Social environment and healthy ageing

growing numbers of people living to older ages, age-related diseases have become an increasing challenge for societies everywhere. Many age-related diseases however, should rather be considered lifestyle-related diseases since lifestyle plays an important role in the etiology and the treatment of cardiovascular disease, obesity, type 2I diabetes and many forms of cancer. This has led to a large body of literature investigating the possibility to change people’s lifestyle. Interventions with, for example, physiotherapists that engage in daily physical activity with older people have shown substantial benefits, even reversing type 2 diabetes and some characteristics of the ageing process (1,2). Most lifestyle interventions, however, struggle to achieve sustained, long-term behavioural change (3,4). Few individuals can maintain the effort to adopt a new diet or exercise regime themselves, without intensive coaching by professionals. These interventions are therefore expensive and this hinders the widespread and continued delivery to the growing number of older people with unhealthy lifestyle and (risk for) age-related disease. Therefore, it is important to explore novel sustainable and cost-effective methods for lifestyle interventions to combat the burden of agerelated disease in ageing societies. One often overlooked influence on the health behaviour of older people is the effect of the social environment. We believe that peer coaching, in which older people coach each other in achieving lifestyle changes, is such a promising method to deliver health benefits in a sustainable, scalable way. Although there is substantial documentation of the effect of peers on adolescents and children, the influence of peers has been overlooked in older people. In peer coaching, the social environment is applied as a method to deliver an intervention. Peer coaching is a face-to-face intervention in which a group is led by a peer, a non-professional, who shares a common background with the participants. A peer coach uses experiential knowledge to understand the wishes, motivations, possibilities and limitations of the participants. In the secondary prevention of alcohol abuse, peer coaching is already applied very successfully through Alcoholics Anonymous, which delivers health benefits through peer coaching to over two million members spread over 150 countries (5,6). Since increasing physical activity is able to ameliorate so many characteristics of the ageing process, we have studied a proof-of-principle in which peer coaching is applied to establish a sustainable and cost-effective increase in physical activity of a group of older adults in The Netherland

Inventarisatie ouderengeneeskunde in medische curricula

Goed opgeleide artsen in de zorgvragen van de komende decennia zijn in ons aller belang. Leyden Academy heeft, mede financieel gesteund door ZonMw in het kader van het Nationaal Programma Ouderenzorg, het initiatief genomen tot een inventarisatie van ouderengeneeskunde in de medische curricula. Het Raamplan 2009 met de eindtermen van de basisopleiding geneeskunde geeft een te summiere beschrijving van ouderengeneeskunde om gedegen onderwijs hierin te waarborgen. Dit is terug te zien in de voortgangstoetsen van studenten geneeskunde. Er is verspreid over de faculteiten goed onderwijs in ouderengeneeskunde, maar een compleet aanbod van theoretisch en praktisch onderwijs ontbreekt op de meeste faculteiten. Slechts op drie van de acht faculteiten is een hoogleraar ouderengeneeskunde in de tweede lijn. De werkgroep doet de volgende aanbevelingen: •Het raamplan dient te worden aangepast zodat alle studenten op gedegen wijze in de ouderengeneeskunde worden onderwezen, waarbij de begrippen in het hier opgestelde toetsingskader aan de orde moeten komen. •Alle studenten dienen in de bachelorfase theoretisch onderwijs over veroudering te krijgen en kennis te maken met de ouderengeneeskundige praktijk in een zorgstage. In de masterfase dienen zij bovendien te worden voorbereid op hun toekomstige praktijk door een verplicht coschap ouderengeneeskunde. •Om gedegen onderwijs in de ouderengeneeskunde op iedere faculteit te waarborgen dient op iedere faculteit een hoogleraar ouderengeneeskunde te worden aangesteld

Het wegwerplichaam : over de rol van het immuunsysteem tijdens de levensloop

De levensverwachting in Nederland is vanaf de 19e eeuw sterk toegenomen. Tot 1870 lag de gemiddelde levensverwachting beneden de 50 jaar,daarna begon de epidemiologische transitie, een overgang van sterfte door infectieziekten op jonge leeftijd naar sterfte door kanker en harten vaatziekten op hogere leeftijd. Deze transitie kan verklaard worden door verbeterde hygiëne, sociaal-economische ontwikkelingen en toegenomen medische kennis. Door deze ontwikkelingen is de kindersterfte vrijwel verdwenen en de gemiddelde levensverwachting fors gestegen. Op dit moment heeft een Nederlandse man een kans van 86 procent om de leeftijd van 65 jaar te bereiken en voor vrouwen is dit zelfs 90 procent. Daarbij is de levensverwachting voor mannen 77 jaar en voor vrouwen 81 jaar. Het resultaat van dit succes is dat er nu meer oude mensen zijn dan ooit te voren. Dat wil echter niet zeggen dat veroudering een nieuw fenomeen is. Ook in vroeger tijden waren er mensen die een hoge leeftijd bereikten, alleen waren er veel minder mensen die dit geluk mochten smaken. In dit hoofdstuk gaan we in op de factoren die de levensverwachting beïnvloeden, waarbij we ons concentreren op de rol die het immuunsysteem speelt gedurende de levensloop.Wetensch. publicati

Composing causes of death

Wetensch. publicati

Design Lessons from an RCT to Test Efficacy of a Hybrid eHealth Solution for Work Site Health

Work site healthy lifestyle interventions hold promise for improving health and employability. As part of a larger employer vitality program and a work site RCT (Randomized Controlled Trial, n=59 intervention arm) to assess cardiac risk impacts, we conducted a design analysis on a hybrid eHealth solution. The control condition was a six weeks waiting list and then start of the hybrid eHealth support (n=57). Based on preliminary 6 week- and 3 month-results, the hybrid eHealth support generated statistically significant risk factors improvement (like LDL cholesterol). The waiting list condition yielded no significant improvements. The late start after the waiting list did yield significant improvements, but not as large as a direct start. The direct start also appears to yield higher satisfaction and intention to recommend. Our analysis supports three types of conclusions. First, the hybrid eHealth intervention did significantly improve physical risk factor variables after 6 weeks. Motivation and measurement alone (waiting list) did not. Second, theory on timing of health support for patient appeared generalizable to employees: it did help to offer support at a moment of high motivation, instead of later. Third, a design analysis was conducted regarding service mix efficacy in relation to key requirements for designing ICT-enabled lifestyle interventions. This resulted in several recommendations and improved service adoption

Vitality club:a proof-of-principle of peer coaching for daily physical activity by older adults

Many age-related diseases can be prevented or delayed by daily physical activity. Unfortunately, many older adults do not perform physical activity at the recommended level. Professional interventions do not reach large numbers of older adults for a long period of time. We studied a peer-coach intervention, in which older adults coach each other, that increased daily physical activity of community dwelling older adults for over 6 years. We studied the format and effects of this peer coach intervention for possible future implementation elsewhere. Through interviews and participatory observation we studied the format of the intervention. We also used a questionnaire (n = 55) and collected 6-min walk test data (n = 261) from 2014 to 2016 to determine the motivations of participants and effects of the intervention on health, well-being and physical capacity. Vitality Club is a self-sustainable group of older adults that gather every weekday to exercise coached by an older adult. Members attend on average 2.5 days per week and retention rate is 77.5% after 6 years. The members perceived improvements in several health measures. In line with this, the 6-min walk test results of members of this Vitality Club improved with 21.7 meters per year, compared with the decline of 2-7 meters per year in the general population. This Vitality Club is successful in durably engaging its members in physical activity. The members perceive improvements in health that are in line with improvements in a physical function test. Because of the self-sustainable character of the intervention, peer coaching has the potential to be scaled up at low cost and increase physical activity in the increasing number of older adults

Scarcity of atrial fibrillation in a traditional African population: a community-based study

BACKGROUND: In western societies, atrial fibrillation is an increasingly common finding among the elderly. Established risk factors of atrial fibrillation include obesity, diabetes, hypertension, and cardiovascular disease. Atrial fibrillation has almost exclusively been studied in western populations where these risk factors are widely present. Therefore, we studied the epidemiology of atrial fibrillation in a traditional African community. METHODS: In rural Ghana, among 924 individuals aged 50 years and older, we recorded electrocardiograms to detect atrial fibrillation. As established risk factors, we documented waist circumference, body mass index (BMI), capillary glucose level, blood pressure, and electrocardiographic myocardial infarction. In addition, we determined circulating levels of interleukin-6 (IL6), a proinflammatory cytokine, and C-reactive protein (CRP), a marker of systemic inflammation. We compared the risk factors with reference data from the USA. RESULTS: Atrial fibrillation was detected in only three cases, equalling 0.3% (95% CI 0.1–1.0%). Waist circumference, BMI, and capillary glucose levels were very low. Hypertension and myocardial infarction were uncommon. Circulating levels of IL6 were similar, but those of CRP were lower compared with the USA. CONCLUSION: Atrial fibrillation is very scarce in this traditional African community. Its low prevalence compared with western societies can be explained by the rareness of its established risk factors, which are closely related to lifestyle, and by possible unmeasured differences in other risk factors or genetic factors

Self-organizing peer coach groups to increase daily physical activity in community dwelling older adults

Many older adults do not reach the recommended level of physical activity, despite many professional-delivered physical activity interventions. Here we study the implementation of a novel physical activity intervention for older adults that is self-sustainable (no financial support) and self-organizing (participants act as organizers) due to peer coaching. We implemented three groups and evaluated process and effect using participatory observations, questionnaires, six-minute walk tests and body composition measures from October 2016 to September 2018. The intervention was implemented by staff without experience in physical activity interventions. Facilitators were a motivated initiator and a non-professional atmosphere for participants to take ownership. Barriers were the absence of motivated participants to take ownership and insufficient participants to ensure the presence of participants at every exercise session. The groups exercised outside five days a week and were self-organizing after 114, 216 and 263 days. The initial investments were 170_ for sport equipment and 81-187 h. The groups reached 118 members and a retention of 86.4% in two years. The groups continue to exist at the time of writing and are self-sustainable. Quality of life increased 0.4 on a ten-point scale (95%CI 0.1-0.7; p = 0.02) and six-minute walk test results improved with 33 m (95%CI 18-48; p < 0.01) annually. Self-organizing peer coach groups for physical activity are feasible, have positive effects on health and require only a small investment at the start. It is a sustainable and potentially scalable intervention that could be a promising method to help many older adults age healthier

The Trade-Off between Female Fertility and Longevity during the Epidemiological Transition in the Netherlands

Several hypotheses have been put forward to explain the relationship between women's fertility and their post-reproductive longevity. In this study, we focus on the disposable soma theory, which posits that a negative relationship between women's fertility and longevity can be understood as an evolutionary trade-off between reproduction and survival. We examine the relationship between fertility and longevity during the epidemiological transition in the Netherlands. This period of rapid decline in mortality from infectious diseases offers a good opportunity to study the relationship between fertility and longevity, using registry data from 6,359 women born in The Netherlands between 1850 and 1910. We hypothesize that an initially negative relationship between women's fertility and their longevity gradually turns less negative during the epidemiological transition, because of decreasing costs of higher parities. An initially inversed U-shaped association between fertility and longevity changes to zero during the epidemiological transition. This does suggest a diminishing environmental pressure on fertility. However, we find no evidence of an initial linear trade-off between fertility and post-reproductive survival

Linking a peer coach physical activity intervention for older adults to a primary care referral scheme

Background Physical inactivity has contributed to the current prevalence of many age-related diseases, including type 2 diabetes and cardiovascular disease. Peer coach physical activity intervention are effective in increasing long term physical activity in community dwelling older adults. Linking peer coach physical activity interventions to formal care could therefore be a promising novel method to improve health in inactive older adults to a successful long-term physical activity intervention. Methods We evaluated the effects of linking a peer coach physical activity intervention in Leiden, The Netherlands to primary care through an exercise referral scheme from July 2018 to April 2020. Primary care practices in the neighborhoods of three existing peer coach physical activity groups were invited to refer patients to the exercise groups. Referrals were registered at the primary care practice and participation in the peer coach groups was registered by the peer coaches of the exercise groups. Results During the study, a total of 106 patients were referred to the peer coach groups. 5.7% of patients participated at the peer coach groups and 66.7% remained participating during the 1 year follow up. The number needed to refer for 1 long term participant was 26.5. The mean frequency of participation of the referred participants was 1.2 times a week. Conclusion Linking a peer coach physical activity intervention for older adults to a primary care referral scheme reached only a small fraction of the estimated target population. However, of the people that came to the peer coach intervention a large portion continued to participate during the entire study period. The number needed to refer to engage one older person in long term physical activity was similar to other referral schemes for lifestyle interventions. The potential benefits could be regarded proportional to the small effort needed to refer