The holy grail of healthy ageing

One of the interesting advantages of my work on healthy ageing in Geneva is that I learn how to live longer. I am now reading an interesting book on the 10 secrets of healthy ageing: “Live longer, look younger and feel great” by Patrick Holford and Jerome Burne. Holford is CEO of the British Food for Brain Foundation and expert in nutrition therapy. Burne is a health journalist and expert on adverse effects of medicines.

I usually donot recommend books and I must be extra careful working for WHO now (so once and for all blogs, I am not a real expert, these are just personal thoughts and certainly not WHO guidelines). However, the more I read the more I feel that there are some valuable and even doable lessons on how to age better. Ageing is a bit like raising kids. It just happens to you but nobody learns you how to do it properly.

The interesting aspect of this book is that the authors start as much as possible from scientific evidence, but also use common sense. It is definitely not alternative medicine, but they recognise and show convincingly that there are many perverse incentives in prescribing medicines and modern medicine. It is indeed insane that old people sometimes have to use multiple prescription drugs with often more adverse than beneficial effects. So how to avoid that and avoid old age illnesses as much as possible from the very beginning?

The book starts by how to check your biological age. You can do that in a simple way by checking your BMI, blood pressure, pulse and waist/hip ratio. But they have also included more advance tests including some blood tests. They then address the ten secrets of healthy ageing, or rather 9 ways of addressing most common issues for old people: Alzheimer, joints & bones, diabetes, stress, skin issues, cancer, high blood pressure, digestive problems, eyesight and one for discovering the natural anti-ageing hormones that perk us up. Based on all this information you can develop your own anti ageing action plan.

Despite all these issues and illnesses addressed, there are basically just a few main recommendations in the book. Easier to remember: it is all about the FIELDS of ageing.

F: for Food. Most of us know or feel that food and ageing are interrelated. And indeed, there is something like an anti-ageing diet. Some of it is well known (not much fat and sugar) but they go much deeper in the book. They introduce the glycemic index of food, telling whether the carbohydrates are fast or slow releasing. And of course the antioxidant rich foods (chocolate and carrots) and food with omega-3 fats such as oily fish and seeds are good for you as well.

There are many things that at least I did not yet know. The Geneva diet: coffee with croissant is a deadly combination as far as blood sugar is concerned. I also didn't know that eating little and often is better than three big meals a day. And that muesli bars are deceptively unhealthy, with refined sugar and fat.

I for extra Intake: as you get older, the case for taking nutritional supplements on a regular basis gets stronger, as nutrients from food are less well absorbed later in life. And with less physical activity you also eat less (so you get even less nutrients). I must admit that I was always very reluctant to take extra vitamins, as they are expensive and I had the feeling that it was more profitable for industry than for my health. But after reading this chapter I partly changed my mind. They warn against too high doses but in general, they state, it is wise to have extra multivitamins, Vitamin C with zinc, omega-3 and 6, and antioxidants plus some additional stuff depending on specific diseases that you may already have. That sounds like a lot and maybe it is. But the main point is that when you get older, you can't get all the necessary nutrients from food anymore – even with the best diet – and you better have some additional Intake.

E for Exercise. As the authors state, modern life is one big conspiracy against physical activity. If governments wanted to do just one thing that would have a major impact on obesity, heart disease, stress and dementia, it would be to get everyone on a regular exercise programme. Exercise is the closest thing to an anti-ageing pill. It makes you less hungry, it boosts your metabolic rate (how fast you burn food), increases your hormone production and so on.

L for Liquids. Most of discussions are about alcohol, but that is not so important. Too much is harmful and one glas of good quality red wine is probably beneficial. Also sugary drinks are clearly wrong, including sugared coffee and tea. But the key issue is water. Start drinking a glass when getting up, with each meal, with each coffee and with each glass of alcohol. Our bodies consist of 85% water so you need it (I mean the water and not the alcohol). 8 glasses of water or herbal tea a day keeps your body in better shape.

D for Drugs, Do not take too many medicines. Medicines can be very useful and sometimes indispensable. One of the authors mentions that both his wife and his kids would be probably dead if they would not have had anti-biotics. But they also quite convincingly argue that medicines do not work that well in elderly patients, that side effects are often underestimated for this group and that side effects often lead to a chain effect (medicines prescribed to address side effects of other medicines). There are many examples in the book of diabetes drugs that raise the risk of heart disease, ineffective prescribing of anti psychotic medication to deal with dementia and the doubtful benefits of the use of statins to people without any heart disease. In a sense many pharmaceuticals follow the agrochemical approach that knocks out weeds and bugs with pesticides or of the preventive use of antibiotics in meat production. That is often not necessary as biological farming shows. Similarly, many drugs are not necessary when you adjust your lifestyle.

S for Stress, feel fine, avoid stress, sleep well and develop a healthy mind style. One useful recommendation is to have a notebook near your bed and write down anything you want to deal with tomorrow. That helps you to let it go during the night. Happy and flexible people live longer. And the worst emotion for longevity is not depression or stress – it's cynicism.

So don't be cynical after reading my blog or you will die earlier. It is so easy: eat well, drink well, sleep well, exercise well and well, take some vitamins and less drugs when you get older. The only thing is that I have to start doing it myself as well.

High tech & old

This week my new computer arrived after I was ageing for a few weeks. Most computers at WHO are small laptops that you can connect to a working station and disconnect when you have to travel. You even have two screens where you can split tasks. And you can install Skype and other useful tools. The help desk is in Kuala Lumpur as is most of WHO administrative support. But it works and I already phoned them late at night (at least for them).

So it is a good week to write a bit about technology and ageing. For example, this week I learnt more about the possibilities of big data / data mining to better treat old people. Up till now, treatment protocols are mostly based on the average patient. Of course there is no such thing as an average patient so decisions on treatment, placements in nursing homes and prioritization with waiting lines are often wrong. But if you use big cohort studies and try to match patients with similar patients in the past, you can better forecast what will happen to them. Due to the large data sets, there will always be a set of patients that had similar diseases and symtoms at any given point of time. As you know what happened to these other patients, you can better predict whether you are better off with home care or in a nursing home. Or doctors can forecast that given your present condition, how much will your ADL score change when you will get a certain intervention (ADL stands for activities of daily living). That will lead to better and more cost effective decisions and may also save a lot of money.

There are many other interesting applications of technology for the eldery. For example health mobile phone apps can monitor whether an old person is still active (moving around or communicating as usual). If not, the device will inform a care giver who can call or visit the immobile older person. A bit inpersonal maybe but very effective. EU research projects have mapped the opportunities for various high tech applications for the different diseases.

 A bit less age specific technology development, but worth mentioning is that this week the three global intergovernmental bodies dealing with health, intellectual property and trade have issued a study of the mix of policies needed to advance medical and health technologies and to ensure that they reach the people who need them. The book, “Promoting Access to Medical Technologies and Innovation: Intersections between Public Health, Intellectual Property and Trade,” was launched on 5 February 2013, by the heads of the three bodies — the World Health Organization (WHO), World Intellectual Property Organization (WIPO) and World Trade Organization (WTO).

The book covers a broad range of complex, yet linked, issues relating to public health and innovation in medical technologies, with the ultimate goal of accessibility — making medical advances available globally to all who are sick.

The book looks in some depth at the development of medical technologies, modern research and development, ways of providing incentives for innovation, and ways of dealing with market failures, in particular with new products for treating neglected diseases. I was involved in this proces some years ago when the topic was on the agenda of the World Health Assembly, leading to negotiations that lasted till deep in the night.

To read the two-page summary of the book, click here: www.wto.org/english/tratop_e/trips_e/trilat_5feb13_e.html

So much about ageing and technology. Probably I will come back to this issue again, as there are so many developments in this field. It will also be a topic that will be addressed during our high level meeting.

Independent or frail?

What is the difference between frailty, disability, dependence and comorbidity (having multiple diseases at the same time)? That is not so very easy to say. The similarity is not difficult. These words are all used to describe the heath status of older people. But there is much discussion in the scientific community about the precise definitions and how to measure them.

Ok, let them discuss it, I was always inclined to say. After all, if you are old why bother whether you are frail or dependent? But there is more to that. If you want to provide the right care to old people, you need to know what their problems are. Hence, you first have to measure their health status. To be able to measure, you must know what to measure. And for this you need good definitions. So, the scientists are right in this case.

After this week in Geneva, I learnt a bit more about the definitions. First we had a visit to WHO by Prof. Linda Fried, a world authority on frailty and now dean at Colombia University. In 2000 she already identified a definition and way to measure frailty. She defined it (in my own shorter version) as a state of high vulnerability for adverse health outcomes that results from decreased physiological reserves. In other words, your life reserves come to an end and your are less able to cope with health threats. Note that it is probable but not absolutely necessary that you have (mutiple) diseases when frail.

She also proposed how to measure it, When you have 3 out of 5 following symptoms you are frail:

1. Unintentional weight loss
2. Self reported exhaustion
3. Weakness (measured by grip strength)
4. Slow walking speed
5. Low physical activity

Later in the week, we had a retreat with the whole department where we elaborated on the issue. That was very pleasant a we had our meeting somewhere in the Alps in a chalet owned by one of the team members. Many people in te team had prepared delicious dishes and cakes so I felt a bit frail when coming back. Especially as I had to postpone my flight back and am now flying at 6 in the morning, while typing this blog

But it was worth it. During our discussion it became clear that the definitions sometimes overlap. You can be disabled, have multiple diseases and be frail at the same time. But also be only disabled, only frail and only have few chronic diseases. Or any combination in between. That is important to know when organising a long term care system.

Then dependence. Instead of measuring the health status, you can also measure what people can still do. To do this we identify activities of daily living (for example eating and personal hygiene) and instrumental activities of daily living (for example shopping and housework). When people cannot perform these activities without help, they are dependent and need help or care. This is a more functional approach to ageing.

Of course dependency is a difficult concept and varies per individual, by country and over time. One old person will be dependent when not being able to do the groceries any more, whereas the other person is not and already solved it one way or another. And in 2030 people will probably be less dependent than in 1980 due to more assistive devices. There are even people who would like to redefine the whole definition of health so that it would focus on the ability to adept.

Anyhow, a very interesting week that made me a bit more frail, but also more independent in my thinking on the topic.