Healthy Aging in a disadvantaged neighborhood


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Eduprof Expertmeeting 14-15 April 2011 Groningen.
General introduction to the workshop Healthy Ageing by Annemiek Bielderman

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Healthy Aging in a disadvantaged neighborhood

  1. 1. Healthy Ageing in adisadvantaged neighborhood Annemiek Bielderman Research and Innovation Group in Health Care and Nursing 1
  2. 2. Contents• Ageing and Healthy Ageing• Healthy Ageing and Lifestyle• Ageing in disadvantaged neighborhoods• Delfgoud project2
  3. 3. Ageing of the population Percentage younger (0-14 years) and older people (65+ years) in various European countries, 1850-2050.3 (Netherlands Interdisciplinary Demographic Institute)
  4. 4. The number of OntwikkelingThe ageing in the adults (>65) related to adultsNetherlands grijze druk (20-64)2010-2025 2010-2025
  5. 5. Healthy Ageing Stephen Hawking 69 years old5
  6. 6. Healthy ageing Development and maintenance of optimal physical, mental and social well-being and function in older adults. (West Virginia Rural Healthy Ageing Network; Hansen-Kyle et al., 2005) Multi-dimensional6
  7. 7. A healthy lifestyle is a prerequisite for healthy ageing Loss in healthy Loss in years years (HALE)SmokingOverweightObesitasExcessive alcohol usePhysical inactivity 7
  8. 8. Health Adjusted Life Years 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)
  9. 9. Effect healthy lifestyle on HALE
  10. 10. 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
  11. 11. 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)
  12. 12. Studies suggest elderly who have positive perceptions of ageing slow down frailty in late life
  13. 13. Disadvantaged neighborhoods• Socio economic status (SES): – Based on income, education, and occupation (Winkleby et al., 1992)14
  14. 14. Disadvantaged neighborhoods• SES is a strong predictor of physical and mental health status Socioeconomic health differences15
  15. 15. Disadvantaged neighborhoods• Socioeconomic health differences = systematic differences in health and mortality between people with a high and a low socioeconomic status (Verweij, 2010) 1. Life expectancy 2. Health-Adjusted Life Expectancy (HALE) 3. Risk factors for disease Life style factors16
  16. 16. Socioeconomic health differences1. Life expectancy is lower in low SES persons: – 7.3 years in men Life expectancy (years) – 6.4 years in women • Stays present at older age (>65 years) men women (Verweij & van der Lucht, 2010; van der Lucht et al.,172010; Pappas et al., 1993; Winkleby et al., 1992)
  17. 17. Socioeconomic health differences1. 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) (Verweij & van der Lucht, 2010; Bruggink et al., 2010)18
  18. 18. Socioeconomic health differences1. Life expectancy lower in low SES persons2. Health Adjusted Life Expectancy (HALE)3. More risk factors for disease in low SES: – Unhealthy life style: Smoking, overweight, less physical exercise, alcohol use – More chronic diseases (Bruggink et al., 2010; Verweij & van der Lucht,19 2010; Pappas et al., 1993)
  19. 19. 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)20
  20. 20. Ageing and low SES• Diminish the health differences between low and high SES elderly people Improve the health of elderly people with a low SES21
  21. 21. Delfzijl Amsterdam Groningen Utrecht Assen22
  22. 22. Regional differences in Social Economic Status in the Netherlands Geografische verschillen in gezondheid. VTV-2006, Bilthoven: RIVM.23
  23. 23. 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 inactivity24
  24. 24. Improve the health of elderly with a low SESHow 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 group25
  25. 25. 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 depressive symptoms.26
  26. 26. 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?27
  27. 27. Theoretical principles of the DELFGOUD project Enhancement of healthy lifestyle in deprived older adults Multi-factorial interventions are effective Healthy lifestyle interventions Resilience is a factor in copingResilience theory with (pre) frailty Enhancement of sense ofSalutogenesis paradigm Enhancement of coherence is a prerequisite for healthy ageing healthy ageingReserve Capacity Model Coping with age related stress due to chronic diseases, anxiety, depression and loneliness Decrease in disability and increase in quality of life 28
  28. 28. DELFGOUD project• DELFGOUD: multi-factorial intervention program• The interventions: – Physical activity – Social skills training – Depression intervention – Healthy eating intervention program29
  29. 29. 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 pattern30
  30. 30. DELFGOUD project planning • How does the program look like? Physical activity 0 months 6 months 12 months 18 months (1) Depression/ Nutrition (2) Nutrition / Social skills (3) Social skills / Depression31
  31. 31. 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 + Nutrition b) Nutrition + Social skills c) Social skills + Depression• Inclusion criteria: – Low SES, sedentary, depressive symptoms, loneliness32
  32. 32. Measurements• Outcome measures: – Quality of life – Physical fitness – Loneliness – Social contacts – Depression and anxiety – Eating pattern33
  33. 33. 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 loneliness34
  34. 34. Take home message Life expectancy is still rising in our society. A healthy lifestyle is a prerequisite for healthy ageing. The salutogenesis theory is a theoretical framework for healthy ageing interventions A multi-factorial lifestyle intervention is an effective way to enhance aAnnemiek Bielderman healthy lifestyle in deprived adults. 35
  35. 35. PartnersNetwerk Ouderenzorg Regio Noord 36