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.

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. 

“Doc, I read on the Internet that probiotics might help me. Is it true?”

Patrick Alexander Wachholz  is a Geriatrician, Research associate at Botucatu Medical School, São Paulo State University (UNESP). His paper Effectiveness of probiotics on the occurrence of infections in older people: systematic review and meta-analysis was recently published in Age and Ageing journal.

In 2001, an international Joint Expert Consultation of sci­entists working on behalf of the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) defined probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”.

Probiotics are intended to have health benefits, and in some countries we can find a huge variety of products sold as probiotics including foods (such as yogurt and fermented milk), dietary supplements, and products that aren’t used orally, such as skin or vaginal creams.

Is it time to redefine old age?

Vedamurthy Adhiyaman is a geriatrician working is North Wales. Here he discusses why we should redefine old age. He tweets @adhiyamanv 

Western literature arbitrarily defines old age as people above the age of 65 (Oxford textbook of geriatric medicine, Wikipedia etc). Few authors subdivide old age further as young old (65-74), old (75-84) and old-old (85+). This would make our reigning monarch ‘old-old’ and the next in line to the throne and our patron, old (not sure whether he would like to be called old…). And definitions of old age vary according to different parts of the world. For African countries, the United Nations set the age 60+ and the WHO defines 50+ as old. Dictionaries define old age as a later part of normal life without defining any numbers.

The Second BGS Cultural Revolution- and the Living Well SIG

Sir Muir Gray has worked for the National Health Service in England since 1972, occupying a variety of senior positions during that time. He is an internationally renowned authority on healthcare systems and has advised governments of several countries outside the UK including Australia, New Zealand, Italy, Spain and Germany. He tweets @muirgray

The British Geriatrics Society can be proud of the culture change it has achieved by providing leadership in the last seventy years.  When the BGS was founded the prevailing beliefs of not only the public but also the medical profession, were that the problems of older people were due to the ageing process and not due to treatable disease – older people therefore needed “care” rather than accurate diagnosis, effective treatment and rehabilitation. The BGS and individual consultants should be proud of their achievements. There has been a revolution in the care of older people with disease.

Retirees leaving sociable workplaces may experience accelerated cognitive decline

A study published recently in Age and Ageing, the scientific journal of the British Geriatrics Society, provides new evidence that workers retiring from occupations which involve high levels of social stimulation may be at greater risk of accelerated cognitive decline in later life.

The study, which was conducted by researchers at University of Liège, in collaboration with the Universities of Bordeaux and South Florida, surveyed 1,048 individuals over the age of 65 from Bordeaux. Participants were evaluated at 2 year intervals for a period of 12 years. Psychologists’ evaluations included detailed assessments of subjects’ mental cognition, general health and information about their former occupation. Three independents raters were asked to evaluate the level of social and intellectual stimulation for each occupation.

Selfie with a centenarian!

Esther Clift is a Consultant Practitioner Trainee in Frailty, and Vice Chair of the BGS nurses and AHP Council. She is undertaking a Doctorate in Clinical Practice at Southampton University on the uptake of exercise by older people. She was inspired by an interview with Dr Frankland on the Today Programme, and went to ask him about his own use of exercise.

‘I just think he should have told me, I’m not stupid!’ – Dr AW Frankland reflects on his introduction to Strength and Balance exercises.

Dr AW Frankland was born the year the Titanic sank, and started medical school in Oxford when Stanley Baldwin was Prime Minister. He was supervised by Sir Alexander Fleming at St Marys and is described as the ‘grandfather of allergy research’. His daily hour long supervisions with Fleming never included discussing patients – ‘he was a pure scientist, who wanted to talk about science.’

Esther Clift’s African Blog Series; Part 4 ‘Healthy ageing’

Esther Clift is a Consultant Practitioner Trainee in Frailty with Health Education Wessex. This is the final part of a four part BGS blog series about her time in Africa. She tweets @EstherClift

“Healthy ageing” is defined by the World report on ageing and health as the process of developing and maintaining the functional ability that enables well-being in older age.

What does that look like in developing countries?

I have had the privilege of travelling through some of Kenya and Uganda and I asked how people view their prospects, as they grow older. Some like Nathani in rural Jinja, Uganda, a retired academic and researcher with a PhD from Strathclyde University felt that his future was tied up in his land, and his children. He had both, and at 74 was fit and well, and held in high esteem by his community. He described his children as his wealth.

Mitochondria, mobility and ageing

Amanda Natanek is a Clinical Senior Lecturer at Imperial College London and a Consultant Physician at the Royal Brompton and Harefield NHS Foundation Trust. She is raising awareness of the clinical relevance of mitochondrial function and the oxidative capacity of skeletal muscle in conditions associated with ageing, by holding the first international symposium on this topic next month.

Mitochondria are fascinating organelles. Thought to have originated as aerobic bacteria that became engulfed by primitive eukaryotic cells, they are the ‘powerhouse’ of the cell. By generating ATP efficiently through a chain of oxygen-requiring reactions, they fuel the multitude of active processes that keep the cell ticking over. When a cell’s time is up, mitochondria are triggers of cell death.

One in three babies born in 2012 will live to reach 100

One of the perennials I get asked to comment on as a geriatrician are Office of National Statistics population projections and what they mean for geriatricians, older people, older patients and the population as a whole.

The most recent ONS paper to draw attention can be found here.

The headline statistic from this – one in three babies born in 2012 will live to see their 100th birthday – was sufficiently compelling to attract the attention of the lay media.

The Telegraph focussed on the financial challenges of providing pensions for the expanding cohort of octo- and nonagenarians.

The Scotsman took a more equivocal stance, worrying about the impact on the health service, whilst also praising the achievements in public health and healthcare underpinning the ever increasing life expectancy.

I was asked to appear on BBC Radio Nottingham to comment on this today (available for 6 days). Before the interview they played a “vox pop” of people on the high street. A consensus was evident, that quantity of life was desirable but only if it came with some quality of life. The challenge for us as geriatricians, as we attempt (and at times struggle) to support a rapidly expanding number of patients with dementia (cf: the National Dementia Strategy) and in care homes (cf: Quest for Quality), is to keep this objective firmly centre-stage.