Yoga-based exercise can improve well-being for older people

This blog was first published on the National Institute for Health Research (NIHR) Dissemination Centre Discover Portal. Read the corresponding Age and Ageing paper Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials.

Yoga-based exercise offers a safe and accessible way to improve health-related quality of life and mental well-being for people over 60. Evidence for a moderate benefit of yoga in later life now extends beyond improved balance and flexibility.

Yoga includes stretches, poses, breathing routines and meditation. This review focused on the physical exercise/activity components. Most of the 12 included trials took place in Western countries and classes were all run by qualified yoga instructors as in the UK. Class attendance was high for eight weeks or more (50 to 96%). However, women outnumbered men by three to one, implying that yoga classes may need adapting to appeal to older men.

Yoga classes are widely available and could offer an accessible way to improve older people’s activity levels and well-being. The research was moderate to high quality, but it cannot yet show exactly how much yoga or which kind works best for particular groups of people. However, the good news is that these approaches seem effective.

Older people are not only living longer: positive results in the temporal trends of physical functioning

Giola Santoni is a researcher on health status and health trends in older people. She has worked at the Aging Research Center, Karolinska Institutet in Sweden and she is currently a biostatistician at the same institute.

Anna-Karin Welmer is associate professor and senior university lecturer at Karolinska Institutet. She is vice-principal investigator of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) population-study. Anna-Karin’s primary area of research interest is the epidemiology of physical function, disability and falls in older persons.

Despite the rapid gain in life expectancy in the last century, it is not clear if the added years consist of healthy years or years lived in poor health and disability.

Previous studies have reported stable or even declining levels of disability. However, disability is defined as the inability to perform basic activities of daily living independently in the environment a person lives. Disability trends can therefore be influenced by changes in the environment such as development of technical equipment. To what extent does the encouraging trend towards declines in disability in the older population reflect actual improvements in physical function?

We need to talk about loneliness

Dr Shibley Rahman is an academic physician interested mainly in dementia and frailty. He tweets at @dr_shibley

This was my first ever BGS conference, just down the road from me, at the Wellcome Collection, London. The day was spent discussing ‘Loneliness in older people and its impact on health’ chaired by Professor Tahir Masud (@TashMasud), President-Elect of the British Geriatrics Society.

In a recent paper by Utz and colleagues (2014), the following is offered:

“The term loneliness is often equated with social isolation or social participation. However, seminal work attempted to distinguish loneliness from these constructs by defining it as the cognitive or psychological appraisal of social relationships and activities. For example, loneliness has been conceptualized as the lack of “meaningful” social relationships or “incongruence” between actual and desired levels of social interaction.”

It’s time to BREAKDOWN these BAME BARRIERS

Dr Gaggandeep Singh Alg is currently a Consultant (AUC) Physician and Geriatrician working at the Royal Berkshire Hospital, UK. He is active in charity work supporting the most vulnerable in society and has an interest in equality and diversity. Twitter Handle @DrGSAlg

How often do we hear about the rapidly growing population of older people? Yes, we hear about it almost every day. But who are these older patients? Where are they originally from? What is their cultural and religious background? No one seems to be talking about that!

In the last 8 years while doing charity work in my free time I have noticed a growth in the older population from black, Asian and minority ethnic (BAME) groups. Older people from BAME backgrounds suffer from the same illnesses our other patients suffer from. However, in my experience they do not always know when and how to seek help. They have cultural, religious and language barriers which may prevent them from accessing health care services. Through the charity work I have seen many over 65 year olds living with signs and symptoms of various diseases, who have not been able to access the services we have built and provide!

Is frailty becoming less fatal?

Professor Fiona Matthews is Professor of Epidemiology at Newcastle University, Newcastle-upon-Tyne, UK. In this blog, she shares a recent Age and Ageing publication looking at data collected since the 1990s on how much frailty exists in the population and whether it is more or less related to dying now than 30 years ago.

Most doctors involved in the care of older people would claim to know a frail patient when they see one. Being able to detect this frailty is crucial to ensure that treatment is appropriate, proportionate and likely to produce positive outcomes wherever possible. The measurement of frailty has become important recently with the inclusion of frailty within the requirements of an assessment in general practice, and tools to assist doctors in emergency departments evaluate frailty quickly. The most popular method for these investigations has been the frailty index, where diseases and impairments are added all together to give a score. The relationship between this frailty index and mortality has been seen across the world, giving rise to suggestions that it is one measure that is consistent across time and place.

Frequent drinkers unravelled

Beth Bareham, NIHR SPCR  doctoral fellow at Newcastle University Institute of Health and Society and Institute for Ageing (@bkateb1) She co-authored the Age and Ageing Paper Drinking in later life: a systematic review and thematic synthesis of qualitative studies exploring older people’s perceptions and experiences with Professor Eileen Kaner @EileenKaner, Liam Spencer @LiamPSpencer and Professor Barbara Hanratty @BarbaraHanratty.

Within the United Kingdom, older people experience more alcohol-related hospitalisations and deaths than any other age group. Risky drinking amongst  older people is not just confined to the United Kingdom. Potentially harmful patterns of drinking are common amongst older age groups across the globe. Older people are not only at risk because they drink more often, but also because quantities of alcohol that may have been safer earlier in life have the potential to damage an older person’s health if, like most, they have medical conditions or take medications. However, moderate drinking in older age has been linked with some health benefits, and drinking may also have a positive impact on their social lives. The impact of alcohol on older people is complex, and many different factors can influence their choices. To modify riskier drinking in later life and support people to live longer, healthier lives, it’s vital that we understand these complexities. 

From uncertainty to understanding: Can psychodynamic theories improve our care of older adults?

Dr Juliette Brown is a locum consultant psychiatrist in CMHT for Older Adults in Newham and in liaison psychiatry at Newham University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS. 

Dr Cate Bailey is a Specialist Registrar in Psychiatry working in Liaison Psychiatry at Homerton University Hospital, and is a member of the Association for Psychoanalytic Psychotherapy in the NHS.

‘Psycho-analysis is not a child of speculation, but the outcome of experience; and for that reason, like every new product of science, is unfinished. It is open to anyone to convince himself by his own investigations of the correctness of the theses embodied in it, and to help in the further development of the study’ Sigmund Freud, On Psycho-analysis (1)

Can psychodynamic theory improve our care of older adults? A century of psychoanalytic thought and a half century of work by old age psychiatrists and psychotherapists suggest that it can (2-3). Psychodynamic approaches help in making sense of complex, bewildering and frustrating clinical encounters through the recognition and observation of unconscious communication (4). By becoming aware of the inner and outer worlds of ourselves and our patients we can provide more thoughtful and effective care.

Beyond text and images: Tackling loneliness with technology

Dr Eiman Kanjo is a Senior Lecturer at Nottingham Trent University. Eiman has written some of the earliest papers in the research area of mobile sensing and she currently carries out work in the areas of technologies and data science for health & Wellbeing, Smart cities, Environmental Monitoring and its impact of health, and wellbeing monitoring. She tweets @eimankanjo She will be speaking at the Loneliness in Older People and its Impact on Health event on 13 June at Wellcome Collection in London.

Loneliness is a sad and frustrating event in anyone’s life, however its impact is more damaging for older people. Many older adults have lost so much of their independence they are left with memories of the life they once knew. Things that were once so important to them are taken away, such as the ability to drive, go to church, read a book, or even connecting with their loved ones.

Among the ways to combat loneliness, technology is starting to play a major role in helping to bridge the gap of interactions that older adults need.

In general, older adults do not necessarily dislike one form of technology or another, however, they are sometimes distrustful about the need for technology or about their ability to utilise it.

Do you know what Yoga is?

Tania Plahay is a yoga teacher and author of Yoga for Dementia: A Guide for People with Dementia, Their Families and Caregivers. Tania is passionate about bringing yoga to a wider audience and adapting the practices of yoga for those living with Dementia. Prior to writing her book Tania ran the FoNS project Yoga for Dementia, in a residential home in Thamesmead London. Tania divides her time between the Costa Blanca, Spain and the UK, where she runs yoga classes, retreats, workshops and training.

There has been a huge growth in the number of yoga practitioners in the UK and US in recent years. With this growth the image of lithe young yoga practitioners has spread around the globe, and has been used to sell products from cars to Tic Tacs.  Therefore, you would be forgiven if you thought that yoga was only for younger, fit women and that it mainly consisted of bending your body into pretzel like poses. However the practice of yoga goes far beyond the physical poses (known as asanas), and yoga can be attainable by all.

Health outcome measures for older people

Asangaedem Akpan (tweets at @asanakpan) is an Honorary Clinical Lecturer at the Institute of Ageing & Chronic Disease, University of Liverpool and Geriatrician, who was part of a global network of experts, including older people and carers, that developed a standard set of health outcome measures for older people.

The background to these set of health outcome measures has previously been discussed in a couple of previous blog articles accessible here: part 1 and part 2. Key partner organisations included the International Consortium for Health Outcome Measurements (ICHOM), NHS England and Age UK.

In a recently published open access article we describe how these health outcome measures were developed. In an era of increasing medical sub-specialisation with an increasing number of people with multimorbidity, that proportionately affects older people, a set of health outcome measures that can unify the agendas of health and social care providers, older people and those who pay for health and social care services has the potential to align health and social care services to what matters to people and their carers.