99–1.09; p=0.027) and 14% higher levels for TGF-β (active), a cytokine with an anti-inflammatory role, (OR 1.14, confidence limits CI 0.99–1.09; p=0.002). CONCLUSION: In this observational study, BELFAST octo/nonagenarians carrying KIR A haplotype showed higher NK cell numbers and percentage compared to KIR B carriers. Conversely, KIR B haplotype carriers, with genes encoding for activating KIRs, showed a tendency for higher serum pro-inflammatory cytokines compared to KIR A carriers. While the findings in this study should be considered exploratory they may serve to stimulate debate about the immune signatures of those who appear to age slowly and who represent a model for good quality survivor-hood

Prompting Medical Students to Self-Assess their Learning Needs during the Ageing and Health Module: A Mixed Methods Study

Understanding our learning needs is fundamental for safe, effective and knowledge-based medical practice and facilitates life-long learning. A mixed methods study investigated fourth-year medical students’ self-perceived understanding of their learning needs using 1] a visual scale, before and after a four-week module in Ageing and Health (A&H) and 2] through focus group discussions. During 2013–14 academic year, all students (252) were invited to use a Visual Analogue Scale (VAS) tool to self-assess their learning needs that were linked to Ageing and Health curriculum learning outcomes. Assenting students (197 at pre-self-assessment, 201 at post-assessment) returned anonymous Visual Analogue Scales, self-assessing history-taking skills, examination skills, knowledge of medication use, co-morbidity, nutritional and swallowing assessment responses, before and after the A&H module. Three student focus groups explored whether completion of the VAS self-assessment had prompted improved self-awareness of their learning needs. The VAS responses increased for each curriculum domain with significant differences between the pre-and post responses – for the student-year-group. Nutritional and swallowing knowledge showed the greatest improvement from a self-assessed low baseline at entry. Focus-group students generally viewed the VAS tool positively, and as an aid for prompting consideration of current and future clinical practice. Some students recognised that ‘a need to be ready-for-work’ focused engaged learning; others demonstrated self-regulated learning through self-motivation and an action plan. The Visual Analogue Scale quantitative responses showed increased student-self-perceived learning for each curriculum domain at fourth-year completion of the A&H module, suggesting that prompting self-assessment had increased students’ knowledge and skills. Focus group students saw the VAS tool as useful for prompting awareness of their current and future learning needs. Additional educational strategies should be explored to enable all students to self-reflect and engage effectively on their learning needs, to gain the skills for the maintenance of professional medical competence. Abbreviations: A&H: Ageing and Health Module; e-portfolio: an electronic version of an evidence portfolio, which allows medical students and graduates to reflect and document learning and competencies; F1: year1 of post-graduate medical clinical training; GMC: General Medical Council-the regulation organisation for maintaining standards for doctors in UK; Logbook: usually a written document which can be used to record procedures and attendance at clinics or case-based discussions and can be used to set learning outcomes and to structure teaching in clinical settings for medical students and doctors; PDP: personal development plan is used to plan future learning and skills needs for work and education with an plan for action/s outcome; SPSS: Statistical Package for the Social Sciences; VAS: Visual Analogue Scale is a visual method of describing an experience